ObjectivesTo provide an overview of the safety and effectiveness of Hospital-at-Home (HaH) according to programme type (early-supported discharge (ESD) vs admission avoidance (AA)), and identify the model with higher evidence for addressing clinical, length of stay (LOS) and cost outcomes.MethodsA systematic review of reviews was conducted by performing a search on PubMed, EMBASE, Cochrane Database of Systematic Reviews, Web of Science and Scopus (January 2005 to June 2020) for English-language systematic reviews evaluating HaH. Data on primary outcomes (mortality, readmissions, costs, LOS), secondary outcomes (patient/caregiver outcomes) and process indicators were extracted. Quality of the reviews was assessed using Assessment of Multiple Systematic Reviews-2. There was no registered protocol.ResultsTen systematic reviews were identified (four high quality, five moderate quality and one low quality). The reviews were classified according to three use cases. ESD reviews generally revealed comparable mortality (RR 0.92–1.03) and readmissions (RR 1.09–1.25) to inpatient care, shorter hospital LOS (MD −6.76 to −4.44 days) and unclear findings for costs. AA reviews observed a trend towards lower mortality (RR 0.77, 95% CI 0.54 to 1.09) and costs, and comparable or lower readmissions (RR 0.68–0.98). Among reviews including both programme types (ESD/AA), chronic obstructive pulmonary disease reviews revealed lower mortality (RR 0.65–0.68) and post-HaH readmissions (RR 0.74–0.76) but unclear findings for resource use.ConclusionFor suitable patients, HaH generally results in similar or improved clinical outcomes compared with inpatient treatment, and warrants greater attention in health systems facing capacity constraints and rising costs. Preliminary comparisons suggest prioritisation of AA models over ESD due to potential benefits in costs and clinical outcomes. Nonetheless, future research should clarify costs of HaH programmes given the current low-quality evidence, as well as address evidence gaps pertaining to caregiver outcomes and adverse events under HaH care.

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Psychological theory and research suggest that religious individuals could have differences in the appraisal of immoral behaviors and cognitions compared to non-religious individuals. This effect could occur due to adherence to prescriptive and inviolate deontic religious-moral rules and socioevolutionary factors, such as increased autonomic nervous system responsivity to indirect threat.The latter thesis has been used to suggest that immoral elicitors could be processed subliminally by religious individuals. In this manuscript we employed masking to test this hypothesis. We rated and pre-selected IAPS images for moral impropriety. We presented these images masked with and without negatively manipulating a pre-image moral label. We measured detection, moral appraisal and discrimination, and physiological responses. We found that religious individuals experienced higher responsivity to masked immoral images. Bayesian and hit-versus-miss response analyses revealed that the differences in appraisal and physiological responses were reported only for consciously perceived immoral images. Our analysis showed that when a negative moral label was presented, religious individuals experienced the interval following the label as more physiologically arousing and responded with lower specificity for moral discrimination. We propose that religiosity involves higher conscious perceptual and physiological responsivity for discerning moral impropriety but also higher susceptibility for the misperception of immorality.

Our report provides the first compelling evidence of the potential success of a secondary fracture prevention program from an Asian country. The ultimate success of the program will be determined by fracture outcomes and cost effectiveness, but in the interim, clear evidence of enhanced assessment and treatment rates has been demonstrated.

Low back pain (LBP) is a common complaint among patients presenting to emergency department (ED) in Singapore. The STarT Back Screening Tool (SBT) was recently developed and validated for triage of LBP patients in primary care settings. This study aimed to investigate whether the SBT could provide prognostic information for long-term outcomes of acute LBP patients visiting the ED, who might benefit from appropriate and timely management at an earlier stage.Data were collected in a prospective observational cohort study from 177 patients who consulted emergency physicians for acute LBP and completed 6-month follow-up. Patients were administered the SBT and assessed at baseline. Follow-up assessments were conducted at 6 weeks and 6 months.A multiple linear regression model incorporating SBT total score, age, employment status, LBP history, and 6-week pain score was constructed to predict 6-month pain score. In the model, SBT total score and 6-week pain score were significantly associated with 6-month pain score (P < .05) with respective coefficients of 0.125 and 0.500. The model explained 40.1% of the variance for 6-month pain score.This study demonstrated that the multiple linear regression model showed predictive performance in determining long-term outcomes for acute LBP patients presenting to the ED.