Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model: ACCESS, an open-labelled randomised clinical trial of effectiveness

Abstract Background Hospital at home (HaH) is an alternative to acute admission for elderly patients. It is unclear if should be cared for a primarily by a hospital intern specialist or by the patient’s own general practitioner (GP). The study assessed whether a GP based model was more effective than a hospital specialist based model at reducing number of hospital admissions without affecting the patient’s recovery or number of deaths. Methods Pragmatic, randomised, open-labelled multicentre parallel group trial with two arms in four municipalities, four emergency departments and 150 GPs in Southern Denmark, including + 65 years old patients with an acute medical condition that required acute hospital in-patient care. The patients were randomly assigned to hospital specialist based model or GP model of HaH care. Five physical and cognitive performance tests were performed at inclusion and after 7 days. Primary outcome was number of hospital admissions within 7 days. Secondary outcomes were number of admissions within 14, 21 and 30 days, deaths within 30 and 90 days and changes in performance tests. Results Sixty seven patients were enrolled in the GP model and 64 in the hospital specialist model. 45% in the hospital specialist arm versus 24% in the GP arm were admitted within 7 days (effect size 2.7, 95% CI 1.3–5.8; p = 0.01) and this remained significant within 30 days. No differences were found in death or changes in performance tests from day 0–7 days between the two groups. Conclusions The GP based HaH model was more effective than the hospital specialist model in avoiding hospital admissions within 7 days among elderly patients with an acute medical condition with no differences in mental or physical recovery rates or deaths between the two models. Registration No. NCT02422849 Registered 27 March 2015. Retrospectively registere

Safety Aspects of Postanesthesia Care Unit Discharge without Motor Function Assessment after Spinal Anesthesia:A Randomized, Multicenter, Semiblinded, Noninferiority, Controlled Trial

Abstract Background Postanesthesia care unit (PACU) discharge without observation of lower limb motor function after spinal anesthesia has been suggested to significantly reduce PACU stay and enhance resource optimization and early rehabilitation but without enough data to allow clinical recommendations. Methods A multicenter, semiblinded, noninferiority randomized controlled trial of discharge from the PACU with or without assessment of lower limb motor function after elective total hip or knee arthroplasty under spinal anesthesia was undertaken. The primary outcome was frequency of a successful fast-track course (length of stay 4 days or less and no 30-day readmission). Noninferiority would be declared if the odds ratio (OR) for a successful fast-track course was no worse for those patients receiving no motor function assessment versus those patients receiving motor function assessment by OR = 0.68. Results A total of 1,359 patients (98.8% follow-up) were available for analysis (93% American Society of Anesthesiologists class 1 to 2). The primary outcome occurred in 92.2% and 92.0%, corresponding to no motor function assessment being noninferior to motor function assessment with OR 0.97 (95% CI, 0.70 to 1.35). Adverse events in the ward during the first 24 h occurred in 5.8% versus 7.4% with or without motor function assessment, respectively (OR, 0.77; 95% CI, 0.5 to 1.19, P = 0.24). Conclusions PACU discharge without assessment of lower limb motor function after spinal anesthesia for total hip or knee arthroplasty was noninferior to motor function assessment in achieving length of stay 4 days or less or 30-day readmissions. Because a nonsignificant tendency toward increased adverse events during the first 24 h in the ward was discovered, further safety data are needed in patients without assessment of lower limb motor function before PACU discharge. </jats:sec

Greenland ice velocity maps from the PROMICE project

We present the Programme for Monitoring of the Greenland Ice Sheet (PROMICE) Ice Velocity product (https://doi.org/10.22008/promice/data/sentinel1icevelocity/greenlandicesheet, Solgaard and Kusk, 2021), which is a time series of Greenland Ice Sheet ice velocity mosaics spanning September 2016 through to the present. The product is based on Sentinel-1 synthetic aperture radar data and has a 500 m grid spacing. A new mosaic is available every 12 d and spans two consecutive Sentinel-1 cycles (24 d). The product is made available within ∼ 10 d of the last acquisition and includes all possible 6 and 12 d pairs within the two Sentinel-1A cycles. We describe our operational processing chain from data selection, mosaicking, and error estimation to final outlier removal. The product is validated against in situ GPS measurements. We find that the standard deviation of the difference between satellite- and GPS-derived velocities (and bias) is 20 m yr−1 (−3 m yr−1) and 27 m yr−1 (−2 m yr−1) for the components in an eastern and northern direction, respectively. Over stable ground the values are 8 m yr−1 (0.1 m yr−1) and 12 m yr−1 (−0.6 m yr−1) in an eastern and northern direction, respectively. This is within the expected values; however, we expect that the GPS measurements carry a considerable part of this uncertainty. We investigate variations in coverage from both a temporal and spatial perspective. The best spatial coverage is achieved in winter due to the comprehensive data coverage by Sentinel-1 and high coherence, while summer mosaics have the lowest coverage due to widespread melt. The southeast Greenland Ice Sheet margin, along with other areas of high accumulation and melt, often has gaps in the ice velocity mosaics. The spatial comprehensiveness and temporal consistency make the product ideal both for monitoring and for studying ice-sheet-wide and glacier-specific ice discharge and dynamics of glaciers on seasonal scales.</p