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	<title>competing-risk analysis &#8211; Science</title>
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	<title>competing-risk analysis &#8211; Science</title>
	<link>https://scienmag.com</link>
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		<title>Experienced Nursing Home Staff Linked to Fewer Emergency Transfers of Residents</title>
		<link>https://scienmag.com/experienced-nursing-home-staff-linked-to-fewer-emergency-transfers-of-residents/</link>
		
		<dc:creator><![CDATA[Ophelia Keating]]></dc:creator>
		<pubDate>Tue, 13 Oct 2026 07:00:52 +0000</pubDate>
				<category><![CDATA[Medicine]]></category>
		<category><![CDATA[Cohort study]]></category>
		<category><![CDATA[competing-risk analysis]]></category>
		<category><![CDATA[elderly care quality and staff training]]></category>
		<category><![CDATA[elderly resident acute illness management]]></category>
		<category><![CDATA[emergency care transfers]]></category>
		<category><![CDATA[ethical considerations in emergency transfers]]></category>
		<category><![CDATA[geriatric care]]></category>
		<category><![CDATA[geriatric care decision-making]]></category>
		<category><![CDATA[health services research]]></category>
		<category><![CDATA[impact of staff experience on geriatric care]]></category>
		<category><![CDATA[improving resident outcomes in nursing homes]]></category>
		<category><![CDATA[international research on nursing home practices]]></category>
		<category><![CDATA[nationwide study on nursing home emergency transfers]]></category>
		<category><![CDATA[non-hospital care options for elderly residents]]></category>
		<category><![CDATA[Norway]]></category>
		<category><![CDATA[Nursing home staff experience and emergency transfer rates]]></category>
		<category><![CDATA[nursing homes]]></category>
		<category><![CDATA[palliative care]]></category>
		<category><![CDATA[professional experience of nursing staff and resident safety]]></category>
		<category><![CDATA[reducing hospital transfers in nursing homes]]></category>
		<category><![CDATA[register-based research]]></category>
		<category><![CDATA[staff experience]]></category>
		<category><![CDATA[staff retention]]></category>
		<category><![CDATA[staff turnover]]></category>
		<guid isPermaLink="false">https://scienmag.com/?p=267027</guid>

					<description><![CDATA[A nationwide Norwegian cohort study of more than 76,000 nursing home residents finds that greater average staff experience is associated with a reduced risk of residents' first emergency care transfer, while higher turnover raises the risk for female residents.]]></description>
										<content:encoded><![CDATA[<p>When an elderly nursing home resident becomes acutely ill in the middle of the night, one of the most consequential decisions in their final years is made within minutes: should they be sent to a hospital emergency department, or can they be cared for safely where they live? A new nationwide study from Norway suggests that the answer depends, in part, on something that has received surprisingly little quantitative attention — the experience level of the nursing home staff standing at the bedside. The research, published in BMC Health Services Research, analyzed data from more than 76,000 nursing home residents across 851 facilities and found that residents were less likely to be transferred to emergency care when the staff caring for them had more years of professional experience behind them.</p>
<p>The study, led by Arne Bastian Wiik of the Centre for Care Research West at the Western Norway University of Applied Sciences, together with colleagues in Bergen and at the University of Manitoba in Canada, tackled a long-standing controversy in geriatric care. Transfers from nursing homes to emergency care facilities are frequently questioned by clinicians and ethicists alike, because many residents are terminally ill and nursing homes are staffed with qualified personnel who can, in principle, deliver palliative and acute care on site. Yet emergency transfers remain common, disruptive, and in some cases arguably avoidable. Understanding what drives the decision to send a resident out of the facility has therefore become a central question for health services researchers.</p>
<p>What makes the Norwegian study methodologically distinctive is its scale and its statistical machinery. The researchers assembled a retrospective, register-based longitudinal cohort covering every nursing home resident aged 65 and older who entered long-term care in Norway between 2017 and 2022 — 76,140 people in total. They linked individual-level records from Statistics Norway, the Norwegian Registry for Primary Health Care, the Control and Payment of Health Reimbursements database, and the Norwegian Patient Registry, creating an unusually complete picture of both the residents and the workforce around them. Staff characteristics at 851 nursing homes between 2016 and 2022 were anchored to each resident&#8217;s date of admission, allowing the team to track how workplace conditions shaped outcomes over time.</p>
<p>The statistical approach was equally careful. Because many nursing home residents die without ever being transferred, the researchers could not simply measure who experienced a transfer; death competes with transfer as an outcome and, if ignored, would distort the estimates. To handle this, the team employed a semi-Markov irreversible illness-death model, a framework that explicitly accounts for the competing risk of mortality. The analyses were stratified by resident sex, and the models adjusted for resident age, comorbidity, the number of residents in the facility, and the proximity of next of kin — factors that could plausibly influence both clinical decisions and family preferences about where care should be delivered.</p>
<p>The headline finding concerns staff experience. For every additional decade of average time since graduation among a nursing home&#8217;s staff, the estimated hazard of a resident&#8217;s first acute transfer to an emergency care facility fell by roughly five to six percent. The hazard ratio was 0.95 for male residents and 0.94 for female residents, and both estimates were statistically significant, with confidence intervals excluding the null value of 1.0. In plain terms, in facilities where the workforce had accumulated more years of professional practice, residents were measurably less likely to be sent out for emergency care — a pattern consistent with the idea that experienced clinicians are better equipped to assess, stabilize, and manage acute deterioration on site.</p>
<p>The study also detected a second, more subtle signal involving staff turnover. Female residents faced a higher estimated risk of transfer in facilities with higher yearly staff turnover, with each additional 10 percentage points of annual turnover associated with a hazard ratio of 1.01 — a small but statistically significant effect. The sex-specific nature of this association is intriguing and the authors themselves flag that the mechanisms behind accumulated staff knowledge and acute care decision-making deserve further investigation. Notably, staff sick leave showed no statistically significant association with transfer risk for either sex, suggesting that it is the stability and depth of the workforce, rather than short-term absences, that matters most.</p>
<p>The raw numbers underlying the analysis underscore how consequential this stage of life is. Of the 76,140 residents studied, 46 percent — 34,899 individuals — underwent at least one emergency transfer to an emergency care facility, while 66 percent — 50,548 people — died before the end of follow-up on December 31, 2022. Nearly two-thirds of the cohort died during the observation window, a stark reminder that nursing home populations are among the frailest in any health system and that decisions about emergency transfer are, for many residents, decisions about the circumstances of their final days.</p>
<p>Why would staff experience translate into fewer transfers? The authors point toward accumulated knowledge as the likely mechanism, though the register-based design cannot observe clinical reasoning directly. Experienced nurses and physicians have typically encountered thousands of episodes of acute deterioration in frail elderly patients. They may be more confident distinguishing reversible conditions that warrant hospital care from expected trajectories of decline that are better managed with on-site palliative interventions. They may also communicate more effectively with out-of-hours emergency services, negotiate alternatives to transport, and implement treatment plans — such as subcutaneous fluids, oxygen, or symptom control — that keep residents comfortable in familiar surroundings. Conversely, a workforce with high turnover may lack the institutional memory and resident-specific knowledge that make such on-site management feasible.</p>
<p>The implications extend well beyond Norway. Many countries face aging populations, chronic nursing shortages, and rising rates of potentially burdensome end-of-life hospitalizations. The Norwegian findings give administrators and policymakers a concrete, quantifiable reason to prioritize staff retention: keeping experienced workers in nursing homes is not merely a matter of continuity or job satisfaction, but appears to be associated with measurable differences in how residents experience acute illness. If a decade of additional average staff experience corresponds to a five to six percent reduction in first-transfer risk, then workforce stability becomes a legitimate clinical intervention, one that could be evaluated alongside medical protocols and staffing ratios in quality improvement programs.</p>
<p>The study does have boundaries that readers should keep in mind. It is observational, so the association between staff experience and transfer risk does not prove causation; facilities with more experienced staff may differ in unmeasured ways, from leadership culture to physician coverage. The effect sizes, while statistically robust, are modest on a per-decade basis, and the turnover finding for female residents is small in magnitude. Still, the sheer scale of the cohort, the nationwide coverage, the competing-risk modeling, and the linkage of multiple national registries give the result unusual credibility for this field. The authors conclude that accumulated knowledge among nursing home staff and the outcomes of acute care decisions should be investigated further, and that the study underscores the need for nursing home administrators and policymakers to prioritize staff retention — a prescription that, if followed, could reshape both workforce policy and the end-of-life experience of hundreds of thousands of older adults.</p>
<p><strong>Subject of Research:</strong> Association between nursing home staff characteristics and residents&#x27; emergency care transfers in Norway</p>
<p><strong>Article Title:</strong> Staff characteristics associated with nursing home residents’ initial transfer to emergency care facilities– a nationwide cohort study in Norway</p>
<p><strong>Article References:</strong> Wiik, A. B., Førland, O., Doupe, M. B., &amp; Hufthammer, K. O. (2026). Staff characteristics associated with nursing home residents’ initial transfer to emergency care facilities– a nationwide cohort study in Norway. <em>BMC Health Services Research</em>. <a href="https://doi.org/10.1186/s12913-026-15748-9" rel="noopener noreferrer">https://doi.org/10.1186/s12913-026-15748-9</a></p>
<p><strong>Image Credits:</strong> AI Generated</p>
<p><strong>DOI:</strong> <a href="https://doi.org/10.1186/s12913-026-15748-9" rel="noopener noreferrer">10.1186/s12913-026-15748-9</a></p>
<p><strong>Keywords:</strong> nursing homes, emergency care transfers, staff experience, staff turnover, competing risk analysis, cohort study, geriatric care, health services research, Norway, staff retention, palliative care, register-based research</p>
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		<post-id xmlns="com-wordpress:feed-additions:1">267027</post-id>	</item>
		<item>
		<title>After the ICU: Teenagers Face Sharply Higher Risks of Depression and PTSD, Landmark Study Finds</title>
		<link>https://scienmag.com/after-the-icu-teenagers-face-sharply-higher-risks-of-depression-and-ptsd-landmark-study-finds/</link>
		
		<dc:creator><![CDATA[Glenn Wilkins]]></dc:creator>
		<pubDate>Tue, 13 Oct 2026 06:21:29 +0000</pubDate>
				<category><![CDATA[Psychology & Psychiatry]]></category>
		<category><![CDATA[ADHD]]></category>
		<category><![CDATA[Adolescent Mental Health]]></category>
		<category><![CDATA[adolescent mental health following critical illness]]></category>
		<category><![CDATA[age-specific psychological outcomes for pediatric ICU patients]]></category>
		<category><![CDATA[Anxiety Disorders]]></category>
		<category><![CDATA[autism spectrum disorder]]></category>
		<category><![CDATA[child development]]></category>
		<category><![CDATA[competing-risk analysis]]></category>
		<category><![CDATA[Depression]]></category>
		<category><![CDATA[depression and PTSD in children after intensive care]]></category>
		<category><![CDATA[impact of ICU admission on child mental health]]></category>
		<category><![CDATA[influence of age at ICU admission on child neuropsych]]></category>
		<category><![CDATA[long-term mental health risks]]></category>
		<category><![CDATA[long-term psychological effects of pediatric intensive care]]></category>
		<category><![CDATA[Neurodevelopmental Disorders]]></category>
		<category><![CDATA[neurodevelopmental disorders post-ICU]]></category>
		<category><![CDATA[pediatric ICU survivors]]></category>
		<category><![CDATA[pediatric intensive care]]></category>
		<category><![CDATA[population-based cohort study]]></category>
		<category><![CDATA[population-based study on pediatric critical care outcomes]]></category>
		<category><![CDATA[Post-Intensive Care Syndrome]]></category>
		<category><![CDATA[PTSD]]></category>
		<category><![CDATA[risks of mental health disorders after pediatric ICU stay]]></category>
		<category><![CDATA[South Korea health insurance database pediatric research]]></category>
		<guid isPermaLink="false">https://scienmag.com/?p=266955</guid>

					<description><![CDATA[A nationwide Korean cohort study finds that children surviving pediatric intensive care face long-term psychiatric risks that differ sharply by age, with adolescents showing nearly fourteenfold higher depression risk and young children bearing the burden of neurodevelopmental diagnoses.]]></description>
										<content:encoded><![CDATA[<p>Surviving a stay in the pediatric intensive care unit is often celebrated as the end of a medical crisis, but a sweeping new study suggests that for many children, it may be the beginning of a quieter, longer struggle. A nationwide analysis of South Korea&#8217;s health insurance records has found that children who survive an ICU admission carry substantially elevated risks of being diagnosed with psychological and neurodevelopmental disorders in the years that follow, and that the nature of those risks depends sharply on how old the child is when they are admitted.</p>
<p>The research, published in BMC Psychiatry by a team at Hanyang University College of Medicine, drew on the Korean National Health Insurance Service database covering the years 2015 to 2019. Because South Korea maintains a single-payer insurance system that captures virtually the entire population, the study offers something rare in pediatric research: a genuinely population-based window into what happens to children after they leave intensive care, rather than a picture distorted by the referral patterns of a handful of academic hospitals.</p>
<p>The investigators stratified their cohort into three age bands: young children under six years old, school-aged children from six to just under thirteen, and adolescents from thirteen to just under eighteen. They then tracked first recorded diagnoses of depression, anxiety disorders, post-traumatic stress disorder, and neurodevelopmental disorders over a follow-up period that extended as long as 8.63 years. Crucially, the team used Fine–Gray subdistribution hazard models, a statistical technique that accounts for death as a competing risk. That matters because children who die after ICU admission can never go on to receive a psychiatric diagnosis, and ignoring those deaths would bias the estimated risks of mental illness among survivors.</p>
<p>The headline finding is stark. Adolescents who survived an ICU admission showed dramatically higher risks of mood and trauma-related disorders than the youngest children. Compared with children under six, adolescents had an adjusted subdistribution hazard ratio of 13.81 for depression, meaning their hazard of receiving a first depression diagnosis was nearly fourteen times higher. The corresponding figures were 5.50 for anxiety disorders and 6.39 for post-traumatic stress disorder, with confidence intervals that excluded the null value in every case. In practical terms, the teenage brain emerging from critical illness appears to be a brain at greatly heightened vulnerability to disorders of mood and fear.</p>
<p>The pattern reverses when the researchers turned to neurodevelopmental outcomes. Young children, those under six at the time of admission, were far more likely than adolescents to receive diagnoses of language developmental disorders and autism spectrum disorders in the years after their ICU stay. When adolescents were compared directly with the youngest group, the hazard ratio for language developmental disorders was just 0.07, and for autism spectrum disorders 0.17, indicating that the burden of these diagnoses falls overwhelmingly on the youngest survivors. The likely explanation lies in developmental timing: the preschool years are precisely when language and social-communication milestones are expected to unfold, so a critical illness that disrupts development at that stage is far more likely to be detected, and to matter, than the same disruption would be in a teenager whose language systems are already mature.</p>
<p>One result stood apart from the age gradient. Attention deficit hyperactivity disorder showed no significant age-dependent variation in risk, suggesting that whatever mechanism links critical illness to later ADHD operates more uniformly across childhood, or that the diagnosis is detected at similar rates regardless of when the ICU admission occurred. The researchers&#8217; overall conclusion is that follow-up care after pediatric intensive care should not be one-size-fits-all. Instead, they argue, it should be age-stratified: neurodevelopmental surveillance for the youngest survivors, and systematic screening for depression, anxiety, and PTSD in adolescents.</p>
<p>The study speaks directly to a growing body of clinical concern known as post-intensive care syndrome in pediatrics, abbreviated PICS-p. Clinicians have long recognized that surviving critical illness in childhood involves more than physical recovery. Prolonged sedation, mechanical ventilation, immobilization, delirium, and the sheer terror of the ICU environment are all plausible contributors to lasting psychological harm, and families frequently report behavioral changes, school difficulties, and emotional distress long after discharge. What has been missing, until now, is large-scale epidemiological evidence quantifying those risks across the whole population of survivors rather than in selected cohorts.</p>
<p>The methodological choices in the new study strengthen its claims. By using nationwide claims data coded with the International Classification of Diseases, 10th Revision, the researchers could capture diagnoses made across the entire Korean health system, in primary care as well as psychiatry. By adjusting for comorbidity burden, measured with the Charlson comorbidity index, they partially controlled for the possibility that sicker children are simply more likely to develop psychiatric problems for reasons unrelated to the ICU itself. And by modeling death as a competing risk rather than censoring it, they avoided one of the classic pitfalls of survivorship research. The study was approved by the Health Insurance Review and Assessment Service and the Institutional Review Board of Hanyang University Hospital, with informed consent waived owing to the retrospective design, and the authors declared no competing interests.</p>
<p>Still, the findings come with the caveats inherent to any observational claims-data study. Diagnostic codes reflect what clinicians record, and recording practices may differ across ages: an adolescent&#8217;s depression is more likely to be recognized and coded than a toddler&#8217;s internalizing distress, while developmental disorders are naturally diagnosed in early childhood. Some of the enormous age gap in depression risk may therefore reflect detection as well as true incidence. The authors also note that the interpretations and conclusions do not represent those of the National Health Insurance Service. Yet even with those qualifications, the direction and magnitude of the effects are difficult to dismiss, and the consistency of the age-stratified pattern across multiple diagnostic categories lends weight to the underlying biological and psychological story.</p>
<p>For intensive care physicians, pediatricians, and mental health services, the message is actionable. A child who leaves the ICU with recovered lungs or a healed injury may still carry invisible wounds, and the form those wounds take depends on developmental stage. The study&#8217;s authors suggest that post-discharge psychological follow-up after pediatric ICU admission may benefit from pairing neurodevelopmental surveillance in younger children with mood-disorder screening in adolescents. If such screening becomes routine, some of the nearly fourteenfold elevation in depression risk among teenage survivors could be caught early, treated, and softened. The research was funded by the research fund of Hanyang University, and the full open-access article is available under a Creative Commons Attribution 4.0 license, allowing clinicians and researchers worldwide to examine the evidence in detail.</p>
<p><strong>Subject of Research:</strong> Long-term psychological and neurodevelopmental disorders in children after pediatric intensive care unit admission</p>
<p><strong>Article Title:</strong> Long-term psychological disorders in children after intensive care unit admission: a population-based study</p>
<p><strong>Article References:</strong> Kim, J., Yoo, K. H., Lee, J., Oh, J., Choi, N., Lim, T. H., Kang, H., Ko, B. S., &amp; Cho, Y. (2026). Long-term psychological disorders in children after intensive care unit admission: a population-based study. <em>BMC Psychiatry</em>. <a href="https://doi.org/10.1186/s12888-026-08643-4" rel="noopener noreferrer">https://doi.org/10.1186/s12888-026-08643-4</a></p>
<p><strong>Image Credits:</strong> AI Generated</p>
<p><strong>DOI:</strong> <a href="https://doi.org/10.1186/s12888-026-08643-4" rel="noopener noreferrer">10.1186/s12888-026-08643-4</a></p>
<p><strong>Keywords:</strong> pediatric intensive care, post-intensive care syndrome, depression, anxiety disorders, PTSD, neurodevelopmental disorders, autism spectrum disorder, ADHD, adolescent mental health, population-based cohort study, competing risk analysis, child development</p>
]]></content:encoded>
					
		
		
		<post-id xmlns="com-wordpress:feed-additions:1">266955</post-id>	</item>
		<item>
		<title>Living Bone Transplants Slowly Heal Devastating Leg Infections, Long-Term Study Finds</title>
		<link>https://scienmag.com/living-bone-transplants-slowly-heal-devastating-leg-infections-long-term-study-finds/</link>
		
		<dc:creator><![CDATA[Ophelia Keating]]></dc:creator>
		<pubDate>Thu, 08 Oct 2026 21:24:43 +0000</pubDate>
				<category><![CDATA[Medicine]]></category>
		<category><![CDATA[amputation]]></category>
		<category><![CDATA[biofilm infection]]></category>
		<category><![CDATA[biomechanical healing of infected bones]]></category>
		<category><![CDATA[bone consolidation]]></category>
		<category><![CDATA[bone grafting]]></category>
		<category><![CDATA[challenges in treating infected non-union]]></category>
		<category><![CDATA[chronic bone infection]]></category>
		<category><![CDATA[competing-risk analysis]]></category>
		<category><![CDATA[complex bone and joint infections]]></category>
		<category><![CDATA[fracture-related infection]]></category>
		<category><![CDATA[infected non-union]]></category>
		<category><![CDATA[infected non-union treatment]]></category>
		<category><![CDATA[limb salvage]]></category>
		<category><![CDATA[living bone transplants]]></category>
		<category><![CDATA[long-term outcomes of limb salvage]]></category>
		<category><![CDATA[management of long-term bone infections]]></category>
		<category><![CDATA[microsurgery]]></category>
		<category><![CDATA[multidisciplinary approach to limb salvage]]></category>
		<category><![CDATA[orthopedic surgery]]></category>
		<category><![CDATA[osteomyelitis]]></category>
		<category><![CDATA[statistical analysis in orthopedic research]]></category>
		<category><![CDATA[surgical options for infected fractures]]></category>
		<category><![CDATA[vascularized fibular graft]]></category>
		<category><![CDATA[vascularized fibular grafting]]></category>
		<guid isPermaLink="false">https://scienmag.com/?p=249641</guid>

					<description><![CDATA[A long-term study of 22 patients shows that vascularized fibular grafting achieved bone healing and infection control in nearly three-quarters of severe infected non-unions of the lower limb, though consolidation often took years and a competing-risk analysis was needed to capture the true timeline.]]></description>
										<content:encoded><![CDATA[<p>When a broken leg bone refuses to heal and the fracture site becomes chronically infected, patients face one of the most daunting scenarios in modern orthopedics: a limb that is simultaneously falling apart biologically and under siege from bacteria. A new study from a French tertiary referral center specializing in complex bone and joint infections now offers the most nuanced long-term picture yet of a last-resort surgical option called vascularized fibular grafting, in which surgeons transplant a segment of living bone, complete with its own blood supply, from one leg to another. The research, published in the Journal of Bone and Joint Infection, followed 22 adults treated between 2014 and 2023 and applied a sophisticated statistical approach that the authors argue is essential for interpreting results honestly in this field.</p>
<p>The condition at the heart of the study, infected non-union, is defined by the combination of two failures: the bone has not consolidated for at least six months with no radiographic progress over the preceding three months, and a fracture-related infection has been confirmed according to international consensus criteria. Confirmation requires at least one hard finding, such as a sinus tract communicating with the fracture, purulent drainage, identical microorganisms cultured from at least two deep tissue samples, or histopathological evidence of infection. At surgery, the Marseille team routinely obtained at least five deep tissue specimens, incubating cultures for a minimum of ten days to capture slow-growing organisms. The stakes are high because bacterial biofilms on implants and dead bone shield pathogens from both the immune system and antibiotics, making spontaneous healing essentially impossible without major surgery.</p>
<p>The 22 patients in the cohort illustrate just how refractory these cases can be. Ninety-five percent had post-traumatic infected non-unions, mostly after high-energy road traffic accidents, and 82 percent had originally sustained open fractures, which carry a high risk of contamination. The median patient was 45 years old, and the median interval between the initial trauma and the reconstructive procedure was 14 months, with one patient not reaching reconstruction until more than 15 years after the original injury. Before arriving at the vascularized graft option, patients had undergone a median of four previous operations, and 41 percent had already failed a Masquelet induced-membrane reconstruction, a two-stage technique that coaxes the body to grow a membrane around a cement spacer before bone grafting. These were, in short, patients for whom conventional reconstruction had already run out of road.</p>
<p>Vascularized fibular grafting, first described in the 1970s, takes advantage of the fibula, the slender bone running alongside the tibia, which can be harvested with its feeding vessel, the peroneal artery, and transplanted as free living tissue. In a single operative session, a combined orthopedic and plastic surgery team first performed radical debridement of infected bone and soft tissue, then harvested the graft from the opposite leg in most cases, preserving at least five centimeters of proximal fibula and seven centimeters of distal fibula to protect knee and ankle stability. The graft was inserted into the healthy bone segments bridging the defect, fixed with internal or external hardware, and connected to recipient vessels through microsurgical anastomoses, with the posterior tibial vessels preferred when anatomy allowed. The median bone defect measured 90 millimeters and the median graft 115 millimeters, lengths that exceed what most non-vascularized techniques can reliably bridge.</p>
<p>The biological rationale for this approach is what makes it so appealing in infected fields. Because the transplanted fibula arrives with intact microcirculation, it does not depend on the often scarred and poorly vascularized recipient bed for survival. Living bone maintains its own osteogenic potential, remodels under load, and, crucially, its preserved blood flow may improve local immune defense and the delivery of antibiotics to the infected site, a decisive advantage against biofilm-associated organisms such as Staphylococcus aureus, coagulase-negative staphylococci, Pseudomonas aeruginosa, and, in one case, even Candida albicans. Eighty-two percent of the infections were polymicrobial, and antimicrobial therapy, individualized by infectious-disease specialists according to intraoperative cultures, continued for a median of 22 weeks after surgery. Notably, no patient remained on suppressive antibiotics at final follow-up, suggesting that in successfully treated cases the infection was truly eradicated rather than merely contained.</p>
<p>The headline results are encouraging but come with an important caveat about time. Bone consolidation, defined as radiographic bridging of at least three of four cortices on orthogonal views together with painless full weight-bearing, was achieved in 17 of 22 patients, or 77 percent. Infection remission occurred in 16 patients, and overall treatment success, the combination of both, in 16 patients, or 73 percent. Nine patients healed with the vascularized graft alone, at a median of 14 months, while seven required a secondary bone graft because consolidation was delayed, and their median time to union stretched to 38 months. Strikingly, all seven patients who underwent secondary grafting ultimately achieved union, although the authors caution that because the procedure was performed selectively at varying time points, this observation cannot be interpreted as proof of a causal benefit.</p>
<p>The methodological heart of the paper lies in its competing-risk analysis, a statistical framework that treats amputation and death not as censored observations, as traditional Kaplan-Meier methods do, but as genuine alternative outcomes that permanently preclude consolidation. This distinction matters because Kaplan-Meier curves can overestimate healing rates when patients leave the risk set for reasons other than the event of interest. Using cumulative incidence functions, the team calculated that the probability of consolidation was only about 18 percent at 12 months, rising to 41 percent at 24 months, 59 percent at 36 months, and roughly 76 percent by the end of follow-up. In other words, judging the success of a vascularized fibular graft at the one-year mark dramatically understates what the procedure can eventually deliver, a finding with direct implications for surgeons and patients deciding whether to persist with reconstruction or abandon the limb.</p>
<p>Not every story ended well, and the study is candid about the price of failure. Six patients, 27 percent of the cohort, had unfavorable outcomes: four amputations, one persistent non-union, and one death. The amputations stemmed from distinct pathways, including persistent infection despite early radiographic progress, ongoing pain and major depression in one patient who requested the procedure, and vascular thrombosis compromising the flap in another. Complications were documented on both the recipient and donor sides, including leg length discrepancies in five patients with a maximum of 65 millimeters, lower-limb malformation in two, a fractured fixation plate, graft non-union requiring multiple reoperations, and arteriovenous thrombosis in two patients, one of whom ultimately lost the limb. These numbers underline that vascularized fibular grafting is a technically demanding microsurgical undertaking that requires careful patient selection and multidisciplinary backup.</p>
<p>The authors are appropriately measured about the limits of their evidence. The study was retrospective, single-center, and small, precluding regression analyses to identify predictors of success, and follow-up duration was heterogeneous, with a median observation time of 21.5 months but a range extending to 90 months. Functional outcomes, quality of life, and patient satisfaction were not systematically collected, and donor-site complications may have been underestimated because they were not prospectively recorded. Consolidation rates in the broader literature, which range from 70 to 90 percent in mixed cohorts that include tumor and congenital reconstructions, are not directly comparable to this exclusively infected, multiply-failed population. Still, the central message stands: for selected patients with infected non-union of the femur or tibia, a living bone transplant can save a limb that would otherwise be amputated, but healing is a marathon measured in years, not months, and only long-term follow-up with methods that respect competing risks can reveal the true odds.</p>
<p><strong>Subject of Research:</strong> Long-term outcomes of vascularized fibular grafting as limb-salvage surgery for infected non-union of the lower limb</p>
<p><strong>Article Title:</strong> Long-term outcomes of vascularized fibular grafting for infected non-union of the lower limb: a competing-risk analysis</p>
<p><strong>Article References:</strong> Le Hir, A., Seng, P., Delarbre, D., Ambrosino, R., Kachouh, N., Legré, R., &amp; Stein, A. (2026). Long-term outcomes of vascularized fibular grafting for infected non-union of the lower limb: a competing-risk analysis. <em>Journal of Bone and Joint Infection, 11</em>(5), 579-590. <a href="https://doi.org/10.5194/jbji-11-579-2026" rel="noopener noreferrer">https://doi.org/10.5194/jbji-11-579-2026</a></p>
<p><strong>Image Credits:</strong> AI Generated</p>
<p><strong>DOI:</strong> <a href="https://doi.org/10.5194/jbji-11-579-2026" rel="noopener noreferrer">10.5194/jbji-11-579-2026</a></p>
<p><strong>Keywords:</strong> vascularized fibular graft, infected non-union, fracture-related infection, limb salvage, bone consolidation, competing-risk analysis, osteomyelitis, microsurgery, bone grafting, amputation, biofilm infection, orthopedic surgery</p>
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		<post-id xmlns="com-wordpress:feed-additions:1">249641</post-id>	</item>
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		<title>Home Visits by Health Teams Cut Hospital Readmissions for Older Patients, Swedish Study Finds</title>
		<link>https://scienmag.com/home-visits-by-health-teams-cut-hospital-readmissions-for-older-patients-swedish-study-finds/</link>
		
		<dc:creator><![CDATA[Ophelia Keating]]></dc:creator>
		<pubDate>Tue, 06 Oct 2026 09:21:37 +0000</pubDate>
				<category><![CDATA[Medicine]]></category>
		<category><![CDATA[competing-risk analysis]]></category>
		<category><![CDATA[continuity of care]]></category>
		<category><![CDATA[elderly patient safety after hospital discharge]]></category>
		<category><![CDATA[evidence-based approaches to reduce readmissions]]></category>
		<category><![CDATA[frail elderly]]></category>
		<category><![CDATA[geriatric care continuity]]></category>
		<category><![CDATA[geriatrics]]></category>
		<category><![CDATA[home health care]]></category>
		<category><![CDATA[home visit hospital readmission reduction]]></category>
		<category><![CDATA[hospital discharge transition strategies]]></category>
		<category><![CDATA[hospital readmission]]></category>
		<category><![CDATA[interprofessional home visit programs]]></category>
		<category><![CDATA[medication management in elderly patients]]></category>
		<category><![CDATA[mortality]]></category>
		<category><![CDATA[older adults]]></category>
		<category><![CDATA[post-discharge home care interventions]]></category>
		<category><![CDATA[primary care home visit initiatives]]></category>
		<category><![CDATA[primary health care]]></category>
		<category><![CDATA[propensity score matching]]></category>
		<category><![CDATA[reducing hospital return rates]]></category>
		<category><![CDATA[Sweden]]></category>
		<category><![CDATA[Swedish healthcare studies on readmission]]></category>
		<category><![CDATA[transitional care]]></category>
		<category><![CDATA[transitional care programs for older adults]]></category>
		<guid isPermaLink="false">https://scienmag.com/?p=240846</guid>

					<description><![CDATA[A Swedish propensity score-matched cohort study found that a time-limited interprofessional home care intervention after hospital discharge was associated with a significantly lower risk of readmission at 90 days among patients aged 75 and older, though effects on mortality and one-year readmission remained unclear.]]></description>
										<content:encoded><![CDATA[<p>For millions of older adults, the journey home from the hospital is the most dangerous leg of their medical care. The first days and weeks after discharge are a well-documented period of vulnerability, when medication errors, missed follow-up appointments, and the sudden loss of round-the-clock monitoring can spiral into complications severe enough to send patients straight back through the emergency department doors. Health systems around the world have tried to blunt this risk with transitional care programs of every description, from pharmacist-led medication reconciliation to intensive home visits, yet the evidence base remains stubbornly mixed. Now a Swedish study offers a fresh and cautiously encouraging data point: a time-limited, interprofessional home care intervention known as Safe homecoming was associated with a substantially lower risk of hospital readmission among patients aged 75 and older, at least in the critical first three months after leaving the hospital.</p>
<p>The study, published in BMC Geriatrics by researchers affiliated with Örebro University and Region Örebro County, took advantage of a natural experiment in Swedish primary care. Between November 2016 and May 2019, a single primary health care centre in Örebro County implemented the Safe homecoming intervention, a structured program in which physicians, nurses, occupational therapists, and other professionals work together to plan and deliver tailored home health care for older patients in the immediate aftermath of a hospital stay. The intervention is deliberately time-limited and interprofessional, designed to catch avoidable complications early, coordinate medication management, and ensure that the transition from hospital to home does not leave patients falling through the cracks between specialist and primary care. Until now, however, the program had never been formally evaluated, leaving its designers without scientific evidence of whether it actually changed outcomes.</p>
<p>To fill that gap, the research team led by Ulrika Westerling assembled an unusually large comparison framework. Drawing on administrative registers and medical records spanning 2013 to 2020, they identified a source cohort of 38,338 patients aged 75 or older who had been hospitalized for at least one day in Örebro County. From this pool, 128 patients who had received the Safe homecoming intervention at the participating centre were matched, using propensity scores, to 512 controls from across the county who received standard care. Propensity score matching is a statistical technique that pairs treated and untreated patients on the basis of observed characteristics, in this case variables such as age, sex, comorbidity burden measured by the weighted Charlson Comorbidity Index, medication use classified by the Anatomical Therapeutic Chemical system, and diagnostic history coded under ICD-10. The goal is to make the two groups as comparable as possible, mimicking the balance of a randomized trial even though patients were not randomly assigned.</p>
<p>The matching appears to have worked well. The mean age in both groups was 85.5 years, and 60.9 percent of patients in each group were women, reflecting the demographics of the very old hospital population in Sweden. Standardized mean differences, the metric researchers use to quantify balance between matched groups, were used to confirm that the intervention and control patients were comparable on the measured covariates. Still, the authors are careful to note the inherent limits of observational designs: patients who received the intervention may have differed from controls in ways the registers could not capture, such as functional status, social support, or the simple fact of being enrolled at a primary care centre motivated enough to run an innovative program. These unmeasured differences, known as residual confounding, always loom over propensity score studies.</p>
<p>The headline result concerns readmissions. At 90 days after discharge, the cumulative incidence of a first hospital readmission was 20.3 percent in the intervention group compared with 33.6 percent among controls, a difference the authors tested with Gray&#8217;s test, yielding a p-value of 0.005. In plain terms, roughly one in five older patients who received Safe homecoming ended up back in the hospital within three months, versus one in three of those receiving usual care. Because death is a competing event that precludes readmission, the team employed the statistical machinery of competing-risk analysis, calculating Fine-Gray subdistribution hazard ratios that account for the fact that some patients died before they could be readmitted. The resulting subdistribution hazard ratio at 90 days was 0.57, with a 95 percent confidence interval of 0.37 to 0.86 and a p-value of 0.008, indicating a statistically significant reduction in readmission risk of roughly 43 percent. A parallel cause-specific Cox model, which treats deaths as censoring events rather than competing risks, produced a nearly identical hazard ratio of 0.55, with a confidence interval of 0.36 to 0.84.</p>
<p>The picture changes, however, when the follow-up window stretches to a full year. At 365 days, the Fine-Gray estimate was 0.79, with a confidence interval of 0.59 to 1.05 and a p-value of 0.098, a result that just misses conventional thresholds for statistical significance and suggests the intervention&#8217;s protective effect may fade over time. This pattern is biologically plausible. Transitional care interventions are, by design, time-limited; once the intensive home visits and coordinated planning end, older patients return to the same baseline risks of disease progression, frailty, and acute illness that precipitated their original hospitalization. The intervention may succeed at preventing the avoidable complications of a poorly managed discharge, but it cannot permanently insulate patients from the chronic conditions that put them in the hospital in the first place.</p>
<p>Mortality tells a more equivocal story. Across all the follow-up time points the researchers evaluated, the mortality estimates numerically favoured the intervention group, hinting that Safe homecoming might also be associated with longer survival. But the confidence intervals at every time point included the null value of one, meaning the observed differences could easily have arisen by chance. With only 128 patients in the intervention arm, the study simply lacked the statistical power to detect anything but a very large effect on death. The authors are explicit on this point: there is no clear evidence of an association between the intervention and mortality, and the numerical trend should be read as hypothesis-generating rather than confirmatory.</p>
<p>The study&#8217;s limitations deserve as much attention as its findings. Beyond the small intervention sample and the retrospective design, the researchers evaluated multiple follow-up time points, which raises the possibility that at least one of the reported results could reflect chance variation across the many analyses performed. The single-centre nature of the intervention also raises questions about generalizability; Safe homecoming was delivered by one primary health care centre with a particular team and a particular patient population, and other settings might implement the model differently or serve patients with different needs. The authors themselves conclude that the findings should be considered exploratory and require confirmation in larger prospective studies, ideally randomized trials that can eliminate confounding altogether and enroll enough patients to detect effects on mortality as well as readmission.</p>
<p>Even with those caveats, the study arrives at a moment when health systems across the high-income world are grappling with the twin pressures of aging populations and strained hospital capacity. Readmissions among older adults are enormously costly, both in financial terms and in the toll they take on patients, for whom each hospitalization brings risks of delirium, functional decline, and loss of independence. If a structured, interprofessional home care program delivered through ordinary primary care can cut 90-day readmissions by more than 40 percent, the potential public health payoff is substantial, particularly in countries like Sweden where primary health care centres already serve as the backbone of the system. The Swedish model examined here, which builds on coordinated individual planning and leverages existing primary care infrastructure rather than requiring new institutions, could be relatively straightforward to scale, though the authors&#8217; call for larger prospective studies makes clear that the evidence is not yet strong enough to justify wholesale adoption. What the study does establish is a rigorous, registry-based template for evaluating such programs, one that other regions could replicate as they experiment with their own versions of a safer homecoming.</p>
<p><strong>Subject of Research:</strong> Effects of a transitional home care intervention on mortality and hospital readmission among older adults after hospital discharge</p>
<p><strong>Article Title:</strong> Safe homecoming intervention after hospital discharge: a retrospective cohort study of mortality and readmission among patients 75 years or older in Sweden</p>
<p><strong>Article References:</strong> Westerling, U., Taj, T., Nilsing Strid, E., Hermansson, L., &amp; Hellgren, M. (2026). Safe homecoming intervention after hospital discharge: a retrospective cohort study of mortality and readmission among patients 75 years or older in Sweden. <em>BMC Geriatrics</em>. <a href="https://doi.org/10.1186/s12877-026-08367-w" rel="noopener noreferrer">https://doi.org/10.1186/s12877-026-08367-w</a></p>
<p><strong>Image Credits:</strong> AI Generated</p>
<p><strong>DOI:</strong> <a href="https://doi.org/10.1186/s12877-026-08367-w" rel="noopener noreferrer">10.1186/s12877-026-08367-w</a></p>
<p><strong>Keywords:</strong> transitional care, older adults, hospital readmission, primary health care, propensity score matching, competing-risk analysis, geriatrics, home health care, Sweden, mortality, frail elderly, continuity of care</p>
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