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sed over time in adults with SRDs. PS is significantly associated with expenditures after controlling for predisposing and enabling factors, but not significant after controlling for need factors. Need factors appear to explain the relationship between lower levels of PS and higher HCE in adults with SRDs.Level of Evidence 2.

Retrospective analysis of administrative billing data.

To evaluate the extent to which a metric of serious complications determined from administrative data can reliably profile hospital performance in spine fusion surgery.

While payers are increasingly focused on implementing pay-for-performance measures, quality metrics must reliably reflect true differences in performance among the hospitals profiled.

We used State Inpatient Databases from nine states to characterize serious complications after elective cervical and thoracolumbar fusion. Hierarchical logistic regression was used to risk-adjust differences in case mix, along with variability from low case volumes. The reliability of this risk-stratified complication rate (RSCR) was assessed as the variation between hospitals that was not due to chance alone, calculated separately by fusion type and year. Finally, we estimated the proportion of hospitals that had sufficient case volumes to obtain reliable (> 0.7) complication estimates.

From 201, such as public reporting or pay-for-performance.Level of Evidence 3.

A metric of serious complications was unreliable for benchmarking cervical fusion outcomes and only modestly reliable for thoracolumbar fusion. Sodium butyrate in vitro When assessed using administrative datasets, these measures appear inappropriate for high-stakes applications, such as public reporting or pay-for-performance.Level of Evidence 3.

To determine if a restrictive visitor policy inadvertently lengthened the decision-making process for dying inpatients without coronavirus disease 2019.

Regression discontinuity and time-to-event analysis.

Two large academic hospitals in a unified health system.

Adult decedents who received greater than or equal to 1 day of ICU care during their terminal admission over a 12-month period.

Implementation of a visit restriction policy.

We identified 940 adult decedents without coronavirus disease 2019 during the study period. For these patients, ICU length of stay was 0.8 days longer following policy implementation, although this effect was not statistically significant (95% CI, -2.3 to 3.8; p = 0.63). After excluding patients admitted before the policy but who died after implementation, we observed that ICU length of stay was 2.9 days longer post-policy (95% CI, 0.27-5.6; p = 0.03). A time-to-event analysis revealed that admission after policy implementation was associated with a significantly longer time to first do not resuscitate/do not intubate/comfort care order (adjusted hazard ratio, 2.2; 95% CI, 1.6-3.1; p < 0.0001).

Policies restricting family presence may lead to longer ICU stays and delay decisions to limit treatment prior to death. Further policy evaluation and programs enabling access to family-centered care and palliative care during the ongoing coronavirus disease 2019 pandemic are imperative.

Policies restricting family presence may lead to longer ICU stays and delay decisions to limit treatment prior to death. Further policy evaluation and programs enabling access to family-centered care and palliative care during the ongoing coronavirus disease 2019 pandemic are imperative.

We investigated the prevalence of pre- and postsepsis depression and examined the association between diagnosis of pre- and postsepsis depression and 5-year all-cause mortality among survivors of sepsis.

A population-based cohort study.

Data were obtained from the National Health Insurance Service database in South Korea.

Sepsis survivors were defined as those who were admitted with a main diagnosis of sepsis or septic shock and had survived for over 365 days.

Sepsis survivors who were diagnosed with depression before sepsis were defined as the presepsis depression group, whereas those who had no history of depression but were newly diagnosed with depression within 1 year of diagnosis of sepsis were defined as the postsepsis depression group. All other participants comprised the control group. A total of 45,826 sepsis survivors were included in the final analysis. Among the survivors, 1,105 (2.4%) were in the postsepsis depression group, whereas 9,626 (21.0%) were in the presepsis depression group. s diagnosis. In addition, postsepsis depression was independently associated with higher 5-year all-cause mortality among sepsis survivors. Our results suggest that patients with a history of sepsis and associated depression may be a high-risk group that interventions may be directed toward.

Determine effect of mental health interventions on psychologic outcomes in informal caregivers of critically ill patients.

Searches conducted in MEDLINE, Embase, and other databases from inception to October 31, 2019.

Interventions for informal caregivers of critically ill patients in adult ICU, PICU, or neonatal ICU.

Two independent, blinded reviewers screened citations and extracted data. Random-effects models with inverse variance weighting pooled outcome data when suitable. Psychologic outcomes categorized 1) negative (anxiety, depression, post-traumatic stress disorder, distress, and burden) or 2) positive (courage, humanity, justice, transcendence, temperance, and wisdom and knowledge). Stratification according to intervention type and patient population was performed.

Of 11,201 studies, 102 interventional trials were included (n = 12,676 informal caregivers). Interventions targeted caregiver experience (n = 58), role (n = 6), or support (n = 38). Meta-analysis (56 randomized controlled trialsers of critically ill patients with capacity to manage interventions.

Mental health interventions for caregivers of critically ill patients improved short-term anxiety, depression, humanity, and transcendence while increasing burden. Clinicians should consider short-term prescriptions of mental health interventions to informal caregivers of critically ill patients with capacity to manage interventions.