Post-acute care for frail older people decreases 90-day emergency room visits, readmissions and mortality: An interventional study.

BACKGROUND: To evaluate the effects of post-acute care (PAC) on frail older adults after acute hospitalization in Taiwan. METHODS: This was a multicenter interventional study. Frail patients aged ≥ 75 were recruited and divided into PAC or control group. The PAC group received comprehensive geriatric assessment (CGA) and multifactorial intervention including exercise, nutrition education, and medicinal adjustments for two to four weeks, while the control group received only CGA. Outcome measures included emergency room (ER) visits, readmissions, and mortality within 90 days after PAC. RESULTS: Among 254 participants, 205 (87.6±6.0 years) were in the PAC and 49 (85.2±6.0 years) in the control group. PAC for more than two weeks significantly decreased 90-day ER visits (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.10-0.43; p = 0.024), readmissions (OR 0.30, 95% CI 0.16-0.56; p < 0.001), and mortality (OR 0.20, 95% CI 0.04-0.87; p = 0.032). Having problems in self-care was an independent risk factor for 90-day ER visits (OR 2.11, 95% CI 1.17-3.78; p = 0.012), and having problems in usual activities was an independent risk factor for 90-day readmissions (OR 2.69, 95% CI 1.53-4.72; p = 0.001) and mortality (OR 3.16, 95% CI 1.16-8.63; p = 0.024). CONCLUSION: PAC program for more than two weeks could have beneficial effects on decreasing ER visits, readmissions, and mortality after an acute illness in frail older patients. Those who perceived severe problems in self-care and usual activities had a higher risk of subsequent adverse outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT Identifier: NCT05452395.

Systematic Screening for SARS-CoV-2 to Detect Asymptomatic Infections: An Epitome of Taiwan's Outbreak

Background Increased studies have revealed that asymptomatic carriers substantially impact the epidemic and that asymptomatic transmission is very common. Therefore, the asymptomatic transmission threat to the spread of the pandemic should not be neglected. Methods The local outbreak in Taiwan, especially in Taipei City, is unprecedented and paramount and has claimed hundreds of lives, tens of thousands of cases, and enormous economic costs. As care providers and gatekeepers of infectious diseases, Taipei City Hospital has to perform regular polymerase chain reaction (PCR) results of admitted patients and healthcare workers (HCWs) to achieve these goals. Results In this study, the results revealed a low positive rate of less than 1%, but the asymptomatic proportions could range from 42% to 46%, which bolsters that systematic screening was effective in controlling coronavirus disease-19 (COVID-19) of Novel Coronavirus or Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) and might be an exemplar to other similar scenarios. Universal screening of admitted patients may be important and necessary, especially in asymptomatic patients. Conclusions Regular screening for healthcare providers is also important during this pandemic, and it is recommended that admitted patients and healthcare providers undergo systemic PCR testing.

Turning Point during COVID-19 Pandemic: Transformation and Innovation of Infection Control in the Hospital

2019年底起源於中國武漢之新型冠狀病毒COVID-19疫情，造成全球大流行。台灣經歷17年前的SARS疫情，對COVID-19及早因應並希望能防堵於境外。COVID-19風暴下，醫療體系、醫療生態及醫療行為都需快速的轉變與因應。本文簡述在台灣防疫政策下，臺北市立聯合醫院仁愛院區面對疫情四個階段的因應作為，並探討COVID-19所帶來的衝擊與創新。第一階段，經由加強入院人員監測及開設專責病房來預防COVID-19院內感染。第二階段，加強社區COVID-19監測、提升特殊單位防護、分艙分流、及非緊急醫療服務量降載來因應可能面臨之本土社區感染。第三階段因應COVID-19全球大流行，規劃重症加護病床。第四階段為如何與COVID-19長期抗戰與共舞。在目前COVID-19尚無有效藥物及疫苗之狀況下，大流行對社會及醫療體系有極大的衝擊與崩壞之可能性。仁愛院區透過各單位水平與垂直整合，根據疫情即時、滾動式調整，建立感染管制文化，守護醫院及台灣。 The outbreak of novel coronavirus disease 2019 (COVID-19) was first reported by the end of 2019 in Wuhan, China, , and is currently causing a global pandemic. Taiwan had a SARS outbreak 17 years ago, which primed the Central Epidemic Command Center to respond to COVID-19 earlier and swiftly and keep the virus away from the country. Timely response and alteration of the healthcare systems, ecology and behaviors of daily are mandatory. This article briefly describes the four stages of Taipei City Hospital Renai Branch, Taiwan in response to the pandemic, and discusses the impact and innovation brought by COVID-19. At the first stage, nosocomial infection was prevented by strengthening of active surveillance of all admitted patients and setting up of quarantine wards for suspected COVID-19 cases. The second stage was to strengthen the community surveillance, enhance protection for health workers in special units, triage and compartmentalization, and reducing inpatient and outpatient number to respond to potential community outbreak. At the third stage, we expanded the capacity of intensive care units for isolation in response to the global pandemic. The fourth stage was to plan a long-term defense and ＂dance＂ with COVID-19. The COVID-19 pandemic may pound and break the society and healthcare systems with force in the absence of effective pharmaceutics and vaccines. The Renai branch adjusts the response strategy in a rolling style and establishes infection control culture to guide the hospital and the nation through horizontal and vertical integration.