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IEEE Journal of Biomedical and Health... Oct 2023This study presents three deidentified large medical text datasets, named DISCHARGE, ECHO and RADIOLOGY, which contain 50 K, 16 K and 378 K pairs of report and summary...
This study presents three deidentified large medical text datasets, named DISCHARGE, ECHO and RADIOLOGY, which contain 50 K, 16 K and 378 K pairs of report and summary that are derived from MIMIC-III, respectively. We implement convincing baselines of automated abstractive summarization on the created datasets with pre-trained encoder-decoder language models, including BERT2BERT, BERTShare, RoBERTaShare, Pegasus, ProphetNet, T5-large, BART and GSUM. Further, based on the BART model, we leverage the sampled summaries from the training set as prior knowledge guidance, for encoding additional contextual representations of the guidance with the encoder and enhancing the decoding representations in the decoder. The experimental results confirm the improvement of ROUGE scores and BERTScore made by the proposed method.
Topics: Humans; Medical Records; Natural Language Processing; Patient Discharge
PubMed: 37566507
DOI: 10.1109/JBHI.2023.3304376 -
Journal of Clinical Nursing Sep 2023The aim of this study was to create a holistic understanding of the psychosocial processes of older persons with multiple chronic conditions' experience with unplanned... (Review)
Review
AIMS AND OBJECTIVES
The aim of this study was to create a holistic understanding of the psychosocial processes of older persons with multiple chronic conditions' experience with unplanned readmission experiences within 30 days of discharge home and identify factors influencing these psychosocial processes.
DESIGN
Mixed methods systematic review.
DATA SOURCES
Six electronic databases (Ovid MEDLINE (R) All 1946-present, Scopus, CINAHL, Embase, PsychINFO and Web of Science).
REVIEW METHODS
Peer-reviewed articles published between 2010 and 2021 and addressed study aims (n = 6116) were screened. Studies were categorised by method: qualitative and quantitative. Qualitative data synthesis used a meta-synthesis approach and applied thematic analysis. Quantitative data synthesis used vote counting. Data (qualitative and quantitative) were integrated through aggregation and configuration.
RESULTS
Ten articles (n = 5 qualitative; n = 5 quantitative) were included. 'Safeguarding survival' described older persons' unplanned readmission experience. Older persons experienced three psychosocial processes: identifying missing pieces of care, reaching for lifelines and feeling unsafe. Factors influencing these psychosocial processes included chronic conditions and discharge diagnosis, increased assistance with functional needs, lack of discharge planning, lack of support, increased intensity of symptoms and previous hospital readmission experiences.
CONCLUSIONS
Older persons felt more unsafe as their symptoms increased in intensity and unmanageability. Unplanned readmission was an action older persons required to safeguard their recovery and survival.
RELEVANCE TO CLINICAL PRACTICE
Nurses play a critical role in assessing and addressing factors that influence older persons' unplanned readmission. Identifying older persons' knowledge about chronic conditions, discharge planning, support (caregivers and community services), changes in functional needs, intensity of symptoms and past readmission experiences may prepare older persons to cope with their return home. Focusing on their health-care needs across the continuum of care (community, home and hospital) will mitigate the risks for unplanned readmission within 30 days of discharge.
REPORTING METHOD
PRISMA guidelines.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution due to design.
Topics: Humans; Aged; Aged, 80 and over; Patient Readmission; Multiple Chronic Conditions; Patient Discharge; Delivery of Health Care; Chronic Disease
PubMed: 37095609
DOI: 10.1111/jocn.16705 -
The Journal of Nursing Administration Dec 2023This article focuses on applying the patient empowerment, engagement, and activation (PEEA) model as an implementation strategy to achieve patient- or person-centered...
This article focuses on applying the patient empowerment, engagement, and activation (PEEA) model as an implementation strategy to achieve patient- or person-centered care. There is substantial evidence linking PEEA to improved patient care outcomes and reduced healthcare costs. Interrelationships among the 3 concepts are discussed and how the PEEA survey can be used to evaluate patients' activation for self-care postdischarge and their perceptions of nurses' empowering and engaging them during the care encounter.
Topics: Humans; Patient Participation; Aftercare; Patient Discharge; Surveys and Questionnaires; Patient-Centered Care
PubMed: 37983606
DOI: 10.1097/NNA.0000000000001364 -
European Heart Journal Feb 2024Natural language processing techniques are having an increasing impact on clinical care from patient, clinician, administrator, and research perspective. Among others...
Natural language processing techniques are having an increasing impact on clinical care from patient, clinician, administrator, and research perspective. Among others are automated generation of clinical notes and discharge letters, medical term coding for billing, medical chatbots both for patients and clinicians, data enrichment in the identification of disease symptoms or diagnosis, cohort selection for clinical trial, and auditing purposes. In the review, an overview of the history in natural language processing techniques developed with brief technical background is presented. Subsequently, the review will discuss implementation strategies of natural language processing tools, thereby specifically focusing on large language models, and conclude with future opportunities in the application of such techniques in the field of cardiology.
Topics: Humans; Artificial Intelligence; Natural Language Processing; Cardiology; Patient Discharge
PubMed: 38170821
DOI: 10.1093/eurheartj/ehad838 -
Journal of the American Medical... Sep 2023To adapt a successful acute care transitional model to meet the needs of veterans transitioning from post-acute care to home.
OBJECTIVES
To adapt a successful acute care transitional model to meet the needs of veterans transitioning from post-acute care to home.
DESIGN
Quality improvement intervention.
SETTING AND PARTICIPANTS
Veterans discharged from a subacute care unit in the VA Boston Healthcare System's skilled nursing facility.
METHODS
We used the Replicating Effective Programs framework and Plan-Do-Study-Act cycles to adapt the Coordinated-Transitional Care (C-TraC) program to the context of transitions from a VA subacute care unit to home. The major adaptation of this registered nurse-driven, telephone-based intervention was combining the roles of discharge coordinator and transitional care case manager. We report the details of the implementation, its feasibility, and results of process measures, and describe its preliminary impact.
RESULTS
Between October 2021 and April 2022, all 35 veterans who met eligibility criteria in the VA Boston Community Living Center (CLC) participated; none were lost to follow-up. The nurse case manager delivered core components of the calls with high fidelity-review of red flags, detailed medication reconciliation, follow-up with primary care physician, and discharge services were discussed and documented in 97.9%, 95.9%, 86.8%, and 95.9%, respectively. CLC C-TraC interventions included care coordination, patient and caregiver education, connecting patients to resources, and addressing medication discrepancies. Nine medication discrepancies were discovered in 8 patients (22.9%; average of 1.1 discrepancies per patient). Compared with a historical cohort of 84 veterans, more CLC C-TraC patients received a post-discharge call within 7 days (82.9% vs 61.9%; P = .03). There was no difference between rates of attendance to appointments and acute care admissions post-discharge.
CONCLUSIONS AND IMPLICATIONS
We successfully adapted the C-TraC transitional care protocol to the VA subacute care setting. CLC C-TraC resulted in increased post-discharge follow-up and intensive case management. Evaluation of a larger cohort to determine its impact on clinical outcomes such as readmissions is warranted.
Topics: Humans; Transitional Care; Patient Discharge; Veterans; Aftercare; Hospitalization
PubMed: 37302797
DOI: 10.1016/j.jamda.2023.05.007 -
BMC Health Services Research Mar 2024Movement of patients through a health establishment is a complex activity reliant upon multi-actor co-ordination across departments. The challenge of enhancing service... (Review)
Review
BACKGROUND
Movement of patients through a health establishment is a complex activity reliant upon multi-actor co-ordination across departments. The challenge of enhancing service delivery to meet the needs of a growing and aging population, whilst minimizing expense, is a global concern. There is an urgent need to understand and quantify systemic gaps in the efficient delivery of healthcare services. Stagnation of patient flow has negative impacts on both staff and patients by increasing risks of adverse outcomes, staff frustration and job dissatisfaction. An inefficient discharge process can be a significant barrier to timely patient movement.
METHODS
A retrospective cohort study was conducted at a tertiary, academic hospital in the Western Cape, South Africa to assess the journey of medical patients from admission to discharge across the five different medical teams (firms) within the general medicine department. Consecutive sampling was used to capture all eligible adult medical in-patients admitted from the emergency department (ED) to general medicine from the 11th - 20th April 2023 and discharged up until the 30th of April 2023. We reviewed the patient notes (folders) of these individuals using a data-extraction tool to ascertain reasons for admission and barriers to timely discharge.
RESULTS
Among 86 patient folders reviewed, cumulatively accounting for 596 in-patient days, a difference in the median length of in-patient stay between medical firms (p = 0.042) was noted. The shortest length of stay corresponded to firms with the greatest proportion of daily senior staff oversight (defined as documented patient reviews by a registrar, medical officer and/or consultant independently or in addition to reviews done for the day by interns and/or students). While 52% of patients vacated their beds between 14:00 and 17:00, 66% of patients were admitted after 20:00. Reasons for prolonged admission were variable, and attributable to a range of different disciplines across the multidisciplinary team.
CONCLUSION
Whilst this study did not evaluate the appropriateness of chosen medical management but rather systemic drivers affecting patient movement and barriers to timely discharge, the delays in discharge were noted to be multi-factorial including facets across the efficient delivery of medical care, availability of resources and the internal operational frameworks for the institution. Understanding the need to optimize internal process efficiencies with regards to prompt acquisition of investigations, improvement of senior staff oversight and the creation of a standardized discharge process, could enhance efficient patient movement.
Topics: Adult; Humans; Aged; Patient Discharge; South Africa; Retrospective Studies; Hospitalization; Hospitals
PubMed: 38448938
DOI: 10.1186/s12913-024-10806-6 -
Journal of Oncology Pharmacy Practice :... Jul 2023Patients with cancer need care from a multidisciplinary team due to the complexity of the clinical picture and proposed treatment. Hospital discharge is a critical step,... (Review)
Review
INTRODUCTION
Patients with cancer need care from a multidisciplinary team due to the complexity of the clinical picture and proposed treatment. Hospital discharge is a critical step, because pharmacotherapy changes may occur during hospitalization, leading to potential medication-related problems at home.
OBJECTIVE
To identify publications which describe the activities performed by the pharmacist at the hospital discharge of patients with cancer.
METHOD
This is an integrative systematic literature review. A search was carried out in the MEDLINE databases, via Pubmed, Embase, and Virtual Health Library, using the following descriptors: "Patient Discharge", "Pharmacists", "Neoplasms." Studies that reported activities performed by the pharmacist at the hospital discharge of patients with cancer were included.
RESULTS
Five hundred and two studies were identified, of which seven met the eligibility criteria. Most were conducted in the United States (n = 3), and the rest in Belgium, Brazil, Canada, and Italy. Among the services provided by the pharmacist at discharge, medication reconciliation was the most widely described. Other activities such as counseling, education, identification, and resolution of drug-related problems were also carried out.
CONCLUSION
In the scenario of hospital discharge of patients with cancer, the participation of pharmacists is still to be seen as of significance in regards to publications. Despite this, the results suggest that the actions of this professional contribute to patient orientation and the safe use of prescription drugs for use at home.
Topics: Humans; Patient Discharge; Pharmacists; Pharmacy Service, Hospital; Medication Reconciliation; Neoplasms; Hospitals
PubMed: 36895125
DOI: 10.1177/10781552231160678 -
Intensive & Critical Care Nursing Dec 2023To examine the needs, perceptions and influencing factors according to former adult intensive care unit patients and relatives with regard to family participation in...
OBJECTIVES
To examine the needs, perceptions and influencing factors according to former adult intensive care unit patients and relatives with regard to family participation in essential care in the unit.
RESEARCH DESIGN
A qualitative interpretive descriptive study using inductive thematic analysis.
SETTING
Twelve pairs of former Dutch patients and their relatives were interviewed within two months after the patient's discharge from the unit between December 2017 and April 2018.
FINDINGS
Four themes emerged: the family's history, the patient's condition, supporting the patient and supporting the relative. The family's history, in particular the relationship with the patient and former experience with care, determined the level of participation in essential care. The level of participation was also influenced by the patient's condition, more specifically level of consciousness, stability of the patient's situation and length of the patient's stay. The third theme, supporting the patient, related to presence/being able to 'be there' for the patient and a mostly positive attitude towards family participation. The last theme was supporting the relative, with three subthemes associated with relatives' needs and perceptions: (dis)comfort with participation in essential care, need for invitation and support, and concern about the possible strain experienced by relatives.
CONCLUSION
Supporting the patient and supporting the relative are reflecting the needs and perceptions of patients and relatives regarding family participation in essential care. Both the family's history and the patient's condition influence the relative's level of participation. Intensive care unit nurses and other healthcare providers could take these themes into account when encouraging family participation in essential care.
IMPLICATIONS FOR CLINICAL PRACTICE
Patients' and relatives' needs and perceptions of family participation in essential care in the intensive care unit vary. Family participation in essential care is influenced by the family's history and the patient's condition. Healthcare providers could take these findings into account when implementing family participation in essential care.
Topics: Adult; Humans; Consciousness; Health Personnel; Intensive Care Units; Patient Discharge; Patients
PubMed: 37598505
DOI: 10.1016/j.iccn.2023.103525 -
Journal of Emergency Nursing May 2024Emergency department discharge education is intended to provide patients with information to self-manage their condition or injury, identify potential complications, and... (Review)
Review
INTRODUCTION
Emergency department discharge education is intended to provide patients with information to self-manage their condition or injury, identify potential complications, and follow-up or referral. However, most patients cannot recall the discharge information provided, leading to adverse clinical outcomes, return visits, and higher costs. A scoping review was undertaken to explore discharge education interventions that have been studied in the emergency department setting and outcomes that have been used to evaluate the effectiveness of the interventions.
METHODS
A literature review was conducted using the databases PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center, with search terms focused on emergency nursing and patient discharge education interventions.
RESULTS
Of the publications identified, 18 studies met the inclusion criteria. There was variation among studies on the conditions/injuries and populations of focus for the intervention. The interventions were categorized by learning styles, including auditory (n=10), kinesthetic (n=1), visual (n=15), reading/writing (n=1), and multimodal (n=7). Outcomes evaluated included those that were patient-specific (education, self-management, clinical, and adherence) and metrics of the health system and public health.
DISCUSSION
Multimodal discharge education that addresses various learning styles and levels of health literacy improved patient education, self-management, and clinical outcomes. Additional support and reminders improved patient adherence. Identified gaps included limited kinesthetic interventions and culturally tailored education. Translational science for advancing sustainable interventions in clinical practice is needed to enhance the emergency department discharge process and patient, system, and public health outcomes.
Topics: Humans; Patient Discharge; Emergency Service, Hospital; Patient Education as Topic; Emergency Nursing; Health Literacy
PubMed: 38323972
DOI: 10.1016/j.jen.2023.12.012 -
Revista Da Escola de Enfermagem Da U S P 2023To analyze the interprofessional team's perception of the actions carried out by means of responsible hospital discharge, and their contribution to improving the...
OBJECTIVE
To analyze the interprofessional team's perception of the actions carried out by means of responsible hospital discharge, and their contribution to improving the transition and continuity of patient care.
METHODS
A qualitative study was carried out in two hospitalization units, in October - November 2020, interviewing health professionals from a teaching hospital in the state of São Paulo. The reports were transcribed and subjected to thematic content analysis.
RESULTS
Twelve professionals participated (doctor, nurse, physiotherapist, nutritionist, speech therapist and social worker) and three thematic categories emerged from the interviews: 1. informational continuity in responsible discharge; 2. interaction between professionals and services for the transition of care; and 3. workload management for better transition and continuity of care.
CONCLUSION
The team recognized interprofessional advances and challenges in responsible discharge related to the informational and relational continuity of patient care and highlighted the (over)workload as an unfavorable aspect in the transition process, generating impacts for patients, professionals and health services.
Topics: Humans; Patient Discharge; Brazil; Hospitalization; Body Fluids; Health Personnel
PubMed: 38047743
DOI: 10.1590/1980-220X-REEUSP-2022-0452en