Care Wards Research Articles

Modelling COVID-19 Vaccination in the UK: Impact of the Autumn 2022 and Spring 2023 Booster Campaigns.

The delivery of COVID-19 vaccines was successful in reducing hospitalizations and mortality. However, emergence of the Omicron variant resulted in increased virus transmissibility. Consequently, booster vaccination programs were initiated to decrease the risk of severe disease and death among vulnerable members of the population. This study aimed to estimate the effects of the booster program and alternative vaccination strategies on morbidity and mortality due to COVID-19 in the UK. A Susceptible-Exposed-Infectious-Recovered (SEIR) model was used to assess the impact of several vaccination strategies on severe outcomes associated with COVID-19, including hospitalizations, mortality, National Health Service (NHS) capacity quantified by hospital general ward and intensive care unit (ICU) bed days, and patient productivity. The model accounted for age-, risk- and immunity-based stratification of the UK population. Outcomes were evaluated over a 48-week time horizon from September 2022 to August 2023 considering the actual UK autumn 2022/spring 2023 booster campaigns and six counterfactual strategies. The model estimated that the autumn 2022/spring 2023 booster campaign resulted in a reduction of 18,921hospitalizations and 1463 deaths, compared with a no booster scenario. Utilization of hospital bed days due to COVID-19 decreased after the autumn 2022/spring 2023 booster campaign. Expanding the booster eligibility criteria and improving uptake improved all outcomes, including averting twice as many ICU admissions, preventing more than 20% additional deaths, and a sevenfold reduction in long COVID, compared with the autumn 2022/spring 2023 booster campaign. The number of productive days lost was reduced by fivefold indicating that vaccinating a wider population has a beneficial impact on the morbidities associated with COVID-19. Our modelling demonstrates that the autumn 2022/spring 2023 booster campaign reduced COVID-19-associated morbidity and mortality. Booster campaigns with alternative eligibility criteria warrant consideration in the UK, given their potential to further reduce morbidity and mortality as future variants emerge.

Knowledge, Attitude, and Practices Toward Kangaroo Mother Care Among Mothers in a Tertiary Neonatal Care Unit

Aim: To study the knowledge, attitude, and practices of Kangaroo Mother Care (KMC) among eligible postnatal mothers in the postnatal ward (PNW) and neonatal intensive care unit (NICU) of a tertiary neonatal unit in Eastern India. Methods: A cross-sectional survey was conducted among 100 mothers of low-birth-weight babies in our PNW and NICU. As part of the unit protocol, all mothers of eligible babies were counseled about KMC at first contact verbally as well as by using an informative video on KMC. Data was collected using a structured questionnaire after the routine counseling of the mothers on their first visit after delivery. The analysis of the data was done using appropriate statistics. Results: More than three-fourths (83.2%) of mothers had good knowledge of KMC. A good attitude toward using KMC was found in 91.6% of the mothers. Almost all the mothers (98%) knew the correct KMC position, and 12% of mothers had a previous preterm baby and had given KMC. Many mothers felt the small size of the baby, pain after cesarean section, and central or peripheral intravenous lines in the baby were barriers to KMC. Conclusion: The knowledge regarding KMC among mothers whose babies were admitted into the PNW/NICU was good. Though the attitude toward KMC was good, mothers felt there were multiple barriers to initiating KMC.

Prevalence of hypophosphatemia in children with diabetic ketoacidosis and treatment with subcutaneous regular insulin. Observational study

To estimate the incidence of hypophosphatemia in children with DKA, treated with subcutaneous regular insulin (IRS), and to explore factors associated with this complication. Prospective, observational study. Patients diagnosed with DKA hospitalized in the general care ward were included. Data on phosphatemia, glycemia, acid-base status, and IRS amount (U/kg) received were recorded at baseline and after 24 h of treatment. Hypophosphatemia was defined as values below 2.5 mg/dl. The correlation between initial phosphate and at 24 h of treatment was evaluated; the incidence of hypophosphatemia at 24 h was expressed as a percentage of the total number of patients. 30 patients were included, 15 were female, mean age 11.4 ± 3.2 years. At 24 h of treatment with IRS, 36.7% (95%CI 22-55%) presented hypophosphatemia, mean value 1.9 ± 1.5 mg/dl. Initial bicarbonate < 10 mmol/L acted as a predictor of hypophosphatemia (OR 7.5; 95%CI 1.4-39.8%; p = 0.01). No patient required intravenous phosphate correction, and no associated clinical complications were observed. In the group studied, the incidence of hypophosphatemia reached 36.7% at 24 hours of treatment. Initial bicarbonate lower than 10 mmol/L was significantly associated with hypophosphatemia. No complications associated with hypophosphatemia were observed.

Effects of the nursing practice environment, nurse staffing, patient surveillance and escalation of care on patient mortality: A multi-source quantitative study

BackgroundA favourable nursing practice environment and adequate nurse staffing have been linked to reduced patient mortality. However, the contribution of nursing care processes such as patient surveillance and escalation of care, on patient mortality is not well understood. ObjectiveThe aim of this study was to investigate the effect of the nursing practice environment, nurse staffing, missed care related to patient surveillance and escalation of care on 30-day inpatient mortality. DesignA multi-source quantitative study including a cross-sectional survey of nurses, and retrospective data extracted from an audit of medical and admission records. Setting(s)A large tertiary teaching hospital (600 beds) in metropolitan Sydney, Australia. MethodsData on the nursing practice environment, nurse staffing and missed care were obtained from the nursing survey. Patient deterioration data and patient outcome data were collected from the medical and admission records respectively. Logistic regression models were used to examine the association between the nursing practice environment, patient deterioration and 30-day inpatient mortality accounting for clustering of episodes within patients using generalised estimating equations. ResultsSurveys were completed by 304 nurses (84.5 % female, mean age 34.4 years, 93.4 % Registered Nurses) from 16 wards. Patient deterioration data was collected for 30,011 patient deterioration events and 63,847 admitted patient episodes of care. Each additional patient per nurse (OR = 1.22, 95 % CI = 1.04–1.43) and the presence of increased missed care for patient surveillance (OR = 1.13, 95 % CI = 1.03–1.23) were associated with higher risk of 30-day inpatient mortality. The use of a clinical emergency response system reduced the risk of mortality (OR = 0.82, 95 % CI = 0.76–0.89). A sub-group analysis excluding aged care units identified a 38 % increase in 30-day inpatient mortality for each additional patient per nurse (OR = 1.38, 95 % CI = 1.15–1.65). The nursing practice environment was also significantly associated with mortality (OR = 0.79, 95 % CI: 0.72–0.88) when aged care wards were excluded. ConclusionsPatient mortality can be reduced by increasing nurse staffing levels and improving the nursing practice environment. Nurses play a pivotal role in patient safety and improving nursing care processes to minimise missed care related to patient surveillance and ensuring timely clinical review for deteriorating patients reduces inpatient mortality. Tweetable abstractPatient mortality can be reduced by improving the nursing practice environment & increasing the number of nurses so that nurses have more time to monitor patients. Investing in nurses results in lower mortality and better outcomes. #PatientSafety #NurseStaffing #WorkEnvironment #Mortality.

Integrating Explainable Machine Learning in Clinical Decision Support Systems: Study Involving a Modified Design Thinking Approach.

Though there has been considerable effort to implement machine learning (ML) methods for health care, clinical implementation has lagged. Incorporating explainable machine learning (XML) methods through the development of a decision support tool using a design thinking approach is expected to lead to greater uptake of such tools. This work aimed to explore how constant engagement of clinician end users can address the lack of adoption of ML tools in clinical contexts due to their lack of transparency and address challenges related to presenting explainability in a decision support interface. We used a design thinking approach augmented with additional theoretical frameworks to provide more robust approaches to different phases of design. In particular, in the problem definition phase, we incorporated the nonadoption, abandonment, scale-up, spread, and sustainability of technology in health care (NASSS) framework to assess these aspects in a health care network. This process helped focus on the development of a prognostic tool that predicted the likelihood of admission to an intensive care ward based on disease severity in chest x-ray images. In the ideate, prototype, and test phases, we incorporated a metric framework to assess physician trust in artificial intelligence (AI) tools. This allowed us to compare physicians' assessments of the domain representation, action ability, and consistency of the tool. Physicians found the design of the prototype elegant, and domain appropriate representation of data was displayed in the tool. They appreciated the simplified explainability overlay, which only displayed the most predictive patches that cumulatively explained 90% of the final admission risk score. Finally, in terms of consistency, physicians unanimously appreciated the capacity to compare multiple x-ray images in the same view. They also appreciated the ability to toggle the explainability overlay so that both options made it easier for them to assess how consistently the tool was identifying elements of the x-ray image they felt would contribute to overall disease severity. The adopted approach is situated in an evolving space concerned with incorporating XML or AI technologies into health care software. We addressed the alignment of AI as it relates to clinician trust, describing an approach to wire framing and prototyping, which incorporates the use of a theoretical framework for trust in the design process itself. Moreover, we proposed that alignment of AI is dependent upon integration of end users throughout the larger design process. Our work shows the importance and value of engaging end users prior to tool development. We believe that the described approach is a unique and valuable contribution that outlines a direction for ML experts, user experience designers, and clinician end users on how to collaborate in the creation of trustworthy and usable XML-based clinical decision support tools.

Bedside-teaching on dementia and delirium: Development, implementation, and evaluation in an acute care hospital

Bedside-teaching on dementia and delirium: Development, implementation, and evaluation in an acute care hospital Abstract: Background: Demographic change and the accompanying increase in people with dementia and delirium in acute care hospitals pose growing challenges for nurses in acute care wards. Objective: Pilot implementation and evaluation of knowledge gain and implementation of previously defined critical behaviors. Method: Implementation of the training by APNs. Parallel evaluation of the training along the New World Kirkpatrick model using questionnaires and non-participant observation. Analysis of the data using descriptive statistics. Results: The training itself was well evaluated by the participants. It showed an increase in knowledge of the participants in the main topic categories. The targeted critical behaviors were implemented for the most part. There are deficiencies in the mapping of interventions in the nursing care process. Conclusion: The training concept is suitable to give nurses confidence in dealing with people with dementia and delirium. Continuous support in practice is needed to maintain the interventions in the long term and sustainably in everyday life.

Impact on Hospital Resource Utilization of Endoluminal Bypass Using the Viabahn Endoprosthesis with Heparin Bioactive Surface Compared With Surgical Femoropopliteal Bypass.

To assess the impact of heparin-bonded endoprosthesis compared with femoropopliteal bypass on key hospital resources and revenues up to 1-year follow-up. A 2-arm scenario resource consumption data analysis was modeled based on a multicentre prospective randomized controlled trial. Six centers in the Netherlands. A total of 100 patients were assigned to 2 arms (50 each arm). The first arm evaluated endovascular treatment using the heparin-bonded Viabahn endoprosthesis and the second the femoropopliteal bypass. Resource consumption rates were compared between arms. Resource consumption rates, including hospital stay for bypass procedure, operating room time, type of anesthesia, number of used (endo)grafts, use of different types of bed locations (vascular ward, medium or intensive care), readmission for wound infections, and reinterventions over a period of 12 months. Endovascular repair used fewer hospital resources, with an overall difference of €149.983. Hospital stay was 118 days less (261 vs 379), including 21 fewer days in medium/intensive care (5 vs 26) and 50 fewer operating room hours (100 vs 150). Fewer patients required general anesthesia (31 vs 39), and there were less surgical site infections (3 vs 12). In the surgical bypass group, there were 18 fewer days of hospital stay related to reinterventions (80 vs 62), and the cost of the devices was €309.996, cheaper. The total monetary difference was € 160.013, in favor of the femoropopliteal bypass (€3.200, per patient). Endovascular repair of the superficial femoral artery reduces the use of valuable hospital resources. Its major limitation is the cost of the devices, which should be balanced against the reduction in peri-procedural morbidity and faster recovery. In the context of shortage of hospital beds, it offers capacity benefits, allowing for the treatment of more patients overall. These benefits may outweigh the fewer reinterventions in the surgical bypass group. The SuperB Trial was registered in clinicaltrials.gov; NCT-ID: NCT01220245. Modeling is a useful technique to predict the impact of treatment modalities on hospital resources and revenue. This study uses real-world data from the SuperB Trial to compare two treatment strategies of superficial femoral artery disease, reflecting actual clinical practice and patient outcomes. The analysis focused on direct costs associated with hospital resources and device usage without considering indirect costs or long-term cost-effectiveness. The analysis showed that endovascular repair reduces the use of valuable hospital resources. Its major limitation is device costs, which should be balanced against the reduction in peri-procedural morbidity and faster recovery. In the context of shortage of hospital beds, it offers capacity benefits, allowing for the treatment of more patients overall.

Outbreak of Streptococcus pyogenes emm89 ST646 in a head and neck surgical oncology ward.

This study describes an outbreak of Streptococcus pyogenes that occurred in a ward caring for patients with head and neck cancer and tracheostomies. Many cases of invasive infections occurred in a short period, and extensive empiric antimicrobial administration on patients and healthcare workers was performed to control the outbreak. Whole-genome sequencing analysis of the causative strains confirmed that it was a monoclonal transmission of strains belonging to emm89/clade 3. The epidemiology and clinical characteristics of S. pyogenes infections have changed with the replacement of the prevalent clones worldwide. In the 1980s, there was a reemergence of S. pyogenes infections in high-income countries due to the spread of hypervirulent emm1 strains. emm89/clade 3 has recently been spreading worldwide and shares common features with emm1, including increased production of two toxins, NADase, and streptolysin O. The outbreak reported here may reflect the high spreading potential and virulence of emm89/clade 3.

High-flow nasal oxygen in resource-constrained, non-intensive, high-care wards for COVID-19 acute hypoxaemic respiratory failure: Comparing outcomes of the first v. third waves at a tertiary centre in South Africa.

High-flow nasal oxygen (HFNO) is an accepted treatment for severe COVID-19-related acute hypoxaemic respiratory failure (AHRF). To determine whether treatment outcomes at Groote Schuur Hospital, Cape Town, South Africa, during the third COVID-19 wave would be affected by increased institutional experience and capacity for HNFO and more restrictive admission criteria for respiratory high-care wards and intensive care units. We included consecutive patients with COVID-19-related AHRF treated with HFNO during the first and third COVID-19 waves. The primary endpoint was comparison of HFNO failure (composite of the need for intubation or death while on HFNO) between waves. A total of 744 patients were included: 343 in the first COVID-19 wave and 401 in the third. Patients treated with HFNO in the first wave were older (median (interquartile range) age 53 (46 - 61) years v. 47 (40 - 56) years; p<0.001), and had higher prevalences of diabetes (46.9% v. 36.9%; p=0.006), hypertension (51.0% v. 35.2%; p<0.001), obesity (33.5% v. 26.2%; p=0.029) and HIV infection (12.5% v. 5.5%; p<0.001). The partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2 /FiO2 ) ratio at HFNO initiation and the ratio of oxygen saturation/FiO2 to respiratory rate within 6 hours (ROX-6 score) after HFNO commencement were lower in the first wave compared with the third (median 57.9 (47.3 - 74.3) mmHg v. 64.3 (51.2 - 79.0) mmHg; p=0.005 and 3.19 (2.37 - 3.77) v. 3.43 (2.93 - 4.00); p<0.001, respectively). The likelihood of HFNO failure (57.1% v. 59.6%; p=0.498) and mortality (46.9% v. 52.1%; p=0.159) did not differ significantly between the first and third waves. Despite differences in patient characteristics, circulating viral variant and institutional experience with HFNO, treatment outcomes were very similar in the first and third COVID-19 waves. We conclude that once AHRF is established in COVID-19 pneumonia, the comorbidity profile and HFNO provider experience do not appear to affect outcome. What the study adds. This study adds to the body of evidence demonstrating the utility of high-flow nasal oxygen (HFNO) in avoiding invasive mechanical ventilation (IMV) in patients with severe COVID-19 hypoxaemic respiratory failure, and shows that this utility remained consistent across different waves of the COVID-19 pandemic.Implications of the study. In resource-constrained settings, HFNO is a feasible non-invasive alternative to IMV and can be employed with favourable and consistent outcomes outside traditional critical care wards. It also confirms that the degree of gas exchange abnormality, and not pre-existing patient-related factors, circulating wave variant or provider experience, is the main predictor of HFNO failure.

Facilitators and barriers of implementing end-of-life care volunteering in a hospital in five European countries: the iLIVE study

BackgroundEnd-of-life (EoL) care volunteers in hospitals are a novel approach to support patients and their close ones. The iLIVE Volunteer Study supported hospital volunteer coordinators from five European countries to design and implement an EoL care volunteer service on general wards in their hospitals. This study aimed to identify and explore barriers and facilitators to the implementation of EoL care volunteer services in the five hospitals.MethodsVolunteer coordinators (VCs) from the Netherlands (NL), Norway (NO), Slovenia (SI), Spain (ES) and United Kingdom (UK) participated in a focus group interview and subsequent in-depth one-to-one interviews. A theory-inspired framework based on the five domains of the Consolidated Framework for Implementation Research (CFIR) was used for data collection and analysis. Results from the focus group were depicted in radar charts per hospital.ResultsBarriers across all hospitals were the COVID-19 pandemic delaying the implementation process, and the lack of recognition of the added value of EoL care volunteers by hospital staff. Site-specific barriers were struggles with promoting the service in a highly structured setting with many stakeholders (NL), negative views among nurses on hospital volunteering (NL, NO), a lack of support from healthcare professionals and the management (SI, ES), and uncertainty about their role in implementation among VCs (ES). Site-specific facilitators were training of volunteers (NO, SI, NL), involving volunteers in promoting the service (NO), and education and awareness for healthcare professionals about the role and boundaries of volunteers (UK).ConclusionEstablishing a comprehensive EoL care volunteer service for patients in non-specialist palliative care wards involves multiple considerations including training, creating awareness and ensuring management support. Implementation requires involvement of stakeholders in a way that enables medical EoL care and volunteering to co-exist. Further research is needed to explore how trust and equal partnerships between volunteers and professional staff can be built and sustained.Trial registrationNCT04678310. Registered 21/12/2020.

Demonstration of Interaction between Carbapenem Group Antibiotics and Different Immunosuppressant Drugs by Molecular Docking

Background: It has been shown that drugs used parenterally cause errors in immunosuppressant concentrations measured by LC-MS / MS method. It is yet unknown whether this measurement error is due to drug-drug interaction or analytical interference. Objective: The aim of this study is to investigate the possible interaction and inhibition concentrations of broad-spectrum antibiotics (ertapenem, meropenem, imipenem) with 4 different immunosuppressants (tacrolimus, sirolimus, everolimus, cyclosporine A) by molecular docking. Method: The docking results of ertapenem, meropenem, and imipenem-cilastatin drugs, which are frequently used in intensive care units and wards, were analyzed with the Autodock 4.2 program. Binding energy levels and inhibition concentrations were recorded. Results: The highest binding energies of the most stable conformations, providing the best compatibility among the active ingredients, belong to cilastatin. The interaction energy of cilastatin with sirolimus in 320 conformations was calculated as -4.08 kcal/mol. Sirolimus interacted with ertapenem at -3.43, imipenem at -2.53, and meropenem at -3.84 kcal/mol. According to these values, the receptor, which is the most compatible host with all ligand molecules, is sirolimus. The least interaction energy value was calculated between cyclosporine and imipenem (-1.12 kcal / mol). Conclusion: Concerning the most stable conformations of models docked with Autodock tools, it has been determined that carbapenems interact with immunosuppressants. Since the detected inhibition concentration levels can be seen in blood samples taken immediately after carbapenem injection, immunosuppressant measurement is recommended before the use of carbapenem in immunosuppressant monitoring of transplant patients.

A pragmatic randomised controlled non-inferiority trial of open-door policy versus treatment as usual in urban psychiatric inpatient wards

IntroductionOpen-door policy (ODP) is an approach to reduce coercion in psychiatric wards recommended by the World Health Organization and the Council of Europe. Observational studies from Switzerland and Germany have shown promising results in reducing coercion, but no RCTs have been conducted. Skeptics have been concerned the observational evidence could mask that ODP could increase risks and harms and / or increase the use of coercive measures staff use to assist patients with psychoses, while proponents have argued that de-escalation and alliance-building will result in no such increase.ObjectivesTo evaluate open-door policy in an openly randomised, ethical-board approved trial of all patients referred to ward care at the Lovisenberg Diaconal Hospital in Oslo, Norway.MethodsA 12-month pragmatic, randomised-controlled non-inferiority trial comparing two ODP and three TAU acute psychiatric wards. The trial was pre-registered (ISRCTN16876467) and conformed to CONSORT. Ethical committee exemption enabled waiver of consent rules for the study, meaning all regular patients were included. Patients were randomly assigned (2:3 ratio) by a clinical admissions team using an open list. The non-inferiority margin was 15 % on the primary outcome: the proportion of patient stays with one or more coercive measures, including involuntary medication, isolation/seclusion, and physical and mechanical restraints. Primary and safety analyses were based on intention-to-treat. Safety analyses included suicides and violent events against staff. Secondary outcomes were individual coercive measures, intensive care, resource use, and patient feedback.ResultsN=556 patients were included and randomised and were similar on all pre-admission demographics: Around 75% of patients were diagnosed with a psychotic disorder and were involuntarily admitted. Primary outcome: Use of coercive measures was within the non-inferiority margin (see table 1). Safety outcomes: No suicides occurred during ward care in any group. Violence against staff did not differ between study wards. Secondary outcomes: Use of intensive care (‘skjerming’) and number of days admitted was significantly less on open-door policy wards. Patients on open-door policy wards rated their experience of coercion and ward atmosphere better than patients on control wards.Table 1.Absolute and relative risk of being subjected to coercion on open-door policy or usual-treatment wards.Number (%) Main outcome Absolute Risk ODP wards (n=245) Absolute Risk TAU wards (n=311) Relative Risk (95% CI) Risk Difference (95% CI) Primary hypothesis confirmedOne or more coercive measures during the admission65 (26.5%)104 (33.4%)1.3 (0.97 to 1.6)6.9% (-0.7 to 14.5)YesConclusionsThis first RCT found open-door policy does not increase use of coercion or resource use. It does not harm staff or patients and is experienced as better by patients.Disclosure of InterestNone Declared

Analysis on the willingness and influencing factors of choosing hospice care service institutions among among older people in Wuhu, China: a cross-sectional study

ObjectiveThe purpose of this study was to evaluate the inclination and determinants influencing the selection of hospice care service institutions among elderly individuals in China.DesignThe study conducted has a cross-sectional...

Comparison of Clinical Characteristics and Biomarkers in Culture-Positive and Culture-Negative Sepsis Patients.

Sepsis is one of the leading causes of morbidity and mortality worldwide, and culture-negative sepsis, despite its prevalence, is largely understudied. The current study intends to examine clinical characteristics and biomarkers in culture-positive and culture-negative sepsis, focusingon 30-day mortality and duration of hospital stay in both groups. Materials and methods: A prospective observational comparative cohort study was done on 150 patients admitted to theintensive care unit (ICU) and wards of Jaipur Golden Hospital. Patients with documented fungal, viral, or parasitic infections, as well as those who had undergone surgery or experienced trauma, were excluded. Results: The mean age of the patients was 51.31±18.94 years. Of150 patients, 95 (63.3%) were culture-negative, whereas 55 (36.7%) were culture-positive, with more men in the former and more women in the latter. Patients with negative cultures had fewer comorbidities. The levels of procalcitonin (PCT), C-reactive protein (CRP), and serum lactate were within the prescribed limit for both culture-negative and positive patients. A higher proportion (87.3%) of the organisms isolatedfrom culture-positive individuals were gram-negative, with Escherichia coli (E. coli) having the highest prevalence (27.3%), followed by Klebsiella (20%). There were 12.7% gram-positive isolates. The culture-negative patients had significantly better outcomes (P=0.003) as well as the duration of hospital stay (P<0.001) than the culture-positive patients. Culture-positive patients had a more severe illness, a higher incidence of septic shock, and a higher fatality rate than culture-negative patients. It can be concludedthat CRP and PCT can be used as clinically reliable sepsis biomarkers in both culture-positive and culture-negative patients. The study found that culture-negative sepsis is more prevalent and that there are substantial differences between culture-negative and culture-positive sepsis, with the former group having fewer comorbidities, less severe illness, a shorter duration of hospital stays, lower death rates, and better outcomes.

Analysis of factors influencing the risk of secondary infection in patients colonized or infected with multidrug-resistant Gram-negative bacteria following hospitalization

We seek to investigate the multifaceted factors influencing secondary infections in patients with multidrug-resistant Gram-negative bacteria (MDR-GNB) colonization or infection post-hospitalization. A total of 100 patients with MDR-GNB colonization or infection were retrospectively reviewed, encompassing those admitted to both the general ward and intensive care unit of our hospital from August 2021 to December 2022. Patients were categorized into the control group (non-nosocomial infection, n = 56) and the observation group (nosocomial infection, n = 44) based on the occurrence of nosocomial infection during hospitalization. Clinical data were compared between the two groups, including the distribution and antibiotic sensitivity of MDR-GNB before nosocomial infection. Significant differences were observed between the two groups in terms of age, underlying diseases, immune status, length of stay, and invasive medical procedures (P < 0.05). The observation group also had fewer patients practicing optimized hygiene, strict isolation, and antibiotic control than the control group (P < 0.05). Factors influencing the risk of secondary infection after hospitalization in patients colonized or infected with MDR-GNB included patient age, underlying diseases, immune status, length of hospitalization, medical invasive procedures, optimized hygiene, strict isolation, and antibiotic control (P < 0.05). The length of hospitalization and treatment cost in the observation group were higher than those in the control group (P < 0.05). This study comprehensively analyzes the intricate mechanisms of secondary infections in patients with MDR-GNB infections post-hospitalization. Key factors influencing infection risk include patient age, underlying diseases, immune status, length of hospitalization, medical invasive procedures, optimized hygiene, strict isolation, and antibiotic control.

Development of an enhanced scoring system to predict ICU readmission or in-hospital death within 24 hours using routine patient data from two NHS Foundation Trusts

RationaleIntensive care units (ICUs) admit the most severely ill patients. Once these patients are discharged from the ICU to a step-down ward, they continue to have their vital signs monitored...

Workload reduction through automated documentation in intensive and intermediate care - a monocentric observational study.

The global coronavirus pandemic has placed an unprecedented and enormous burden on health systems worldwide. In addition to a shortage of resources, nurses were also confronted with high levels of sick leave and an increasing exodus from the profession. Automating documentation obligations is an effective way of reducing the burden on the workplace. The study was conducted at a tertiary university hospital. The time required for the manual documentation of administered medication and dose changes of syringe and infusion pumps was recorded using the patient data management system (PDMS) representing all intensive and intermediate care wards (n = 6). Subsequently, all medication administration - grouped into five classes - was evaluated from January 1st, 2019, until December 31st, 2022. A total of 1,373,340 drug applications were studied, treating 32,499 patients. Data were obtained from ICUs (68%) and IMC wards (32%). This corresponds to an overall time of 2,901 ± 233 hours per year. Based on publicly known national rates for intensive care nurses, an annual financial expenditure of approximately 83,300 € (~ USD 89,300) per year was estimated. A non-negligible part of the daily working time in the medical sector is spent on documentation duties. This aggravates the high workload, which has increased in recent years. Automated documentation systems can lead to considerable relief and the possibility of focusing primarily on the patient and on other core competencies and activities. This is even more important, as available staff will be a key resource in patient care for the foreseeable future.

The impact of a hospital-based special care unit on behavioural and psychological symptoms in older people living with dementia.

Hospital patients with behavioural and psychological symptoms of dementia (BPSD) are vulnerable to a range of adverse outcomes. Hospital-based Special Care Units (SCUs) are secure dementia-enabling environments providing specialised gerontological care. Due to a scarcity of research, their value remains unconfirmed. To compare hospital based SCU management of BPSD with standard care. Single-case multiple baseline design. One-hundred admissions to an 8-bed SCU over 2 years in a large Australian public hospital. Repeated measures of BPSD severity were undertaken prospectively by specialist dementia nurses for patients admitted to a general ward (standard care) and transferred to the SCU. Demographic and other clinical data, including diagnoses, medication use, and care-related outcomes were obtained from medical records retrospectively. Analysis used multilevel models to regress BPSD scores onto care-setting outcomes, adjusting for time and other factors. When receiving standard care, patients' BPSD severity was 6.8 (95% CI 6.04-7.64) points higher for aggression, 15.6 (95% CI 13.90-17.42) points higher for the neuropsychiatric inventory, and 5.8 (95% CI 5.14-6.50) points higher for non-aggressive agitation compared to SCU. Patients receiving standard care also experienced increased odds for patient-to-nurse violence (OR 2.61, 95% CI 1.67-4.09), security callouts (OR 5.39 95% CI 3.40-8.52), physical restraint (OR 17.20, 95% CI 7.94-37.25) and antipsychotic administration (OR 3.41, 95% CI 1.60-7.24). Clinically significant reductions in BPSD and psychotropic administration were associated with SCU care relative to standard ward care. These results suggest more robust investigation of hospital SCUs, and dementia-enabling design are warranted.

Improvement of scoring system used before discharge to predict 30-day all-cause unplanned readmission in geriatric population: a prospective cohort study

BackgroundData taken from tertiary referral hospitals in Indonesia suggested readmission rate in older population ranging between 18.1 and 36.3%. Thus, it is crucial to identify high risk patients who were readmitted. Our previous study found several important predictors, despite unsatisfactory discrimination value.MethodsWe aimed to investigate whether comprehensive geriatric assessment (CGA) -based modification to the published seven-point scoring system may increase the discrimination value. We conducted a prospective cohort study in July–September 2022 and recruited patients aged 60 years and older admitted to the non-surgical ward and intensive coronary care unit. The ROC curve was made based on the four variables included in the prior study. We conducted bivariate and multivariate analyses, and derived a new scoring system with its discrimination value.ResultsOf 235 subjects, the incidence of readmission was 32.3% (95% CI 26–38%). We established a new scoring system consisting of 4 components. The scoring system had maximum score of 21 and incorporated malignancy (6 points), delirium (4 points), length of stay ≥ 10 days (4 points), and being at risk of malnutrition or malnourished (7 points), with a good calibration test. The C-statistic value was 0.835 (95% CI 0.781–0.880). The optimal cut-off point was ≥ 8 with a sensitivity of 90.8% and a specificity of 54.7%.ConclusionsMalignancy, delirium, length of stay ≥ 10 days, and being at risk of malnutrition or malnourished are predictors for 30-day all-cause unplanned readmission. The sensitive scoring system is a strong model to identify whether an individual is at higher risk for readmission. The new CGA-based scoring system had higher discrimination value than that of the previous seven-point scoring system.

NADA Acupuncture in Specialized Palliative Care: Patients’ and Family Caregivers’ Experiences

ContextOver the last 30 years, non-pharmacological treatment with ear acupuncture, including National Acupuncture Detoxification Association (NADA) acupuncture, has become popular in Western society to relieve cancer-related symptoms. ObjectivesThis study aim is to explore whether NADA acupuncture plays a role in relieving suffering experienced by patients hospitalized in a specialized palliative care ward and their family caregivers and whether it contributes to their coping skills. MethodsA qualitative study with a hermeneutic approach utilizing inductive thematic content analysis. Purposeful sampling took place in a specialized palliative care ward in Denmark and all data were collected through semi-structured interviews with patients and family caregivers as either individual or family interviews. ResultsA total of 10 patients and 15 family caregivers participated in interviews. Four themes emerged: (1) communication about treatment with NADA acupuncture, (2) relief of suffering generates extra energy and inner strength, (3) sharing the experience with the family is beneficial, and (4) physical and psychological effects after receiving NADA acupuncture. ConclusionPatients in palliative care and their family caregivers experienced relief of suffering after receiving NADA acupuncture, as well as improved well-being, and extra energy and inner strength to cope with their life situation. The ability to share NADA acupuncture gave family caregivers the feeling of being cared for and contributed to feelings of fellowship and togetherness within the family, strengthening their ability to communicate and cope.