Search Results (714)

Background: Skin and soft tissue infections (SSTIs) are a major cause of emergency room (ER) visits and hospitalizations. Long-acting lipoglycopeptides (LALs), such as dalbavancin and oritavancin, offer potential for early discharge and outpatient management, especially in patients at risk for methicillin-resistant Staphylococcus aureus (MRSA) or with comorbidities. Methods: We conducted a retrospective observational cohort study from March to December 2024 in an Italian tertiary-care hospital. Adult patients treated in the ER with a single dose of dalbavancin (1500 mg) or oritavancin (1200 mg) for SSTIs were included. Demographic, clinical, and laboratory data were collected. Follow-up evaluations were performed at 14 and 30 days post-treatment to assess outcomes. Results: Nineteen patients were enrolled (median age 59 years; 53% female). Most had lower limb involvement and elevated inflammatory markers. Three patients (16%) were septic. Fourteen patients (74%) were discharged without hospital admission; hospitalization in the remaining cases was due to comorbidities rather than SSTI severity. No adverse drug reactions were observed. At 14 days, 84% of patients had clinical resolution; only 10% had recurrence by day 30, with no mortality nor readmission reported. Conclusions: LALs appear effective and well-tolerated in the ER setting, supporting early discharge and reducing healthcare burden. Broader use may require structured care pathways and multidisciplinary coordination. Full article

Background: Schizophrenia affects patients’ organizational thinking, as well as their ability to identify problems. The main objective of this study was to explore healthcare consultants’ application of AI mind maps to educate patients with schizophrenia regarding their perceptions of family function, social support, quality of life, and loneliness, and to help these patients think more organizationally and understand problems more effectively. Methods: The study used a survey research design and purposive sampling method to recruit 66 participants with schizophrenia who attended the psychiatric outpatient clinic of a hospital in central Taiwan. They needed to be literate, able to respond to the topic, and over 18 years old (inclusive), and they attended individual and group health education using AI mind maps over a 3-month period during regular outpatient clinic visits. Results: The study results show that patients’ family function directly affects their quality of life (p < 0.05) and loneliness (p < 0.05), satisfaction with social support affects quality of life and loneliness directly (p < 0.05), and satisfaction with social support is a mediating factor between family function and quality of life (p < 0.05), as well as a mediating factor between family function and loneliness (p < 0.05). Conclusions: Therefore, this study confirms the need to provide holistic, integrated mental health social care support for patients with schizophrenia, showing that healthcare consultants can apply AI mind maps to empower patients with schizophrenia to think more effectively about how to mobilize their social supports. Full article

Background: Lung cancer remains one of the leading causes of cancer-related mortality worldwide. While most diagnoses occur in outpatient settings, a subset of cases are incidentally identified during emergency department (ED) visits. The clinical characteristics and treatment decisions of these patients, particularly in relation to social background factors such as living situation and access to primary care, remain poorly understood. Methods: We conducted a retrospective study of patients diagnosed with malignancies in the ED of a single institution between April 2018 and December 2021. Patients diagnosed with lung cancer within 60 days of an ED visit were included. Data on demographics, disease status, treatment decisions, and background factors—including whether patients lived alone or had a primary care physician (PCP)—were extracted and analyzed. Results: Among 32,108 patients who visited the ED, 148 were diagnosed with malignancy within 60 days; 23 had lung cancer. Of these, 69.6% had metastatic disease at diagnosis, and 60.9% received active treatment (surgery or chemotherapy). No significant associations were observed between the extent of disease and either living arrangement or PCP status. However, the presence of a PCP was significantly associated with the selection of best supportive care (p = 0.023). No significant difference in treatment decisions was observed based on age (cutoff: 75 years). Conclusions: Although social background factors such as living alone were not significantly associated with cancer stage or treatment choice, the presence of a primary care physician was associated with a higher likelihood of best supportive care being selected. This may indicate that patients with an established PCP have more clearly defined care goals at the end of life. These findings suggest that primary care access may play a role in shaping end-of-life care preferences, highlighting the importance of personalized approaches in acute oncology care. Full article

Background: Diabetes mellitus is a chronic metabolic disorder that increases mortality and morbidity rates. Infections of the hand can easily cause long-term morbidity and dysfunction, but despite their associated high morbidity, diabetic hand infections are more neglected than diabetic foot infections. Objectives: This study was conducted over a one-year follow-up period, considering the total costs of treatment over one year post discharge for patients with diabetic hand infections that required surgery. A Monte Carlo Simulation was used in this study as a sensitivity analysis of all the cost calculations. Materials and Methods: A total of 62 out of 75 patients were diagnosed with Type 2 diabetes; 11 were female, and 64 were male. Out of all the patients, 15 visited outpatient clinics 30 times or more, and due to their recurrent visits, the outpatient treatment costs reached USD 5162.41 ± 3838.55. The total cost incurred over the period from the patients’ first hospitalization to the completion of all treatments and the end of the one-year follow-up was USD 24,602.22 ± 5257.15. Conclusions: The cost of hospitalization was the most important factor affecting the total expenses. Therefore, taking precautions before a diabetic hand infection occurs, or when one does occur, performing treatment without delay is expected to reduce the economic burden. Full article

Pharmacist-led transitions of care (TOC) services decrease preventable hospital readmission. TOC service implementation assessment can inform translation to real-world settings. The purpose of this study was to evaluate the implementation of a TOC service for patients with multiple admissions at a regional hospital using the RE-AIM framework. In this quasi-experimental, non-randomized study, individuals with ≥2 recent hospitalizations received pharmacist-led discharge medication reconciliation and counseling, management of drug-related problems, post-discharge telephonic visits, and social support. The reach, effectiveness, implementation, and maintenance RE-AIM dimensions were assessed using patient and service records. Outcomes included 30-day readmission rates for individuals completing ≥1 outpatient pharmacist visit (intervention) versus those unreachable in the outpatient setting (comparison), completed interventions, implementation features, and service adaptations. Chi-square and Fisher’s exact tests were used for comparison of categorical variables and the t-test was used for continuous variables. From February 2022 to August 2023, 72.7% of the 66 service participants participated in the intervention (reach). Additionally, 30-day readmission was 22.9% (intervention) versus 55.6% (comparison; p = 0.01). In total, 2279 interventions were documented (effectiveness). The service was adapted (implementation) and expanded to include additional populations (maintenance) to enhance sustainability. Based on RE-AIM evaluation, the pharmacist-led TOC intervention appears to be a sustainable solution for addressing readmission in multivisit patients. Full article

Background: In advanced heart failure patients implanted with a fully magnetically levitated HeartMate 3 (HM3) Abbott left ventricular assist device (LVAD), it is unknown how the role of the LVAD outpatient clinic may affect the long-term survival after hospital discharge. Our objective is to share our standardized protocol for outpatient care, to describe the role of the LVAD outpatient clinic in postoperative long-term care after LVAD implantation, and to report survival. Methods: We retrospectively reviewed all patients implanted with HM3 LVAD in our institute between September 2015 and January 2025. Patients who received HeartWare Ventricular Assist Device (HVAD) and HeartMate 2 LVAD devices were excluded from our study, to ensure a homogenous cohort focusing on the latest and the only currently used LVAD device generation. We included a total of 48 patients. After LVAD patients are discharged from our center, they are followed in our outpatient clinic in 3-month intervals. During visits, bloodwork, EKG, wound inspection, and echocardiography are performed in addition to LVAD analysis. The role of the outpatient clinic is to detect early signs of deterioration or problems and act accordingly to prevent serious complications. Results: Thirty-three patients (68.7%) are still alive in 2025; two patients (4.2%) had a successful heart transplantation; and thirty-one patients (64.5%) are still on LVAD support. There were 210 total patient years of support. The mean time on device is 4.4 years. During the follow-up period we noticed 15 deaths (31.3%). Notably, there was no technical device-related death. Kaplan–Meier analysis estimated an overall survival rate of 97.9%, 92.8%, 83.7%, and 51.1% at 1, 2, 4, and 8 years, respectively. Conclusion: Strict control of patients after discharge in an outpatient clinic is essential for the long-term survival of these patients. A well-structured outpatient program is of utter importance to avoid LVAD-related complications and should be a cornerstone for the treatment, especially in non-transplant centers. Full article

Background: Pain is a common, often debilitating ailment that may necessitate considerable health service utilization. However, there is a need to assess the associations of pain intensity and other variables with health service utilization among United States adults who have pain. Methods: This cross-sectional database analysis made use of the Medical Expenditure Panel Survey full-year consolidated data file and included United States adults (≥18 years) who have pain. The dependent variables consisted of four health service utilization variables, which included the number of emergency room visits, inpatient discharges, office visits, and outpatient visits in 2021. The number of visits or discharges were categorized as either ≥1 or 0. The independent variable was pain intensity (extreme, quite a bit, moderate, or little pain). Other variables analyzed included age, race, ethnicity, sex, marriage, education, employment, income, insurance, chronic conditions, limitations, exercise, smoking, physical health, and mental health. Chi-squared tests compared differences between pain intensity groups, and multivariable logistic regression models assessed the associations of pain intensity and other variables with each of the four health service utilization variables. The analysis was weighted for national estimates. The significance (alpha) level was 0.05. Results: This analysis included 6280 adults, representing 89,314,769 United States adults with pain. In the multivariable analyses, there were statistically significant associations for extreme pain (odds ratio = 1.72, 95% confidence interval = 1.27–2.33), quite a bit of pain (odds ratio = 1.75, 95% confidence interval=1.37–2.24), and moderate pain (odds ratio = 1.28, 95% confidence interval = 1.02–1.60) versus little pain with emergency room visits, extreme pain (odds ratio = 2.10, 95% confidence interval = 1.44–3.08) and quite a bit of pain (odds ratio = 1.66, 95% confidence interval = 1.21–2.28) versus little pain with inpatient discharges, and quite a bit of pain (odds ratio = 1.47, 95% confidence interval = 1.03–2.11) versus little pain with office visits. There was no correlation between pain intensity levels and outpatient visits. In addition, several other variables were associated with various health service utilization variables. Conclusions: This database analysis discovered greater pain intensity levels were often correlated with increased health service utilization, including more emergency room, inpatient, and office visits. These findings may inform the development of targeted interventions for people with specific characteristics. Further work is needed to implement initiatives that optimize health service utilization and ultimately improve health outcomes for United States adults who have pain. Full article

Background: Since the pathophysiology of long COVID is not yet fully understood, there are no specific methods for its treatment; however, its individual symptoms can currently be treated. Long COVID is characterized by symptoms that persist at least 2 to 3 months after contracting COVID-19, although it is difficult to predict how long such symptoms may persist. Methods: In the present study, 774 patients who first visited our outpatient clinic during the Omicron period from February 2022 to October 2024 were divided into two groups: the early recovery (ER) group (370 cases; 47.8%), who recovered in less than 180 days (median 33 days), and the persistent-symptom (PS) group (404 cases; 52.2%), who had symptoms that persisted for more than 180 days (median 437 days). The differences in clinical characteristics between these two groups were evaluated. Results: Although the median age of the two groups did not significantly differ (40 and 42 in ER and PS groups, respectively), the ratio of female patients was significantly higher in the PS group than the ER group (59.4% vs. 47.3%). There were no significant differences between the two groups in terms of the period after infection, habits, BMI, severity of COVID-19, and vaccination history. Notably, at the first visit, female patients in the PS group had a significantly higher rate of complaints of fatigue, insomnia, memory disturbance, and paresthesia, while male patients in the PS group showed significantly higher rates of fatigue and headache complaints. Patients with more than three symptoms at the first visit were predominant in the PS groups in both genders. Notably, one to two symptoms were predominant in the male ER group, while two to three symptoms were mostly reported in the female PS group. Moreover, the patients in the PS group had significantly higher scores for physical and mental fatigue and for depressive symptoms. Conclusions: Collectively, these results suggest that long-lasting long COVID is related to the number of symptoms and presents gender-dependent differences. Full article

Cone-beam computed tomography (CBCT) offers low radiation, cross-sectional imaging that is a suitable alternative to conventional fan-beam computed tomography (FBCT). The initial experience using in-clinic CBCT in the Rhinology outpatient clinic at Waikato Hospital, New Zealand, is described. The first 5 months of CBCT use for Rhinologic imaging was compared to FBCT use in the equivalent 5-month period one year prior. Data relating to 61 CBCTs and 115 FBCTs was analysed. We compared the time and number of hospital visits required for a confirmed treatment decision (CTD) to be made and the duration of the clinic appointment at which the scan was requested between the two groups. The CBCT group required significantly less time (171 vs. 316 days, p < 0.001) and fewer hospital visits (1.5 vs. 3.2 visits, p < 0.001) before a CTD was made, but a longer appointment duration (86 vs. 53 min, p < 0.001). The use of in-clinic CBCT in Rhinology was therefore associated with reduced time and fewer hospital visits before definitive management was decided, but longer clinic appointments were observed. Increased access to CT imaging may result in increased demand. Expertise is required to optimise the quality of imaging, and we recommend that a dedicated Radiographer be allocated. Full article

Background and Objectives: Physical activity represents a cornerstone in the management of diabetes mellitus; however, the majority of persons with diabetes remain insufficiently active. Current guidelines emphasise the need to educate individuals with diabetes on physical activity at each clinical visit. The aim of the study was to develop an adequate instrument and test diabetologists’ knowledge on physical activity and related guidelines in diabetes, as well as investigate their prescribing habits. Materials and Methods: The instrument was developed with four diabetologists using Delphi and RAND appropriateness methods, then distributed to diabetologist societies in 12 Southeast European countries for anonymous completion by their members. Data were analysed using Mann–Whitney U test and Pearson ${ x}^2$ test. Results: Out of 302 analysed respondents, 123 (41%) worked at university hospitals, at average four days a week in outpatient departments, mean number of patients was 16 a day; 95 (32%) had a PhD, and 105 (35%) university teaching positions. Median overall knowledge was 15 (Q1–Q3, 13–17) out of 22 maximum points. 26% diabetologists knew recommended level of physical activity for people with diabetes. Physical activity goals were discussed during check-ups in 53.0% of cases; re-education and goal adjustments were provided in 33.4% when health status changed; and clear instructions were documented in 25.5% of medical records. Conclusions: Diabetologists’ overall knowledge of physical activity was found to be at least satisfactory in 90% of participants. Knowledge of the guidelines is insufficient in 75% of participants. The prescribing habits are inadequate in half of the participants. Full article

Background: Advanced home care is becoming increasingly common for cancer patients and serves as a viable alternative to inpatient hospital care. The transition to home care is driven by both the rising costs of healthcare and evidence indicating better quality of care. This study aims to compare the costs of hospital-at-home treatment and in-hospital care for patients undergoing allo-HSCT. Methods: The cost analysis was conducted as a case–control study comparing the costs of allo-HSCT at home (HaH) to the costs of allo-HSCT for patients receiving in-hospital care (INH). The cost evaluation was conducted from the hospital’s perspective, which means that costs incurred outside the hospital setting were not included. Post-procedural costs for the first year after allo-HSCT included all readmissions and outpatient visits at Oslo University Hospital. Results: The cost for the peritransplant period could be reduced by up to 33% by treating allo-HSCT recipients at home instead of in the hospital. During the study period, 24% of the allo-HSCT recipients were treated at home, but our data from 2021 and 2022 indicate that at least a third of the patients scheduled for allo-HSCT are candidates for HaH. Conclusions: The findings demonstrate that patients in advanced home care experience significantly lower total costs compared to those receiving in-hospital treatment. Full article

Background: The COVID-19 pandemic has had a profound impact on pediatric mental health, contributing to a global surge in psychiatric emergencies among children and adolescents. This study aimed to evaluate trends in pediatric emergency department (PED) visits for three key psychiatric conditions—anxiety disorders (ADs), self-injury behaviors (SIBs), and psychomotor agitation (PMA)—before and after the onset of the COVID-19 pandemic. Methods: We conducted a retrospective observational study at a tertiary pediatric hospital in Italy, analyzing all psychiatric presentations to the PED from 1 January 2018 to 31 December 2024. The data were divided into pre-COVID and post-COVID periods and included patient demographics, recurrence of visits, clinical features, hospital admissions, and pharmacological management. Diagnoses were confirmed by chart review. Results: Of 233,867 total PED visits, 1082 were due to primary psychiatric concerns. A marked increase in visits was observed postCOVID: SIB incidence rose from 3.6 to 15.1 per 10,000 visits (p < 0.0001), PMA from 9.4 to 17.8 (p < 0.0001), and AD from 17.7 to 21.6 (p = 0.018). SIB cases showed increased recurrence (from 3.4% to 27.4%, p = 0.004) and greater pharmacological intervention, whereas PMA was associated with a rise in heteroaggression (from 14.3% to 39.8%, p < 0.0001). Pharmacological treatment remained largely consistent, with benzodiazepines and neuroleptics most frequently used. The emerging use of intranasal ketamine was noted in select cases. Conclusions: This study highlights the increasing burden of pediatric psychiatric emergencies in the wake of the COVID-19 pandemic. The findings underscore the urgent need to implement standardized emergency care protocols, strengthen outpatient mental health services, and develop pediatric-specific pharmacological guidelines to improve outcomes in this vulnerable population. Full article

This retrospective cohort study evaluated characteristics, treatment patterns, and clinical outcomes in adults with locally advanced/metastatic urothelial carcinoma (la/mUC) receiving first-line (1L) systemic treatment with or without avelumab 1L maintenance (1LM) between January 2020 and July 2023. The index date was the first date with a claim for 1L systemic therapy after a la/mUC diagnosis. Patients with continuous health plan enrollment for ≥6 months before and ≥1 month after the index date were identified from Carelon Research’s Healthcare Integrated Research Database. Of 2820 patients receiving 1L treatment, 37.0% received platinum-based chemotherapy (PBC); 39.0%, immuno-oncology (IO) monotherapy; and 24.0%, other therapies. Renal disease and other comorbidities influenced 1L regimen choice. Healthcare resource utilization (HCRU) and costs were reported for patients receiving second-line (2L) treatment. HCRU was high in 32.8% of patients (926 of 2820) who received 2L treatment. Median all-cause direct medical costs per patient per month were USD 15,859, USD 19,781, USD 11,346, and USD 9516 for 1L PBC, 1L PBC + avelumab 1LM, 1L IO monotherapy, and 1L other therapies, respectively. Most direct healthcare costs were attributed to all-cause outpatient visits. Full article

Background and Objectives: In Germany, access to medical care is often hindered by long wait times for specialist appointments and emergency department care. Inappropriate utilization of emergency services further exacerbates delays for truly urgent cases. To evaluate the utilization of the statutory ophthalmic emergency service in Freiburg and identify patient- and system-level factors contributing to inappropriate use. Materials and Methods: A paper-based, anonymous questionnaire was distributed to patients attending the ophthalmologic emergency practice (Notfallpraxis) of the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung), which is located within the premises of the Eye Center of the University Hospital Freiburg, Germany, at selected periods between July and September 2020, alongside a short physician assessment. Standardized instruments were used to assess symptom severity, urgency perception, and healthcare-seeking behavior. Statistical analyses were performed using R and Excel. Results: A total of 157 questionnaires were included (response rate: 63%). Most visits occurred on weekends (47%) and before 10 p.m. (83%). While 68% of patients believed their symptoms required same-day treatment, physicians assessed only 30% of cases as clinically urgent. A total of 60% of patients did not attempt to contact an outpatient ophthalmologist beforehand, and only 38% reported having a regular ophthalmologist. Patients’ perceived urgency was significantly associated with symptom severity and older age, whereas physician-assessed urgency was strongly linked to symptom duration. Conclusions: A substantial proportion of ophthalmic emergency visits in Freiburg are for non-urgent conditions. These findings underscore the need for improved coordination with outpatient care providers, better patient education, and structural reforms to reduce inappropriate utilization and ensure timely access for truly urgent cases. Full article

Background/Objectives: Children with sickle cell disease (SCD) often experience limited access to care, contributing to poor health outcomes. Patient-level predictors and outcomes associated with telehealth use among Medicaid-enrolled children with SCD remain unknown. This study aims to (1) analyze telehealth trends before and during the pandemic (March 2020–March 2022), (2) identify patient-level predictors of telehealth use, (3) assess its association with care continuity and health outcomes, and (4) identify physician specialties involved in telehealth visits. Methods: Using Texas Medicaid claims (March 2017–March 2022), we conducted a retrospective analysis of children aged 1–18 with ≥3 SCD-related claims. Monthly trends in outpatient visits (in-person and telehealth) were visualized from March 2019 to March 2022. Multivariable regression models examined predictors of telehealth use and associations with ≥10 hydroxyurea fills, emergency department (ED) visits, and hospitalizations, adjusting for age, sex, regions with SCD clinics, and prior healthcare utilization. Results: Among 903 included patients (mean [SD] age = 10.4 [4.1], 52.6% male), 59.4% had ≥1 telehealth visits between March 2019 and March 2022. Telehealth use peaked between March 2020 and May 2020, then gradually declined. Children with ≥10 SCD-related outpatient visits 1 year before the lockdown (March 2019–February 2020) had 77.4% higher odds of using telehealth compared to those with 0–4 visits (OR = 1.774, 95% CI = 1.281–2.457, p = 0.0006), while controlling for sociodemographic characteristics. However, SCD-related telehealth use during the pandemic was not associated with either ≥10 hydroxyurea fills or reduced ED visits. Prior healthcare utilization remained a strong predictor of both outcomes. The majority of telehealth visits were conducted at multispecialty clinics (74%). Conclusions: Telehealth use surged early in the pandemic but later declined among Texas Medicaid-enrolled children with SCD. Children with high healthcare needs adopted telehealth, but this did not impact care continuity or extensive healthcare utilization. While maintaining telehealth access, other measures should be implemented to improve access and outcomes for this vulnerable population. Full article