Post-discharge mortality in adult patients hospitalized for tuberculosis: a prospective cohort study

Determining outcomes and predictors of mortality following discharge from tuberculosis (TB) hospitalization is crucial to establish health policies. The objective of this study was to analyze outcomes and, secondarily, predictors of mortality following discharge from TB hospitalization. This was a prospective cohort study of patients diagnosed with TB (all forms) discharged from the hospital who began treatment during hospitalization. Out of 169 subjects included, 38 died during the 13-months of follow-up, within a median of 3 months (95%CI: 1.49-4.51). In the multivariate analysis, the variables independently associated with death were age (HR=1.04, 95%CI: 1.01-1.06, P=0.001), presence of sputum production (HR=2.18, 95%CI: 1.09-4.34, P=0.027), and Charlson Comorbidity Index (HR=1.19, 95%CI: 1.04-1.36, P=0.015). In conclusion, post-discharge mortality in subjects hospitalized for TB was 22.5%, with mean survival of 4.6 months. The mortality was higher in older subjects, in those who reported sputum production, and in those with a high comorbidity index.

Physical growth and neurodevelopment of preterm infants at the corrected age of 18-24 months / 中国当代儿科杂志

OBJECTIVES@#To investigate the levels of physical growth and neurodevelopment in preterm infants at the corrected age of 18-24 months.@*METHODS@#The physical growth data and neurodevelopment data of 484 preterm infants at corrected age of 18-24 months were prospectively collected by a post-discharge follow-up system for preterm infants. The infants were regularly followed up in Shenzhen Bao'an Maternal and Child Health Hospital Affiliated to Jinan University from April 2018 to December 2021. The neurodevelopment was evaluated by the Children Neuropsychological and Behavioral Scale-Revision 2016. A total of 219 full-term infants served as controls. The infants were divided into groups (extremely preterm, very preterm, moderate late preterm, and full-term) based on gestational age, and the groups were compared in the levels of physical growth and neurodevelopment.@*RESULTS@#Except that the moderate preterm group had a higher length-for-age Z-score than the full-term group (P=0.038), there was no significant difference in physical growth indicators between the preterm groups and the full-term group (P>0.05). Each preterm group had a significantly lower total developmental quotient (DQ) than the full-term group (P<0.05). Except for the social behavior domain, the DQ of other domains in the extremely preterm and very preterm groups was significantly lower than that in the full-term group (P<0.05). The <32 weeks preterm group had a significantly higher incidence rate of global developmental delay than the full-term group (16.7% vs 6.4%, P=0.012), and the incidence rate of global developmental delay tended to increase with the reduction in gestational age (P=0.026).@*CONCLUSIONS@#Preterm infants can catch up with full-term infants in terms of physical growth at the corrected age of 18-24 months, but with a lower neurodevelopmental level than full-term infants. Neurodevelopment monitoring and early intervention should be taken seriously for preterm infants with a gestational age of <32 weeks.

Research hotspots in post-discharge follow-up management of preterm infants / 中国当代儿科杂志

Preterm infants, especially those born extremely or very prematurely, are at high risk for growth retardation and neurodevelopmental disorders. Regular follow-up after discharge, early intervention, and timely catch-up growth are important guarantees for improving the quality of life of preterm infants and improving the quality of the population. This article provides an overview of the research hotspots in follow-up management of preterm infants after discharge over the past two years, including follow-up modes, nutritional metabolism and body composition follow-up, growth pattern follow-up, neurodevelopmental follow-up, early intervention, etc., in order to provide clinical guidance and research ideas for domestic peers.

Mortality in post-discharge COVID-19 patients from a tertiary care center - A follow-up study

Background: Among many responsibilities, the doctors from the COVID war room of our institute were assigned to take telephonic follow-up of discharged COVID patients to provide any medical assistance if needed. During this process, few relatives of the patient’s informed back that the patients had died after discharge from the COVID wards. Aim and Objective: Such data of death in the COVID patients after discharged are limited in India; hence, we conducted this study so that more information is generated. Materials and Methods: Relatives of these COVID patients were asked about date and place of death. Other data including gender, age, date of admission, date of discharge, and requirement of oxygen were available with the COVID war room and were used for evaluation. Results: Out of the 892 COVID discharged patients (between August and October 2020) who could be contacted, 19 (2.13%) patients (6 females and 13 males) had died after discharge from the COVID ward. Characteristics of these 19 patients included higher age (n = 11 were 61–80 years old and n = 3 were >80 years old), hospital stay of 11–20 days (n = 12), and required oxygen support (n = 12). Most deaths occurred within 20 days (n = 16) after discharge from the COVID ward. Conclusions: The current study reports deaths occurring COVID patients after discharge. Most of these deaths occurred within 4 weeks of cure and in elderly patients. More research with long-term follow-up is needed in “cured” COVID-19 patients so that appropriate preventive measures can be undertaken in the future.

Sepse após a alta da UTI: um problema de saúde pública / Sepsis after ICU discharge: a public health problem

A sepse é uma disfunção orgânica aguda secundária à infecção e suas taxas de mortalidade hospitalar vêm reduzindo em muitos países nos últimos anos. Esta redução da mortalidade resulta em um maior número de pacientes que recebem alta hospitalar, porém frequentemente os sobreviventes experimentam novas incapacidades (físicas, cognitivas e psicológicas) e piora das condições crônicas de saúde em longo-prazo. Além disso, sua evolução pós-alta hospitalar cursa com elevado risco de morte e frequentes reinternações nos primeiros meses pós-hospitalização, bem como elevado uso de recursos de saúde. Esta revisão tem como objetivo descrever a morbimortalidade em longo prazo dos pacientes sobreviventes de sepse, seus efeitos sobre o sistema de saúde e as possíveis ações voltadas a minimizar as sequelas desta síndrome que acomete aproximadamente 1/3 dos pacientes admitidos em unidades de tratamento intensivo. (AU)

Sepsis is an acute organ dysfunction secondary to infection and its hospital mortality rates have been decreasing in many countries in recent years. This reduction in mortality results in a greater number of patients being discharged from the hospital, but survivors often experience new disabilities (physical, cognitive and psychological) and worsening chronic long-term health conditions. In addition, the post-discharge evolution leads to a high risk of death and frequent readmissions in the first months after hospitalization, as well as a high use of health resources. This review aims to describe the long-term morbidity and mortality of survivors of sepsis, its effects on the health system and the possible actions aimed at minimizing the sequelae of this syndrome that affects approximately 1/3 of patients admitted to intensive care units. (AU)

Discharge teaching, readiness for discharge, and post-discharge outcomes in cataract patients treated with day surgery: A cross-sectional study

Purpose: To investigate the quality of discharge teaching, readiness for hospital discharge (RHD), and post-discharge outcomes (PDO) of cataract patients in a day ward and to explore the relationships among these three variables. Methods: This cross-sectional study used an opportunistic sample from the ophthalmic day ward in a general hospital in Sichuan province, China. Data were collected using four questionnaires. Results: The total average score on the Quality of Discharge Teaching Scale was 192.95, and the dimension with the lowest score was “guidance obtained practically.” The total average score on the Readiness for Hospital Discharge Scale was 175.51, and the dimension with the lowest score was “knowledge of disease.” The total average score on the Post-Discharge Outcome Questionnaire was 77.08, and the four dimensions with the lowest scores were “compliance behaviors,” “avoiding excessive use of eye,” “avoiding strenuous exercise,” and “regular check-up.” Pearson correlation coefficients indicated low to moderate correlations between discharge teaching quality and PDO (0.245, P < 0.01), RHD and PDO (0.271, P < 0.01), and discharge teaching quality and PDO (0.559, P < 0.01). Conclusion: The quality of discharge teaching among cataract patients who underwent day surgery was relatively high, and patient preparation for discharge and PDO were good. However, medical staff should focus more attention on patients' individualized needs for discharge teaching while emphasizing the importance of compliance behavior.

Incidencia de infección del sitio quirúrgico y cumplimiento de prácticas de prevención en apendicectomía y cirugía herniaria / Incidence of the surgical infection site and fulfillment of preventive practices in appendicectomy and hernial surgery

Introducción: La vigilancia de infección del sitio quirúrgico en procederes quirúrgicos frecuentes es esencial para su prevención. Objetivo: Determinar la incidencia de infección del sitio quirúrgico y el cumplimiento de las prácticas de prevención en apendicectomía y cirugía de hernia. Método: Estudio descriptivo de pacientes intervenidos de estos procederes desde enero 2017 hasta marzo 2018 en Hospital Clínico Quirúrgico Universitario Joaquín Albarrán. La Habana, Cuba. Se recolectó información de las características demográficas de los pacientes, los procederes y el CPP (profilaxis antibiótica, normoglicemia, normotermia y eliminación del pelo). Se utilizaron técnicas de vigilancia durante el ingreso y posterior al egreso para identificar los pacientes con infección del sitio quirúrgico. Se calculó la tasa total de infección del sitio quirúrgico y según índice de riesgo (por cada100 procederes quirúrgicos), para cada proceder y el CPP por cada 100 procederes quirúrgicos. Resultados: Se evaluaron 174 pacientes con apendicectomía y 389 de cirugía de hernia, con tasas de infección de 13,8 por ciento y 5,7 por ciento, respectivamente. El cumplimiento del tiempo de administración del antibiótico profiláctico, la selección y dosis, y la discontinuación fueron respectivamente de 53,3 por ciento, 83,3 por ciento y 80,0 por ciento, en apendicectomía, y de 46,3 por ciento, 72,9 por ciento y 63 por ciento, en cirugía de hernia. La normotermia fue alcanzada en 32,4 por ciento y 27,1 por ciento de los casos. La mayoría de los pacientes con infección del sitio quirúrgico fueron diagnosticados utilizando métodos de vigilancia posterior al egreso. Conclusión: Se ha identificado la incidencia de infección del sitio quirúrgico y brechas en el cumplimiento de las prácticas de prevención que requieren acciones correctivas, que incluyan fortalecimiento del sistema de vigilancia y capacitación de los profesionales(AU)

Introduction: Surveillance of the surgical site infection in frequent surgical procedures is essential for its prevention. Objective: To determine the incidence of surgical site infection and the fulfillment of prevention practices in appendicectomy and hernial surgery. Method: Descriptive study of patients operated on by these procedures from January 2017 to March 2018 in "Joaquin Albarran" clinical, surgical and university hospital in Havana, Cuba. Data on demographic characteristics of patients, the types of procedures and the CPP (antibiotic prophylaxis, normoglycemia, normothermia and hair removal) were collected. The use of surveillance techniques during hospitalization and after discharge allowed identifying the patients with surgical site infection. The total surgical site infection rate and the risk index (per 100 surgical procedures) for each procedure and the CPP per 100 surgical procedures were all estimated. Results: One hundred and seventy-four patients with appendicectomy and 389 with hernial surgery were evaluated and their infection rates were 13.8 percent and 5.7 percent, respectively. The compliance with the time of administration of prophylactic antibiotic, selection and dosage, and discontinuation of treatment were 53.3 percent, 83.3 percent and 80 percent, respectively in appendicectomy where those of hernial surgery were 46.3 percent,72.9 and 63 percent, respectively. Normothermia was reached in 32.4 percent and 27.1 percent of cases. Most of the patients with surgical site infection were diagnosed by using the surveillance methods after discharge from hospital. Conclusions: The incidence of the surgical site infection and gaps in the fulfillment of prevention practices has been identified, which require corrective actions including strengthening of the surveillance system and professional training(AU)

Cirugía ambulatoria: ¿qué hacer en el período posoperatorio? desde el término de la cirugía hasta el control domiciliario / Outpatient surgery: what to do in the postoperative period? from the end of surgery to home surveillance

La recuperación posoperatoria, el control y apoyo posalta son esenciales en el éxito de la cirugía ambulatoria. El proceso de recuperación posoperatoria se divide en recuperación Fase I y Fase II, en las cuales se utilizan criterios clínicos predefinidos para decidir si un paciente puede ser trasladado a la fase siguiente o ser dado de alta al domicilio, respectivamente. Al momento del alta, las indicaciones posoperatorias se entregan por escrito y el paciente debe estar acompañado por un adulto. Después del alta, se realiza un seguimiento del paciente durante los primeros días, habitualmente a través de llamado telefónico, evaluando parámetros clínicos predefinidos. La evaluación de resultados en cirugía ambulatoria se realiza a través de indicadores específicos, tales como retardo del alta, hospitalización no programada y rehospitalización posalta.

Postoperative recovery and post discharge surveillance and support are essential in outpatient surgery success. The postoperative recovery process is divided into Phase I and Phase II, in which predefined clinical criteria are used to decide whether a patient can be moved to the next phase or be discharged to home, respectively. At discharge, postoperative indications are given in writing and an adult must accompany the patient. After discharge, the patient is monitored during the first few days, usually through a telephone call and predefined clinical parameters are evaluated. Outpatient surgery outcome evaluation is performed through specific indicators such as prolonged postoperative stay, unanticipated hospital admission, and return to hospital and readmission.

A prospective study of wound infection among post‑discharge patients at a level 1 trauma centre of India.

Background and Aim: To study the rate of wound infections in the post‑discharged patient population and to assess the usefulness of post‑discharge surveillance. Methods: A prospective surveillance of all the post‑discharged trauma patients was done during a period of 6 months. Discharge instructions were given to all the patients regarding identification of the signs and symptoms of wound infections. They were telephonically followed up after a week to enquire about the wound condition and followed up in the outpatient department (OPD). Microbiology culture samples of those showing any signs and symptoms of infections were sent and their antimicrobial therapy, any change in the treatment schedule and the length of their hospital stay were noted. Factors such as wound class, type of surgeries and readmissions were noted. Results: A total of 281 postdischarge patients were enrolled, of which 101 were completely followed up for wound infections. Males were predominant (89%). Of the 101 patients, 42 (41.6%) patients wound showed infection during the intense follow‑up in the OPD. However, 59 patients (59/101, 58.4%) showed wound swab culture positivity before discharge. These 42 patients developed signs and symptoms of infection post‑discharge; 23 (22.7%) of them had change of antibiotic therapy during the follow‑up period due to culture positivity. Acinetobacter sp., Staphylococcus aureus and Klebsiella pneumoniae were the predominant organisms isolated in the study. A total of 45 patients (44.5%) had to be readmitted due to wound site infections. Conclusions: Wound infections are common after discharge among trauma patients highlighting the importance of active surveillance and participation of patients.

Post-discharge life adaptations of spouses of allotransplanted male patients

Purpose: The aim of this study was to characterize the process of adaptation experienced by the spouses of allotransplanted male patients following discharge. Methods: We conducted semi-structured interviews with six spouses and questioned them about the difficulties experienced in daily life following the discharge of their husband, and their coping strategies. We descriptively analyzed the interview data using the modified grounded theory approach. Results: We extracted ‘habituation of combating communicable diseases' from “responsibility for making effort,” “management of everyday life, ”confidence derived from experience “ and “habituation in the family.” We also extracted ‘change in anxiety and concern' from “perception of differences in attitude in daily life between husband and wife,” “change in the sense of values,” “finding a point of compromise in each family,” “benefit from allotransplant,” and “persistent anxiety.” Conclusion: The females habituated themselves to combating communicable diseases by gaining self-efficacy so that they reconciled a new, fixed lifestyle with their husbands following allotransplantation. Although their anxiety and concerns changed over time, they had persistent anxiety about both their husbands' health, including the risk of relapse or graft-versus-host disease, and financial hardships.

Structured Periodic Rehabilitation Intervention Sessions To Stroke Patients. A Longitudinal Review

Despite evidence showing that structured rehabilitation after stroke improves functional outcomes, providing seamless rehabilitation from hospital to community has been elusive. The service provided should be able to accommodate variable degree of impairments and needs of the stroke survivors. This study aimed to assess the outcome of a multidisciplinary-based outpatient rehabilitation service for stroke patients living in the community. Patients who were discharged from Universiti Kebangsaan Malaysia Medical Centre after an acute stroke were referred to the Combined Stroke Rehabilitation Clinic (CSRC). Post stroke patients were assigned individually designed programs which were problem based and used task specific activities to achieve desired goals. Patients were reviewed on a regular basis either up to completion of the 2 year-program, or are able to be discharged to the community, whichever is earlier. Modified Barthel Index (MBI) and Berg Balance Scores (BBS) were used for monitoring. A total of 68 patients were managed in CSRC for two years since its initiation, with mean age of 62.4 years (SD 12.4) with the mean duration of stroke when first reviewed in CSRC was 11.5 months (SD 11.9). Majority of patients (64.7%) received either two or three types of intervention. Both MBI and BBS demonstrated significant improvement over 12-months period (p value of 0.006 and 0.017 respectively). CSRC proved that structured rehabilitation intervention was beneficial in terms of functional status and improvement in balance to post-stroke patients.

A Post-Discharge Service for Brain Injury Patients in Hong Kong / 中国康复医学杂志

To establish an affordable and easily accessible post-discharge telephone follow-up service for people with brain injuries and their caregivers,and thus to provide an evidence base for developing cost-effective continuous care,region-wide.Method:Thirty-five adult patients with brain injuries and 26 caregivers were recruited from Neurosurgical Unit at QueenMary Hospital in this study.Participants were administered a structured telephone interview at the fourth week post-discharge,and again at the twelfth week post-discharge.Patients and caregivers at risk of poor adjustment were referred for further medical consultation or psychological intervention.Patients' physical and cognitive functioning were investigated while both patients and caregivers' emotional functioning and perceived socialsupport were explored.Satisfaction of the current service provided was also examined.Result:Majority of patients reported significant improvement in physical condition.A sizable number of patientsexperienced cognitive difficulties and reported insufficient psychosocial support received following discharge fromhospital.Majority of caregivers reported compromising health,emotional and social functioning in caregiving.Bothpatients and caregivers reported satisfaction with the service with caregivers reported higher satisfaction.Conclusion:Findings from current study showed that both patients of brain injuries and caregivers benefited from the post-discharge telephone follow-up service.Both of them agreed that such service helped to identify peopleat risk of poor adjustment,provide timely advice and emotional support.Our findings also indicated that caregiving significantly impairs caregivers' physical,emotional,and social functioning,suggesting a need to offer them advice on care skills,role or living adjustments,and stress management.

Delirium in hospitalized elderly patients and post-discharge mortality

OBJECTIVE: To determine the impact of delirium on post-discharge mortality in hospitalized older patients. INTRODUCTION: Delirium is frequent in hospitalized older patients and correlates with high hospital mortality. There are only a few studies about its impact on post-discharge mortality. METHODS: This is a prospective study of patients over 60 years old who were hospitalized in the Geriatric Unit at Hospital das Clínicas of São Paulo between May 2006 and March 2007. Upon admission, demographics, comorbidities, number of drugs taken, and serum albumin concentration were evaluated for each patient. Delirium was diagnosed according to the DSM-IV criteria. Patients were divided into group A (with delirium) and group B (without delirium). One year after discharge, the patients or their caregivers were contacted to assess days of survival. RESULTS: The sample included 199 patients, 66 (33 percent) of whom developed delirium (Group A). After one year, 33 (50 percent) group A patients had died, and 45 (33.8 percent) group B patients had died (p = 0.03). There was a significant statistical difference in average age (p = 0.001) and immobility (p <0.001) between groups A and B. There were no statistically significant differences between groups A and B in number of drugs taken greater than four (p = 0.62), sex (p = 0.54) and number of diagnoses greater than four (p = 0.21). According to a multivariate analysis, delirium was not an independent predictor of post-discharge mortality. The predictors of post-discharge mortality were age > 80 years (p = 0.029), albumin concentration < 3.5 g/dl (p = 0.001) and immobility (p = 0.007). CONCLUSION: Delirium is associated with higher post-discharge mortality as a dependent predictor.

Post-discharge Nutrition

Preterm infants are frequently discharged from the hospital with growth retardation. Given the potentially lifelong effects of growth impairmnet during a critical time of development, considerable effort should be focused on improving growth after discharge. Growth monitoring must be based on regular measurements of weight, length, and head circumference to identify those preterm infants with poor growth that may need additional nutritional support. Although prior studies vary in design and the intervention used, the evidence supports the use of fortified formulas in formula-fed preterm infants after discharge. The situation for infants fed human milk is much less clear, it seems prudent to concentrate our efforts on the encouragement of breast-feeding in this population. Catch up growth may have many benefits, and may lead to improved development. However, its long-term metabolic consequences are currently unclear. Understanding the optimal means of providing nutrition after discharge is an ongoing process.