Effectiveness of a transition plan at discharge of patients hospitalized with heart failure: a before-and-after study.

We evaluated the effectiveness of a multidisciplinary transition plan to reduce early readmission among heart failure patients. We conducted a before-and-after study in a tertiary internal medicine department, comparing 3 years of retrospective data (pre-intervention) and 13 months of prospective data (intervention period). Intervention was the introduction in 2013 of a transition plan performed by a multidisciplinary team. We included all consecutive patients hospitalized with symptomatic heart failure and discharged to home. The outcomes were the fraction of days spent in hospital because of readmission, based on the sum of all days spent in hospital, and the rate of readmission. The same measurements were used for those with potentially avoidable readmissions. Four hundred thirty-one patients were included and compared with 1441 patients in the pre-intervention period. Of the 431 patients, 138 received the transition plan while 293 were non-completers. Neither the fraction of days spent for readmissions nor the rate of readmission decreased during the intervention period. However, non-completers had a higher rate of the fraction of days spent for 30 day readmission (19.2% vs. 16.1%, P = 0.002) and for potentially avoidable readmission (9.8% vs. 13.2%, P = 0.001). The rate of potentially avoidable readmission decreased from 11.3% (before) to 9.9% (non-completers) and 8.7% (completers), reaching the adjusted expected range given by SQLape® (7.7-9.1%). A transition plan, requiring many resources, could decrease potentially avoidable readmission but shows no benefit on overall readmission. Future research should focus on potentially avoidable readmissions and other indicators such as patient satisfaction, adverse drug events, or adherence

Ready for Qualified Practice? A Comparative Study of Capability for Critical Reflection and Analysis of MA Social Work and MA Step Up to Social Work Students at the End of Second Placement

Social Work education is faced with substantial changes. New programmes like Step Up to Social Work have emerged and were evaluated in relation to intake, programme development and subjective student experiences. The lack of evidence on outcomes of such programmes was addressed in this study. In a comparative study of a MA in Social Work and a MA in Step Up to Social Work, the authors analysed students' capability to critically reflect on and analyse social work practice scenarios at the end of their final placement at one university. The PCF domain ‘Critical Reflection and Analysis’ was operationalised and the study design employed qualitative and quantitative data analysis. Demographic data, academic marks achieved during social work education and written reflections on case vignettes from the two programmes were analysed statistically. The findings suggest that, while there are some differences in outcomes between the programmes, they are not statistically significant. However, reflections on children and family vignettes were significantly better (U = 185, p=0.008). Thematic analysis revealed considerable variation in the levels of curiosity and critical thinking and that respondents who framed their answers with reference to policy guidance, theory and research often extended their critical thinking

Le bon moment pour un médicament: comment faire passer la pilule ? [The best time for a medication: how to sweeten the pill ?]

Is it worth improving the effectiveness of a treatment by modulating the prescription schedule? Data show that the preferred administration timing depends on biological rhythms. Taking this into consideration can improve efficiency or reduce side effects. Food also plays a role. However, for most medications, setting a schedule that is too strict in relation to meals may not be clinically relevant and can lead to « therapeutic weariness ». To ensure effectiveness, tolerance and economy of a treatment, it is more important to ask patients about their habits and to define with them the best schedule

The incidence of non-affective psychotic disorders in Chile between 2005 and 2018: results from a national register of over 30 000 cases

BACKGROUND: Evidence suggests the incidence of non-affective psychotic disorders (NAPDs) varies across persons and places, but data from the Global South is scarce. We aimed to estimate the treated incidence of NAPD in Chile, and variance by person, place and time. METHODS: We used national register data from Chile including all people, 10-65 years, with the first episode of NAPD (International Classification of Diseases, Tenth Revision: F20-F29) between 1 January 2005 and 29 August 2018. Denominators were estimated from Chilean National Census data. Our main outcome was treated incidence of NAPD and age group, sex, calendar year and regional-level population density, multidimensional poverty and latitude were exposures of interest. RESULTS: We identified 32 358 NAPD cases [12 136 (39.5%) women; median age-at-first-contact: 24 years (interquartile range 18-39 years)] during 171.1 million person-years [crude incidence: 18.9 per 100 000 person-years; 95% confidence interval (CI) 18.7-19.1]. Multilevel Poisson regression identified a strong age-sex interaction in incidence, with rates peaking in men (57.6 per 100 000 person-years; 95% CI 56.0-59.2) and women (29.5 per 100 000 person-years; 95% CI 28.4-30.7) between 15 and 19 years old. Rates also decreased (non-linearly) over time for women, but not men. We observed a non-linear association with multidimensional poverty and latitude, with the highest rates in the poorest regions and those immediately south of Santiago; no association with regional population density was observed. CONCLUSION: Our findings inform the aetiology of NAPDs, replicating typical associations with age, sex and multidimensional poverty in a Global South context. The absence of association with population density suggests this risk may be context-dependent