Factors Associated with Functional Decline in Older Adults After Discharge from an Acute-Care Hospital.

PURPOSE: This study was conducted to investigate the trend in functional changes over time and factors associated with the number of areas showing functional decline in older adults who had been discharged from acute care hospitals. METHODS: This longitudinal study involved 156 patients aged ≥ 65 years who were admitted to one tertiary hospital in Seoul and discharged home. Authors investigated patient demographic and health-care characteristics and the number of areas showing functional decline at 1 and 3 months after discharge. The data were analyzed using univariate and multivariate Poisson regression models. RESULTS: The number of areas showing functional decline increased between admission and 1 month after discharge and had declined slightly at 3 months after discharge. The factors associated with the number of areas showing functional decline at 3 months after discharge were age, education level, and length of hospitalization (p < .05); the factors associated at 1 month after discharge were medical department and caregiver relationship (p < .05). CONCLUSION: The results indicate that older patients with no spouse or those with their elderly spouse as their caregiver are at risk of functional decline in a greater number of areas after discharge. Therefore, a comprehensive health-care policy to ensure care continuity is required for functional health maintenance for older adults after hospital discharge.

Effect of Mobile Health on Obese Adults: A Systematic Review and Meta-Analysis.

OBJECTIVES: This study was conducted to examine the effects of mobile health (mHealth), using mobile phones as an intervention for weight loss in obese adults. METHODS: An electronic search was carried out using multiple databases. A meta-analysis of selected studies was performed. The effects of mHealth were analyzed using changes in body weight and body mass index (BMI). RESULTS: We identified 20 randomized controlled trials (RCTs) involving 2,318 participants who fit our inclusion criteria. The meta-analysis showed that body weight was reduced with a weighted mean difference (WMD) of -2.35 kg (95% confidence interval [CI], -2.84 to -1.87). An examination of the impact of duration of intervention showed that weight loss was greater after 6 months of mHealth (WMD = -2.66 kg) than between three and four months (WMD = -2.25 kg); it was maintained for up to 9 months (WMD = -2.62 kg). At 12 months, weight loss was reduced to a WMD of -1.23 kg. BMI decreased with a WMD of -0.77 kg/m2 (95% CI, -1.01 to -0.52). BMI changes were not statistically significant at 3 months (WMD = -1.10 kg/m2), but they were statistically significant at 6 months (WMD = -0.67 kg/m2). CONCLUSIONS: The use of mHealth for obese adults showed a modest short-term effect on body weight and BMI. Although the weight loss associated with mHealth did not meet the recommendation of the Scottish Intercollegiate Guideline Network, which considers a reduction of approximately 5 to 10 kg of the initial body weight as a successful intervention. Well-designed RCTs are needed to reveal the effects of mHealth interventions.

Predictors of hospital-acquired pressure ulcers among older adult inpatients.

AIM AND OBJECTIVES: To provide basic information on the preventive care for pressure ulcer (PU) by analysing PU-related characteristics and identifying PU predictors. BACKGROUND: The incidence of PUs in hospitals is increasing, and continuous PU management is required. The occurrence of PU was an important standard for hospital certification. There is a need to identify predictors of PUs for proper management of PUs. DESIGN: This is a descriptive study that analyses the electronic medical records of a university hospital. METHODS: Of all older adult inpatients aged over 65 years admitted to the hospital (from January 1, 2011-December 31, 2015), 34,287 were included in this study. To identify the PU predictors, a logistic regression analysis was performed using IBM SPSS Statistics 24. RESULTS: Predictors influencing PU were gender (OR = 1.36, 95% CI = 1.03-1.05), age, (OR = 1.04, 95% CI = 1.03-1.05), admission method (OR = 0.39, 95% CI = 0.32-0.46), consciousness status (OR = 3.77, 95% CI = 1.83-7.77) and Braden Scale score (OR = 0.07, 95% CI = 0.69-0.72). Among the predictors, consciousness is the most important variable. Patients who are drowsy were 3.77 times more likely to develop PU than those who are alert. CONCLUSIONS: To prevent and manage PU, the level of consciousness of older adult patients who are hospitalised should be assessed, and appropriate interventions should be provided. RELEVANCE TO CLINICAL PRACTICE: Pressure ulcer-specific interventions should be provided systematically by healthcare providers to those with altered consciousness beginning at hospital admission.

Development of the Korean framework for senior-friendly hospitals: a Delphi study.

BACKGROUND: Aging is an inevitable part of life. One can maintain well-being and wellness even after discharge and/or transition if his or her functional decline is minimized, sudden decline is prevented, and functioning is promoted during hospitalization. Caring appropriately for elderly patients requires the systematic application of Senior-Friendly Hospital principles to all operating systems, including medical centres' organization and environment, as well as patient treatment processes. The Senior-Friendly Hospital framework is valid and important for patient safety and quality improvement. This study aimed to make recommendations regarding the development of the Korean Framework for Senior-Friendly Hospitals for older patients' care management, patient safety interventions, and health promotion, via a Delphi survey. METHODS: Two rounds of Delphi surveying were conducted with 15 participants who had at least 3 years' experience in accreditation surveying and medical accreditation standards, survey methods, and accreditation investigator education. In each round, we calculated statistics describing each standard's validity and feasibility. RESULTS: The Korean Framework for Senior-Friendly Hospitals included 4 Chapters, 11 categories, and 67 standards through consensus of the Senior-Friendly Hospitals task force and experts' peer review. After the two rounds of Delphi surveying, validity evaluation led to no changes in standards of the Senior-Friendly Hospitals; however, the number of standards showing adequate validity decreased from 67 to 58. Regarding feasibility, no changes were necessary in the standards; however, the number of categories showing adequate feasibility decreased from 11 to 8 and from 67 to 30, respectively. The excluded categories were 3.2, 4.2, and 4.3 (service, transportation, and signage and identification). The highest feasibility values were given to standards 2.1.1, 4.1.4, and 4.1.6. The highest feasibility score was given to standard 2.4.2. CONCLUSIONS: The Korean Framework for Senior-Friendly Hospitals needs to include 4 Chapters, 8 categories, and 30 standards. The Accreditation Program for Healthcare Organizations should include Senior-Friendly Hospitals -relevant standards considering Korea's medical environment.

Effect of Postpartum Outcomes in Mother's Upright Position During the Second Stage of Labor: Systematic Review.

PURPOSE: The purpose of this study was to determine whether upright position is effective in labor through systematic review in randomized controlled trials. METHODS: We established the PICO (Patient-Intervention-Comparator-Outcome) strategy, and reviewed 282 literatures from national and international electronic databases, and finally selected 9 references based on inclusion and exclusion criteria. We evaluated the quality of references and carried out a meta-analysis. RESULTS: The maternal outcomes showed that the duration of their second-stage labor was 2.29 minutes shorter than that of the women in the recumbent position, and were less likely to have episiotomy. The other outcomes, including the mode of delivery, blood loss, hemoglobin level, use of oxytocin, use of analgesics, and perineal laceration, did not differ between the groups. The fetal heart rate abnormality occurred less than in the control group. The Apgar scores of the groups did not differ. CONCLUSION: There is evidence that an upright position in the second stage of labor reduces the duration of the second stage of labor, the incidence of episiotomy, and an abnormal fetal heart rate.

Relationship between physician characteristics and their injection use in Korea.

OBJECTIVE: To determine the relationships among physicians' knowledge and beliefs, perceived patient demand and treatment with injection drugs in Korean primary care settings. DESIGN: A cross-sectional, nationwide survey. SETTING: A total of 644 clinics were selected from the 9660 clinics with more than 1000 patient visits from April 1 to June 30, 2004, among four specialties (general practice, internal medicine, otorhinolaryngology, family medicine) that dealt mainly with acute upper respiratory infections in primary care settings. PARTICIPANTS: We surveyed one physician per clinic with a questionnaire investigating their knowledge and beliefs on and perceived patient demand for injections. Among the 644 physicians, the data of 608 were analysed after responses with incomplete data were excluded. The survey data were merged with their injection prescription rate for acute upper respiratory infections. Main outcome measure Prescription rate for injection drugs. RESULTS: The mean prescription rate for injection drugs per physician was 41.8%. Of respondents, 85.2% had faulty knowledge and beliefs about injection drugs, and 72.9% perceived a strong patient demand for injections. Older, male and generalist physicians had higher prescription rate. After controlling for physician and clinic characteristics, the prescription rates were significantly related with physicians' knowledge and beliefs on and perception of patient demand for injection drugs. CONCLUSIONS: Physicians with faulty knowledge and beliefs on and a perception of strong patient demand for injection drugs had higher prescription rates. Some potential interventions are described to encourage primary care physicians to use injection drugs appropriately in South Korea.

[Comparing the performance of three severity scoring systems for ICU patients: APACHE III, SAPS II, MPM II].

OBJECTIVES: To evaluate the predictive validity of three scoring systems; the acute physiology and chronic health evaluation(APACHE) III, simplified acute physiology score(SAPS) II, and mortality probability model (MPM) II systems in critically ill patients. METHODS: A concurrent and retrospective study conducted by collecting data on consecutive patients admitted to the intensive care unit (ICU) including surgical, medical and coronary care unit between January 1, 2004, and March 31, 2004. Data were collected on 348 patients consecutively admitted to the ICU (aged 16 years or older, no transfer, ICU stay at least 8 hours). Three models were analyzed using logistic regression. Discrimination was assessed using receiver operating characteristic (ROC) curves, sensitivity, specificity, and correct classification rate. Calibration was assessed using the Lemeshow-Hosmer goodness of fit H-statistic. RESULTS: For the APACHE III, SAPS II and MPM II systems, the area under the receiver operating characterist ic(ROC) curves were 0.981, 0.978, and 0.941 respectively. With a predicted risk of 0.5, the sensitivities for the APACHE III, SAPS II, and MPM II systems were 81.1, 79.2 and 71.7%, the specificities 98.3, 98.6, and 98.3%, and the correct classification rates 95.7, 95.7, and 94.3%, respectively. The SAPS II and APACHE III systems showed good calibrations(chi-squared H=2.5838 p=0.9577 for SAPS II, and chi-squared H=4.3761 p=0.8217 for APACHE III). CONCLUSIONS: The APACHE III and SAPS II systems have excellent powers of mortality prediction, and calibration, and can be useful tools for the quality assessment of intensive care units (ICUs).