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Subacute sclerosing panencephalitis: clinical phenotype, epidemiology, and preventive interventions.Developmental Medicine and Child... Oct 2019Subacute sclerosing panencephalitis (SSPE) is a preventable condition reported in 6.5 to 11 per 100 000 cases of measles, and highest in children who contracted measles... (Review)
Review
Subacute sclerosing panencephalitis (SSPE) is a preventable condition reported in 6.5 to 11 per 100 000 cases of measles, and highest in children who contracted measles infection when they were less than 5 years of age. Children residing in areas with poor vaccination coverage and high prevalence of human immunodeficiency virus are at increased risk of developing SSPE. SSPE is life-threatening in most affected children. This report documents current data relating to the clinical phenotype, epidemiology, and understanding of SSPE, inclusive of preventive interventions. While improvements in disease progression with immunomodulation may occur, overall there is no cure. Most therapies focus on supportive needs. Seizures and abnormal movements may respond to carbamazepine. Many countries advocate policies to enhance vaccination coverage. Effective preventive health care programmes, assurance of parental perceptions, and crisis support for unprecedented events obstructing effective primary health care are needed. Until measles is eradicated worldwide, children in all regions remain at risk. WHAT THIS PAPER ADDS: Measles contracted under 5 years of age has highest risk of developing subacute sclerosing panencephalitis (SSPE). Children with, or exposed to, human immunodeficiency virus infection, who contract measles may be at increased risk of SSPE.
Topics: Humans; Phenotype; Risk Factors; Subacute Sclerosing Panencephalitis; Treatment Outcome; Vaccination
PubMed: 30680706
DOI: 10.1111/dmcn.14166 -
Journal of the American Medical... Dec 2021To examine the effect of the COVID-19 pandemic on post-acute care utilization and spending.
OBJECTIVE
To examine the effect of the COVID-19 pandemic on post-acute care utilization and spending.
DESIGN
We used a large national multipayer claims data set from January 2019 through October 2020 to examine trends in posthospital discharge location and spending.
SETTING AND PARTICIPANTS
We identified and included 975,179 hospital discharges who were aged ≥65 years.
METHODS
We summarized postdischarge utilization and spending in each month of the study: (1) the percentage of patients discharged from the hospital to home for self-care and to the 3 common post-acute care locations: home with home health, skilled nursing facility (SNF), and inpatient rehabilitation; (2) the rate of discharge to each location per 100,000 insured members in our cohort; (3) the total amount spent per month in each post-acute care location; and (4) the percentage of spending in each post-acute care location out of the total spending across the 3 post-acute care settings.
RESULTS
The percentage of patients discharged from the hospital to home or to inpatient rehabilitation did not meaningfully change during the pandemic whereas the percentage discharged to SNF declined from 19% of discharges in 2019 to 14% by October 2020. Total monthly spending declined in each of the 3 post-acute care locations, with the largest relative decline in SNFs of 55%, from an average of $42 million per month in 2019 to $19 million in October 2020. Declines in total monthly spending were smaller in home health (a 41% decline) and inpatient rehabilitation (a 32% decline). As a percentage of all post-acute care spending, spending on SNFs declined from 39% to 31%, whereas the percentage of post-acute care spending on home health and inpatient rehabilitation both increased.
CONCLUSIONS AND IMPLICATIONS
Changes in posthospital discharge location of care represent a significant shift in post-acute care utilization, which persisted 9 months into the pandemic. These shifts could have profound implications on the future of post-acute care.
Topics: Aftercare; COVID-19; Humans; Medicare; Pandemics; Patient Discharge; Retrospective Studies; SARS-CoV-2; Skilled Nursing Facilities; Subacute Care; United States
PubMed: 34555340
DOI: 10.1016/j.jamda.2021.09.001 -
Maturitas Apr 2016Methods of identifying malnutrition in the rehabilitation setting require further examination so that patient outcomes may be improved. The purpose of this narrative... (Review)
Review
Methods of identifying malnutrition in the rehabilitation setting require further examination so that patient outcomes may be improved. The purpose of this narrative review was to: (1) examine the defining characteristics of malnutrition, starvation, sarcopenia and cachexia; (2) review the validity of nutrition screening tools and nutrition assessment tools in the rehabilitation setting; and (3) determine the prevalence of malnutrition in the rehabilitation setting by geographical region and method of diagnosis. A narrative review was conducted drawing upon international literature. Starvation represents one form of malnutrition. Inadequate energy and protein intake are the critical factor in the aetiology of malnutrition, which is distinct from sarcopenia and cachexia. Eight nutrition screening tools and two nutrition assessment tools have been evaluated for criterion validity in the rehabilitation setting, and consideration must be given to the resources of the facility and the patient group in order to select the appropriate tool. The prevalence of malnutrition in the rehabilitation setting ranges from 14-65% worldwide with the highest prevalence reported in rural, European and Australian settings. Malnutrition is highly prevalent in the rehabilitation setting, and consideration must be given to the patient group when determining the most appropriate method of identification so that resources may be used efficaciously and the chance of misdiagnosis minimised.
Topics: Australia; Cachexia; Europe; Humans; Nutrition Assessment; Nutritional Status; Prevalence; Protein-Energy Malnutrition; Rehabilitation; Rural Population; Sarcopenia; Starvation
PubMed: 26921933
DOI: 10.1016/j.maturitas.2016.01.014 -
Journal of Applied Gerontology : the... Oct 2022Accidental falls are preventable adverse events for older post-acute care (PAC) patients. Yet, due to the functional and medical care needs of this population, there is... (Review)
Review
Accidental falls are preventable adverse events for older post-acute care (PAC) patients. Yet, due to the functional and medical care needs of this population, there is little guidance to inform multidisciplinary prevention efforts. This scoping review aims to characterize the evidence for multifactorial PAC fall prevention interventions. Of the 33 included studies, common PAC intervention domains included implementing facility-based strategies (e.g., staff education), evaluating patient-specific fall risk factors (e.g., function), and developing an individualized risk profile and treatment plan that targets the patient's constellation of fall risk factors. However, there was variability across studies in how and to what extent the domains were addressed. While further research is warranted, health system efforts to prevent accidental falls in PAC should consider a patient-centered multifactorial approach that fosters a culture of safety, addresses individuals' fall risk, and champions a multidisciplinary team.
Topics: Accidental Falls; Aged; Humans; Risk Factors; Subacute Care
PubMed: 35618304
DOI: 10.1177/07334648221104375 -
Journal of the American Medical... Oct 2020Examine whether the introduction of the Hospital Readmissions Reduction Program (HRRP) is associated with changes in post-acute care (PAC) use and 30-day readmission.
OBJECTIVES
Examine whether the introduction of the Hospital Readmissions Reduction Program (HRRP) is associated with changes in post-acute care (PAC) use and 30-day readmission.
DESIGN
A retrospective cohort study examined data prepassage, preimplementation, and postimplementation of the HRRP.
SETTING AND PARTICIPANTS
In total, 7,851,430 Medicare beneficiaries discharged from 5116 acute hospitals to PAC settings including inpatient rehabilitation, skilled nursing, home health, or a long-term care hospital during 2007‒2015. We examined HRRP-targeted conditions (acute myocardial infarction, heart failure, and pneumonia) and nontargeted conditions (ischemic stroke, total hip arthroplasty/total knee arthroplasty, and hip/femur fractures).
MEASURES
The hospital-level of quarterly PAC use and the association with 30-day risk-standardized readmission rates. Outcomes were calculated for HRRP-targeted and nontargeted conditions/diagnoses across 3 phases of HRRP implementation.
RESULTS
An increase in quarterly PAC use was significantly (P < .001) associated with a decrease in 30-day risk-standardized readmission rates for acute myocardial infarction, heart failure, and hip/femur fracture. In contrast, an increase in quarterly PAC use was significantly associated with an increase in readmission rate for total hip arthroplasty/total knee arthroplasty (P < 001). PAC quarterly use and readmission rates varied significantly during implementation periods for HRRP- targeted and nontargeted conditions.
CONCLUSIONS AND IMPLICATIONS
The impact on readmission after PAC for selected impairment groups may be mediated by the type of PAC services received and whether the diagnoses is included in the HRRP. Additional research is necessary to determine if a reduction in readmission is associated with inclusion in the HRRP or is a side effect related to diagnostic group and/or type of PAC services received.
Topics: Aged; Hospitals; Humans; Medicare; Patient Readmission; Retrospective Studies; Subacute Care; United States
PubMed: 32660855
DOI: 10.1016/j.jamda.2020.05.018 -
BMJ Open Aug 2022Major organ complications have been reported in patients hospitalised for COVID-19; most studies lacked controls.
BACKGROUND
Major organ complications have been reported in patients hospitalised for COVID-19; most studies lacked controls.
OBJECTIVE
Examine major organ damage postdischarge among adults hospitalised for COVID-19 versus non-COVID-19 controls.
DATA SOURCES
MEDLINE, Embase and Cochrane Library from 1 January 2020 to 19 May 2021.
STUDY ELIGIBILITY CRITERIA
English language studies of adults discharged from hospital for COVID-19; reporting major organ damage. Single review of abstracts; independent dual review of full text.
STUDY APPRAISAL AND SYNTHESIS METHODS
Study quality was assessed using the Joanna Briggs Institute Appraisal Checklist for Cohort Studies. Outcome data were not pooled due to heterogeneity in populations, study designs and outcome assessment methods; findings are narratively synthesised.
RESULTS
Of 124 studies in a full evidence report, 9 included non-COVID controls and are described here. Four of the nine (three USA, one UK) used large administrative databases. Four of the remaining five studies enrolled <600 COVID-19 patients. Mean or median age ranged from 49 to 70 years with 46%-94% male and 48%-78% White race; 10%-40% had been in intensive care units. Follow-up ranged from 4 weeks to 22 weeks postdischarge. Four used hospitalised controls, three non-hospitalised controls and two were unclear. Studies used various definitions of, and methods to assess, major organ damage outcomes. While the magnitude of effect differed across studies, incident cardiac, pulmonary, liver, acute and chronic kidney, stroke, diabetes, and coagulation disorders were consistently greater in adults hospitalised for COVID-19 compared with non-COVID-19 controls.
LIMITATIONS
Applicability to subgroups (age, gender, COVID-19 severity, treatment, vaccination status) and non-hospitalised patients is unknown.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
Postacute COVID-19 major organ damage is common and likely higher than controls. However, there is substantial uncertainty. More consistent reporting of clinical outcomes and pre-COVID health status along with careful selection of control groups are needed to address evidence gaps.
PROSPERO REGISTRATION NUMBER
CRD42020204788.
Topics: Adult; Aftercare; Aged; COVID-19; Female; Humans; Intensive Care Units; Male; Middle Aged; Patient Discharge; Subacute Care
PubMed: 36002211
DOI: 10.1136/bmjopen-2022-061245 -
Journal of the American Medical... Jan 2024To evaluate the evolution and challenges of China's post-acute care (PAC) system over the past 20 years and suggest actionable policy recommendations for its improvement. (Review)
Review
OBJECTIVES
To evaluate the evolution and challenges of China's post-acute care (PAC) system over the past 20 years and suggest actionable policy recommendations for its improvement.
DESIGN
A retrospective review of policies and initiatives aimed at PAC system development, analyzed alongside unsolved challenges in light of global PAC practices, informed by literature reviews and collaborative discussion.
SETTING AND PARTICIPANTS
PAC in China involves diverse settings such as general hospitals, inpatient rehabilitation centers, skilled nursing facilities, community health centers, and homes. The patients are mainly those discharged from acute hospitals with functional impairment and in need of continuous care.
METHOD
An extensive search of government policy documents, statistical sources, peer-reviewed studies, and the gray literature. The research team conducted literature reviews and discussions regularly to shape the findings.
RESULTS
China has strengthened its PAC system through improved rehabilitation and nursing infrastructure, establishment of tiered rehabilitation networks, and adoption of innovative payment methods. However, challenges persist, including a lack of clinical consensus, resource constraints in PAC facilities and among professionals, the need for integrated care coordination, and the unification of PAC assessment tools and payment mechanisms.
CONCLUSIONS AND IMPLICATIONS
Although China has made substantial progress in its PAC system over 2 decades, continued efforts are needed to address its lingering challenges. Elevating awareness of PAC's significance and instituting policy adjustments targeting these challenges are essential for the system's optimization.
Topics: Humans; Subacute Care; Rehabilitation Centers; Retrospective Studies; Patient Discharge; China
PubMed: 37935380
DOI: 10.1016/j.jamda.2023.09.034 -
American Journal of Physical Medicine &... Sep 2020This analysis extrapolates information from previous studies and experiences to bring physical medicine and rehabilitation perspective and intervention to the... (Review)
Review
This analysis extrapolates information from previous studies and experiences to bring physical medicine and rehabilitation perspective and intervention to the multidisciplinary treatment of COVID-19. The purpose of pulmonary rehabilitation in COVID-19 patients is to improve symptoms of dyspnea, relieve anxiety, reduce complications, minimize disability, preserve function, and improve quality of life. Pulmonary rehabilitation during the acute management of COVID-19 should be considered when possible and safe and may include nutrition, airway, posture, clearance technique, oxygen supplementation, breathing exercises, stretching, manual therapy, and physical activity. Given the possibility of long-term disability, outpatient posthospitalization pulmonary rehabilitation may be considered in all patients hospitalized with COVID-19.
Topics: Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Pandemics; Physical and Rehabilitation Medicine; Pneumonia, Viral; Respiratory Therapy; SARS-CoV-2; Subacute Care
PubMed: 32541352
DOI: 10.1097/PHM.0000000000001505 -
Establishing a hospital based fracture liaison service to prevent secondary insufficiency fractures.International Journal of Surgery... Jun 2018In the aging population worldwide, osteoporosis is a relatively common condition and a major cause of long-term morbidity. Initial fragility fractures can lead to... (Review)
Review
In the aging population worldwide, osteoporosis is a relatively common condition and a major cause of long-term morbidity. Initial fragility fractures can lead to subsequent fractures. After a vertebral fracture, the risk of any another fracture increases 200% and that of a subsequent hip fracture increases 300%. For starting a hospital based Fracture Liaison Service (FLS) program, the nucleus is based on a physician champion, a FLS coordinator, and a nurse manager. A Fracture Liaison Service (FLS) is a multidisciplinary system approach to reducing subsequent fracture risk in patients with a recent fragility fracture due to compromised bone health by identifying them at or close to the time when they are treated at the hospital for fracture and providing them with easy access to osteoporosis care. It has been shown that when compared to other models such as referral letters to primary care physicians or endocrinologists, the FLS model results in a higher rate of diagnosis and treatment with less attrition in the posffracture phase. Insufficiency fracture care requires more than surgery to stabilize a fractured bone. The FLS program provides an opportunity to treat osteoporosis from a public health perspective rather than leaving this to the whims of individual physicians. This is achieved by providing a seamless integration of care by health care providers, nursing staff and administration. The FLS can be adapted to any model of care including academic health systems. FLS provides a holistic approach to identify patients as well as to provide evidence-based interventions to prevent subsequent fractures. The long term goal is that internationally FLS will result in in decreased fracture-related morbidity, mortality and overall health care expenditure.
Topics: Aged; Aged, 80 and over; Female; Fractures, Stress; Hip Fractures; Humans; Male; Osteoporotic Fractures; Patient Care Team; Referral and Consultation; Secondary Prevention; Spinal Fractures; Subacute Care
PubMed: 28919380
DOI: 10.1016/j.ijsu.2017.09.010 -
Health Services Research Dec 2021The objectives of this study are to compare the relative use of different postacute care settings in different countries and to compare three important outcomes as... (Comparative Study)
Comparative Study
OBJECTIVE
The objectives of this study are to compare the relative use of different postacute care settings in different countries and to compare three important outcomes as follows: total expenditure, total days of care in different care settings, and overall longevity over a 1-year period following a hip fracture.
DATA SOURCES
We used administrative data from hospitals, institutional and home-based long-term care (LTC), physician visits, and medications compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) from five countries as follows: Canada, France, Germany, the Netherlands, and Sweden.
DATA EXTRACTION METHODS
Data were extracted from existing administrative data systems in each participating country.
STUDY DESIGN
This is a retrospective cohort study of all individuals admitted to acute care for hip fracture. Descriptive comparisons were used to examine aggregate institutional and home-based postacute care. Care trajectories were created to track sequential care settings after acute-care discharge through institutional and community-based care in three countries where detailed information allowed. Comparisons in patient characteristics, utilization, and costs were made across these trajectories and countries.
PRINCIPAL FINDINGS
Across five countries with complete LTC data, we found notable variations with Germany having the highest days of home-based services with relatively low costs, while Sweden incurred the highest overall expenditures. Comparisons of trajectories found that France had the highest use of inpatient rehabilitation. Germany was most likely to discharge hip fracture patients to home. Over 365 days, France averaged the highest number of days in institution with 104, Canada followed at 94, and Germany had just 87 days of institutional care on average.
CONCLUSION
In this comparison of LTC services following a hip fracture, we found international differences in total use of institutional and noninstitutional care, longevity, and total expenditures. There exist opportunities to organize postacute care differently to maximize independence and mitigate costs.
Topics: Aged; Aged, 80 and over; Canada; Europe; Female; Hip Fractures; Home Care Services; Hospitalization; Humans; Long-Term Care; Male; Patient Discharge; Retrospective Studies; Subacute Care
PubMed: 34378190
DOI: 10.1111/1475-6773.13864