Bowlesfarley2044

Hospital at Home (HaH) programs have been shown to improve quality of care and patient satisfaction, and reduce bed occupancy rate in hospitals. Despite the prevalence of HaH in Western countries, studies in Asia are limited and the perception of HaH remains underexplored in Asian context. Understanding the perceptions of stakeholders is vital before implementing HaH in any new settings. Thus, the aim of this study is to explore the perceptions of referring physicians, care providers, patients, and caregivers on HaH programs in a multiracial country such as in Singapore.

This study used a descriptive qualitative design. Participants from 2 tertiary hospitals in Singapore, including 13 referring physicians, 10 care providers, 15 patients, and 3 caregivers, were interviewed between June 2020 and September 2020. Data were analyzed using inductive thematic analysis.

The overarching theme titled "The stakeholders' perception on HaH" was pillared by 4 main themes (1) patients suitable for HaH; (2) perceived advantages and benefits of HaH; (3) perceived risks, anxiety, and concerns about HaH; and (4) potential enablers of HaH. Overall, the findings reported that most of the stakeholders embraced HaH. Timely medical interventions and support from care providers were reportedly important factors to maintain patient safety and quality of care. The importance of having adequate resources and sound financing mechanisms to develop a successful HaH program was also highlighted.

This study offered insights into HaH from the perspectives of stakeholders in Singapore and facilitate the planning of future HaH pilot programs in multiracial Singapore and other Asian countries.

This study offered insights into HaH from the perspectives of stakeholders in Singapore and facilitate the planning of future HaH pilot programs in multiracial Singapore and other Asian countries.

United States veterans face an even greater risk of homelessness and associated medical conditions, mental health conditions, and fatal and nonfatal overdose as compared with nonveterans. Beginning 2009, the Department of Veterans Affairs developed a strategy and allocated considerable resources to address veteran homelessness and the medical conditions commonly associated with this condition.

This study aimed to examine the Veterans Health Administration National Center for Patient Safety database for patient safety events in the homeless veteran population to mitigate future risk and inform policy.

This was a retrospective, descriptive quality improvement study of reported patient safety events of homeless veterans enrolled in Veterans Health Administration care between January 2012 and August 2020. 2-Methoxyestradiol mouse A validated codebook was used to capture individual patient characteristics, location and type of event, homeless status, and root causes of the events and proposed actions for prevention.

Suicide attempable services are root causes of these events.Radiotherapy is a mainstay of efficient treatment of brain metastases from solid tumors. Immunotherapy has improved the survival of metastatic cancer patients across many tumor types. However, targeted therapy is a feasible alternative for patients unable to continue immunotherapy or with poor outcomes of immunotherapy. The combination of radiotherapy and targeted therapy for the treatment of brain metastases has a strong theoretical underpinning, but data on the efficacy and safety of this combination is still limited. A systematic search of PubMed, Embase, Web of Science and the Cochrane library database was conducted. Eleven studies were included for a total of 316 patients. Median OS was about 6.2-17.8 months from radiotherapy. Weighted survival and local control at 1 and 2 years were correlated (50.1 and 17.8%, 90.7 and 14.7% at 1 and 2 year, respectively). Radiotherapy given before or concurrently to targeted therapy provided the best effect on the outcome. For patients with brain metastases from cutaneous melanoma, the addition of concurrent targeted therapy to brain radiotherapy can increase survival and provide long-term control.

Suicide is a leading cause of death among adolescents and young adults (AYA). AYA living with perinatally-acquired HIV infection (AYALPHIV) are at higher risk of attempted suicide as compared to AYA who were perinatally HIV-exposed but uninfected (AYAPHEU). To inform interventions we identified risk and protective factors for attempted suicide among AYALPHIV and AYAPHEU.

Data come from a longitudinal New York City-based study of AYALPHIV and AYAPHEU (n=339; enrollment age 9-16 years) interviewed approximately every 12-18 months.

Our main outcome was suicide attempt at any follow-up. The DISC was used to assess psychiatric disorder diagnoses and attempted suicide and the Child Depression Inventory (CDI) to assess depression symptoms. Psychosocial and sociodemographic risk factors were also measured. Analyses employed backward stepwise logistic regression modeling.

At enrollment, 51% were female, 49% Black, 40% Latinx, and 11% both Black and Latinx. Attempted suicide prevalence was significantly higher among AYALPHIV compared to AYAPHEU (27% vs 16%, p = 0.019) with AYALPHIV having 2.21 times the odds of making an attempt (95% CI [1.18, 4.12], p = 0.013). Higher CDI scores were associated with an increased risk of attempted suicide in both groups and the total sample. The presence of DISC-defined behavior disorder increased risk of attempted suicide in the total sample and the AYALPHIV sub-group. Religiosity was protective of attempted suicide in AYALPHIV.

AYALPHIV had increased suicide attempts compared to AYAPHEU. link2 Religiosity was protective in AYALPHIV. Highlighting a need for prevention early mental health challenges were associated with risk.

AYALPHIV had increased suicide attempts compared to AYAPHEU. Religiosity was protective in AYALPHIV. Highlighting a need for prevention early mental health challenges were associated with risk.

The relationship between HIV infection, the functional organization of the brain, cognitive impairment, and aging remains poorly understood. Understanding disease progression over the lifespan is vital for the care of people living with HIV (PLWH).

Virologically suppressed PLWH (n=297) on combination antiretroviral therapy and 1509 controls were evaluated. PLWH were further classified as cognitively normal (CN) or impaired (CI) based on neuropsychological testing.

Feature selection identified resting state networks (RSNs) that predicted HIV and cognitive status within specific age bins (< 35, 35-55, >55). Deep learning models generated voxelwise maps of RSNs to identify regional differences.

Salience (SAL) and parietal memory networks (PMN) differentiated individuals by HIV status. When comparing controls to PLWH CN the PMN and SAL had the strongest predictive strength across all ages. When comparing controls to PLWH CI SAL, PMN, and frontal parietal (FPN) were the best predictors. When comparinaging, and HIV associated cognitive impairment.

Although one of the touted benefits of the direct anterior approach (DAA) includes decreased postoperative pain, there is no consensus on the effect of surgical approach on postoperative pain and subsequent analgesic consumption.

Consecutive patients undergoing total hip arthroplasty by a single surgeon from May 2016 to March 2020 were identified. Procedures were categorized as DAA or posterior approach. Patient demographics and surgical details were assessed. Patient-reported maximum pain by postoperative day (POD), total opioid consumption during hospitalization, and whether the patient required a refill of opioid prescription within 3 months after discharge were compared between the two surgical approaches through multivariate analyses.

A total of 611 patients were included in this study (447 DAA and 164 posterior approaches). On multivariate analyses that controlled for preoperative/intraoperative differences, patients in the DAA group had lower average maximum reported pain (0 to 10 scale) on POD #perative factors may be more important to opioid use reduction than the surgical approach alone.

Posttraumatic stress disorder (PTSD) is prevalent in patients who have had a cardiac arrest and their partners. Accordingly, acute traumatic stress screening is recommended, but its association with later PTSD symptoms has never been addressed in postresuscitation settings.

The aim of this study was to examine whether acute traumatic stress is associated with PTSD symptoms in patients who have had a cardiac arrest and their partners.

This multicenter longitudinal study of 141 patients and 97 partners measures acute traumatic stress at 3 weeks and PTSD symptoms at 3 months and 1 year after resuscitation, using the Impact of Event Scale. Linear regression models were used to evaluate the association between severity of acute traumatic stress and PTSD symptoms and post hoc to explore effects of group (patients/partners), age, and sex on acute traumatic stress severity. link3 We categorized Impact of Event Scale scores higher than 26 at 3 months and 1 year as clinical severe PTSD symptoms.

Higher acute traumatic stress severity is significantly positively associated with higher PTSD symptom severity at 3 months (patients and partners P < .001) and 1 year (patients and partners P < .001) postresuscitation, with the strongest association for women compared with men (P = .03). Acute traumatic stress was higher in women compared with men across groups (P = .02). Clinical severe PTSD symptoms were present in 26% to 28% of patients and 45% to 48% of partners.

Experiencing a cardiac arrest may elicit clinical severe PTSD symptoms in patients, but particularly in their partners. Screening patients and partners for acute traumatic stress postresuscitation is warranted to identify those at increased risk of long-term PTSD symptoms.

Experiencing a cardiac arrest may elicit clinical severe PTSD symptoms in patients, but particularly in their partners. Screening patients and partners for acute traumatic stress postresuscitation is warranted to identify those at increased risk of long-term PTSD symptoms.

Heart failure is a troublesome condition with high healthcare utilization and cost. Most individuals with heart failure experience multiple symptoms including breathlessness, pain, depression, and anxiety.

The aim of this study was to review the literature describing the use of the Edmonton Symptom Assessment Scale to assess the burden of symptoms and the impact of symptoms on heart failure outcomes including quality of life and functional outcomes.

The search engines PubMed, Scopus, CINAHL, and Web of Science were searched from January 2001 to March 2020. A review of literature was undertaken using key terms "heart failure," "CHF," "cardiac failure," "heart decompensation," "myocardial failure," "Edmonton Symptom Assessment Scale". Hand searching of articles was also undertaken.

The search resulted in 33 relevant articles, which were imported into Rayyan, a Web-based systematic review software program. We present synthesis of results of studies (1) using the Edmonton Symptom Assessment Scale as an asctional outcomes and provides useful information on symptom burden.

The Edmonton Symptom Assessment Scale may be useful in measuring patient-reported symptom burden in patients with heart failure in the clinical setting because it correlates well with other heart failure measures on quality of life and functional outcomes and provides useful information on symptom burden.