Objectives
Skeletal muscle loss or sarcopenia is a frequent complication in heart failure (HF) and contributes to adverse clinical outcomes. We evaluated if age (primary) and chronic disease ...(secondary) related sarcopenia, that we refer to as compound sarcopenia, impacts clinical outcomes in hospitalized patients with HF.
Design
Cross‐sectional study using hospitalized patient data.
Setting
Data from the Agency for Healthcare Research and Quality through the Healthcare Cost and Utilization Project (HCUP).
Participants
Hospitalized adult patients with a primary or secondary diagnosis of HF (n = 64,476) and a concurrent random 2% sample of general medical population (GMP; n = 322,217) stratified by age (<50 years of age y, 51‐65y, >65y) from the Nationwide Inpatient Sample (NIS) database (years 2010–2014).
Measurements
In‐hospital mortality, length of stay (LoS), cost of hospitalization per admission (CoH), comorbidities and discharge disposition, with and without muscle loss phenotype, were analyzed. Muscle loss phenotype was defined using a comprehensive code set from international classification of diseases‐9 (ICD‐9).
Results
Muscle loss phenotype was observed in 8673 (13.5%) patients with HF compared to 5213 (1.6%) GMP across all age strata. In patients with HF, muscle loss phenotype was associated with higher mortality, LoS, and CoH. Patients with HF (>65y) and muscle loss phenotype had higher mortality (adjusted OR: 1.81; 95% CI 1.56–2.10), CoH (adjusted OR 1.48; 95% CI 1.44–1.1.52), and LoS (adjusted OR 1.40; 95% CI 1.37–1.43) compared to >65y GMP with muscle loss phenotype.
Conclusion
Muscle loss phenotype is more commonly associated with increasing age in hospitalized patients with HF. Clinical outcomes were significantly worse in patients with HF aged >65y compared to younger patients with HF and all age strata in GMP with and without a muscle loss phenotype.
See related editorial by Reeves et al. in this issue.
Abstract Objective Major depressive disorder (MDD) is associated with decreased physical activity and increased rates of the metabolic syndrome (MetS), a risk factor for the development of type 2 ...diabetes and cardiovascular disorders. Exercise training has been shown to improve cardiorespiratory fitness and metabolic syndrome factors. Therefore, our study aimed at examining whether patients receiving an exercise program as an adjunct to inpatient treatment will benefit in terms of physiological and psychological factors. Method Fourty-two inpatients with moderate to severe depression were included. Twenty-two patients were randomized to additional 3x weekly exercise training (EXERCISE) and compared to treatment as usual (TAU). Exercise capacity was assessed as peak oxygen uptake (VO2peak), ventilatory anaerobic threshold (VAT) and workload expressed as Watts (W). Metabolic syndrome was defined according to NCEP ATPIII panel criteria. Results After 6 weeks of treatment, cardiorespiratory fitness (VO2peak, VAT, Watt), waist circumference and HDL cholesterol were significantly improved in EXERCISE participants. Treatment response expressed as ≥50% MADRS reduction was more frequent in the EXERCISE group. Conclusions Adjunctive exercise training in depressed inpatients improves physical fitness, MetS factors, and psychological outcome. Given the association of depression with cardiometablic disorders, exercise training is recommended as an adjunct to standard antidepressant treatment.
Background:
The majority of expected deaths in high income countries occur in hospital where optimal palliative care cannot be assured. In addition, a large number of patients with palliative care ...needs receive inpatient care in their last year of life. International research has identified domains of inpatient care that patients and carers perceive to be important, but concrete examples of how these might be operationalised are scarce, and few studies conducted in the southern hemisphere.
Aim:
To seek the perspectives of Australian patients living with palliative care needs about their recent hospitalisation experiences to determine the relevance of domains noted internationally to be important for optimal inpatient palliative care and how these can be operationalised.
Design:
An exploratory qualitative study using semi-structured interviews.
Setting/participants:
Participants were recruited through five hospitals in New South Wales, Australia.
Results:
Twenty-one participants took part. Results confirmed and added depth of understanding to domains previously identified as important for optimal hospital palliative care, including: Effective communication and shared decision making; Expert care; Adequate environment for care; Family involvement in care provision; Financial affairs; Maintenance of sense of self/identity; Minimising burden; Respectful and compassionate care; Trust and confidence in clinicians and Maintenance of patient safety. Two additional domains were noted to be important: Nutritional needs; and Access to medical and nursing specialists.
Conclusions:
Taking a person-centred focus has provided a deeper understanding of how to strengthen inpatient palliative care practices. Future work is needed to translate the body of evidence on patient priorities into policy reforms and practice points.
Background:
Structured family meeting procedures and guidelines suggest that these forums enhance family–patient–team communication in the palliative care inpatient setting. However, the ...vulnerability of palliative patients and the resources required to implement family meetings in accordance with recommended guidelines make better understanding about the effectiveness of this type of intervention an important priority.
Aim and design:
This systematic review examines the evidence supporting family meetings as a strategy to address the needs of palliative patients and their families. The review conforms to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.
Data sources:
Six medical and psychosocial databases and “CareSearch,” a palliative care–specific database, were used to identify studies reporting empirical data, published in English in peer-reviewed journals from 1980 to March 2015. Book chapters, expert opinion, and gray literature were excluded. The Cochrane Collaboration Tool assessed risk of bias.
Results:
Of the 5051 articles identified, 13 met the inclusion criteria: 10 quantitative and 3 qualitative studies. There was low-level evidence to support family meetings. Only two quantitative pre- and post-studies used a validated palliative care family outcome measure with both studies reporting significant results post-family meetings. Four other quantitative studies reported significant results using non-validated measures.
Conclusion:
Despite the existence of consensus-based family meeting guidelines, there is a paucity of evidence to support family meetings in the inpatient palliative care setting. Further research using more robust designs, validated outcome measures, and an economic analysis are required to build the family meeting evidence before they are routinely adopted into clinical practice.
Abstract
Introduction
Delirium is associated with a wide range of adverse patient safety outcomes, yet it remains consistently under-diagnosed. We undertook a systematic review of studies describing ...delirium in adult medical patients in secondary care. We investigated if changes in healthcare complexity were associated with trends in reported delirium over the last four decades.
Methods
We used identical criteria to a previous systematic review, only including studies using internationally accepted diagnostic criteria for delirium (the Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases). Estimates were pooled across studies using random effects meta-analysis, and we estimated temporal changes using meta-regression. We investigated publication bias with funnel plots.
Results
We identified 15 further studies to add to 18 studies from the original review. Overall delirium occurrence was 23% (95% CI 19–26%) (33 studies) though this varied according to diagnostic criteria used (highest in DSM-IV, lowest in DSM-5). There was no change from 1980 to 2019, nor was case-mix (average age of sample, proportion with dementia) different. Overall, risk of bias was moderate or low, though there was evidence of increasing publication bias over time.
Discussion
The incidence and prevalence of delirium in hospitals appears to be stable, though publication bias may have masked true changes. Nonetheless, delirium remains a challenging and urgent priority for clinical diagnosis and care pathways.
To explore the rehabilitation goals measured with the Patient-Specific Functional Scale (PSFS) in patients undergoing acute and subacute stroke rehabilitation. In addition, to assess whether PSFS ...goals corresponded to impairments and activity limitations, as identified by standardized measures.
Observational study.
A total of 71 participants undergoing inpatient stroke rehabilitation.
The PSFS goals were linked to second-level categories in the International Classification of Functioning, Disability and Health (ICF), using established linking rules. Frequencies of the linked ICF categories were calculated. Frequencies of participants with limitations in walking, activities of daily living (ADL), vision, language, and cognition, were calculated, along with goals in corresponding areas of functioning.
The participants' goals were linked to 50 second-level ICF categories, comprising areas such as walking and moving, ADL, language, vision, and cognition. The most frequent ICF categories were "Moving around in different locations" (n = 24), "Walking" (n = 23), "Toileting" (n = 16), "Hand and arm use (n = 12) and "Fine hand use (n = 12)". Of participants with limitations in walking, cognition, and vision, 85%, 10%, and 16%, respectively, had goals in these areas.
Participants' goals included walking, ADL, language, vision, and cognition. Few with impairments in cognition or vision had goals in these corresponding areas on the PSFS.
Studies suggest that symptom reduction is not necessary for improved return-to-work after occupational rehabilitation programmes. This secondary analysis of a randomized controlled trial examined ...whether pain intensity and mental distress mediate the effect of an inpatient programme on sustainable return-to-work.
The randomized controlled trial compared inpatient multimodal occupational rehabilitation (n = 82) with outpatient acceptance and commitment therapy (n = 79) in patients sick-listed due to musculoskeletal and mental health complaints. Pain and mental distress were measured at the end of each programme, and patients were followed up on sick-leave for 12 months. Cox regression with an inverse odds weighted approach was used to assess causal mediation.
The total effect on return-to-work was in favour of the inpatient programme compared with the control (hazard ratio (HR) 1.96; 95% confidence interval (95% CI) 1.15-3.35). There was no evidence of mediation by pain intensity (indirect effect HR, 0.98; 95% CI, 0.61-1.57, direct effect HR, 2.00; 95% CI, 1.02-3.90), but mental distress had a weak suppression effect (indirect effect HR, 0.89; 95% CI, 0.59-1.36, direct effect HR, 2.19; 95% CI, 1.13-4.26).
These data suggest that symptom reduction is not necessary for sustainable return-to-work after an inpatient multimodal occupational rehabilitation intervention.
To ensure equitable and effective rehabilitation for neuro-oncological patients the development of an effective treatment strategy is necessary.
To identify evidence for interventions used in acute ...rehabilitation for patients with neuro-oncological conditions and to systematize them according to the International Classification of Health Interventions (ICHI) classification Methods: A scoping review was conducted, comprising 3 parts: identification of interventions in publications; linking the interventions to ICHI classification; and identifying problems targeted by these interventions and linking them to International Classification of Functioning, Disability and Health (ICF) categories.
The search strategy selected a total of 6,128 articles. Of these, 58 publications were included in the review. A total of 150 interventions were identified, 47 of which were unique interventions. Forty-three of the interventions were linked to the ICHI classification; 4 of these interventions were evidence level I, 18 evidence level II, 23 evidence level III, and 2 evidence level IV. Five interventions were linked to the ICF One-Level Classification, and the remaining 42 interventions were linked to the ICF Two-Level Classification. All interventions regarding the Body Systems and Functions were linked to the ICF Two-Level Classification. Only 5 interventions in the Activities and Participation domain, 3 interventions in the Health-related Behaviors domain, and 1 intervention in the Environment domain were linked to the ICF Two-Level Classification. Two identified problems (inpatient nursing and comprehensive inpatient rehabilitation) were not classified according to the ICF.
A total of 47 unique interventions were identified, revealing a significant focus on addressing issues related to bodily functions and structures. The study also highlighted the challenge of linking specific interventions to ICHI codes, particularly when the source documentation lacked adequate detail. While this review offers valuable insights into rehabilitation for neuro-oncological patients and lays the groundwork for standardized coding and data exchange, it also emphasizes the need for further refinement and validation of the ICHI classification to better align with the multifaceted interventions used in rehabilitation.
There is evidence in the literature of 47 interventions used by various rehabilitation professionals in the acute rehabilitation of neuro-oncological patients. However, most of these interventions are evidence level II and III. Four interventions (virtual reality, mirror therapy, robotic upper extremity training to improve function, and cognitive group therapy) are not included in the ICHI. The problems analysed in the literature that are targeted by interventions often do not coincide with the purpose of the specific intervention or are too broadly defined and not specific. These findings emphasize the need for greater precision in describing and documenting interventions, as well as the importance of aligning interventions more closely with ICF categories, particularly in the domains of Activities and Participation. This work highlights the heterogeneity in the reporting of rehabilitation interventions, and the challenges in mapping them to standardized classifications, emphasizing the ongoing need for refining and updating these classification systems.
Objective: To evaluate the impact of frailty, measured using the Canadian Study of Health and Aging Clinical Frailty Scale, on outcomes of older people hospitalized with acute illness. Method: ...Consecutive patients were randomly allocated to a model development sample or a model validation sample. Multivariate analyses were used to model in-hospital mortality, new nursing home placement, and length of stay. Variables selected in the development samples were tested in the validation samples. Results: The mean age of all 2,125 patients was 82.9 years. Most (93.6%) were admitted through the emergency department. Frailty predicted in-hospital mortality (odds ratio OR = 2.97 2.11, 4.17), new nursing home placement (OR = 1.60 1.14, 2.24), and length of hospital stay (hazard ratio = 0.87 0.81, 0.93). Discussion: Frailty is a strong predictor of adverse outcomes in older people hospitalized with acute illness. An increased awareness of its impact may alert clinicians to screen for frailty.
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