Care Of Hospitalized Patients Research Articles

Situational analysis of medical care for heart failure patients in a regional hospital in central Taiwan

Abstract Background: Heart failure (HF) is a complex clinical syndrome and a leading cause of morbidity and mortality worldwide. Its symptoms are the ultimate severe results of all heart diseases. Objectives: To assess the situation of medical care for patients with HF in a regional hospital in central Taiwan. Methods: This retrospective study was conducted from June 1, 2019, to September 30, 2021, collecting basic information of patients, hospitalization and medication after discharge, emergency room visit, readmission, and mortality. Results: This study included 101 patients with HF with reduced ejection fraction, of which 71.3% were males. Their mean age was 64.9 ± 15.4 years, and the mean body mass index was 26.4 ± 5.6 kg/m2. Moreover, 89.1% of them had chronic diseases, such as hypertension, diabetes, and heart disease; the mean left ventricular ejection fraction was 27.4% ± 7.7%. During hospitalization and at 1, 6, and 12 months after discharge, the administration rates were 61.4%, 39.6%, 26.7%, and 22.8% for angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker/angiotensin-neprilysin inhibitor; 64.4%, 41.6%, 27.7%, and 35.6% for beta-blocker; 47.5%, 26.7%, 14.9%, and 17.8% for mineralocorticoid receptor antagonist; and 4.9%, 2.0%, 1.0%, and 3.0% for sodium-glucose cotransporter-2 inhibitor, respectively. The rates of emergency room visit, readmission, and mortality due to cardiac reasons within 12 months after discharge were 18.8%, 20.8%, and 8.9%, respectively. Conclusion: Given that HF is a complex disease, the underlying causes must be treated, and the guideline-directed medical therapy must be applied to prevent the recurrence of an acute attack. Given the complexity of this high-functioning disease, it is essential to have a dedicated case manager who can ensure comprehensive integration of care.

Situational analysis of medical care for heart failure patients in a regional hospital in central Taiwan

Situational analysis of medical care for heart failure patients in a regional hospital in central Taiwan

A Pilot Study of a Palliative Care Service Embedded in a Hepatology Clinic at a Large Public Hospital.

Background: End-stage liver disease (ESLD) patients carry heavy symptom burdens and risk receiving aggressive and sometimes unwanted care at end of life. Palliative care (PC), which aims to alleviate symptoms and facilitate goal-concordant care in serious illness, may offer substantial benefits for ESLD patients but is not widely provided. Objectives: To assess the impact of PC integrated within hepatology (PCIH) services on health care utilization, advance care planning (ACP), and hospice enrollment. Design: We compared patients who received PCIH (n = 55) to a retrospective cohort (n = 57) receiving usual care in an outpatient hepatology clinic. Setting/Subjects: From June 2016 to November 2017, we enrolled patients receiving care in a U.S. public hospital clinic who met the following inclusion criteria: (1) ESLD with a Model for End-Stage Liver Disease score ≥20, (2) hepatology approval for PC referral, and (3) at least one advanced complication of ESLD. Measurements: We assessed patient demographics, clinical information, health care insurance status, health care utilization, completion of psychosocial assessments, and ACP using two-sided Fisher's exact test and Mann-Whitney U tests. Results: Patients receiving PCIH more frequently had goals of care discussions (87.3% vs. 21.2% p ≤ 0.01), completed ACP documentation (56.4% vs. 7.0%, p ≤ 0.01), psychosocial assessments (98.2% vs. 35.1%, p ≤ 0.01), and hospice enrollment (25.5% vs. 7.0%, p = 0.01). Patients receiving PCIH who were hospitalized also had fewer mean hospitalization days (13 vs. 19.7 days, p ≤ 0.01). Conclusions: Embedding PC services in a hepatology clinic is a promising strategy to improve care for ESLD patients in public hospitals.

Prediction of hospital readmission of multimorbid patients using machine learning models.

The objective of this study is twofold. First, we seek to understand the characteristics of the multimorbid population that needs hospital care by using all diagnoses information (ICD-10 codes) and two aggregated multimorbidity and frailty scores. Second, we use machine learning prediction models on these multimorbid patients characteristics to predict rehospitalization within 30 and 365 days and their length of stay. This study was conducted on 8 882 anonymized patients hospitalized at the University Hospital of Saint-Étienne. A descriptive statistical analysis was performed to better understand the characteristics of the patient population. Multimorbidity was measured using raw diagnoses information and two specific scores based on clusters of diagnoses: the Hospital Frailty Risk Score and the Calderon-Larrañaga index. Based on these variables different machine learning models (Decision Tree, Random forest and k-nearest Neighbors) were used to predict near future rehospitalization and length of stay (LoS). The use of random forest algorithms yielded better performance to predict both 365 and 30 days rehospitalization and using the diagnoses ICD-10 codes directly was significantly more efficient. However, using the Calderon-Larrañaga's clusters of diagnoses can be used as an efficient substitute for diagnoses information for predicting readmission. The predictive power of the algorithms is quite low on length of stay indicator. Using machine learning techniques using patients' diagnoses information and Calderon-Larrañaga's score yielded efficient results to predict hospital readmission of multimorbid patients. These methods could help improve the management of care of multimorbid patients in hospitals.

SUICIDAL BEHAVIOR IN A GENERAL HOSPITAL AND THE KNOWLEDGE OF NURSING PROFESSIONALS: CROSS-SECTIONAL STUDY

Objective: to evaluate the knowledge of nursing professionals about suicidal behavior of patients in a general hospital. Method: cross-sectional study conducted in a general hospital in Paraná, Brazil, with 228 nursing professionals. Data were collected in the period between May 2019 and September 2020 by means of a structured instrument containing 20 sentences about suicidal behavior and its characteristics. Data were analyzed by descriptive statistical methods. Results: participants reported having experiences with patients whose behavior was suicidal (RMi=3.83); as for the statements that evaluated knowledge (RMi=2.73), they agreed on care and disagreed with the stigmatizing statements, demonstrating adequate conceptions about the phenomenon, however, it was identified that they need more knowledge to improve suicide preventive strategies (RMi=3.99). Conclusion: the study contributes to the construction of a comprehensive view regarding the care of patients in general hospital, encompassing the psycho-emotional needs, demystifying, and further promoting mental health.

Competing Incentives: For-Profit Hospitals Add Complexity to Graduate Medical Education (Commentary).

Competing Incentives: For-Profit Hospitals Add Complexity to Graduate Medical Education (Commentary).

Nurse Led Collaboration and Innovation: Creating Standardized Care for Same Day Joint Arthroplasty Patients

<h3>Background Information</h3> As a Magnet designated hospital, BWFH strives to achieve excellent patient outcomes. Our dedication to provide innovative, high-quality care for patients in a busy 171-bed community teaching hospital in Boston, MA has led to the development of a successful same day joint (SDJ) program. <h3>Objectives of Project</h3> To implement strategies that facilitate the safe discharge of patients undergoing SDJ replacement surgery. <h3>Process of Implementation</h3> After successfully launching a SDJ replacement program, it was identified that nurses needed education and resources to support safe discharge home for this patient population. Identification and education of dedicated resource nurses •Development of SDJ Resource binder that includes tip sheets and checklists opre-discharge medications, hydration and nourishment guidelines, spinal anesthesia recovery protocols, pre-discharge required consultations (PT and Care Continuum Management), and home discharge instructions. <h3>Statement of Successful Practice</h3> Since April 2019, >600 patients have been discharged home the same day as their joint replacement surgery resulting in a reduced hospital length of stay compared with traditional practice. With the identification of dedicated resource nurses and the implementation of a SDJ resource binder, nurses have been able to provide high quality, standardized care. In addition, nurses have been able to identify deviations from the SDJ care pathway that might impede a successful discharge home. Nurses have reported a decrease in anxiety when caring for this population since the addition of these resources. Providers from the orthopedic teams have reported receiving fewer phone calls to clarify post-op orders and instructions. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Perianesthesia nurses are collaborative and innovative in designing systems that allow for a successful SDJ program. Standardizing post-op care and having resources such as informational binders and PACU nurse champions play an important role in the safe care and discharge of SDJ patients.

Improving Standards of Physical Health Care of Patients in Secure Mental Health Hospital

AimsEvidence suggests that individuals with serious mental illness (SMI) die up to twenty years prematurely compared to the average population without SMI with the main causes of death linked to preventable cardiovascular disease, respiratory failure, and endocrine disorders. This early mortality remains despite national efforts to recognise the issue and promote development of processes to enhance quality of physical health care in patients with SMI. The National Institute for Health and Care Excellence (NICE) clinical guidelines (CG178) recommendation 1.5.3.5 states that healthcare professionals in secondary care should ensure individuals with SMI receive physical health checks from primary care. This idea may be suitable for patients in the community setting or those who undergo shorter hospital admissions, however the process of psychiatric rehabilitation in secure mental health hospitals is challenged by long average stays resulting in no access to routine primary care facilities. The aim of the project is to introduce tailored measures that would aid in delivering high quality physical health care to patients within secure mental health hospitals.MethodsRavenswood House Medium Secure Hospital supported a project to improve the physical health of individuals with SMI. An audit was completed to evaluate the assessment and management of baseline physical health measures that would have usually been completed in primary care as per the standards set out in NICE guidelines. The results showed that not all measures were being met and there was room for improvement.Based on these NICE recommendations, an annual health check template and a centralised documentation toolkit were implemented and integrated within a new Physical Health Care Pathway in collaboration with General Practitioners, Dentists, Physiotherapists and other Allied Healthcare professionals.ResultsFollowing implementation of the Physical Health Care Pathway, the number and quality of annual physical health checks in Ravenswood House Medium Secure Hospital increased resulting in significantly better-quality outcomes for patients by completing appropriate referrals and follow-up care.ConclusionThis collaborative approach of providing a high-quality physical health care was delivered in-house by arrangement with external healthcare practitioners. This pathway of providing care assisted us in overcoming several challenges faced within secure hospitals due to legal sanctions and related security protocols involving the patient group.

Inpatient psychiatric care of COVID-19 infected patients in a Hungarian general hospital

Introductionduring the study period (08/02/2021 – 11/05/2021) the Centre of Psychiatry in the Jahn Ferenc South-pest Hospital (CP-JFSH) was one of the two psychiatric wards in Budapest, specialized for the treatment of COVID-19 infected psychiatric patients.Objectivesthe aim of the study was to survey the characteristics and evaluate the outcome of the COVID-19 infected psychiatric patients treated in the CP-JFSH.Methodsretrospective analysis of the files of COVID-19 infected psychiatric patients admitted to the CP-JFSH in a 3 month period. In addition to demographic data, diagnostic distribution, co-morbidities, date of infection, method of detection of the virus, presence of pneumonia, severity of infection, outcome, treatment, vaccination data were evaluated.Resultsin the study period 124 COVID-19 infected psychiaric patients were admitted to the CP-JFSH. The gender distribution was aproximately equal, the mean age of the patients was 62.8+/-15.7 years. Majority of the patients suffered from major neurocognitive disorder followed by schizophrenia spectrum disorder. Most common co-morbidities were cardiovascular diseases and diabetes. Pneumonia was present in 41% of the patients. Majority of the patients were already infected at the time of admission, detected with the first PCR examination and haven’t been vaccinated yet. Thirty-one percent of the patients suffered from moderate to severe COVID-19 illness. COVID-19 specific therapy (favipiravir, remdesivir, fluvoxamin) was introduced in 57%. Mortality was 12% while the relaps rate 4%.Conclusionscomparing with inpatient mortality rate published in the literature, mortality rate was higher among psychiatric patients, underlining the need for special attention of this population.DisclosureNo significant relationships.

Diversified nutritional support of patients in severe forms of COVID-19

The Coronavirus Disease 2019 (COVID-19) pandemic, declared by the World Health Organization on March 11, 2020, has made significant adjustments to the principles of organizing medical care, including treatment, nutrition, and care of patients in infectious hospitals. The disease has different clinical courses: from mild asymptomatic to extremely severe, requiring aggressive medical interventions, such as organ replacement therapy to replace vital body functions.&#x0D; The spread of viral infection was global, but the pathophysiological aspects of the course of COVID-19 have not been studied comprehensively. The development of acute respiratory distress syndrome and systemic inflammatory response syndrome as part of the severe course of the disease is accompanied by severe metabolic disorders that require close attention. It is necessary to correct the clinical manifestations of organ dysfunction under severe hypercatabolism. Considerable importance is given to the peculiarities of providing nutritional support to patients using specialized nutritional mixtures to prevent conditions that worsen the prognosis of recovery and survival of patients.&#x0D; The target cells of the virus are angiotensin-converting enzyme receptors of the respiratory, nervous, urinary, and cardiovascular systems and organs of the gastrointestinal tract. Consequently, the site of the infection at different organs and systems gives rise to the phenomena of respiratory failure and several heterogeneous clinical manifestations of the disease, which can affect all ties in the pathogenesis of nutritional deficiency. Malnutrition is usually due to the mismatch between the intake and consumption of nutrients, micro- and macroelements.&#x0D; The causes for the imbalance of the intake-expenditure system can be divided into three groups: reduced nutrient intake, increased consumption due to hypercatabolism or hypermetabolism, and malabsorption and increased nutritional losses due to direct and indirect damages to the gastrointestinal tract. The division is traditional because, in the case of severe forms of coronavirus infection, there is always the presence of two or more factors leading to nutritional deficiencies.&#x0D; In this study, we systematized the ways in which we provide nutritional support based on the prevalent causes of protein-energy malnutrition, taking into account the patients individual needs and the extent of respiratory support. Several articles published by foreign colleagues and our own experience in the Department of Anesthesiology and Intensive Care for Patients with a New Coronavirus Infection COVID-19 at the Russian Academy of Sciences Central Clinical Hospital in Moscow in 2020 were analyzed.&#x0D; This study discusses in detail the problems and characteristics of clinical nutrition that a practicing intensive care specialist faces when enduring all possible measures to maintain the stable homeostasis of the patient.

Analyzing the effective healthcare management model for a COVID-19 pandemic

COVID-19's global pandemic created a situation in which healthcare resources such as diagnostic kits, medications, and basic healthcare infrastructure were in short supply throughout the period, resulting in a detrimental impact on the socio-economic system. In a pandemic crisis, standardized public healthcare models were lacking, spanning everything from hospitalized patient care to local resident healthcare management in terms of monitoring, assessment, diagnosis, and medicines. The goal of this exploratory and intervention-based study is to propose a COVID-19 Care Management Model that represents complete care for society, encompassing patients (with COVID-19 and other disorders) and healthy people, within an integrated framework of healthier management. Better COVID-19 preventive and care outcomes can be achieved by shifting policies toward technology-oriented models with well-aligned infrastructure. The planned development of technical healthcare models for prognosis and improved treatment outcomes that consider not only genomics, proteomics, nanotechnology, and materials science perspectives, but also the potential contribution of advanced digital technologies, is one of the best strategies for early diagnosis and infection control.

Extended length of stay and related costs associated with dementia in acute care hospitals in Ireland

Objective To estimate the additional impact of dementia on in-patient length of stay (LOS) and related costs in Irish acute hospitals. Both principal and secondary diagnosis effects are estimated and valued. Methods This is a cross-sectional study based on administrative data collected on all public hospital in-patient discharges in Ireland for people aged 65 years and older in 2019. Coarsened exact matching (CEM) was undertaken to account for observed confounders between dementia and non-dementia groups, while generalised linear modelling (GLM) was used to compare differences in LOS. Results Patients with a principal diagnosis of dementia spent on average 17.5 (CI: 15.42, 19.56; p < .01) d longer in hospital than similar patients with no principal diagnosis of dementia. LOS was 6.7 (CI: 6.31, 7.14; p < .01) d longer for patients with a secondary diagnosis of dementia compared to similar patients with no secondary diagnosis of dementia. The additional annual cost of care for patients in hospitals with a secondary (principal) diagnosis of dementia was €62.0 million (€13.2 million). Conclusions This study highlights the economic impact of extended LOS for patients with dementia in Irish acute hospitals. Addressing specific dementia-related needs of people in hospital is likely to optimise resource use and decrease health care costs in acute care settings.

Thermal discomfort caused by personal protective equipment in healthcare workers during the delta COVID-19 pandemic in Guangzhou, China: A case study

BackgroundIn contrast to the previous COVID-19 pandemic, most frontline healthcare workers (HCWs) worked on residents’ nucleic acid tests in outdoor environments, instead of taking care of COVID-19 patients in hospitals during the hot summer of 2021. Therefore, it is necessary to investigate the prevalence and characteristics of thermal discomfort caused by personal protective equipment (PPE).MethodsA cross-sectional survey was conducted online at hospitals from 11 administrative regions of Guangzhou for the assessment of thermal discomfort among HCWs from June 12–16, 2021. Univariate and logistic regression analyses were used to explore the risk factors associated with thermal discomfort.ResultsA total of 3658 valid responses were collected. The thermal discomfort and humid discomfort levels increased from 2.91 ± 1.19 to 3.61 ± 0.72 and from 0.98 ± 1.36 to 3.06 ± 1.1 after wearing PPE, respectively (p < 0.01). Feelings of being “very hot” and “uncomfortably humid” were the most influenced by wearing PPE, increasing from 31% to 69.1% and from 9.1% to 45.7%, respectively. There were significant increases in the thermal discomfort level (3.75 ± 0.57 vs. 3.33 ± 0.89, p < 0.01) and the humid discomfort level (3.33 ± 0.95 vs. 2.54 ± 1.19, p < 0.01) between the comfortable group and uncomfortable group, accompanied by similar patterns in the feelings of being “very hot” and “uncomfortably humid.” For general thermal-related symptoms, the most common new-onset symptom was profuse sweating (80%) followed by labored breathing (55.2%) and excessive dehydration (46.8%), while facial swelling (74%) was associated with local thermal-related symptoms, followed by hand maceration erosion (56.7%) and visual impairment (49.3%). In the multivariate analysis, the apparent temperature of the environment (≥35 °C), working in negative-pressure ambulances and outdoors, continuing to wear PPE for 1–3 days during this period, being aged >40 years, and previous experiences fighting the pandemic were independently associated with thermal discomfort (p < 0.01). Immediately after PPE removal, 32.3% of respondents considered drinking ice water/another drink, followed by 25% shortening the duration of wearing PPE and 19.1% going to the toilet. A large proportion of the participants looked forward to modifications to the material of the suit (72.9%) and mask (53.4%) for heat dissipation and dehumidification, as well as anti-fogging goggles (60.2%), adding hydration equipment to PPE (53.4%), and using soft materials to reduce pressure (40%).ConclusionsThermal discomfort is common and degrades health physiology related to PPE in summer environments. This suggests that modifications to the current working practices are urgently required to improve the resilience of HCWs and enhance their services during pandemics.

Teams and continuity of end-of-life care in hospitals: managing differences of opinion

BackgroundRecognised as an essential element in end-of-life care by the Australian Commission on Safety and Quality in Health Care, effective teamwork can enhance the quality and safety of end-of-life care...

Cost-saving prediction model of transfer to palliative care for terminal cancer patients in a Japanese general hospital

ABSTRACT Background Although medical costs need to be controlled, there are no easily applicable cost prediction models of transfer to palliative care (PC) for terminal cancer patients. Objective Construct a cost-saving prediction model based on terminal cancer patients’ data at hospital admission. Study design Retrospective cohort study. Setting A Japanese general hospital. Patients A total of 139 stage IV cancer patients transferred to PC, who died during hospitalization from April 2014 to March 2019. Main outcome measure Patients were divided into higher (59) and lower (80) total medical costs per day after transfer to PC. We compared demographics, cancer type, medical history, and laboratory results between the groups. Stepwise logistic regression analysis was used for model development and area under the curve (AUC) calculation. Results A cost-saving prediction model (AUC = 0.78, 95% CI: 0.70, 0.85) with a total score of 13 points was constructed as follows: 2 points each for age ≤ 74 years, creatinine ≥ 0.68 mg/dL, and lactate dehydrogenase ≤ 188 IU/L; 3 points for hemoglobin ≤ 8.8 g/dL; and 4 points for potassium ≤ 3.3 mEq/L. Conclusion Our model contains five predictors easily available in clinical settings and exhibited good predictive ability.

The impact of Mental Health Nurse Consultants on the care of general hospital patients experiencing concurrent mental health conditions: An integrative literature review.

Mental Health Nurse Consultants are advanced practice mental health nurses who consult with nurses and other health professionals in a general hospital setting. The aim of this review was to analyse and synthesize the available evidence related to the impact of Mental Health Nurse Consultants on the care of general hospital patients experiencing concurrent mental health conditions. The integrative literature review method was utilized as it allows for the inclusion and integration of quantitative, qualitative, and mixed methods research which produces a synthesized understanding of data to inform practice, policy, and research. The Preferred Reporting Items of Systematic Review and Meta‐Analyses guided the search strategy. All published studies examining the impact of clinical consultations provided by Mental Health Nurse Consultants on the mental health care of general hospital patients were included. The 19 selected articles were from North America, Australia, the United Kingdom, and Europe. Fifteen were quantitative, three were qualitative, and one used mixed methods. The findings highlight the role is generally positively received by hospital staff. The results indicate that clinical consultations provided by Mental Health Nurse Consultants (i) may improve patient experiences of mental health conditions, (ii) influence aspects of care delivery, (iii) are valued by staff, particularly nurses, and (iv) increase staff competence and confidence in the provision of mental health care. The review highlighted significant limitations of the available evidence, the need for contemporary discussion and debate of MHNC theory and practice, and further evaluation of the role to inform future service delivery.

Achievement of Key Performance Indicators in Initial Assessment and Care of Injured Patients in Ghanaian Non-tertiary Hospitals: An Observational Study.

We aimed to determine the level of achievement of key performance indicators (KPIs) during initial assessment and management of injured persons, as assessed by independent observers, at district and regional hospitals in Ghana. Trained observers were stationed at emergency units of six district (first level) and two regional (referral) hospitals, from October 2020 to February 2021, to observe management of injured patients by health service providers. Achievement of KPIs was assessed for all injured patients and for seriously injured patients (admitted for ≥ 24h, referred, or died). Management of 1006 injured patients was observed. Road traffic crash was the most common mechanism (63%). Completion of initial triage ranged from 65% for oxygen saturation to 92% for mobility assessment. For primary survey, airway was assessed in 77% of patients, chest examination performed in 66%, and internal abdominal bleeding assessed in 43%. Reassessment rates were low, ranging from 16% for respiratory rate to 23% for level of consciousness. Thirty-one percent of patients were seriously injured. Completion of KPIs was higher for these patients, but reassessment remained low, ranging from 25% for respiratory rate to 33% for level of consciousness. KPIs were performed at a high level, but several specific elements should be performed more frequently, such as oxygen saturation and assessment for internal abdominal bleeding. Reassessment needs to be performed more frequently, especially for seriously injured patients. Overall, care for the injured at non-tertiary hospitals in Ghana could be improved with a more systematic approach.

Anxiety and depression levels of healthcare workers during Covid-19 pandemic.

Coronavirus disease 2019 (covid-19), which causes a pandemic in the world, has started to appear in turkey since march 2020. Healthcare workers are at the top of the groups most at risk for covid-19 infection, which can have a negative impact on psychological state. It was aimed to evaluate anxiety and depression levels among healthcare workers. this cross-sectional study performed via an online survey in april 2020. Participants answered questions about sociodemographic features, personal views and experiences about covid-19 and the hospital anxiety and depression scale (hads). A total of 300 healthcare workers,193 men and 107 women, participated in the survey. According to hads, 44.6% of participants scored above anxiety and 68.2% scored above depression cut-off points. Being younger than 50 and taking care of covid-19 patients in hospitals were independently associated with anxiety risk. Female gender, young age (less than 50) and having comorbidity were independent risk factors for depression. Healthcare workers were at high risk of anxiety and depression during covid-19 outbreak. For this reason, psychological support should be given, especially to the group with high risk.

A survey of nurses, physiotherapists and occupational therapists in mobility care and gait aid use for hospital patients with dementia

This study described mobility care practice of nurses, physiotherapists and occupational therapists and gait aid use for hospital patients with dementia. Two surveys, tailored to staff mobility care roles were distributed in Australian hospitals. Physiotherapists and occupational therapists were asked additional questions regarding assessments and factors for prescribing gait aids to patients with dementia. Descriptive statistics for closed-ended and summative content analyses for open-ended questions were undertaken. Nurses (n=56), physiotherapists (n=11) and occupational therapists (n=23) used various practices to ensure ambulation safety for patients with dementia. Nurses and occupational therapists commonly referred patients with dementia to physiotherapists for mobility and gait aid assessments. Therapists predominantly considered the severity of dementia, the person's learning ability and mobility history in deciding about gait aid use. Exploring ways to strengthen nursing and health professional education, and inter-professional practice for safe mobility in patients with dementia, with and without gait aids, could be helpful.

Care provided by nurses to patients with juvenile systemic lupus erythematosus.

To describe the care provided by Brazilian nurses to patients with Juvenile Systemic Lupus Erythematosus (JSLE) using a self-administered questionnaire and to evaluate the possible association of demographic data and knowledge of the disease with availability of tools for diagnosis and treatment in Brazilian pediatric services. This is a cross-sectional observational descriptive study that analyzed the care provided by Brazilian nurses to patients with JSLE based on the answers to a self-administered questionnaire. Questions included demographics of professionals, nursing consultation, usage of tools to assess disease activity, diagnostic criteria, general care, available practices, transition program, and practices needed for better care. A total of 111/373 (29.4%) questionnaires were completed, most professionals were female (90.1%). Hospitalization (45.9%) and poor medication adherence (27.9%) were the most reported problems, and lack of knowledge about the institutional transition process to adult care was mentioned by half of the professionals (50.5%). Comparisons of professionals on expected care of patients regarding the type of service, hospitalized patient care, and care provided to patients with JSLE did not reveal statistically significant differences (p > 0.05). Nurses who care for patients with JSLE are more likely to work in a public setting (14.5% vs. 36.8%, p = 0.048) and less likely to verify vaccination records (0.12.9% vs. 36.8%, p = 0.038). Nurses who worked in the inpatient setting with patients with JSLE were less likely to address pain concerns (11.7% vs. 61.6%, p < 0.0001) compared to nurses who didn't work with JSLE patients. However, they were more likely to discuss sunscreen use (54.9% vs. 25%, p < 0.05) and be part of a multi-disciplinary team (84.3 vs. 50%, p < 0.0001). This study demonstrates that the care provided by nurses to patients with JSLE does not consider all the resources available to assess the disease and occurs differently in the inpatient versus outpatient settings. Future research should address this gap in care. Lack of JSLE awareness was commonly reported among professionals, confirming the need for greater knowledge about JSLE, its treatment, and ways to improve adherence.