Articles: hospitals.
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Anesthesia and analgesia · Dec 2024
Association of General Anesthesia for Cesarean Delivery with Postpartum Depression and Suicidality.
Compared to neuraxial anesthesia, general anesthesia (GA) for cesarean delivery is associated with an increased risk of postpartum depression (PPD) requiring hospitalization. However, obstetric complications occurring during childbirth (eg, stillbirth) are associated with both increased use of GA and increased risk of PPD, and may account for the reported association between GA and PPD. This study assessed the association of GA for cesarean delivery with PPD requiring hospitalization, outpatient visit, or emergency department (ED) visit, accounting for obstetric complications. ⋯ Use of GA for cesarean delivery is independently associated with a significantly increased risk of PPD requiring hospitalization and suicidality. It underscores the need to avoid using GA whenever appropriate and to address the potential mental health issues of patients after GA use, specifically by screening for PPD and providing referrals to accessible mental health providers as needed.
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A growing number of aging adults are living with multiple chronic conditions (MCC). Older adults living with MCC are predisposed to developing frailty, a state of decreased physiologic reserve that increases risk for geriatric syndromes and associated morbidity and mortality. ⋯ Here, we discuss current gaps for using eFI to identify frail older adults living with MCC, and artificial intelligence (AI) approaches to enhance eFI accuracy. Accurate and routine frailty assessment can aid the generalist providing care to older adults living with MCC across multiple care settings to optimize physiologic reserve for these vulnerable patients.
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Hospitalized patients often experience disrupted sleep due to nighttime patient-staff interactions (PSIs). This study evaluates how PSIs impact sleep opportunities in neurology inpatients using electronic health record (EHR) data and introduces surrogate measures of sleep such as longest uninterrupted sleep opportunity (LUSO) and interruptive episodes. ⋯ This study demonstrates the utility of LUSO and interruptive episodes as EHR-based measures to link PSIs to sleep opportunities. While vital signs and medications were the most frequent PSIs, neurological checks and off-unit testing were associated with the largest impact on reducing LUSO. The predominance of single-PSI interruptive episodes underscores that the bundling of PSIs is not occurring. These findings highlight that PSIs impact sleep opportunities in distinct ways, supporting the use of this methodology to evaluate and address EHR-linked disruptions to patient sleep.