In 2008, Sweden changed its labor migration legislation and allowed for labor migrants from non EU/EEA countries to migrate to Sweden, which had been heavily restricted since the 1970s. This shift in labor migration policy is mirrored in Swedish integration policy where the focus in recent years has been on labor market integration. This thesis aims to investigate the sociocultural integration of migrants who are employed and, in the Swedish context, assumed to be integrated. In addition, sociocultural integration is related to employment and length of stay. Sociocultural integration is measured by three indicators: knowledge of Swedish language, having Swedish friends, and membership in organizations. The data was collected through sixteen semi-structured interviews of highly educated migrants with employment in Sweden and analyzed using four integration theories.The study reveals that employed migrants are only partially socioculturally integrated. Respondents presented low levels of Swedish-language knowledge, which can be explained by their short stay in the country as well having international workplaces where mostly English is spoken. However, these workplaces also offer respondents opportunities to meet natives and most respondents met their Swedish friends through work. There is a need for further studies of integration, in particular those that would explore multiple dimensions of integration and incorporate migrants who are already economically integrated.

Thesis advisor: Monica O'Reilly-Jacob / Background: Emergency department crowding (EDC) is a major issue affecting hospitals in the United States and has devastating consequences, including an increased risk of patient mortality. Solutions to address EDC are traditionally focused on adding resources, including increased nurse staffing ratios. However, these solutions largely ignore the value of the experience and expertise that each nurse possesses and how those attributes can impact patient outcomes. This dissertation uses Benner’s Novice to Expert theory of professional development to describe how individual emergency nurse expertise influences patient length of stay in the emergency department and how it can be part of the strategy in addressing EDC.Purpose: The purpose of this program of research was to identify, articulate, and demonstrate a new approach to emergency nurse performance evaluation that integrates patient outcome data and emergency nurse characteristics. Methods: First, in a scoping review, we explored the different approaches to measuring nurse performance using patient outcome data and identified common themes. Second, a concept analysis introduced Emergency Nurse Efficiency as a novel framework to understand how emergency nurses can be evaluated using patient outcome data. Finally, a retrospective correlational study established the association between nurse expertise and emergency patient length of stay. Results: In Chapter Two of this dissertation, the researchers conducted a scoping review of nurse performance metrics and identified twelve articles for inclusion. We identified three themes: the emerging nature of these metrics in the literature, variability in their applications, and performance implications. We further described an opportunity for future researchers to work with nurse leaders and staff nurses to optimize these metrics. In Chapter Three, we performed a concept analysis to introduce a novel metric, called Emergency Nurse Efficiency, that is a measurable attribute that changes as experience is gained and incorporates the positive impact of an individual nurse during a given time while subtracting the negative. Using this measurement to evaluate ED nurse performance could guide staff development, education, and performance improvement initiatives. In Chapter Four, we performed a retrospective correlational analysis and administered an online survey to describe the relationship between individual emergency nurses, and their respective level of expertise, and their patients’ ED LOS. We found that, when accounting for patient-level variables and the influence of the ED physicians, emergency nurses are a statistically significant predictor of their patients’ ED LOS. A higher level of clinical expertise among emergency likely produces a lower ED LOS for their patients, and nurse leaders should seek to better understand these metrics for professional development and quality improvement activities. Conclusions: This dissertation made substantial knowledge contributions to the literature regarding the evaluation of individual emergency nurses and the influence that they have on patient outcomes. It established, first, that the measurement of individual nurse performance is varied and inconsistent; second, that considering emergency nursing as a team activity similar to professional sports results in a conceptual framework that can evaluate individual performance within a group context; and, third, that there is a relationship between the individual emergency nurse and their patients’ ED LOS, and that relationship can be further understood within Benner’s Novice to Expert theoretical model. We recommend that nurse leaders use these data as part of their strategy to decrease EDC. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25157号 / 医博第5043号 / 新制||医||1070(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 石見 拓, 教授 西浦 博, 教授 江木 盛時 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DFAM

Les effets de l'immigration sur les individus comme étant le résultat des influences sociales, culturelles et économiques du nouveau contexte sont très bien connus dans la littérature scientifique. Ainsi, pour ceux qui ont immigré en couple, l'expérience d'immigration les amène à renégocier leurs rôles afin de s'ajuster aux conditions du nouvel environnement. Cette renégociation apporte des changements dans la répartition du pouvoir conjugal et permet l'adaptation de chacun des partenaires à la nouvelle société ainsi que le retour à l'équilibre dans le couple. Cependant, cette adaptation ne se fait pas de façon uniforme entre les hommes et les femmes. La présente recherche vise à prédire les changements dans la répartition du pouvoir conjugal au sein de trente couples d'origine colombienne ayant immigré à Montréal, en fonction de la durée de séjour et de leur degré d'identification à la société d'accueil (Canada et Québec). Le pouvoir conjugal est évalué dans cette étude selon la perception des membres du couple face à leurs responsabilités respectives lors de la prise de décisions globale ainsi que dans quatre catégories spécifiques, avant et après avoir immigré à Montréal. À propos de la durée de séjour, les données obtenues révèlent que, pour les femmes, le temps vécu dans la société d'accueil permet de prédire des changements dans la répartition du pouvoir conjugal. Ces résultats confirment aussi que ces changements favorisent l'augmentation du pouvoir des femmes au sein du couple dans deux des quatre catégories, soit « loisirs et activités sociales » et « soins et éducation des enfants ». Cependant, la perception des femmes n'est pas partagée par les hommes ; pour les hommes, le temps passé dans la société d'accueil ne permet pas de prédire des changements dans la répartition du pouvoir conjugal. Concernant le degré d'identification, nos données révèlent que, pour les femmes interviewées, l'identification au Canada peut prédire des changements dans la répartition du pouvoir conjugal au niveau global. En ce qui concerne le degré d'identification au Québec, celui-ci permet de prédire des changements dans la répartition du pouvoir conjugal dans la catégorie « soins et éducation des enfants », tant chez les hommes que chez les femmes. / The effects of immigration on individuals as the result of social, cultural and economic influences of the new context are well known in the scientific literature. So for those who immigrated as a couple, the immigration experience leads them to renegotiate their roles in order to adjust to the conditions of the new environment. This renegotiation makes changes in the distribution of marital power and allows the adaptation of the partners in the new society and the return to balance in the couple. However, this adaptation is not done evenly between men and women. This research aims to predict changes in the distribution of marital power among a group of thirty Colombian couples who immigrated to Montreal, depending on length of stay and degree of identification with the host society (Canada and Quebec). Marital power is evaluated in this study according to the perception of the partners about their responsibilities in making global decisions and in four specific categories before and after immigrating to Montreal. About the length of stay, the data obtained show that, for women, the time lived in the host society predicts changes in the distribution of marital power. These results also confirm that these changes favour the empowerment of women within the couple in two of four categories: « leisure time and social activities » and « care and education of children ». However, the perception of women is not shared by men ; for men, the time spent in the host society does not predict changes in the distribution of marital power. Regarding the degree of identification, our data show that for the women interviewed, identification with Canada can predict changes in the distribution of marital power globally. Regarding the degree of identification with Quebec, it predicts changes in the distribution of marital power in the « care and education of children » category for both men and women.

Aim: The overall objective of the present thesis was to describe and assess the importance and impact of visits by the patients’ families in an ICU, from patient and family perspectives, and to develop, from a hermeneutic perspective, a research method to study the interplay between patient and family during the visit. Method: The comprehensive methodology of the thesis was hermeneutic. Qualitative as well as quantitative methods were applied to elucidate the issues at stake. In paper I, 198 patients were consecutively included, and data were statistically analysed to establish patient mortality and length of stay at the hospital, in relation to visits of families in the ICU. In paper II, ten patients and 24 visitors were observed during visits. In paper III, seven patients and five relatives were interviewed about their memories of the visits in the ICU. Field notes from the observations, and the interviews with patients and relatives, were interpreted and analysed inspired by Gadamer’s hermeneutic philosophy. Paper IV represents a theoretical discourse, and presents methodological aspects of the hermeneutic interpretation of data from the observations. Results: There were no significant differences between the patients having visitors and those who did not. The patient group with no visits comprised 25 %; they were older, and lived in single households, which contrasted to the patient group having visitors. Analyses of the three clinical studies revealed four themes. The themes relate to the meaning of visiting for patients and their relatives, and are as follows: the visit means to see and realize, to guard and watch, to meet, and to sacrifice. The caring entails that you witness and see with your own eyes, and that you feel a communion with the sick. From the patient perspective, the visit signifies that you are confirmed, empowering you to fight to get back to life. Communion and availability in conjunction enable an individual to achieve a thorough involvement with another being. The results of study IV disclosed that what you observe is depending on your theoretical view. If you see from your heart, you interpret from your heart. Conclusions: The conclusions drawn from the studies of the present thesis are that opportunities to create a presence in the community - a communion - between patients, relatives, and carers, are at want. The present fundamental view of caring in intensive care units is in need of change, in order to create optimal conditions for a communion. Visits need to be regarded as an essential part of caring, and relatives’ visits ought to be facilitated and encouraged. Furthermore, visits are important both for patients and their relatives, as sharing the event of critical illness, in the sense of sharing the suffering, the healing, and the restoration of health, is considered a precondition for their recovery. Care should be organized around the patients and their families. Families and patients bring their fellow stories of life, including values and beliefs, thereby increasing the probability of dignified individualized care. / <p>Akademisk avhandling som för avläggande av filosofie doktorsexamen vid Sahlgrenska akademin vid Göteborgs universitet kommer att offentligt försvaras i hörsal 2118, Institutionen för vårdvetenskap och hälsa, Arvid Wallgrens backe, Hus 2, Göteborg, fredagen den 19 oktober 2012 kl. 09.00</p>

Title: Effect of physiotherapy to reduce the length of hospital stay in patients with total hip arthroplasty: a literature review Objective: The purpose of this thesis is to research and compare available studies investigating the effect of extra physiotherapy in reducing the length of stay for patients with total hip arthroplasty. In addition, to make a compilation of available sources about issue of the hip, total hip arthroplasty in terms of anatomy, kinesiology and biomechanics and length of hospital stay. Methods: This diploma thesis has descriptively-analytical character and is structured in the form of literary review. Results: Physiotherapy decreases length of stay in patients with total hip arthroplasty. Future research could address a specific group of subjects and the issue of cost-effectiveness in reducing the length of hospital stay by physiotherapy. Key words: Hip joint, total joint replacement, THA, physiotherapy, length of stay

No description available.

Sepse é causa comum de óbito, e vários fatores prognósticos têm sido identificados. Entretanto, é possível que a rota do paciente séptico no hospital também tenha efeito sobre o prognóstico. Nosso objetivo foi verificar se a rota do paciente séptico antes da admissão na UTI tem efeito sobre a letalidade hospitalar. Métodos Foi realizado um estudo de coorte retrospectiva com 489 pacientes com sepse grave ou choque séptico (idade >=18 anos), internados na Unidade de Terapia Intensiva. Analisamos se a rota está associada a mortalidade hospitalar usando modelo de regressão de Cox com variância robusta. Resultados Dos 489 pacientes, 207 (42,3%) foram diagnosticados com sepse na Unidade de Pronto Atendimento (UPA), 185 (37,8%) em unidade de internação clínica ou cirúrgica (Clínica Médica Cirúrgica - CMC), 56 (13,3%) em Unidade Semi-Intensiva (USI) e 32 (6,5%) em Unidade Terapia Intensiva.(UTI). A maioria (56,6%) dos pacientes era do sexo masculino, a idade média foi de 66,3 anos, 39,8% tinham APACHE II de 25 ou mais, e 77,5% tinham o diagnóstico de choque séptico. A letalidade foi 41,9%. Na análise multivariada com ajuste para diversos fatores prognósticos, incluindo tempo de internação hospitalar antes da admissão na UTI, não houve diferença estatisticamente significativa no risco de óbito entre pacientes com sepse grave diagnosticada na UPA ou CMC (risco relativo [RR] 1,36; intervalo de confiança [IC] 95% 1,00 a 1,83). Porém, o risco de óbito hospitalar foi maior nos pacientes em que a sepse grave foi diagnosticada na USI ou UTI (RR 1,64; IC 95% 1,20 a 2,25). Conclusão A mortalidade dos pacientes com sepse grave ou choque séptico atendidos na CMC é similar à de pacientes com sepse diagnosticada na UPA. Entretanto, o risco de óbito hospitalar foi maior nos pacientes que desenvolveram sepse na USI ou UTI / Sepsis is a common cause of death. Several predictors of hospital mortality have been identified. However, it is possible that the route the septic patient takes within the hospital may also affect endpoints. Thus, our main objective was to verify whether the routes of septic patients before being admitted to ICU affect their in-hospital mortality. Methods Retrospective cohort study of 489 patients with severe sepsis or septic shock (age >= 18 years) admitted to the Intensive Care Unit. We analyzed the impact of route on in-hospital mortality using Cox regression with robust variance. Results Of 489 patients, 207 (42.3%) presented with severe sepsis in the ED, 185 (37.8%) were diagnosed with severe sepsis in the ward, 56 (13.3%) in the step down unit and 32 (6.5%) in the ICU. The mortality rate was 41.9%. The mean age was 66.3 years, and 56.6% were men. APACHE II scores were >25 in 39.8% of patients, and 77.5% were diagnosed with septic shock. In the multivariate analysis, with adjustment for several prognostic factors including length of hospital stay before ICU admission, there was no statistically significant difference in the risk of death between patients who had severe sepsis diagnosed in the ED compared to CMC (relative risk [RR] 1,36; IC 95% 1,00 a 1,83). However, the risk of death was increased in patients who had severe sepsis diagnosed in the step-down unit or ICU (RR 1,64; IC 95% 1,20 a 2,25). Conclusion Patients who have severe sepsis or septic shock diagnosed in the CMC have in-hospital mortality similar to those who present with severe sepsis or septic shock in the ED. However, patients who develop severe sepsis in the step-down unit or ICU have higher mortality

INTRODUÇÃO: O diagnóstico do estado nutricional por rastreamento e avaliação nutricional permite detectar desnutrição e se associa com desfechos clínicos negativos em pacientes adultos hospitalizados. OBJETIVO: Identificar o teste mais adequado para avaliação de risco e estado nutricional em relação a desfechos clínicos negativos em pacientes adultos hospitalizados; e investigar a complementaridade existente entre os testes de rastreamento (NRS 2002) e avaliação nutricional (SGA). MÉTODOS: Estudo prospectivo, sequencial, não intervencionista, realizado em 705 pacientes adultos de ambos os sexos, de distintas enfermarias, no Instituto Central do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Em até 48 horas da admissão aplicou-se em todos os pacientes quatro testes de rastreamento e avaliação nutricional (NRS 2002: Triagem de Risco Nutricional 2002, MUST: Triagem Universal de Risco Nutricional, MNA-SF: Mini Avaliação Nutricional Reduzida, e SGA: Avaliação Subjetiva Global). Os pacientes foram seguidos até o desfecho final, obtendo-se as intercorrências clínicas de complicações, tempo de internação prolongado e mortalidade. Analisou-se o desempenho de todos os testes por curvas ROC (Receiver Operating Characteristic Curve) e razão de verossimilhança (LR). Verificou-se a complementaridade entre NRS 2002 e SGA por regressão logística e o número necessário de pacientes a avaliar para encontrar um desfecho negativo (NNS). RESULTADOS: NRS 2002 detectou 27,9% (n=197) de risco nutricional, MUST 39,6% (n=279), MNA-SF 73,2% (n=516) e SGA indicou 38,9% de desnutrição moderada e grave (n=274). Os testes NRS 2002 e SGA mostraram melhor desempenho em predizer desfechos clínicos negativos que MUST e MNA-SF pela curva ROC. NRS 2002 apresentou LR positiva maior que os demais testes para todos os desfechos clínicos. Segundo a regressão logística, 13% (IC 10,0- 17,0%) dos doentes podem ter tempo de internação prolongado, 9% (IC 7,0- 12,0%) complicação moderada ou grave e 1% (IC 0,3 - 2,1%) mortalidade. Para tempo de internação prolongado, os pacientes desnutridos por SGA, classe B (SGA B) aumentam esta probabilidade em 1,9 vezes (IC 1,2-3,2 vezes, p=0,008) e SGA classe C (SGA C) em 3,8 vezes (IC 2,0-7,2 vezes, p<0,0001). Para pacientes em risco nutricional por NRS 2002 (NRS+), a probabilidade de complicação moderada e grave aumenta em 1,9 vezes (IC 1,1-3,5 vezes, p=0,03), em 1,9 vezes (IC 1,1-3,4 vezes, p=0,02) para doentes SGA B e em 17,8 vezes (IC 1,4-5,8 vezes, p=0,003) para doentes SGA C. A probabilidade para mortalidade aumenta em 3,9 vezes (IC 1,2- 13,1 vezes, p=0,03) para pacientes NRS+. O NNS calculado para todos os desfechos clínicos negativos em pacientes NRS+ & SGA C (em risco nutricional por NRS 2002 e desnutridos graves pela SGA) foi menor que para os testes isolados. CONCLUSÕES: NRS 2002 é o melhor teste de rastreamento nutricional. A aplicação de SGA em doentes sob risco nutricional por NRS 2002 aumenta a capacidade de predição de desnutrição em relação a desfechos clínicos negativos. / INTRODUCTION: The diagnosis of nutritional status by nutritional screening and assessment tools detects malnutrition and is associated with negative clinical outcomes in adult hospitalized patients. OBJECTIVE: To identify the most appropriate tool for analysis of nutritional risk and malnutrition in relation to adverse clinical outcomes in adult hospitalized patients, and to investigate the complementarity of the nutritional screening (NRS 2002) and nutritional assessment (SGA) tests. METHODS: A prospective, sequential, non-interventional study, conducted in 705 adult patients of both sexes, from different wards in the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Within 48 hours of admission, all the patients were submitted to four nutritional screening and assessment tests (NRS 2002: Nutritional Risk Screening 2002, MUST: Malnutrition Universal Screening Tool, MNA-SF: Mini Nutritional Assessment Short Form and SGA: Subjective Global Assessment). Patients were followed until the final outcome, obtaining clinical outcomes of complications, length of hospital stay and death. The performance of the tests was analyzed by the ROC (Receiver Operating Characteristic) curve and likelihood ratio (LR). The complementarity of screening and assessment tools was analyzed by logistic regression, and the number of patients required to screen was obtained by calculating the number needed to screen (NNS). RESULTS: NRS 2002 detected 27.9% (n = 197) of nutritional risk, MUST 39.6% (n = 279), MNA-SF 73.2% (n = 516), and SGA detected moderate or severe malnutrition in 38.9% of the patients (n = 274). NRS 2002 and SGA had a better performance in predicting adverse clinical outcomes than MUST and MNA-SF confirmed by ROC curve. NRS 2002 had higher positive LR compared to the other tests for all the clinical outcomes. According to the logistic regression analysis, 13% (CI 10.0-17.0%) of the patients may have length of hospital stay, 9% (CI 7.0-12.0%) moderate or severe complications and 1% (CI 0.3 - 2.1%) mortality. For length of hospital stay, malnourished patients by SGA, class B (SGA B) increase this probability in 1.9 times (CI 1.2-3.2 times, p = 0.008) and SGA class C (SGA C) in 3.8 times (CI 2.0-7.2 times, p <0.0001). For patients nutritionally at risk by NRS 2002 (NRS +), the probability of moderate and severe complication increase in 1.9 times (CI 1.1-3.5 times, p = 0.03), in 1.9 times (CI 1.1-3.4 times, p = 0.02) for SGA B patients and 17.8 times (CI 1.4-5.8 times, p = 0.003) for SGA C patients. The probability of mortality increase in 3.9 times (CI 1.2-13.1 times, p = 0.03) for NRS+ patients. The NNS calculated for all adverse clinical outcomes in patients NRS+ & SGA C (at nutritional risk by NRS 2002 and severe malnourished by SGA), was lower than for the test separately. CONCLUSIONS: NRS 2002 is the best test for nutritional risk screening. The application of SGA in nutritionally at risk patients by NRS 2002 increases the predictive capacity of malnutrition in relation to adverse clinical outcomes.

Diversos serviços de saúde no Brasil vem apresentado episódios de superlotação, em um contexto onde os recursos são limitados. A redução do tempo de permanência em internações hospitalares tem como consequência direta a disponibilização de mais leitos-dia. O gerenciamento e melhoria do fluxo de pacientes ao longo das internações hospitalares é importante, sendo que o uso eficiente dos leitos pode acontecer devido a uma série de fatores. Estudos demonstram que equipes multidisciplinares podem realizar uma assistência de qualidade, reduzindo custos e o tempo em que os pacientes permanecem internados, sem impacto na reinternação ou mortalidade. Também há trabalhos que apontam a eficácia de unidades dedicadas ao atendimento de doenças específicas. A admissão de pacientes dentro de critérios bem definidos aumenta o giro de leitos. Com o objetivo de analisar se a equipe multidisciplinar Medicina Interna – Emergência (MIE) poderia contribuir para a redução do tempo de permanência hospitalar dos pacientes portadores de doenças prevalentes, sem alterar os indicadores de reinternação e mortalidade, o presente estudo experimental, controlado, não-randomizado, comparou o período pré e pós-intervenção, ou seja, a criação de uma Unidade de Curta Permanência no Serviço de Medicina Interna, do Hospital de Clínicas de Porto Alegre (HCPA). Foram analisadas internações ocorridas através da Emergência do HCPA, de pacientes com 14 anos ou mais, com as doenças prevalentes classificadas conforme grupos do CID-10 (J09-J018; J40-J47; N30-N39; I30-I52; I60-I69; B20-B24; C15-C26; A30-A49; e E10-E14), no período compreendido entre 01 de dezembro de 2008 a 30 de novembro de 2010 (n = 11040). Os resultados do estudo demonstram que após a criação da equipe E-MEI e a sua unidade de curta permanência, houve uma redução do tempo de permanência dos pacientes internados pelas causas selecionadas (antes: 10,89 ± 13,17 dias, após: 9,47 ± 11,24 dias, p = 0,006), e uma diminuição mais acentuada nas internações do Serviço de Medicina Interna [antes (n = 680): 14,33 ± 14,57 dias, após (n = 1243): 9,77 ± 10,62 dias, p = 0,000]. Não ocorreu alteração na taxa de mortalidade de todos os pacientes admitidos para as causas selecionadas [antes (n = 3800): 11,3%, após (n = 3958): 11,8% p = 0,123]. Também não houve alteração na taxa de reinternação de 7 dias na amostra estudada [antes (n = 3369): 7,2%, depois de (n = 3491): 6,7%, p = 0,407]. / Several health services in Brazil has shown episodes of overcrowding, in a context where resources are limited. Reducing the length of stay in hospital has as a direct consequence the provision of more beds-day. Managing and improving the flow of patients throughout the hospital is important, and the efficient use of beds can happen due to a number of factors. Studies have shown that multidisciplinary teams can perform quality care, reducing costs and the time patients remain hospitalized, with no impact on mortality or rehospitalization. There are also studies that show the effectiveness of units dedicated to the treatment of specific diseases. The admission of patients into well-defined criteria increases the turnover of beds. With the objective of analyzing the multidisciplinary team Internal Medicine – Emergency, could help to reduce the length of hospital stay of patients with diseases prevalent, without changing the indicators of rehospitalization and mortality, the present study experimental, controlled, not -randomized study compared the pre-and post-intervention, ie the creation of a Short Stay Unit in the Department of Internal Medicine, Hospital de Clinicas de Porto Alegre (HCPA). We analyzed hospital admissions through the Emergency HCPA, for patients aged 14 years or older with prevalent disease groups classified according to the ICD-10 (J09-J018, J40-J47, N30-N39, I30-I52, I60-I69; B20-B24, C15-C26, A30-A49, and E10-E14), during the period from December 1, 2008 to November 30, 2010 (n = 11,040). The study results show that after the creation of the multidisciplinary team, and its Short Stay Unit, there was a reduction in the length of stay of inpatients by selected causes (before: 10.89 ± 13.17 days after: 9 47 ± 11.24 days, p = 0.006) and a greater reduction in hospitalizations Service of Internal Medicine [before (n = 680): 14.33 ± 14.57 days after (n = 1243): 9, 77 ± 10.62 days, p = 0.000]. No change in the mortality rate of all patients admitted to selected causes [before (n = 3800): 11.3% after (n = 3958): 11.8% p = 0.123]. There was also no change in the rate of readmission than 7 days in our sample [before (n = 3369): 7.2% after (n = 3491): 6.7%, p = 0.407].