The intervention’s study nurses, known as Cardiolotsen, contacted patients after discharge, checked their health status and adherence to therapy, and helped them navigate the healthcare system. The process evaluation examined how this support was delivered and which mechanisms were involved in producing change, rather than presenting the intervention as a demonstrated clinical treatment. Researchers followed the Medical Research Council framework for process evaluation and gathered evidence through semi-structured interviews with relevant target groups, questionnaires and medical records.

They analyzed the qualitative material using content analysis with both deductive and inductive categories, while descriptive statistics and subgroup analyses were used to explore the quantitative information. The study nurses responded positively to the designed training program. Patients receiving support from the Cardiolotsen also gave positive satisfaction ratings, and their reports of interacting with the nurses emphasized trust and reliability.

These findings document how the intervention was experienced by the nurses and patients included in the evaluation; they do not establish that Cardiolotse reduced readmissions or improved clinical outcomes. The evaluation was less conclusive about some aspects of coordination involving wider care teams. Researchers could not determine whether satisfaction scores concerning medical treatment or interactions among healthcare providers differed between the intervention and control groups.

At the same time, the quantitative and qualitative data suggested that Cardiolotse had difficulty reaching office-based physicians: regular contact between the study nurses and 90% of participating general practitioners and cardiologists could not be achieved. The authors therefore identified communication and information exchange across sectors between Cardiolotsen and office-based physicians as an implementation challenge. The results portray two different aspects of the program.

Its patient-facing support functions were recorded across the intervention: nurses checked patients’ health and therapy adherence at regular intervals, patients reported positive satisfaction, and the nurse-patient interactions were characterized as trustworthy and reliable. The model’s intended links with community-based physicians were less consistently established. Because this was a process evaluation embedded within the Cardiolotse randomized controlled trial, the reported findings concern implementation and participant experience rather than a direct comparison of clinical benefit.

The analysis was conducted in Germany within the trial registered retrospectively at the German Clinical Trial Register as DRKS00020424.

Subject of Research: Process evaluation of nurse-led transitional care for cardiovascular patients after hospital discharge in Germany

Article Title: Process evaluation of a nurse-led transitional care model (Cardiolotse) within a randomized controlled trial aiming to improve care coordination for patients with cardiovascular diseases in Germany

Article References: Kropp, S., Schüttig, W., Barzen Coors, M., Reber, K. C., Darius, H., Holzgreve, A., Karmann, S., Stürtz, A., Zöller, R., Riesner, P., & Sundmacher, L. (2026). Process evaluation of a nurse-led transitional care model (Cardiolotse) within a randomized controlled trial aiming to improve care coordination for patients with cardiovascular diseases in Germany. BMC Health Services Research, 26(1), Article 1254. https://doi.org/10.1186/s12913-026-15555-2

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15555-2

Keywords: Cardiolotse, transitional care, cardiovascular disease, nurse-led care, hospital discharge, process evaluation, care coordination, patient satisfaction, healthcare communication, randomized controlled trial, Process, evaluation

Intrinsic capacity has become a central concept in the science of healthy ageing since the WHO first defined it in 2015. In 2017, the organization proposed a five-dimensional model comprising mobility, vitality (often operationalized as nutrition), cognition, sensory function and psychosocial function. Unlike disease-oriented measures, intrinsic capacity captures the functional reserve of an ageing body and mind, and its trajectory is dynamically reversible: decline can be slowed, halted and in some domains even reversed if deficits are identified early. That reversibility is precisely what the Ningbo team set out to exploit at the vulnerable transition point between hospital and home.

The clinical problem the researchers targeted is well documented. Hospital stays are steadily shortening as health systems push to use medical resources more efficiently, which means most older patients with chronic conditions must continue rehabilitation and care at home or in community settings. Patients who leave hospital without adequate understanding of their condition or preparation for home-based care face a heightened risk of unplanned readmission, and each such setback can accelerate the loss of functional capacity. Reported rates of intrinsic capacity decline among older patients range widely, from roughly 19 percent to as high as 98 percent, underscoring both the prevalence and the variable severity of the problem.

Between December 2023 and June 2024, the researchers enrolled 112 geriatric inpatients aged 65 or older and randomly assigned them in a 1:1 ratio to a control group receiving routine care or an experimental group receiving routine care plus an ICOPE-based discharge planning service. Randomization used a random number table generated with SAS 9.4 software by a researcher not involved in recruitment or the intervention, with allocation cards sealed in opaque envelopes. Outcome assessors and statistical analysts were blinded to group allocation, although participants and care providers could not be, given the nature of the service. The trial was registered with ISRCTN and approved by the hospital’s ethics committee, and all participants gave written informed consent.

The intervention itself was elaborate. A multidisciplinary team — two geriatricians, four nurses including specialist and head nurses, a dietitian, a rehabilitation therapist and a pharmacist, all with more than five years of clinical experience — completed a two-month training programme before the trial began. Upon admission, each patient was assessed across the five intrinsic capacity domains using validated instruments: the Short Physical Performance Battery for mobility, the Saint Louis University Mental Status examination for cognition, the Geriatric Depression Scale-Short Form for psychological status, and the Mini Nutritional Assessment-Short Form for vitality. Individualized plans were then built from those results, following WHO’s guidelines for community interventions to manage declining intrinsic capacity.

The domain-specific prescriptions were strikingly concrete. Patients scoring low on physical performance received a standardized resistance training plan three times a week, using elastic bands for lower limbs and 550-millilitre water bottles as improvised dumbbells, supported by a training video. Those flagged for nutritional risk received weekly dietary counselling from a dietitian along with a nutrient composition conversion table. Patients with cognitive impairment took part in weekly in-hospital group cognitive stimulation — number solitaire, word association, picture memory matching, reality orientation through newspaper reading — and, after discharge, twice-daily ten-minute home training sessions supervised by caregivers who reported progress to the medical team through a dedicated WeChat group. Patients with elevated depression scores received music therapy, reminiscence therapy and narrative and emotional nursing.

Discharge itself was re-engineered. Rather than leaving timing solely to physicians’ orders, the discharge planning model used joint physician–nurse decision-making that factored in continuous care needs, social and family support and psychological readiness. Before leaving, patients and their primary caregivers received a detailed discharge plan manual, their mastery of its content was reassessed, and a discharge preparation checklist was finalized within 48 hours of departure. Post-discharge destinations were confirmed, and patient data plus care plans were transmitted to receiving institutions to maintain information continuity. Follow-up then ran for three months, beginning with a telephone check at one week and continuing biweekly, with a reassessment at the hospital’s geriatric specialty nursing clinic at the three-month mark.

The results were unambiguous. Of the 112 randomized patients, 108 completed follow-up, and an intention-to-treat analysis included all participants with missing data imputed. On the exploratory composite intrinsic capacity score, the experimental group declined by only 1.2 ± 0.2 points compared with 3.1 ± 0.3 in the control group — a mean difference of −1.9 (95% confidence interval: −2.5 to −1.3, p < 0.001). Adjusted analyses controlling for baseline scores, living status and gender showed significantly better outcomes in the intervention group on every primary continuous measure: mobility improved by an adjusted 1.8 points on the physical performance battery, cognition by 3.1 points on the mental status examination, depression scores fell by 1.6 points, and nutritional scores rose by 1.4 points (all p < 0.001). Only sensory function, assessed by self-report, showed no difference between groups. A sensitivity analysis treating the continuous domain scores as separate outcomes confirmed the robustness of the composite findings, and no intervention-related or serious adverse events were reported.

The contrast with routine care was telling. In the control group, the median physical performance score actually slipped from 8.5 to 8 over the three months, a natural decline in mobility once patients left the structured hospital environment; only a modest, statistically insignificant change appeared in any other domain. In the experimental group, all four measured domains improved significantly. The authors note that baseline imbalances in living status and gender, though not statistically significant, were clinically meaningful — the control group contained more patients living alone, who typically have less social support — and including these variables as covariates did not weaken the intervention effect. If anything, the disadvantage faced by the control group makes the positive results more compelling, since those patients had the least support to improve.

The study is, according to its authors, the first to integrate the ICOPE concept with discharge planning, and it arrives with caveats. The sample was small, follow-up lasted only three months, sensory function was measured with a single self-report question rather than objective vision or hearing tests, and the composite score remains an exploratory tool validated in a pilot of just 30 patients. The intervention also demanded abundant multidisciplinary resources and two months of team training that primary care facilities may struggle to replicate, and the more frequent contact experienced by the intervention group raises the possibility of an attention effect. Even so, the findings offer a concrete template for transitional care at a moment when roughly 85 percent of older adults receive care in community settings while the vast majority of nurses work in hospitals. Closing that staffing gap, the results suggest, may begin with what happens in the 48 hours before an older patient walks out of the hospital door.

Subject of Research: Effect of ICOPE-based discharge planning on intrinsic capacity decline in older hospitalized adults

Article Title: Effect of discharge planning rooted in the integrated Care for Older People Concept on the maintenance of intrinsic capacity in older adults

Article References: Zheng, D., Xu, R., Cai, S., Pang, D., Zhang, X., Zhu, Y., & Zhao, M. (2026). Effect of discharge planning rooted in the integrated Care for Older People Concept on the maintenance of intrinsic capacity in older adults. Frontiers in Public Health, 14, Article 1838558. https://doi.org/10.3389/fpubh.2026.1838558

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1838558

Keywords: intrinsic capacity, healthy ageing, discharge planning, integrated care for older people, geriatrics, randomized controlled trial, transitional care, older adults, multidisciplinary team, WHO ICOPE guidelines, nursing, hospital discharge

The research team, led by Randa Al-Kharabsheh and Muayyad Ahmad, analyzed the electronic health records of 2,795 adult neurology admissions treated between 2022 and 2024. Each patient’s diagnosis was coded and grouped according to the International Classification of Diseases, Tenth Revision, allowing the investigators to compare readmission patterns across disease categories rather than treating every neurological admission as interchangeable. From the same records, they extracted the clinical and demographic variables that hospitals routinely collect, and then put nine different prediction models head to head to see which could best identify patients at risk of an unplanned return.

The headline numbers are sobering. Across the full cohort, 8.9 percent of neurological patients were readmitted unexpectedly after discharge. But that average conceals dramatic variation: among patients whose primary diagnosis was a neoplasm, roughly one in four, 24 percent, came back to the hospital unplanned, a rate nearly three times the overall figure. That single statistic illustrates why the researchers argue that population-level risk stratification, rather than one-size-fits-all discharge planning, could meaningfully change how neurology services allocate follow-up resources.

After comparing the nine candidate models, the team selected the Chi-square Automatic Interaction Detection algorithm, better known as CHAID. The method works by repeatedly splitting the patient population on the variable that shows the statistically strongest association with the outcome, in this case unplanned readmission, and then splitting each branch again, producing a tree whose paths can be read like a flowchart. A clinician can trace a branch and see, in plain terms, that a patient with a particular combination of comorbidity burden, age, sex, and region of residence lands in a high-risk leaf. That interpretability is precisely why the authors chose CHAID over more accurate but opaque competitors: in a hospital setting, a model that clinicians can understand and challenge is often more useful than one that performs marginally better but cannot explain itself.

The model’s raw discriminative power was modest. On a held-out test set, it achieved an area under the receiver operating characteristic curve, or AUC, of 0.671, a value the authors themselves characterize as poor to fair. In practical terms, the model distinguishes between patients who will and will not be readmitted only somewhat better than chance would allow at the individual level. For risk stratification across the full cohort, it reached a balanced accuracy of 0.63, with sensitivity of 0.52, meaning it caught about half of eventual readmissions, and specificity of 0.74, meaning it correctly cleared most patients who would not return. The researchers are candid that these numbers do not support using the tool to predict any single patient’s fate, and they frame the model instead as a screening instrument for identifying subgroups that deserve intensified attention.

What the model lacks in individual precision, it partly compensates for in the clarity of its risk profiles. The strongest single predictor was the Charlson Comorbidity Index, a weighted score that tallies a patient’s burden of chronic illnesses; patients scoring five or higher sat firmly in the high-risk branches of the tree. Age, sex, length of hospital stay, and geographic region also shaped the splits. The subgroup analyses are where the study becomes genuinely revealing. Vascular patients, such as those admitted after stroke, who also carried high comorbidity scores formed a distinctly high-risk cluster, an association so strong that it reached a p-value below .001 with a chi-square statistic of 66.368. Among younger female patients, 37.3 percent had neoplasms, a statistically significant enrichment that flags a group in whom cancer-related readmissions drive much of the risk. And patients diagnosed with functional disorders who came from northern regions emerged as a third distinct profile, a finding the authors report with a p-value of .009.

Each of these profiles tells a different operational story. High-comorbidity stroke patients may need tighter medication reconciliation, earlier outpatient follow-up, and coordinated management of diabetes, kidney disease, and cardiac conditions that neurologists alone cannot address. Young women with brain tumors may require oncology-linked discharge planning, symptom management protocols, and clearer pathways back to specialized care when complications arise. The geographic signal among functional disorder patients hints at structural inequities, possibly in access to follow-up services or in the burden of travel, that no amount of bedside clinical care can fix on its own. A decision tree cannot say which intervention will work, but by making the risk architecture visible, it tells hospital administrators where to look first.

The study carries additional weight because of where it was conducted. The authors note that this is one of the first investigations from the Middle East to demonstrate the potential of CHAID-based risk stratification for neurology readmissions. Much of the readmission-prediction literature comes from North American and European health systems with different payment structures, discharge practices, and patient populations, and models trained in those settings often transfer poorly. Building local evidence from Jordanian electronic health records is a step toward risk tools that reflect the actual epidemiology and health-service geography of the region, including the role of regional referral patterns that emerged as a predictor in this analysis.

The researchers are equally clear about the limits of their work. The analysis was retrospective and internally validated only; the risk-stratification metrics were calculated descriptively from the complete cohort, while independent validation rested on the held-out test-set AUC. Before any clinical deployment, the model must undergo external validation in different hospitals, different regions, and ideally prospective data collection. Readmission is also a notoriously messy outcome, influenced by social factors, access to primary care, and hospital discharge practices that electronic records capture imperfectly. An AUC of 0.671 is a floor, not a ceiling, and the authors position their model as a foundation for refinement rather than a finished clinical instrument.

Even so, the study lands at a moment when health systems everywhere are under pressure to reduce avoidable returns, and it makes a case that is easy to underestimate: sometimes the most valuable algorithm is not the most accurate one but the most legible. A gradient-boosted ensemble might have squeezed a few extra points of AUC out of the same data, but no clinician could read it at a glance. A CHAID tree, by contrast, hands neurology departments a structured picture of their readmission problem, anchored in variables they already measure, and points them toward the specific combinations of diagnosis, comorbidity, age, sex, and geography where intervention is most likely to matter. For the one in eleven neurological patients in this cohort who returned to the hospital unplanned, and for the one in four cancer patients among them, that kind of clarity is a practical first step toward care that anticipates, rather than reacts to, the revolving door.

Subject of Research: AI-based prediction of unplanned hospital readmissions among neurological patients

Article Title: Predicting unplanned readmissions in neurological patients: A large-scale AI-driven analysis using CHAID decision trees

Article References: Al-Kharabsheh, R., & Ahmad, M. (2026). Predicting unplanned readmissions in neurological patients: A large-scale AI-driven analysis using CHAID decision trees. PLOS One, 21(10), e0360077. https://doi.org/10.1371/journal.pone.0360077

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360077

Keywords: unplanned readmissions, neurology, CHAID decision tree, machine learning, electronic health records, risk stratification, Charlson Comorbidity Index, Jordan, PLOS One, predictive modeling, hospital discharge, health informatics

The research, conducted by Fabricio González-Andrade of Universidad Tecnológica Indoamérica in Quito, took the form of a retrospective ecological time-series study, a design that aggregates population-level data rather than following individual patients. The investigator drew on thirteen annual national hospital discharge datasets from Ecuador’s National Institute of Statistics and Censuses, using registered live births as the denominator to calculate hospitalization rates, and paired these with six annual mortality datasets covering 2019 through 2024. Because the analysis relied exclusively on publicly available, de-identified administrative and vital statistics data, no individual informed consent or ethics committee approval was required under Ecuadorian regulations governing observational health research. The methodological rigor of the approach was reinforced by adherence to internationally recognized reporting standards for observational studies conducted with routinely collected health data.

The headline finding concerns respiratory distress of the newborn, classified under ICD-10 code P22, which towered over the other conditions in every measure of burden examined. Over the study period, this single condition accounted for 110,091 hospitalizations, more than 1.03 million hospital days, 2,381 deaths, and an estimated 220,778 disability-adjusted life years lost. To put those numbers in perspective, respiratory distress alone generated roughly forty-four percent of all the hospital discharges captured in the analysis. Its hospitalization rate climbed from 25.90 to 41.57 per 1,000 registered live births across the thirteen-year window, a statistically significant overall annual percent change of 3.15 percent, with a confidence interval running from 1.33 to 5.00 percent. That trajectory suggests a steady, compounding pressure on neonatal services rather than a sudden shock, and it implies that demand for surfactant therapy, mechanical ventilation, and specialized nursing care has been growing year after year regardless of other disruptions to the health system.

Birth asphyxia, coded P21, told a very different and arguably more alarming story. Although it did not dominate hospitalization counts, it recorded the highest ecological deaths-to-hospitalizations ratio in the study at 11.22 percent, meaning that for every hundred hospitalizations attributed to asphyxia, more than eleven infant deaths were registered nationally. More significantly, it was the only one of the four conditions to show a statistically significant increase in mortality over the period analyzed, with an annual percent change of 9.60 percent and a confidence interval of 4.33 to 15.13 percent, yielding a P value of 0.007. Birth asphyxia, which results from a failure of oxygen delivery around the time of delivery, is in many settings considered a marker of the quality of intrapartum care, including fetal monitoring, timely recognition of distress, and access to emergency obstetric and neonatal resuscitation services. A rising mortality signal in this category therefore points toward systemic weaknesses in the chain of care surrounding childbirth rather than merely changes in how illnesses are coded.

The two remaining conditions added further nuance to the national picture. Disorders related to short gestation and low birth weight, the P07 category that captures the consequences of prematurity, and bacterial sepsis of the newborn, coded P36, each followed their own trajectories. Sepsis in particular increased rapidly in the early years of the series before reaching a statistical joinpoint in 2017, after which it declined modestly. This pre-existing deceleration proved methodologically important: when the investigator applied exploratory interrupted time-series estimates to the pandemic years of 2020 through 2024, the results for sepsis had to be interpreted against the backdrop of a trend that was already flattening before COVID-19 arrived. In other words, apparent pandemic-era changes in sepsis hospitalizations cannot be straightforwardly attributed to the disruption itself, a caution that applies to many observational studies attempting to isolate the effects of the pandemic on health services.

One of the study’s notable technical strengths is that it avoided the imputation problems that have plagued similar analyses elsewhere. Because complete national hospitalization data were available for every year from 2012 through 2024, including the pandemic period, all years were analyzed as directly observed records. This eliminated the need to model or estimate missing pandemic-era values, a source of considerable uncertainty in time-series research from countries where routine data collection faltered during 2020 and 2021. The analytical toolkit was correspondingly rich: segmented regression to identify joinpoints where trends changed direction, negative binomial regression suited to overdispersed count data, incidence rate ratios to quantify relative risk, deviations from prepandemic projections, and an acute disability-adjusted life year metric combining years of life lost with years lived with disability to translate hospitalizations and deaths into a single measure of population health burden.

The concept of the deaths-to-hospitalizations ratio deserves particular attention, because it illustrates both the power and the limits of ecological surveillance. As a ratio computed from two independent national datasets, it cannot identify whether the infants who died were the same individuals who had been hospitalized, and it cannot distinguish between a condition becoming more lethal, patients arriving at hospitals sicker, or deaths occurring outside hospital settings entirely. The author is explicit on this point, noting that linked birth, hospital, and mortality records are needed to separate true changes in disease occurrence from shifts in referral patterns, diagnostic coding practices, and access to care. Ecuador, like many middle-income countries, has expanded health insurance coverage and hospital infrastructure over the past decade, and such expansions can plausibly increase recorded hospitalizations for conditions like respiratory distress simply because more newborns reach facilities where the diagnosis is made and coded.

Even with those caveats, the policy implications are difficult to ignore. The finding that respiratory distress dominates hospital days is essentially a statement about intensive care capacity: more than a million accumulated hospital days over thirteen years represents an enormous commitment of neonatal cots, ventilators, and skilled staff, and the upward trend in hospitalization rates suggests that this commitment will need to grow. Meanwhile, the rising mortality from birth asphyxia signals a different kind of intervention, one aimed upstream at labor wards, rural referral systems, and the training of birth attendants rather than at neonatal units. The study’s central conclusion, that distinct perinatal conditions generate different patterns of frequency, lethality, and resource use, amounts to an argument against managing infant health through a single aggregate indicator. A national infant mortality rate that appears stable or slowly improving could conceal a worsening asphyxia problem offset by gains elsewhere, and only condition-specific surveillance would reveal it.

The research also arrives at a moment of broader reflection in global health about the architecture of newborn survival programs. Worldwide, the leading causes of neonatal death, prematurity, birth asphyxia and trauma, and infection, have proven stubbornly resistant to interventions that succeeded against infectious diseases of later childhood. Ecuador’s experience, documented here with unusual completeness for the region, offers a case study in how middle-income health systems experience that resistance at the level of hospital wards and vital statistics registries. The absence of external funding for the work, and its foundation entirely in publicly available government data, underscore that the findings reflect the country’s own administrative record rather than a specially constructed research cohort.

For the scientific community, the study stands as a demonstration of how much can be extracted from routine data when the analytical methods are matched to the question. Segmented time-series analysis, negative binomial modeling, and burden estimation with disability-adjusted life years are not exotic techniques, but applying them coherently to thirteen years of national discharge data and six years of mortality data produced findings that no single-year report or aggregate mortality statistic could have surfaced. The author’s call for linked national surveillance, connecting birth registries, hospital discharges, and death certificates at the individual level, is the natural next step, and it would transform ratios like the 11.22 percent asphyxia figure from a population-level signal into a traceable clinical pathway. Until then, Ecuador’s neonatal wards, and the policymakers who fund them, now have a clearer map of where the burden lies: a rising tide of respiratory illness filling hospital beds, and a quieter but more lethal rise in birth asphyxia that demands attention where babies are born, not just where they are treated afterward.

Subject of Research: National trends in infant hospitalization, mortality, and health-service burden from four major perinatal conditions in Ecuador, 2012–2024

Article Title: National trends in hospitalization, mortality, and health-service burden from selected perinatal conditions among infants in Ecuador: a retrospective ecological time-series study, 2012–2024

Article References: González-Andrade, F. (2026). National trends in hospitalization, mortality, and health-service burden from selected perinatal conditions among infants in Ecuador: a retrospective ecological time-series study, 2012–2024. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07780-9

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07780-9

Keywords: infant mortality, hospital discharge, respiratory distress of newborn, birth asphyxia, neonatal sepsis, premature birth, low birth weight, Ecuador, time-series analysis, disability-adjusted life years, neonatology, health services research

The research, conducted by a team at The Third People’s Hospital of Shenzhen in Guangdong Province, China, enrolled 92 children aged zero to fourteen years who had been diagnosed with chronic liver disease. Chronic liver disease in children, which encompasses conditions such as biliary atresia, metabolic liver disorders, and cirrhosis of various origins, imposes a heavy physical toll on patients and a profound burden on families. Unlike acute illnesses that resolve with a single course of treatment, chronic liver disease demands sustained management, frequent monitoring of liver function, careful nutritional support, and in severe cases, preparation for transplantation. The period immediately after discharge, when families must translate hospital-based care into home-based routines, has long been recognized as a point of vulnerability where complications can emerge and readmissions become more likely.

The study’s central innovation lies in its systematic approach to building the intervention. Rather than designing a care program from assumptions alone, the research team integrated findings from questionnaire surveys, qualitative interviews with families, a structured review of the existing literature, and consultation with clinical experts. This multi-method development process allowed the program to be tailored to the actual needs and concerns reported by caregivers, and critically, to be adjusted according to each child’s individual level of discharge readiness. Discharge readiness, as a concept, refers to the degree to which a patient and family are prepared, both practically and psychologically, to manage care outside the hospital. It encompasses knowledge of the condition, technical skills such as medication administration, emotional preparedness, and the availability of expected support resources.

The study employed a comparative design in which children were assigned to an intervention group receiving the continuity of care program and a control group receiving standard discharge procedures. At baseline, the two groups were well matched: the researchers report no significant differences in demographic or clinical characteristics, nor in levels of social support available to the families. This methodological rigor matters because social support is one of the strongest confounders in studies of post-discharge outcomes. Families with robust networks of relatives, friends, and community resources tend to fare better regardless of the formal care they receive, so demonstrating equivalence at baseline strengthens the argument that any observed differences in outcomes can be attributed to the intervention itself.

The results were striking. Children in the intervention group demonstrated significantly higher discharge readiness across all measured dimensions compared with those in the control group, with differences reaching statistical significance at p less than 0.001. This threshold indicates that the probability of such a large difference arising by chance is less than one in a thousand, a level of statistical confidence that lends considerable weight to the finding. The intervention group also received higher-quality discharge guidance scores, suggesting that the program improved not only the preparedness of families but also the performance of the clinical staff responsible for preparing them for the transition home.

Beyond the technical measures of readiness and guidance quality, the program appeared to deliver meaningful psychological benefits. Anxiety scores were significantly lower in the intervention group, with differences reaching significance at p less than 0.05. This finding deserves particular attention because anxiety among caregivers of children with chronic illness is not a peripheral concern. Elevated parental anxiety has been linked to impaired caregiving behaviors, difficulty retaining medical instructions, and worse health outcomes for the child. A parent who is overwhelmed by worry may hesitate to administer medications correctly, may miss early signs of decompensation, or may avoid seeking timely medical help. By reducing anxiety, the continuity of care program may have created a virtuous cycle in which calmer, better-prepared caregivers provide more effective home care, which in turn reinforces their confidence and competence.

The architecture of a continuity of care program of this kind typically involves several coordinated elements that extend the hospital’s reach into the home. While the source study describes the program as being tailored to discharge readiness levels, the underlying logic is that families at different stages of preparedness require different intensities and types of support. A family that scores low on readiness might need intensive education sessions, hands-on demonstrations of care techniques, and frequent telephone follow-up in the first days after discharge, whereas a family that is already well prepared might benefit primarily from scheduled check-ins and access to a consultation channel for questions as they arise. This stratified approach stands in contrast to one-size-fits-all discharge instructions, which often overwhelm some families while leaving others with unmet informational needs.

The theoretical case for such programs rests on a well-established observation in health services research: the transition from hospital to home is a period of heightened risk, particularly for patients with complex chronic conditions. Medication errors, missed follow-up appointments, and failure to recognize deteriorating symptoms cluster in the days and weeks after discharge. For children with chronic liver disease, the stakes are especially high because hepatic decompensation can progress rapidly, and because many of these children are on complicated medication regimens that may include immunosuppressants, diuretics, or nutritional supplements whose dosing requires careful adjustment. A structured continuity of care program acts as a bridge across this risky interval, ensuring that the expertise of the hospital team remains accessible while families gradually build the self-care abilities the study’s authors highlight as a key intended outcome.

The study’s conclusions extend beyond the immediate endpoints of readiness and anxiety. The authors suggest that the program may promote the development of self-care abilities among both children and their caregivers, enhance satisfaction with nursing care, and ultimately improve quality of life. These are ambitious claims, and the study’s design, which measured readiness, guidance quality, and anxiety directly, supports the first two more firmly than the longer-term quality-of-life outcomes, which the authors frame as potential downstream benefits. Still, the logic of the pathway is coherent: families who leave the hospital feeling prepared and supported are better positioned to manage daily care, maintain follow-up schedules, and sustain the child’s health over time, all of which contribute to a better lived experience with a chronic condition.

The research carries practical implications for pediatric hepatology services far beyond Shenzhen. Hospitals caring for children with chronic liver disease could adopt the program’s development methodology, combining quantitative surveys, qualitative family interviews, literature synthesis, and expert consultation, to build discharge support systems matched to their own patient populations. The finding that discharge readiness can be measurably improved across all dimensions suggests that readiness is not a fixed family trait but a modifiable clinical target, something that skilled nursing intervention can move. As health systems worldwide grapple with rising rates of chronic disease in children and pressure to reduce readmissions, this study offers a concrete, evidence-based template: assess each family’s readiness before discharge, tailor the continuity of care program to that readiness level, and maintain structured contact after the child goes home. For the families navigating the daily realities of childhood liver disease, that structured support may transform the daunting journey from hospital ward to home into a managed, supported transition rather than a leap into the unknown.

Subject of Research: A discharge readiness-based continuity of care program for children with chronic liver disease

Article Title: Efficacy of a continuity of care program based on discharge readiness for children with chronic liver disease

Article References: Liao, Q.-H., Fu, K.-H., Ma, S., Zhang, S.-Y., Ning, X.-L., Hu, X.-Q., Sun, L.-L., & Xiao, W.-L. (2026). Efficacy of a continuity of care program based on discharge readiness for children with chronic liver disease. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15630-8

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15630-8

Keywords: chronic liver disease, pediatrics, discharge readiness, continuity of care, nursing, caregivers, anxiety, health services research, patient transition, hospital discharge, self-care, quality of life

The review team searched four major biomedical databases, PubMed, CINAHL, the Cochrane Library, and Scopus, for studies published in English from 2010 onward that involved adults aged 65 or older and evaluated programs designed to carry patients from hospital to home. The methodological net was deliberately wide, capturing randomized controlled trials, cohort studies, and qualitative investigations alike. From 42 initial records, the researchers removed 12 duplicates, screened 22 full-text articles, and ultimately included 15 studies in the synthesis. Two independent reviewers extracted study characteristics, intervention components, outcome measures, and implementation factors, a dual-extraction approach that reduces the risk of single-reviewer bias creeping into the evidence base.

What emerged from the synthesis is a remarkably consistent picture of what a transitional care program looks like when it is done well. Across the included studies, the authors identified a recurring set of core components: patient-centred assessment, comprehensive discharge planning, care coordination, patient and family education, medication management, follow-up monitoring, home-care services, and multidisciplinary team involvement. None of these elements is exotic. They are, in essence, the plumbing of continuity of care, the deliberate engineering of information flow and human contact across the boundary between two very different care environments. The review’s contribution lies in showing how frequently these components co-occur in successful programs and how their combination, rather than any single element, appears to drive benefit.

The reported outcomes give the components their weight. Programs built on this template were associated with improved functional status, better quality of life, higher patient satisfaction, and improved medication management. Perhaps most striking for health system planners, the studies documented reductions in hospital readmissions, fewer emergency department visits, and shorter lengths of stay. These are the metrics that hospital administrators watch most closely, because readmissions within 30 days of discharge have long served as a proxy for fragmented care and a driver of avoidable cost. The review’s findings align with a broader literature, including landmark randomized trials of comprehensive discharge planning with home follow-up and pharmacist-led medication reconciliation programs, which have repeatedly shown that structured post-discharge support changes hard clinical endpoints rather than merely softening patient experience.

Behind the headline outcomes sits a technical question that the review confronts directly: why do some programs succeed where others fail? The authors point to variation in intervention intensity and implementation across settings as a critical moderating factor. A transitional care program that assigns an advanced practice nurse to make home visits within 72 hours of discharge is a fundamentally different intervention from one that consists of a phone call a week later, even if both are labelled with the same name. This heterogeneity, sometimes called the black box problem in implementation science, makes it difficult to know which dose of care, in terms of contact frequency, duration, and professional skill mix, produces the measured effect. The review found that reporting of intervention fidelity and dose was limited across the included studies, meaning that even the positive results come with an asterisk about reproducibility.

The review also identifies a persistent structural blind spot: family caregivers. Older adults with multiple chronic conditions rarely manage their recovery alone, yet the analysis found insufficient integration of family caregivers into discharge planning and follow-up across the included programs. This finding echoes a growing body of evidence, including meta-analytic work showing that caregiver engagement enhances outcomes in randomized trials of transitional care interventions. Caregivers are, in functional terms, the only members of the care team who are present around the clock. When they are not taught to recognize warning signs, not included in medication conversations, and not given a direct line back to the clinical team, the transitional care model loses its most continuous sensor. Programs that treat caregivers as trained partners rather than passive recipients of instructions appear to perform measurably better.

Measurement inconsistency poses a further challenge to the field. The review notes that outcome measurement varied across studies, complicating any attempt to pool effects or compare programs head to head. One trial may report readmission rates at 30 days while another tracks functional status at 90 days; a third may rely on patient-reported satisfaction without capturing utilization at all. Without standardized outcome domains and time points, the evidence base resembles a collection of portraits rather than a single landscape. The authors argue that future models should standardize intervention delivery and outcome measurement, a recommendation that aligns with international movements toward core outcome sets in geriatric research and with the World Health Organization’s integrated care for older people framework, which emphasizes person-centred assessment pathways in primary care.

The clinical logic underlying these programs is worth unpacking for readers unfamiliar with the mechanics of care transitions. Hospital discharge represents a handoff of responsibility from an environment with continuous monitoring, standardized medication administration, and immediate access to diagnostics, to an environment with none of these safeguards. Physiologically vulnerable patients, particularly those with heart failure, frailty, or polypharmacy, are discharged into a period of heightened risk that begins the moment they leave the ward. Transitional care programs work by extending elements of the hospital’s safety architecture into the home: a structured assessment identifies who is at highest risk, discharge planning ensures the receiving environment is prepared, education equips patients and families to act on early symptoms, medication reconciliation prevents the dangerous discontinuities that arise when inpatient and outpatient medication lists diverge, and scheduled follow-up creates a feedback loop that catches deterioration before it becomes a 911 call.

The review’s conclusions are measured but constructive. Transitional care programs, the authors write, can facilitate safer and more effective transitions for older adults. The prescription for the next generation of models is threefold: strengthen family engagement, standardize intervention delivery and outcome measurement, and ensure continued post-discharge follow-up rather than support that evaporates after the first week. That last point deserves emphasis, because the risk window after discharge does not close neatly at 30 days, and several of the most successful models in the broader literature have extended nurse-led follow-up across weeks or months for patients with complex needs.

As populations age worldwide, the stakes of getting this right will only climb. Older adults with multiple chronic conditions account for a disproportionate share of hospital utilization, and each transition between settings is an opportunity for error, omission, or decline. What this review offers is not a single breakthrough therapy but something arguably more useful for health systems: a validated checklist of the components that repeatedly appear in programs that work, paired with an honest accounting of the gaps, in fidelity reporting, caregiver integration, and measurement, that still separate the evidence from a fully reproducible blueprint. The task now, the authors suggest, is to move from knowing that transitional care can work to specifying exactly how, for whom, and at what intensity, so that the safest room in the hospital is the one the patient has already left.

Subject of Research: Core components and outcomes of transitional care programs for older adults moving from hospital to home

Article Title: Transitioning to Care: Core Components and Outcomes of Transitional Care Programs for Older Adults

Article References: Ray Panda, S., Shetty, A. P., & Dwibedi, B. (2026). Transitioning to Care: Core Components and Outcomes of Transitional Care Programs for Older Adults. Ageing International, 51(4), Article 41. https://doi.org/10.1007/s12126-026-09679-3

Image Credits: AI Generated

DOI: 10.1007/s12126-026-09679-3

Keywords: transitional care, older adults, hospital discharge, care coordination, readmissions, family caregivers, medication management, systematic review, geriatrics, continuity of care, discharge planning, home care

The research, conducted by a team at Prince of Songkla University in collaboration with Songkhla Hospital and Auckland University of Technology, was published in BMC Geriatrics. Rather than launching immediately into a large clinical trial, the investigators designed a rigorous feasibility study, the essential first step in testing whether a complex health intervention can actually work in the messy reality of patients’ homes. Sixteen Thai families took part, each consisting of an older adult recovering from hip fracture surgery and the primary family caregiver responsible for day-to-day assistance. Healthcare providers who delivered the program were also asked to evaluate it after implementation.

The theoretical backbone of the intervention is Meleis’ theory of transition, a well-established nursing framework that describes how people experience and adapt to fundamental changes in health status, roles, and environments. Transition theory holds that recovery is not simply a biological process but a lived experience shaped by readiness, support, and the meaning patients attach to their new circumstances. The researchers combined this with the concept of family-based illness care, which treats the household, not the isolated patient, as the true unit of recovery. In practical terms, that means the program aimed to empower both the patient and the caregiver with the knowledge and skills needed to manage rehabilitation together, rather than leaving the family to improvise after a brief discharge conversation.

The delivery mechanism is where the study acquires a distinctly modern flavor. The program’s components were integrated into a mobile application, designed to support communication between families and healthcare providers during the vulnerable weeks after discharge. The app was linked to a Line Official Account, reflecting the dominance of the Line messaging platform in Thai digital life. This choice matters for anyone thinking about digital health equity: rather than asking elderly patients and their often middle-aged or elderly caregivers to master an unfamiliar standalone product, the researchers embedded the intervention in technology many Thai families already use daily. The application served as a channel for guidance, monitoring, and continuity of care, bridging the gap between the orthopedic ward and the home.

Measurement in the study was thorough and multidimensional, reflecting the many ways a hip fracture can diminish a life. Hip function was assessed using the Thai version of the Modified Harris Hip Score, a validated instrument that quantifies pain, function, and deformity specific to the hip joint. Activities of daily living were measured with the Thai version of the Barthel Index, which scores independence in fundamental tasks such as feeding, bathing, dressing, and toileting. Mobility was evaluated with the Timed Up and Go test, a deceptively simple clinical measure in which a patient rises from a chair, walks three meters, turns, returns, and sits down again, with the time taken serving as a sensitive indicator of balance and fall risk. Fear of falling, a psychological barrier that can be as disabling as physical weakness, was captured with the Thai version of the Falls Efficacy Scale International.

These outcomes were assessed at three time points: before hospital discharge, two weeks after discharge, and six weeks after discharge. This timeline is clinically meaningful, because the first six weeks after hip surgery are precisely when patients either build momentum toward recovery or slide into complications, deconditioning, and dependence. The researchers analyzed the data using descriptive statistics and Repeated-Measures Analysis of Variance, a statistical technique suited to tracking the same individuals across multiple time points and determining whether changes over time are larger than would be expected by chance alone.

The results were striking, even in a sample of only sixteen families. Hip function improved significantly across the recovery period, with an F statistic of 254.72 and a p-value reported as .00, indicating a difference so large it is exceedingly unlikely to have arisen by chance. Activities of daily living showed an F of 230.55, mobility function an F of 159.63, and fear of falling an F of 155.68, all with the same highly significant p-values. In plain language, patients not only regained physical capability over the six weeks but also grew measurably more confident about moving without falling, a psychological shift that often determines whether an older person resumes normal activity or retreats into a chair. The program was judged feasible and satisfactory by both the participating families and the healthcare providers who implemented it.

Why should a modest feasibility study with sixteen families attract attention? The answer lies in the scale of the underlying problem and the scarcity of good solutions. Hip fractures are among the most consequential injuries of aging, associated with elevated mortality, long-term disability, and loss of independence. Surgical techniques such as total hip arthroplasty, closed reduction and internal fixation, and proximal femoral nail antirotation, all referenced in the study’s clinical setting, have become reliable, yet the post-discharge period remains a weak link in the chain of care. Patients are typically sent home within days of surgery, often with limited rehabilitation support, and family caregivers are expected to assume responsibilities for which they have received little training. Transitional care programs that deliberately prepare and support families during this window address a genuine and widespread gap in health systems, particularly in countries where formal home-care services are limited.

The study’s design also offers a template for how nursing science can translate theory into testable practice. Content validity of the program materials was established through expert review, reflected in the use of the content validity index, and reliability of the outcome measures was supported by statistics such as intraclass correlation coefficients and interrater reliability. The researchers obtained ethics approval from both the Social and Behavioral Sciences Institutional Review Board of Prince of Songkla University and the Research Ethics Committee of Songkhla Hospital, and participation was voluntary with full informed consent. These procedural details may seem dry, but they signal that the intervention was developed with the methodological discipline needed before any claim of effectiveness can be taken seriously.

The authors are appropriately cautious about what their findings prove. With sixteen families and no control group, the study cannot establish that the program caused the improvements; recovery after hip surgery naturally progresses over six weeks, and a randomized controlled trial is needed to separate the program’s effect from ordinary healing. The researchers explicitly recommend a larger sample and more rigorous evaluation in future work. Still, the combination of strong preliminary signals, high satisfaction among families and providers, and a delivery model grounded in everyday technology makes this a promising candidate for that decisive trial. If the results hold up, the implications could extend well beyond Thailand: aging societies everywhere are searching for scalable, affordable ways to support older adults through the fragile weeks after major surgery, and this study suggests the answer may lie in equipping families, not just hospitals, to deliver care.

Subject of Research: Family-based transitional care with a mobile application for older adults recovering from hip fracture surgery

Article Title: Family-based transitional care for older adults after hip fracture surgery: a feasibility study

Article References: Puttakun, N., Songwathana, P., Promnoi, C., & Holroyd, E. (2026). Family-based transitional care for older adults after hip fracture surgery: a feasibility study. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08273-1

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08273-1

Keywords: transitional care, hip fracture, older adults, family caregivers, mobile application, feasibility study, geriatrics, hospital discharge, rehabilitation, fear of falling, nursing theory, Thailand

The study, published in the Journal of General Internal Medicine, was led by Robert E. Burke of the Corporal Michael J. Crescenz VA Medical Center and the University of Pennsylvania, together with colleagues across the VA and several academic institutions. The team assembled a retrospective descriptive cohort covering January 1, 2015 through December 31, 2022, drawing on the VA Residential History File, an unusually rich data resource that stitches together hospitalizations and post-acute stays across VA-provided care, VA-paid community care, Medicare, and Medicaid. That integration matters because it allowed the researchers to see the full landscape of options each Veteran actually had, rather than just the slice of care visible to any single payer.

The sample included 926,860 hospitalizations followed by skilled nursing facility stays among 662,432 unique Veterans, all aged 66 or older and enrolled in the VA. To be included, a Veteran had to be discharged from an acute hospitalization directly into a nursing facility within one day, and the researchers excluded patients admitted from nursing homes, those who stayed more than 100 consecutive days (who were effectively long-term residents), and discharges from psychiatric units, long-term acute care hospitals, or inpatient rehabilitation facilities. The overwhelming majority of stays, 94.6 percent, occurred in non-VA facilities paid for by Medicare, while 5.4 percent occurred in VA Community Living Centers or VA-contracted nursing homes.

To measure quality, the team relied on the five-star rating systems used by both the Centers for Medicare and Medicaid Services and the VA itself, which composite together health inspections, staffing levels, and individual quality measures on a scale from one star, the worst, to five stars, the best. Crucially, the researchers matched each Veteran to the facilities whose zip code centroid fell within 16 miles of the Veteran’s own home zip code, a distance chosen because more than 80 percent of urban Veterans actually used a facility within that radius. The VA publishes its own star ratings for Community Living Centers through a methodology that closely mirrors the CMS approach and correlates strongly with patient outcomes, allowing a fair comparison across the two systems of care.

The headline numbers are sobering. Only 34.4 percent of Veterans attended the highest-rated facility available in their area, while 15.4 percent ended up in the worst-rated one. Nearly two-thirds, 64.5 percent, had at least one higher-quality option nearby than the one they actually used, and 43.7 percent had five or more such options. Just 54.9 percent received care in a facility rated four stars or better, even though 96.9 percent of Veterans had at least one four-star facility within 16 miles and, on average, had 16.4 such facilities to choose from. These patterns were remarkably stable across the eight-year study window, suggesting that neither the maturation of public reporting nor the disruption of the COVID-19 pandemic fundamentally changed how Veterans and their families navigate this decision.

The findings echo, almost eerily, an earlier analysis by the Medicare Payment Advisory Commission using 2015 data on the general Medicare population. MedPAC found that 84 percent of beneficiaries had at least one higher-quality facility within roughly 15 miles of home than the one they chose, and 47 percent had five or more. The new Veteran study’s figure of 43.7 percent with five or more better options is strikingly similar, implying that a decade of star ratings, comparison websites, and quality campaigns has barely moved the needle. Veterans were supposed to be a best-case scenario: unlike typical Medicare beneficiaries, they can often choose between a VA nursing home, a VA-contracted community facility, or any Medicare-certified home, an expanded menu of options that might reasonably be expected to translate into better choices.

It did not. Veterans who used VA-provided or VA-paid care actually had slightly more high-quality options nearby, an average of 18.8 facilities rated four stars or better, compared with 16.2 for those using Medicare-paid facilities, yet they were no more likely to attend the best one: 31.4 percent versus 34.6 percent. More troubling still were the disparities buried in the subgroup analyses. Only 24.6 percent of Black Veterans used the highest-quality facility available, compared with 35.6 percent of white Veterans, even though Black Veterans had more high-quality options nearby on average, 24.2 versus 15.3. Unmarried Veterans, Veterans with higher comorbidity burden, those with longer hospital stays, and Veterans hospitalized primarily for mental, behavioral, or neurodevelopmental disorders all used the best available facility at lower rates than the overall population, again despite having equal or greater access to high-quality options.

Rural Veterans tell a different and somewhat paradoxical story. Within 16 miles, they had only 3.9 high-quality facilities on average, compared with 20.3 for urban Veterans, yet 36.1 percent of them used the best option available, slightly more than the 33.9 percent of urban Veterans. When the researchers expanded the radius to 36 miles, a distance at which more than 80 percent of rural Veterans actually obtained care, rural Veterans’ options ballooned to 17.3 high-quality facilities, but the share using the best one dropped to 27.4 percent. The pattern hints that when choices are scarce, families and discharge planners may scrutinize them more carefully, while abundance may breed a kind of decisional inertia in which proximity, habit, or convenience wins out over quality.

Why do so many people bypass better care that is demonstrably within reach? The authors lay out a three-gate framework: the Veteran or family must select the facility, the payer must approve it, and the facility must have a bed and accept the patient. Each gate can fail. Decision-making at hospital discharge is rushed and poorly supported, and families frequently lean on whatever facility the hospital team mentions first. Insurance networks constrain choice, particularly for the growing share of older adults enrolled in Medicare Advantage plans, whose skilled nursing networks have been shown to skew toward slightly lower-quality facilities. And bed availability is tightening: national nursing home occupancy rebounded to 84 percent by 2024, and because staffing shortages limit the number of beds that can actually be staffed, functional capacity is even scarcer than raw bed counts suggest. Pay-for-performance pressures add another layer, incentivizing facilities to prefer lower-risk, more profitable patients.

The stakes are not abstract. Recent quasi-experimental studies, including analyses that exploit bed vacancies to isolate the effect of facility quality, confirm that attending a higher-rated nursing home genuinely improves outcomes, even for patients at high risk of complications. That makes the subgroup disparities especially worrisome, and it also points toward practical fixes. The authors note that clinicians can, contrary to a common misconception about anti-kickback and Stark laws, recommend specific high-quality facilities to families, and that many hospitalists remain unfamiliar with the Medicare Care Compare tool. Because high-quality facilities cluster in wealthier areas while low-quality ones cluster in lower-income neighborhoods, sometimes the right advice is simply to travel farther, balanced against the caregiving burden longer distances impose on families. For the VA, the next step may be mapping post-acute care markets to identify where its dual leverage as provider and payer could most effectively steer Veterans toward the best care that, in most cases, is already just down the road.

Subject of Research: Access to and choice of high-quality skilled nursing facility care among older Veterans after hospitalization

Article Title: Access to and Choice of High-Quality Skilled Nursing Facility Care for Veterans After Hospitalization: A Cohort Analysis

Article References: Burke, R. E., Cidav, T., Tjader, A., Roberts, C. B., Benson, J. A., Piazza, K. M., Song, H., Wang, G., & Rose, L. (2026). Access to and Choice of High-Quality Skilled Nursing Facility Care for Veterans After Hospitalization: A Cohort Analysis. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10823-7

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10823-7

Keywords: skilled nursing facility, Veterans, post-acute care, nursing home quality, star ratings, Medicare, VA Community Living Centers, hospital discharge, health disparities, rural health, geriatrics, care transitions

The study, published in BMC Geriatrics by a team of hospital pharmacists and pharmacoepidemiologists affiliated with Assistance Publique–Hôpitaux de Paris and Paris-Saclay University, set out to measure how often DOAC prescriptions in hospitalized older adults deviated from European Society of Cardiology (ESC) guidelines, and whether the situation had improved since a comparable assessment in 2018. The answer, in short, is that it had not.

Between November 2022 and May 2023, the researchers consecutively enrolled older adults who were already taking a DOAC before admission and who stayed in one of three French university hospitals for more than 24 hours. The participating departments spanned cardiology, internal medicine, post-emergency care, and acute geriatrics, giving a broad picture of real-world prescribing across the acute care pathway. In total, 536 patients were eligible, with a mean age of 84.1 years and a slight majority of women; 421 patients formed the primary analysis cohort.

The pharmacological profile of the cohort reflected current practice. Apixaban dominated, accounting for 70.1 percent of prescriptions, and atrial fibrillation was the indication in 83.6 percent of cases. This matters because apixaban, like all DOACs, has a narrow therapeutic window whose appropriateness hinges on patient-specific factors: renal function, age, body weight, and the indication being treated. Unlike warfarin, which is monitored with routine blood tests, DOAC dosing is fixed at prescription time, so an error at the moment of prescribing persists silently until harm occurs.

Using ESC guidelines as the benchmark, the team classified prescriptions as appropriate or inappropriate at two critical moments: hospital admission and hospital discharge. On admission, 32.0 percent of prescriptions were judged inappropriate. By discharge, the figure had fallen to 24.9 percent, a statistically significant improvement (p = 0.004), suggesting that the hospital stay does correct some errors, but leaves a substantial fraction of patients heading home with potentially unsafe anticoagulation.

The consequences of such errors are not abstract. An excessive dose in a frail 85-year-old with declining kidney function increases the risk of major bleeding, including intracranial hemorrhage. An insufficient dose, conversely, can mean therapeutic failure, allowing a stroke or systemic embolism to occur despite the patient dutifully taking their medication. In older patients with polypharmacy, where DOACs interact with other drugs and renal clearance is often reduced, the margin for error shrinks further, which is why inappropriate prescribing is considered a major patient safety concern in geriatric care.

To understand who was most at risk, the researchers used logistic regression to identify predictive factors for inappropriate prescribing. Two variables stood out at admission: age over 80 years nearly doubled the odds of an inappropriate prescription (odds ratio 1.80, 95 percent confidence interval 1.20–2.72), and elevated serum creatinine above 133 µmol/L, a marker of impaired kidney function, similarly raised the odds (OR 1.84, 95 percent CI 1.13–2.98). At discharge, age over 80 remained a strong risk factor (OR 2.71, 95 percent CI 1.63–4.61), while a body weight below 60 kilograms was unexpectedly protective (OR 0.42, 95 percent CI 0.25–0.69), possibly because clinicians scrutinize low-weight patients more carefully when selecting doses.

The renal connection deserves particular emphasis. DOACs are cleared substantially by the kidneys, and estimates of glomerular filtration rate in older adults vary depending on the formula used, whether Cockcroft–Gault, MDRD, or CKD-EPI. The study’s authors assessed prescriptions against the Summary of Product Characteristics for each molecule, which specify dose reductions based on renal function, age, and weight. When kidney function is overestimated, or when a hospitalization changes a patient’s renal status without the prescription being adjusted, the fixed daily dose can quickly become dangerous. Advanced age and impaired renal function, the two risk factors identified here, are precisely the conditions that make this pharmacokinetic tightrope hardest to walk.

Perhaps the most sobering finding is the comparison with 2018. Using chi-squared tests, the team compared their results with data collected five years earlier and found no significant changes. Despite growing awareness of DOAC dosing pitfalls, updated guidelines, and the expansion of clinical pharmacy services in French hospitals, the rate of inappropriate prescribing in this vulnerable population has remained essentially flat. The authors conclude that further efforts to optimize DOAC prescribing are warranted, and they point toward concrete interventions: pharmacist-led medication reviews at admission and discharge, and integrated prescribing tools embedded in electronic medical records that would automatically flag doses inconsistent with renal function, age, and weight.

The study has the strengths and limits of its design. As a prospective observational study, it captures real prescribing behavior rather than idealized trial conditions, and its multicenter scope across four department types strengthens generalizability within the French hospital system. But it also reflects a single country’s practice in a single year, and appropriateness was defined by ESC guidelines rather than patient-specific outcomes, so the findings measure guideline concordance rather than directly measured harm. Even so, the message is clear and actionable: the transition points of hospital care, admission and discharge, remain moments where older patients on DOACs are at elevated risk of a prescribing error, and after years of stagnation, systematic medication reconciliation and decision support may be the tools that finally bend the curve.

Subject of Research: Appropriateness of direct oral anticoagulant prescribing in hospitalized older adults

Article Title: Appropriateness prescriptions of direct oral anticoagulants in hospital in 2023 in the older population: a prospective observational multicenter study

Article References: Rodier, T., Gibert, A., Lepors, A., Fernandez, C., Hindlet, P., Savoldelli, V., & Schwab, C. (2026). Appropriateness prescriptions of direct oral anticoagulants in hospital in 2023 in the older population: a prospective observational multicenter study. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08330-9

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08330-9

Keywords: DOACs, anticoagulants, older adults, prescribing appropriateness, medication safety, atrial fibrillation, apixaban, renal function, polypharmacy, hospital discharge, pharmacist-led medication review, geriatrics

The research, conducted at Kagoshima University in Japan, followed 185 adults with newly diagnosed glioblastoma treated between 2011 and 2020. Rather than assessing walking at a single moment, the investigators tracked it at six distinct points spanning the treatment trajectory: before surgery, on postoperative day five, before the start of chemoradiotherapy, at hospital discharge, and at one and four months after discharge. The instrument they chose was the Functional Ambulation Category, or FAC, a six-point ordinal scale that classifies walking according to the level of human assistance required, ranging from nonfunctional ambulation at level 0 to fully independent walking on all surfaces at level 5. Because the scale depends on observation of assistance rather than timed performance, it remains feasible even in patients whose motor impairment, reduced consciousness, aphasia, or cognitive dysfunction would make stopwatch-based gait tests impractical or impossible.

The study’s central finding is striking in its consistency. Higher FAC scores were associated with longer overall survival at all six assessment points, but the association was strongest at hospital discharge. When patients were grouped by discharge walking ability, median survival measured from surgery was 346 days for those with FAC 0 to 1, 590 days for those with FAC 2 to 4, and 879 days for those with FAC 5, a gradient that the log-rank test confirmed was highly unlikely to arise by chance. Using hospital discharge as a landmark origin for survival measurement, median post-discharge survival was 286, 531, and 823 days for the three groups respectively, again with a highly significant overall difference. Patients unable to walk or requiring constant human support separated clearly from those with partial independence, while the distinction between partial assistance and full independence narrowed once statistical corrections for multiple comparisons were applied.

The methodological care behind these numbers deserves attention. In the primary analysis, the researchers used a discharge-landmark design in 162 patients with 138 deaths, aligning the survival clock with the assessment itself and adjusting hazard estimates for age, sex, extent of resection, and the Karnofsky Performance Status measured at the same discharge moment. Against the reference group with FAC 0 to 1, the adjusted hazard ratio for death was 0.45 for patients with FAC 2 to 4 and 0.33 for those who walked fully independently, meaning that better walking categories were associated with mortality risks roughly half to a third of those seen in the most impaired group. Discharge Karnofsky Performance Status itself remained independently prognostic, with each ten-point increase associated with a fourteen percent lower hazard of death, which makes the persistence of the FAC signal all the more notable.

To determine whether the walking measure truly added information beyond global performance status, the team compared statistical models with and without discharge FAC using the Akaike information criterion, Harrell’s concordance index, and a likelihood-ratio test. Adding FAC improved model fit by 8.4 AIC units and improved discrimination by 0.022 on the C-index, a modest but statistically significant gain with a p value of 0.002. In a head-to-head comparison of the four in-hospital assessments on a common complete-case subset, discharge FAC produced the largest improvement over the clinical reference model, with an AIC gain of 20.1 and a C-index improvement of 0.043, while earlier assessments contributed less. Systematic landmark sensitivity analyses that shifted the survival origin to match each assessment reproduced the same temporal pattern, reinforcing that the discharge measurement sits at a uniquely informative moment in the clinical course.

The authors are careful to explain why discharge, rather than any earlier or later point, carries the strongest signal. Discharge FAC is measured only after surgery, early postoperative recovery, inpatient rehabilitation, and a substantial portion of the initial chemoradiotherapy course have already unfolded. It therefore functions as an integrated clinical marker, summarizing the net effect of tumor biology, treatment intensity, surgical sequelae, and functional recovery up to a meaningful transition point, rather than as a purely baseline prognostic factor. Walking ability in the cohort followed a characteristic trajectory: lowest immediately after surgery, then progressively recovering toward discharge and beyond. This pattern carries a practical clinical warning, namely that early postoperative deterioration should not automatically be read as a patient’s eventual functional ceiling, since meaningful recovery often continues throughout hospitalization.

The findings also illuminate the relationship between function and treatment delivery. Patients with higher discharge FAC were markedly more likely to begin post-discharge adjuvant temozolomide, with initiation rates of 60 percent in the FAC 0 to 1 group, 90 percent in the FAC 2 to 4 group, and 98 percent in the FAC 5 group. This suggests that walking ability may partly serve as a proxy for treatment readiness, the physiological and cognitive reserve required to tolerate continued intensive therapy. Importantly, statistical adjustment for adjuvant temozolomide did not materially change the FAC estimates, and the authors emphasize that because exact initiation dates were unavailable, the findings establish prognostic association rather than a causal effect of walking recovery or rehabilitation on survival. Subgroup analyses found the inverse association present in every stratum of age, sex, preoperative performance status, and extent of resection, with no significant interactions; the age interaction p value of 0.783 argues against the possibility that the effect simply reflects younger patients walking better.

The study Situates itself against a backdrop of mixed prior evidence. Earlier work had associated balance performance with subsequent loss of walking ability and mortality in glioblastoma, while timed tests such as the ten-meter walk test and the six-minute walk test failed to emerge as independent survival predictors in their respective cohorts. This new study extends the evidence to an assistance-based, non-timed measure, one that can be assigned at the bedside without equipment or patient cooperation with standardized testing. Reliability support came from a substudy of 71 patients in whom a second physical therapist independently assigned discharge FAC ratings, yielding a linear weighted Cohen’s kappa of 0.819, indicating strong agreement for chart-based assessment. Rehabilitation was delivered within an integrated institutional pathway that initiated inpatient rehabilitation typically within three days of surgery and continued it throughout chemoradiotherapy, a context that shaped both the long median hospital stay of 63 days and the timing of the discharge assessment itself.

The investigators are forthright about the limitations that temper interpretation. The retrospective, single-center design, the absence of systematically collected IDH and MGMT molecular data across the historical cohort, possible misclassification under contemporary WHO diagnostic criteria, heterogeneous treatment including upfront bevacizumab, and the inability to model corticosteroid exposure all leave room for residual confounding. The three-group FAC categorization requires external validation, and the incremental gain in discrimination, while real, was modest. The authors accordingly position discharge FAC not as a stand-alone prediction tool or a validated clinical model, but as a practical, complementary bedside marker available precisely at the transition from inpatient treatment to post-discharge care, before further survivor selection accumulates. Within that frame, the message is clear and clinically actionable: in newly diagnosed glioblastoma, how a patient walks on the day they leave the hospital encodes prognostic information that global performance scores alone do not fully convey, and it can be captured with nothing more than an attentive clinical eye. Future multicenter prospective studies, the authors conclude, should validate the finding and explore how walking independence integrates with neurological, oncological, and supportive-care factors in modern, molecularly stratified glioblastoma care.

Subject of Research: Prognostic value of walking ability at hospital discharge for overall survival in newly diagnosed glioblastoma

Article Title: Prognostic significance of walking ability at hospital discharge for overall survival in newly diagnosed glioblastoma: a comparison across six peri-treatment assessments

Article References: Tokiwa, S., Natsume, K., Yoshida, A., Yonezawa, H., Kawamura, K., Nakanishi, K., Higa, N., Hanaya, R., & Shimodozono, M. (2026). Prognostic significance of walking ability at hospital discharge for overall survival in newly diagnosed glioblastoma: a comparison across six peri-treatment assessments. Journal of Neuro-Oncology, 179(2), Article 78. https://doi.org/10.1007/s11060-026-05784-0

Image Credits: AI Generated

DOI: 10.1007/s11060-026-05784-0

Keywords: glioblastoma, walking ability, Functional Ambulation Category, hospital discharge, overall survival, prognosis, Karnofsky Performance Status, rehabilitation, chemoradiotherapy, brain tumor, functional outcomes, neuro-oncology