Care Of Hospitalized Patients Research Articles

Value of the Safety Management System (VMS) frailty instrument as a frailty screener in care for older hospital patients: a systematic review.

Dutch hospitals are required to screen older patients for the risk of developing functional decline using the Safety Management System (VMS) which assesses four domains associated with functional decline; fall risk, risk of delirium, malnutrition, and physical impairment. The aim is twofold, first to compare the VMS frailty instrument as a frailty screener with existing frailty instruments and second to provide an overview of the available evidence. We performed a literature search to identify studies that used the VMS instrument as frailty screener to asses frailty or to predict adverse health outcomes in older hospitalized patients. Pubmed, Cinahl, and Embase were searched from January 1st 2008 to December 11th 2023. Our search yielded 603 articles, of which 17 studies with heterogenous populations and settings were included. Using the VMS, frailty was scored in six different ways. The agreement between VMS and other frailty instruments ranged from 57 to 87%. The highest sensitivity and specificity of VMS for frailty were 90% and 67%, respectively. The association of the VMS with outcomes was studied in 14 studies, VMS was predictive for complications, delirium, falls, length of stay, and adverse events. Conflicting results were found for hospital (re)admission, complications, change in living situation, functional decline, and mortality. The VMS frailty instrument were studied as a frailty screening instrument in various populations and settings. The value of the VMSinstrument as a frailty screener looks promising. Our results suggest that the scoring method of the VMS could be adapted to specific requirements of settings or populations.

PTSD prevalence and factors in intern nursing students after COVID-19 full liberalization in China: a cross-sectional study.

This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) and its influencing factors among intern nursing students after the full liberalization of the COVID-19 prevention and control policy in China. Participants completed the online survey from January 14 to January 19, 2023. A demographic questionnaire, COVID-19 and internship-related questionnaire, the Fear of COVID-19 scale, the Primary Care PTSD Screen, and the Connor-Davidson Resilience Scale were used to conduct the online survey. Of 438 participants, 88.4% tested positive for COVID-19 in the last 6 months. The prevalence of fear, resilience, and PTSD was 16.9, 15.5, and 11.2%, respectively. Direct care of COVID patients in hospital (OR = 2.084, 95%CI 1.034 ~ 4.202), the experience of occupational exposure (OR = 2.856, 95%CI 1.436 ~ 5.681), working with an experienced team (OR = 2.120, 95%CI 1.070 ~ 4.198), and fear COVID-19 (OR = 8.269, 95%CI 4.150 ~ 16.479) were significantly and positively associated with PTSD in nursing internship students. After COVID-19 full liberalization in China, intern nursing students still experienced pandemic-related mental distress, which can bring PTSD. Adequate support and counseling should be provided, as needed, to intern nursing students who are about to enter the workforce and have experienced severe PTSD symptoms related to COVID-19. Our findings indicated that should understand the importance of screening, formulate intervention strategies and preventive measures to address psychosocial problems, and provide coping skills training to intern nursing students.

More than a mouth to clean: Case studies of oral health care in an Australian hospital.

This study aimed to explore older patients' oral health status, their opinions about oral health care and their experiences with oral health care while in hospital. Improving older adults' oral health is considered an urgent priority at both the national and international levels, especially for hospitalised older patients who have been found to have poor oral health. However, a one-size-fits-all standardised approach to oral care delivery may not be the answer. This study was an embedded, multiple-case study, integrating qualitative and quantitative data. Seven patients were recruited from a geriatric ward of an acute hospital in Australia and participated in semi-structured interviews and oral health assessments using the Oral Health Assessment Tool (OHAT) in June-July 2022. Data were analysed descriptively and presented in case summaries. OHAT assessments identified oral health problems in all patients, but not all patients self-reported problems with their mouths. Each patient valued oral health care, but the reasons given varied. Patients had established, individualised oral health care routines, which they brought to hospital. Clinical observations of patient's oral health status might not match the patient's own judgement of their oral health and, if not explicitly addressed, may mask the need for oral health and hygiene intervention. Assessment and care planning needs to incorporate patients' own perceptions of their oral health and existing oral health care routines. Oral health histories may provide a means of facilitating this person-centred oral health care for older patients in hospital.

Multi-Site Randomized Trial of Inpatient Palliative Care for Hospitalized Patients Undergoing Hematopoietic Stem Cell Transplantation

Background: Patients with hematologic malignancies experience a substantial decline in their quality of life (QOL) and psychological health during their hospitalization for hematopoietic stem cell transplantation (HSCT). Early single center studies established the feasibility and promising preliminary efficacy of integrating palliative care during the HSCT hospitalization. However, data to test the efficacy of this care model across diverse care settings are lacking. Methods:We conducted a multi-site randomized trial among 360 adults with hematologic malignancies undergoing autologous or allogeneic HSCT at three academic institutions. Patients were randomly assigned to an inpatient palliative care intervention (n= 180) versus usual care (n=180), stratified by study site and type of HSCT. Intervention participants met with a palliative care clinician at least twice weekly during the HSCT hospitalization to address their physical and psychological symptoms. Patients assigned to usual care received all supportive care measures provided by the HSCT team and could be seen by palliative care upon request. We assessed patient QOL (Functional Assessment of Cancer Therapy (FACT) - Bone Marrow Transplant), depression and anxiety symptoms (Hospital Anxiety and Depression Scale), post-traumatic stress (PTSD) symptoms (PTSD Checklist), symptom burden (Edmonton Symptom Assessment Scale-Revised), and fatigue (FACT-Fatigue, higher scores indicate lower fatigue) at baseline and week-2 during hospitalization. The primary endpoint was QOL at week-2 during the HSCT hospitalization when patients typically experience their QOL nadir during HSCT. We used analysis of covariance, adjusting for baseline scores, to evaluate the effect of the intervention on patient-reported outcomes at week-2. Results:We enrolled 69.5% (360/518) of eligible patients (mean age = 55.4 (SD=12.5), 61.9% male, 76.6% White, 23.4% racial minorities, 8.7% Hispanic ethnicity, and 50.2% underwent allogeneic HSCT) between October 2018 and July 2022. Compared to those receiving usual care, participants receiving the inpatient palliative care intervention reported better QOL (95.5 vs. 89.3, P<0.001), and lower depression (5.9 vs. 6.9, P=0.041) and PTSD symptoms (26.0 vs. 28.2, P = 0.022) at week-2. Intervention participants also reported lower symptom burden (35.3 vs. 40.1, P=0.018) and better fatigue scores (28.6 vs. 25.6, p=0.014) compared to those assigned to usual care at week-2 during HSCT hospitalization. Anxiety symptoms (HADS-A) did not demonstrate a measurable difference between the two groups at week-2 during HSCT. Conclusions: In this multi-site randomized clinical trial, inpatient palliative care led to substantial improvements in patients' QOL, depression and PTSD symptoms, symptom burden, and fatigue during HSCT hospitalization compared to usual care. Integrated palliative care should be considered a new standard of care for patients hospitalized for HSCT.

Measurement and documentation of quality indicators for the end-of-life care of hospital patients a nationwide retrospective record review study

BackgroundQuality of care at the end of life in hospitals is often perceived to be lower compared to the care that is provided to people who die in their own home. Documenting and measuring indicators of common end-of-life symptoms could help improve end-of-life care in hospitals. This study provided insight into quality indicators for the end-of-life care of patients who died in a Dutch hospital, and assessed differences between deceased patients who were admitted for palliative/terminal care versus patients admitted for other reasons.MethodsIn a retrospective record review study, trained nurses reviewed electronic health records (EHRs) of patients who died in 2019 (n = 2998), in a stratified sample of 20 Dutch hospitals. The nurses registered whether data was found in de EHRs about quality indicators for end-of-life care. This concerned: symptoms (pain, shortness of breath, anxiety, depressive symptoms), spiritual and psychological support and advance care planning. Multilevel regression analyses were performed to assess differences between patients who had been admitted for palliative/terminal care and patients admitted for other reasons.ResultsCommon end-of-life symptoms were rarely measured using a standardized method (e.g. Numeric Rating Scale, Visual Analogue Scale or Utrecht Symptom Diary). The symptom burden of pain was measured using a standardized method more often (63.3%) than the symptom burden of shortness of breath (2.2%), anxiety (0.5%) and depressive symptoms (0.3%). Similarly, little information was documented in the EHRs regarding wish to involve a spiritual counsellor, psychologist or social worker. Life expectancy was documented in 66%. The preferred place of death was documented less often (20%). The documentation of some quality indicators differed between patients who were admitted for palliative/terminal care compared to other patients.ConclusionExcept for the burden of pain, symptoms are rarely measured with standardized methods in patients who died in Dutch Hospitals. This study underlines the importance of documenting information about symptom burden and aspects related to advance care planning, and spiritual and psychological support to improve the quality of end-of-life care for patients in hospitals. Furthermore, uniformity in measuring methods improves the possibility to compare results between patient groups and settings.

Exploring professionals' views regarding prenatal counselling in congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) is a congenital malformation in which the diaphragm and lungs are underdeveloped, leading to cardiorespiratory and other problems. This study aimed to explore professionals' views regarding prenatal counselling in CDH. A qualitative study was performed among healthcare professionals involved in the care of CDH patients in Radboud university medical center Amalia Children's Hospital. Semi-structured interviews were conducted until saturation was achieved. Transcripts were qualitatively analysed to gain insight into professionals' views regarding counselling. Eighteen professionals with various backgrounds were included. The professionals agreed that the first counselling session should be soon after diagnosis and additional sessions should be offered. Concerning counselling content, participants considered explanation of the diagnosis, prognosis, short- and long-term consequences, treatment options and practical aspects important. As for decision-making about possible termination of pregnancy, all professionals emphasised the importance of the parental role, but the preferred parental involvement varied. Regarding practical aspects, preferred counsellors were a neonatologist, obstetrician, paediatric surgeon and/or medical social worker. Participants emphasised that the counselling should be adjusted to parents' needs. This study gained insight into professionals' views regarding the timeline, content, decision-making process, and practical aspects of prenatal counselling in CDH.

Pendampingan Motivasi bagi Tenaga Kesehatan di Rumah Sakit Umum Daerah Kabupaten Karawang berbasis Webinar

In the Covid-19 pandemic situation, everyone can feel they are in a crisis position, including health workers who take care of Covid-19 patients in hospitals so they need support. The purpose of implementing this service is to provide support, strengthening, and assistance in the implementation of handling Covid-19 patients at Karawang Hospital. Increase morale, loyalty, and performance of health workers. The implementation method used is (1) lecture and (2) brainstorming. The results obtained after carrying out assistance through this webinar, 90% of health workers feel happy to be cared for by the campus community. Their loyalty is guaranteed to be very, very good, it can be seen that 100% no one wants to resign. Awareness of self-performance management has increased, it can be seen that 92,7% of them feel reminded by this webinar, that personal performance documentation should not be neglected even though the Covid-19 pandemic situation. Lectures that emphasize calm and optimism, and ensure that the Covid-19 pandemic situation is certain has passed, have a significant impact on the morale, loyalty, and performance of health workers. The brainstorming which combines the stories and feelings of the health workers at the Karawang Hospital has ensured that we really empathize with them (health workers), so they no longer experience mental fatigue.

The performance of the clinical pharmacist in hospitalized patient care

The performance of the clinical pharmacist in hospitalized patient care

Randomized Trial of a Novel Artificial Intelligence/Machine Learning Model to Predict the Need for Specialty Palliative Care in Hospitalized Patients (FR205A)

Randomized Trial of a Novel Artificial Intelligence/Machine Learning Model to Predict the Need for Specialty Palliative Care in Hospitalized Patients (FR205A)

Mental health care for COVID-19 patients in a multidisciplinary hospital: managerial aspects

Introduction. COVID-19 affects not only the respiratory tract and lungs, but also the central nervous system. These organic lesions lead to the development of mental and neurological disorders. The structure of psychiatric disorders in COVID-19 is poorly understood, but the data are important for the management and planning of medical care.
 The purpose of the study. Analysis of the management of psychiatric care in a multidisciplinary hospital from the point of view of the algorithmization of the work of a psychiatrist and psychotherapist in the context of COVID-19.
 Material and methods. The relevant materials on the results of the activities of the psychiatric service of the hospital for war veterans in St. Petersburg during the coronavirus pandemic were analyzed.
 Results. Psychiatric and psychotherapeutic care was provided to COVID-19 patients or suspected of having the disease admitted to the hospital. As a result of a psychiatric examination, the observation mode was determined in the admissions department, the intensive care unit and the infectious diseases department. Indications for the provision of psychiatric and psychotherapeutic care and transfer to a psychiatric hospital with departments for patients with coronavirus infection have been developed.
 Limitations of the study. The results of this study cannot be extrapolated to the work of all multidisciplinary hospitals, because associated with the presence of a psychiatrist and a psychotherapist in the staff of the institution. A limitation can be considered the non-inclusion in the study of persons under 45 years of age.
 Conclusion. The experience of the psychiatric service of a multidisciplinary hospital reflects the need for the activity of the psychosomatic link in the context of the COVID-19 pandemic.

Cardiovascular Statistics from the Good Practices in Cardiology Program - Data from a Brazilian Tertiary Public Hospital.

The Good Practices in Cardiology Program is an initiative created by the Brazilian Society of Cardiology (SBC) to improve the quality of care of cardiovascular disease patients in Brazilian public hospitals. To characterize patients admitted to a tertiary public hospital with diagnosis of acute coronary syndrome (ACS) or heart failure (HF) and to evaluate performance indicators in both ACS and HF arms, with a pre-established target of 85% adherence to the SBC recommendations. This was a descriptive cross-sectional study through data collection of patients hospitalized between May 2016 and September 2019. A total of 1,036 patients were included, 273 in the HF arm and 763 in the ACS arm. Mean age was 59.8 ± 12.0 years in the ACS and 57.0 ± 14.1 years in the HF, with a predominance of male patients in both groups. More than half of patients had some primary education and more than 90% reported a monthly income of less than five minimum wages. In ACS, the diagnosis of ACS with ST segment elevation was predominant (66.3%), and 2.9% of patients died. In HF, the most common etiology was Chagas disease (25.8%), and 17.9% died. Analysis of the performance indicators revealed an adherence rate higher than 85% to nine of the 12 indicators. Quality programs are essential for improvement of quality of care. Performance indicators pointed to a good adherence to the SBC guidelines, mainly in the ACS arm.

Geriatric care for surgical patients: results and reflections from a cross-sectional survey in acute Belgian hospitals

Key summary pointsAimThis survey aims to explore geriatric care for surgical patients in acute Belgian hospitals and geriatricians’ reflections on current practice.FindingsTo date, geriatric support for surgical patients in Belgian hospitals is mainly reactive, although geriatricians favour more proactive care. The main barriers to expand geriatric support are shortage of geriatricians and geriatric nurses, lack of financing and inadequate legislation.MessageA transition towards proactive models of care and adapted financing is needed to improve geriatric support for older surgical patients.

Current situation of acute ST-segment elevation myocardial infarction in a county hospital chest pain center during an epidemic of novel coronavirus pneumonia.

Our object was to examine how the pre- and post-pandemic COVID-19 impacted the care of acute ST-segment elevation myocardial infarction (STEMI) patients in county hospitals. Using January 20, 2020, as the time point for the control of a unique coronavirus pneumonia epidemic in Jieshou, 272 acute STEMI patients were separated into pre-epidemic (group A, n = 130) and epidemic (group B, n = 142). There were no significant differences between the two groups in terms of mode of arrival, symptom onset-to-first medical contact time, door-to-needle time, door-to-balloon time, maximum hypersensitive cardiac troponin I levels, and in-hospital adverse events (P > 0.05). Emergency percutaneous coronary intervention (PCI) was much less common in group B (57.7%) compared to group A (72.3%) (P = 0.012), and the proportion of reperfusion treatment with thrombolysis was 30.3% in group B compared to 13.1% in group A (P < 0.001). Logistic regression analysis showed that age ≥76 years, admission NT-proBNP levels ≥3,018 pg/ml, and combined cardiogenic shock were independent risk factors for death. Compared with thrombolytic therapy, emergency PCI treatment further reduced the risk of death in STEMI. In conclusion, the county hospitals treated more acute STEMI with thrombolysis during the COVID-19 outbreak.

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.