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1.
MMWR Morb Mortal Wkly Rep ; 71(24): 791-796, 2022 Jun 17.
Article in English | MEDLINE | ID: covidwho-1903984

##### ABSTRACT

Approximately 27% of adults in the United States live with a disability,* some of whom qualify for Medicare benefits. Persons with disabilities are at increased risk for severe COVID-19-associated outcomes compared with the general population (1); however, existing studies have limited generalizability or only pertain to a specific disability (e.g., intellectual) (2). Older age is also associated with COVID-19-associated hospitalization and death, but the extent to which age might contribute to increased risk for severe COVID-19-associated outcomes among persons with disabilities is unknown (3). To describe the impact of COVID-19 on persons with disabilities and whether and how age contributes to disease rates, CDC assessed COVID-19 cases and hospitalizations during January 2020-November 2021, among Centers for Medicare & Medicaid Services (CMS) Medicare beneficiaries aged ≥18 years who were either eligible because of a disability (disability-eligible§) or only eligible because of age ≥65 years (age-eligible). COVID-19 incidence and hospitalization rates were higher in the disability-eligible group (10,978 and 3,148 per 100,000 population, respectively) throughout the study period compared with the age-eligible group (8,102 and 2,129 per 100,000 population, respectively). Both COVID-19 incidence and hospitalization rates increased with age in both disability- and age-eligible beneficiaries. American Indian or Alaska Native (AI/AN) persons had the highest disability-eligible (4,962 per 100,000) and age-eligible (5,024 per 100,000) hospitalization rates. Among all other racial and ethnic groups, hospitalization rates were higher among disability-eligible than among age-eligible patients. COVID-19 incidence and hospitalization rates among disability-eligible Medicare beneficiaries were disproportionally higher than rates among age-eligible beneficiaries. Collection of disability status as a core demographic variable in public health surveillance data and identification, as well as the addition of disability questions in other existing data sources can guide research and development of interventions for persons with disabilities. Efforts to increase access to and use of COVID-19 prevention and treatment strategies, including activities that support equitable vaccine access regardless of the substantial challenges that older adults and persons with disability face, are critical to reducing severe COVID-19-associated outcomes among these groups.

##### Subject(s)
COVID-19 , Disabled Persons , Adolescent , Adult , Aged , COVID-19/epidemiology , COVID-19/therapy , Hospitalization , Humans , Medicare , United States/epidemiology
2.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-325255

##### ABSTRACT

Background: Since December, 2019, the 2019 Coronavirus disease (COVID-19) from Wuhan, China, has caused worldwide outbreak with more than 200,000 people infected and thousands of deaths. The clinical characteristics of COVID-19 patients in non-Wuhan areas of Hubei province have not been described. Methods: We retrospectively analyzed the clinical characteristics and treatment progress of 91 patients diagnosed with COVID-19 in Jingzhou Central Hospital. Results: Of the 91 patients diagnosed with COVID-19, 30 (33.0%) cases were severe and two (2.2%) patients died. The severe patients tended to be older (50.5 vs 42.0, P=0.049), and have more chronic disease (40% vs 14.75%, P=0.009), compared to mild group. Only 73.6% of the patients were quantitative polymerase chain reaction (qPCR) positive on their first tests, while typical chest computed tomographic (CT) images were obtained for each patient. The most common complaints were cough (75, 82.4%), fever (59, 64.8%), fatigue (35, 38.5%), and diarrhea (14, 15.4%). Non-respiratory injur y was identified by elevated levels of aspartate aminotransferase (18, 19.8%), creatinine (5, 5.5%) and creatine kinase (14, 15.4%) in laboratory tests. In sum, 28 (30.8%) cases suffered non-respiratory injury, including 50% of the critically ill patients and 21.3% of the mild patients. Conclusions: Overall, the mortality rate of patients in Jingzhou is lower than that of Wuhan. Importantly, we discovered liver, kidney, digestive tract and heart injury in COVID-19 cases besides respiratory problems. Combining Chest CT images with qPCR of throat swab samples would improve the accuracy of COVID-19 diagnose.

3.
Open Forum Infect Dis ; 9(2): ofab640, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1672244

##### ABSTRACT

BACKGROUND: There is mounting evidence for the presence of postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC), but there is limited information on the spectrum, magnitude, duration, and patterns of these sequelae as well as their influence on quality of life. METHODS: We assembled a cohort of adults with a documented history of SARS-CoV-2 RNA positivity atâ≥2 weeks past onset of coronavirus disease 2019 (COVID-19) symptoms or, if asymptomatic, first positive test. At 4-month intervals, we queried physical and mental health symptoms and quality of life. RESULTS: Of the first 179 participants enrolled, 10 were asymptomatic during the acute phase of SARS-CoV-2 infection, 125 were symptomatic but not hospitalized, and 44 were symptomatic and hospitalized. During the postacute phase, fatigue, shortness of breath, concentration problems, headaches, trouble sleeping, and anosmia/dysgeusia were most common through 8 months of observation. Symptoms were typically at least somewhat bothersome and sometimes exhibited a waxing-and-waning course. Some participants experienced symptoms of depression, anxiety, and post-traumatic stress, as well as difficulties with performance of usual activities. The median visual analogue scale rating of general health was lower at 4 and 8 months compared with pre-COVID-19. Two clusters of symptom domains were identified. CONCLUSIONS: Many participants report bothersome symptoms following onset of COVID-19 with variable patterns of persistence and impact on quality of life. The substantial variability suggests the existence of multiple subphenotypes of PASC. A rigorous approach to the prospective measurement of symptoms and functional manifestations sets the stage for the next phase of research focusing on the pathophysiologic causes of the various subgroups of PASC.

4.
Open forum infectious diseases ; 2021.
Article in English | EuropePMC | ID: covidwho-1624185

##### ABSTRACT

BACKGROUND There is mounting evidence for the presence of post-acute sequelae of SARS-CoV-2 infection (PASC), but there is limited information on the spectrum, magnitude, duration, and patterns of these sequelae as well as their influence on quality of life. METHODS We assembled a cohort of adults with documented history of SARS-CoV-2 RNA-positivity who were ≥ 2 weeks past onset of COVID-19 symptoms or, if asymptomatic, first positive test. At 4-month intervals, we queried physical and mental health symptoms and quality of life. RESULTS Of the first 179 participants enrolled, 10 were asymptomatic during the acute phase of SARS-CoV-2 infection, 125 symptomatic but not hospitalized, and 44 symptomatic and hospitalized. During the post-acute phase, fatigue, shortness of breath, concentration problems, headaches, trouble sleeping and anosmia/dysgeusia were most common through 8 months of observation. Symptoms were typically at least somewhat bothersome and sometimes exhibited a waxing-and-waning course. Some participants experienced symptoms of depression, anxiety, and post-traumatic stress, as well as difficulties with performance of usual activities. The median visual analogue scale rating of general health was lower at 4 and 8 months compared to pre-COVID-19. Two clusters of symptom domains were identified. CONCLUSION Many participants report bothersome symptoms following onset of COVID-19 with variable patterns of persistence and impact on quality of life. The substantial variability suggests the existence of multiple sub-phenotypes of PASC. A rigorous approach to the prospective measurement of symptoms and functional manifestations sets the stage for the next phase of research focusing on the pathophysiologic causes of the various sub-groups of PASC.

5.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-291715

##### ABSTRACT

The $β$-model is a powerful tool for modeling network generation driven by node degree heterogeneity. Its simple yet expressive nature particularly well-suits large and sparse networks, where many network models become infeasible due to computational challenge and observation scarcity. However, existing estimation algorithms for $β$-model do not scale up;and theoretical understandings remain limited to dense networks. This paper brings several major improvements to the method and theory of $β$-model to address urgent needs of practical applications. Our contributions include: 1. method: we propose a new $\ell_2$ penalized MLE scheme;we design a novel algorithm that can comfortably handle sparse networks of millions of nodes, much faster and more memory-parsimonious than any existing algorithm;2. theory: we present new error bounds on beta-models under much weaker assumptions;we also establish new lower-bounds and new asymptotic normality results;distinct from existing literature, our results cover both small and large regularization scenarios and reveal their distinct asymptotic dependency structures;3. application: we apply our method to large COVID-19 network data sets and discover meaningful results.

6.
《国际护理与健康》 ; 2021.
Article in Chinese | Omniscient | ID: covidwho-1411129

##### ABSTRACT

Abstract: Objective: To study on the existing nursing problems of patients with Corona Virus Disease 2019 (COVID-19) at night and discuss solutions. Method: 62 COVID-19 patients treated in the general ward of infectious diseases department of a infectious disease hospital in Wuhan on 13-25 February 2020 were selected. The night nursing problems were observed from night sickness, night safety, night medication and psychological support and targeted nursing was implemented. Results: 60 cases were cured and 2 were transferred to ICU for treatment. The patients were safe at night, there is no falling accidents and anxiety or depression was relieved in time. Conclusion: COVID-19 patients’ night care problems are special and it should be highly valued. Effective nursing can ensure patients’ night safety and promote their recovery.

7.
《国际护理与健康》 ; 2021.
Article in Chinese | Omniscient | ID: covidwho-1411128

##### ABSTRACT

Abstract: Objective: To provide door-to-door nursing service for disabled elderly patients during Corona Virus Disease 2019, so as to ensure patient safety and improve service quality. Methods: Set up home visiting service commando team, reengineer the visiting process, do a good job in hierarchical management, strengthen the protection of medical staff, patients and their families, and provide online and offline health education guidance. Results: there were 178 cases of on-site service, including 44 emergency cases and 134 non emergency cases;69 times of dressing change, 85 times of catheter change, 19 times of gastric tube change, 71 times of bladder irrigation, 6 times of health assessment and 2 times of foot disease treatment. All the visiting officers Corona Virus Disease 2019 suspected or confirmed cases to do their own protection, no cross infection occurred in 1 cases. Conclusion: during the epidemic period of Corona Virus Disease 2019, the needs of elderly patients with disability were met, which provided practical experience for dealing with public health emergencies and preventing the risk of infectious diseases.

8.
Clin Infect Dis ; 73(Suppl 1): S110-S117, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1364763

##### ABSTRACT

BACKGROUND: Respiratory tract infections are common, often seasonal, and caused by multiple pathogens. We assessed whether seasonal respiratory illness patterns changed during the COVID-19 pandemic. METHODS: We categorized emergency department (ED) visits reported to the National Syndromic Surveillance Program according to chief complaints and diagnosis codes, excluding visits with diagnosed SARS-CoV-2 infections. For each week during 1 March 2020 through 26 December 2020 ("pandemic period"), we compared the proportion of ED visits in each respiratory category with the proportion of visits in that category during the corresponding weeks of 2017-2019 ("pre-pandemic period"). We analyzed positivity of respiratory viral tests from 2 independent clinical laboratories. RESULTS: During March 2020, cough, shortness of breath, and influenza-like illness accounted for twice as many ED visits compared with the pre-pandemic period. During the last 4 months of 2020, all respiratory conditions, except shortness of breath, accounted for a smaller proportion of ED visits than during the pre-pandemic period. Percent positivity for influenza virus, respiratory syncytial virus, human parainfluenza virus, adenoviruses, and human metapneumovirus was lower in 2020 than 2019. Although test volume decreased, percent positivity was higher for rhinovirus/enterovirus during the final weeks of 2020 compared with 2019, with ED visits similar to the pre-pandemic period. CONCLUSIONS: Broad reductions in respiratory test positivity and respiratory ED visits (excluding COVID-19) occurred during 2020. Interventions for mitigating spread of SARS-CoV-2 likely also reduced transmission of other pathogens. Timely surveillance is needed to understand community health threats, particularly when current trends deviate from seasonal norms.

##### Subject(s)
COVID-19 , Virus Diseases , Emergency Service, Hospital , Humans , Pandemics , SARS-CoV-2 , Seasons , United States/epidemiology , Virus Diseases/epidemiology
9.
Transpl Immunol ; 69: 101445, 2021 12.
Article in English | MEDLINE | ID: covidwho-1347842

##### ABSTRACT

The coronavirus disease 2019 (COVID-19) has swept the world, posing a serious threat to people's lives and health. Several cases of COVID-19 infection in renal transplant recipients (RTRs) have been reported, but the treatment and prognosis have not been fully elucidated. We followed-up with RTRs infected with SARS-CoV2 in our center and classified them as five clinical types-asymptomatic, mild, moderate, severe, and critical. The immunosuppressive agents were not adjusted in asymptomatic carriers and mild patients, the former was mainly treated by isolation, and the latter was treated by low-dose intravenous immunoglobulin (IVIG) to enhance immunity. For moderate or severe patients, the immunosuppressive agents were largely reduced or even interrupted, low-dose IVIG was adopted, and low-dose methylprednisolone (MP) was used to inhibit inflammation and rejection. Immunosuppressants were discontinued early in critical patients; IVIG, high-dose MP, and antibiotics were used. Meanwhile, all patients received at least one antiviral drugs. After aggressive treatment, three patients developed acute kidney injury, and two showed reversal, while the remaining one lost the allograft kidney; one patient died, while other patients were discharged. For different clinical types of RTRs infected with COVID-19, personalized therapies were essential, Meanwhile, patients with COVID-19 infection may have different outcomes due to their different clinical manifestations.

##### Subject(s)
COVID-19/drug therapy , Immunocompromised Host/immunology , Immunosuppressive Agents/therapeutic use , Kidney Transplantation , SARS-CoV-2/drug effects , Acute Kidney Injury/pathology , Adult , Antiviral Agents/therapeutic use , COVID-19/immunology , COVID-19/pathology , COVID-19/therapy , Female , Humans , Immunization, Passive/methods , Immunoglobulins, Intravenous/therapeutic use , Immunosuppressive Agents/adverse effects , Male , Methylprednisolone/therapeutic use , Middle Aged , Prognosis , Transplant Recipients
10.
Clin Infect Dis ; 73(Suppl 1): S110-S117, 2021 07 15.
Article in English | MEDLINE | ID: covidwho-1207263

##### ABSTRACT

BACKGROUND: Respiratory tract infections are common, often seasonal, and caused by multiple pathogens. We assessed whether seasonal respiratory illness patterns changed during the COVID-19 pandemic. METHODS: We categorized emergency department (ED) visits reported to the National Syndromic Surveillance Program according to chief complaints and diagnosis codes, excluding visits with diagnosed SARS-CoV-2 infections. For each week during 1 March 2020 through 26 December 2020 ("pandemic period"), we compared the proportion of ED visits in each respiratory category with the proportion of visits in that category during the corresponding weeks of 2017-2019 ("pre-pandemic period"). We analyzed positivity of respiratory viral tests from 2 independent clinical laboratories. RESULTS: During March 2020, cough, shortness of breath, and influenza-like illness accounted for twice as many ED visits compared with the pre-pandemic period. During the last 4 months of 2020, all respiratory conditions, except shortness of breath, accounted for a smaller proportion of ED visits than during the pre-pandemic period. Percent positivity for influenza virus, respiratory syncytial virus, human parainfluenza virus, adenoviruses, and human metapneumovirus was lower in 2020 than 2019. Although test volume decreased, percent positivity was higher for rhinovirus/enterovirus during the final weeks of 2020 compared with 2019, with ED visits similar to the pre-pandemic period. CONCLUSIONS: Broad reductions in respiratory test positivity and respiratory ED visits (excluding COVID-19) occurred during 2020. Interventions for mitigating spread of SARS-CoV-2 likely also reduced transmission of other pathogens. Timely surveillance is needed to understand community health threats, particularly when current trends deviate from seasonal norms.

##### Subject(s)
COVID-19 , Virus Diseases , Emergency Service, Hospital , Humans , Pandemics , SARS-CoV-2 , Seasons , United States/epidemiology , Virus Diseases/epidemiology
11.
Transpl Immunol ; 67: 101395, 2021 08.
Article in English | MEDLINE | ID: covidwho-1199110

##### ABSTRACT

Since its emergence in December 2019 many end-stage renal disease (ESRD) patients have been infected with coronavirus disease 2019 (COVID-19). Herein, we describe the case of an ESRD patient who received a kidney transplant after recovering from COVID-19. We described the clinical course of COVID-19 and kidney transplant management, including the patient's symptoms, laboratory results, computed tomography, and antibody profiles. He recovered well, without complications. Chest computed tomography, PCR, and IgG results indicated no recurrence of COVID-19 during the subsequent two weeks. Therefore, kidney transplantation is feasible in an ESRD patient who has recovered from COVID-19, under a normal immunosuppressive regimen.

##### Subject(s)
COVID-19/therapy , Immunocompromised Host , Kidney Failure, Chronic/surgery , Kidney Transplantation , Transplant Recipients , Adult , Antiviral Agents/therapeutic use , Glomerulonephritis/surgery , Humans , Immunosuppressive Agents/adverse effects , Immunosuppressive Agents/therapeutic use , Male , SARS-CoV-2
12.
Transl Pediatr ; 10(3): 616-624, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1184109

##### ABSTRACT

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) epidemic has spread globally, along with its incidence among children. The purpose of this study was to evaluate the clinical characteristics and outcomes of children infected with COVID-19 and to provide a reference for clinical work. METHODS: The study retrospectively reviewed the clinical characteristics and prognosis of 7 children diagnosed with COVID-19 infection at The First People's Hospital of Jingzhou between January 30 and February 29, 2020. RESULTS: Of the 7 cases, 2 were male and 5 were female, aged 3 months and 14 days to 12 years old (median age 3 years old). There was 1 asymptomatic carrier, 5 cases with mild type infection, which had the main symptoms of cough (4/5) and fever (4/5), and 1 case of moderate type. Among the 7 cases, serum white blood cell count was increased in 1 case, decreased in 1 case, liver transaminase was increased in 1 case, lactate dehydrogenase was increased in 3 cases, creatine kinase MB (CK-MB) was increased in 2 cases, and C-reactive protein was elevated in 2 cases. A total of 4 cases were complicated with mycoplasma pneumoniae and/or influenza B virus infection. A single case of chest computed tomography (CT) showed viral pneumonia. With routine antiviral and symptomatic support therapy, the median time taken for the results of nucleic acid testing by pharyngeal swab to become negative was 14 days (6-26 days) and the median hospital stay was 15 days (8-31 days). All participants were cured and subsequently discharged from hospital. Only 1 case was positive for nucleic acid testing by pharyngeal swab 1 month after being discharged, and the anal swab of 1 case for nucleic acid testing was positive 2 months after being discharged. CONCLUSIONS: All children with COVID-19 who were included in this study in Jingzhou were infected via family clustering, and the laboratory examinations were not specific. Fever and cough were common symptoms, but all cases were mild and had good prognoses.

13.
SSRN; 2020.
Preprint | SSRN | ID: ppcovidwho-807

##### ABSTRACT

Background: The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, HubeProvince, China spread worldwide, resulting in a large number of deaths. br br

14.
Ann Allergy Asthma Immunol ; 126(1): 89-90, 2021 01.
Article in English | MEDLINE | ID: covidwho-764177
15.
Zhongguo Dang Dai Er Ke Za Zhi ; 2020.
Article | WHO COVID | ID: covidwho-344795

##### ABSTRACT

OBJECTIVE: To study the clinical features of coronavirus disease 2019 (COVID-19) in children aged <18 years. METHODS: A retrospective analysis was performed from the medical data of 23 children, aged from 3 months to 17 years and 8 months, who were diagnosed with COVID-19 in Jiangxi, China from January 21 to February 29, 2020. RESULTS: Of the 23 children with COVID-19, 17 had family aggregation. Three children (13%) had asymptomatic infection, 6 (26%) had mild type, and 14 (61%) had common type. Among these 23 children, 16 (70%) had fever, 11 (48%) had cough, 8 (35%) had fever and cough, and 8 (35%) had wet rales in the lungs. The period from disease onset or the first nucleic acid-positive detection of SARS-CoV-2 to the virus nucleic acid negative conversion was 6-24 days (median 12 days). Of the 23 children, 3 had a reduction in total leukocyte count, 2 had a reduction in lymphocytes, 2 had an increase in C-reactive protein, and 2 had an increase in D-dimer. Abnormal pulmonary CT findings were observed in 12 children, among whom 9 had patchy ground-glass opacities in both lungs. All 23 children received antiviral therapy and were recovered. CONCLUSIONS: COVID-19 in children aged <18 years often occurs with family aggregation, with no specific clinical manifestation and laboratory examination results. Most of these children have mild symptoms and a good prognosis. Epidemiological history is of particular importance in the diagnosis of COVID-19 in children aged <18 years.

16.
BMC Infect Dis ; 20(1): 311, 2020 Apr 29.
Article in English | MEDLINE | ID: covidwho-133666

##### ABSTRACT

BACKGROUND: Since December 2019, the 2019 coronavirus disease (COVID-19) has expanded to cause a worldwide outbreak that more than 600,000 people infected and tens of thousands died. To date, the clinical characteristics of COVID-19 patients in the non-Wuhan areas of Hubei Province in China have not been described. METHODS: We retrospectively analyzed the clinical characteristics and treatment progress of 91 patients diagnosed with COVID-19 in Jingzhou Central Hospital. RESULTS: Of the 91 patients diagnosed with COVID-19, 30 cases (33.0%) were severe and two patients (2.2%) died. The severe disease group tended to be older (50.5 vs. 42.0 years; p = 0.049) and have more chronic disease (40% vs. 14.8%; p = 0.009) relative to mild disease group. Only 73.6% of the patients were quantitative polymerase chain reaction (qPCR)-positive on their first tests, while typical chest computed tomography images were obtained for each patient. The most common complaints were cough (n = 75; 82.4%), fever (n = 59; 64.8%), fatigue (n = 35; 38.5%), and diarrhea (n = 14; 15.4%). Non-respiratory injury was identified by elevated levels of aspartate aminotransferase (n = 18; 19.8%), creatinine (n = 5; 5.5%), and creatine kinase (n = 14; 15.4%) in laboratory tests. Twenty-eight cases (30.8%) suffered non-respiratory injury, including 50% of the critically ill patients and 21.3% of the mild patients. CONCLUSIONS: Overall, the mortality rate of patients in Jingzhou was lower than that of Wuhan. Importantly, we found liver, kidney, digestive tract, and heart injuries in COVID-19 cases besides respiratory problems. Combining chest computed tomography images with the qPCR analysis of throat swab samples can improve the accuracy of COVID-19 diagnosis.

##### Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Adult , COVID-19 , China/epidemiology , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Cough/etiology , Diarrhea/etiology , Disease Outbreaks , Fatigue/etiology , Female , Fever/etiology , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
17.
J Med Virol ; 92(10): 2019-2026, 2020 10.
Article in English | MEDLINE | ID: covidwho-133656

##### ABSTRACT

Coronavirus disease 2019 (COVID-19) had its evolution in Wuhan, Hubei Province, China, and now it has spread around the world, resulting in a large number of deaths. Temporary Ark hospitals (TAHs) have played an important role in controlling the spread of the epidemic in the city of Wuhan. Taking one TAH with 800 beds as an example, we summarized details of the layout, setting, working mode of medical staff, patient management, admission standards, discharge standards, and standards for transferring to another hospital, hospital operation, and so on. Over the period of operation, a total of 1124 patients were admitted for treatment. Of these, 833 patients were cured and discharged from the hospital and 291 patients were transferred to other designated hospitals, owing to aggravation of their condition. The achievement was to have zero infection for medical staff, zero in-hospital deaths among admitted patients, and zero readmission for discharged patients. The rapid deployment of TAH provided a suitable place for treating mild/moderate or no asymptomatic COVID-19 patients, which successfully helped to control the infection in Wuhan. The successful model of TAH would rapidly and effectively control the spread of COVID-19 in other cities.

##### Subject(s)
COVID-19/therapy , Hospitals/classification , Pandemics , COVID-19/epidemiology , China/epidemiology , Hospital Mortality , Hospitalization , Humans , Infection Control , Patient Discharge/standards , Patient Readmission