Care Outcomes Research Articles

A comprehensive analysis of twin births: clinical characteristics, morbidity trends, and risk determinants

Background: Twin births are often associated with increased risks and complications compared to singleton births. This study aims to analyze the clinical profile, morbidity pattern, and risk factors associated with twin births, focusing on maternal characteristics, neonatal outcomes, and the prevalence of conditions such as low birth weight (LBW) and preterm births. Methods: This hospital-based observational study was conducted at a tertiary care center, involving 25 mothers who had given birth to twins and their 50 neonates. The study assessed maternal age, antenatal care, parity, medical history, and neonatal outcomes including birth weight, gestational age, respiratory and cardiac parameters, and overall health status. Data were collected through medical records and direct observations in the neonatal intensive care unit. Results: The majority of mothers (64%) were aged between 21-30 years, with a mean age of 24.8 years. A significant proportion (92%) had regular antenatal visits, and 96% were multiparous. The majority of neonates (68%) were aged ≤12 hours at assessment, with a near-equal distribution between very low birth weight (VLBW) and LBW. Preterm births were common, affecting 84% of the neonates. Respiratory challenges were evident, with 62% of neonates having SpO2 levels below 94%. The mortality rate among the neonates was 32%. Conclusions: The study highlights the high-risk nature of twin pregnancies, characterized by a significant prevalence of LBW, VLBW, and preterm births. The findings emphasize the need for enhanced prenatal care and specialized neonatal interventions. The high mortality rate among neonates indicates the critical need for targeted strategies to improve neonatal outcomes in twin pregnancies. These insights are crucial for informing clinical practices and developing comprehensive care protocols for managing twin pregnancies and their associated risks.

Does pay-for-performance design matter? Evidence from Brazil.

Pay-for-performance (P4P) schemes have been shown to have mixed effects on health care outcomes. A challenge in interpreting this evidence is that P4P is often considered a homogenous intervention, when in practice schemes vary widely in their design. Our study contributes to this literature by providing a detailed depiction of incentive design across municipalities within a national P4P scheme in Brazil (PMAQ) and exploring the association of alternative design typologies with the performance of primary health /care providers. We carried out a nation-wide survey of municipal health managers to characterize the scheme design, based on the size of the bonus, the providers incentivized, and the frequency of payment. Using OLS regressions and controlling for municipality characteristics, we examined whether each design feature was associated with better family health team performance. To capture potential interactions between design features, we used cluster analysis to group municipalities into five design typologies and then examined associations with quality of care. A majority of the municipalities included in our study used some of the PMAQ funds to provide bonuses to family health team workers, while the remaining municipalities spent the funds in the traditional way using input-based budgets. Frequent bonus payments (monthly) and higher size bonus allocations (share of 20-80%) were strongly associated with better team performance, while who within a team was eligible to receive bonuses did not in isolation appear to influence performance. The cluster analysis showed what combinations of design features were associated with better performance. The PMAQ score in the 'large bonus/many workers/high-frequency' cluster was 8.44 points higher than the 'no bonus' cluster, equivalent to a difference of 21.7% in the mean PMAQ score. Evidence from our study shows how design features can potentially influence health provider performance, informing the design of more effective P4P schemes.

Croatian Translation and Validation of the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ).

Patient satisfaction is a crucial measure of the quality of healthcare, especially with regard to nursing services in hospital settings. Understanding and increasing patient satisfaction with nursing care is critical to improving overall healthcare and ensuring positive patient experiences during their hospital stay. The aim of this research was to evaluate the psychometric properties of the Croatian version of the Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), test the reliability and validity of the tool after translation, and investigate differences in patient satisfaction based on demographic variables, as well as their contribution to satisfaction with the quality of nursing care. After translation and adaptation, the Croatian version of the PSNCQQ was applied to 350 hospitalized patients (average age 51.19 years (range: 18-87)), of whom 194 (55.4%) were men and 156 (44.6%) were women. The results showed high internal consistency (Cronbach's α = 0.977) and confirmed the one-factor structure of the questionnaire, explaining 70.64% of the total variance. Confirmatory factor analysis supported the unidimensional model, showing strong fit indices (χ2 = 583.047, df = 149, p < 0.001, GFI = 0.861, AGFI = 0.818, NFI = 0.936, TLI = 0.946, CFI = 0.955, RMSEA = 0.080, PCLOSE < 0.001). In conclusion, the validation of the PSNCQQ in the Croatian language increases resources for evaluating and improving the quality of nursing care. This research lays the foundation for future studies and practical applications aimed at improving patient satisfaction and nursing care outcomes in Croatia, but there are also limitations to this study, including its one-institution scope, the possible influence of factors outside the current treatment on satisfaction, and the lack of comparison with objective clinical indicators.

Indirect impact of the war in Ukraine on primary percutaneous coronary interventions for ST-elevation myocardial infarction in Poland.

The Russian invasion of Ukraine in February 2022 resulted in the displacement of approximately 12.5 million refugees to adjacent countries including Poland, that may have strained healthcare service delivery. Using the ST-elevation myocardial infarction (STEMI) data, we aimed to evaluate whether the Russian invasion of Ukraine has indirectly impacted the delivery of acute cardiovascular care in Poland. We analyzed all adult patients undergoing percutaneous coronary interventions (PCI) for STEMI across Poland between 25th February 2017 to 24th May 2022. Centers were allocated to regions of <100km and >100km of the Polish-Ukraine border. Mixed effect generalized linear regression models with random effects per hospital were used to explore the associations between the war in Ukraine starting with several outcomes of interest, and whether these associations differed across regions of </>100km from the Polish-Ukraine border. A total of 90,115 procedures were included in the analysis. The average number of procedures per-month was similar to predicted volume for centers in the >100km region, while the average number of PCI was higher than expected (by an estimated 15 (11-19)) for the <100km region. There was no difference in adjusted fatality rate or quality of care outcomes pre- vs. during-war in both <100 and >100 km regions, with no evidence of a difference-in-difference across regions. Following the Russian invasion of Ukraine, there was only a modest and temporary increase in primary PCI predominantly in centers situated within 100km of the border, although no significant impact on in-hospital fatality rate.

Feasibility of a quality-improvement program based on routinely collected health outcomes in Dutch primary care physical therapist practice: a mixed-methods study

BackgroundThis study evaluates the feasibility of a nine-month advanced quality-improvement program aimed at enhancing the quality of care provided by primary care physical therapists in the Netherlands. The evaluation is based on routinely collected health outcomes of patients with nonspecific low back pain, assessing three feasibility domains: (1) appropriateness, feasibility, and acceptability for quality-improvement purposes; (2) impact on clinical performance; and (3) impact on learning and behavioral change.MethodsA mixed-methods quality-improvement study using a concurrent triangulation design was conducted in primary care physical therapist practice. Feedback reports on the processes and outcomes of care, peer assessment, and self-assessment were used in a Plan-Do-Study-Act cycle based on self-selected goals. The program’s appropriateness, feasibility, and acceptability, as well as the impact on clinical performance, were evaluated using the Intervention Appropriate Measure, Feasibility Intervention Measure, Acceptability Intervention Measure (for these three measure, possible scores range from 4 to 20), and with a self-assessment of clinical performance (scored 0–10), respectively. The impact on learning and behavioral change was evaluated qualitatively with a directed content analysis.ResultsTen physical therapists from two practices participated in this study. They rated the program with a mean of 16.5 (SD 1.9) for appropriateness, 17.1 (SD 2.2) for feasibility, and 16.4 (SD 1.5) for acceptability. Participants gave their development in clinical performance a mean score of 6.7 (SD 1.8). Participants became aware of the potential value of using outcome data and gained insight into their own routines and motivations. They changed their data collection routines, implemented data in their routine practice, and explored the impact on their clinical behavior.ConclusionsThis explorative study demonstrated that a quality-improvement program, using health outcomes from a national registry, is judged to be feasible.Impact statementThis study provides preliminary evidence on how physical therapists may use health outcomes to improve their quality, which can be further used in initiatives to improve outcome-based care in primary physical therapy.

P056 Patient Satisfaction Survey of a Newly Set-Up Fast Track Giant Cell Arteritis Service in a District General Hospital

Abstract Background/Aims Giant Cell Arteritis (GCA) is a multisystem, large and medium artery vasculitis, which results in significant comorbidity, even mortality. Prompt diagnosis is a pivotal first step in its effective management. To that effect, we set up a fast track service in Eastbourne District General Hospital (EDGH) for a one-stop-shop assessment of GCA referrals with Ultrasound Doppler. Fifteen months from service commencement, we embarked on assessing patient satisfaction of our service users. This exercise could provide vital insight into the effectiveness of our new service, and thus drive improvement. Furthermore, it is well established that patient satisfaction is associated with improved outcomes in patient care, be it due to improved compliance, engagement with the service, or overall better understanding of the underlying condition. Aims 1. To assess overall level of patient satisfaction of our new fast track GCA service against a number of internally set criteria; 2. To improve the effectiveness of the service based on feedback from the actual service users; 3. To improve the level of satisfaction of patients coming through the GCA service. Methods We set up a dedicated GCA clinic aiming to see patients within five days of referral. In order to assess overall patient satisfaction of the service, we formulated a questionnaire-based survey that was posted to 99 service users. We assessed five areas overall: appointment allocation process; staff attitude; information supplied; advice line effectiveness; overall satisfaction. Data were collected and analysed on Microsoft Excell. No patient identifiable details were collected. Results Out of the 99 feedback forms that were sent out, 51 were returned completed within the survey period. The appointment allocation process was assessed as “excellent” by 95% of responders, and “satisfactory” by 5%. Staff received 98% “excellent” rating. Information provided to the patient was assessed as 91% “excellent”, 8% “satisfactory”, and 1% “poor”. Response to advice line inquiries received 54% “excellent”, 18% “satisfactory”, and 2% “poor” rating (26% of responders answered “non-applicable”). Finally, overall satisfaction was rated at 93%, with, crucially, no service user providing a “poor” rating. Conclusion We conducted a patient survey to assess overall satisfaction of our new fast track GCA pathway, ultimately aiming at improving our service. The overwhelming majority of the feedback was positive, but we focused and acted on suggestions. Following the survey, we have a) designed a GCA “passport” with useful information for newly diagnosed patients; b) revisited the advice line with a modified information leaflet for this service; c) endeavoured to optimise the referrals process via education sessions on GCA for Hospital and Primary Care clinicians. Following a period of intervention, we will be reassessing patient satisfaction, aiming to continue improving our service. Disclosure A. Hall: None. P. Kamperidis: None. H. Perera: None. S. Panthakalam: None.

The role of vitamin D in outcomes of critical care in COVID-19 patients: Evidence from an umbrella meta-analysis of interventional and observational studies.

Several meta-analyses have suggested the beneficial effect of vitamin D on patients infected with SARS-CoV-2. This umbrella meta-analysis aims to evaluate influence of vitamin D supplementation on clinical outcomes and the mortality rate of COVID-19 patients. Present study was designed as an umbrella meta-analysis. The following international databases were systematically searched till March 2023: Web of Science, PubMed, Scopus, and Embase. Random-effects model was employed to perform meta-analysis. Using AMSTAR critical evaluation tools, the methodological quality of the included meta-analyses was evaluated. Adult patients suffering from COVID-19 were studied. Overall, 13 meta-analyses summarizing data from 4 RCTs and 9 observational studies were identified in this umbrella review. Our findings revealed that vitamin D supplementation and status significantly reduced mortality of COVID-19 [Interventional studies: (ES= 0.42; 95% CI: 0.10, 0.75, p <0.001; I2 = 20.4%, p=0.285) and observational studies (ES= 1.99; 95% CI: 1.37, 2.62, p <0.001; I2 = 00.0%, p=0.944). Also, vitamin D deficiency increased risk of infection and disease severity among patients. Overall, vitamin D status is a critical factor influencing the mortality rate, disease severity, admission to ICU and being detached from mechanical ventilation. It is vital to monitor the vitamin D status in all patients with critical conditions including COVID patients.

Vein segmentation and visualization of upper and lower extremities using convolution neural network.

The study focused on developing a reliable real-time venous localization, identification, and visualization framework based upon deep learning (DL) self-parametrized Convolution Neural Network (CNN) algorithm for segmentation of the venous map for both lower and upper limb dataset acquired under unconstrained conditions using near-infrared (NIR) imaging setup, specifically to assist vascular surgeons during venipuncture, vascular surgeries, or Chronic Venous Disease (CVD) treatments. A portable image acquisition setup has been designed to collect venous data (upper and lower extremities) from 72 subjects. A manually annotated image dataset was used to train and compare the performance of existing well-known CNN-based architectures such as ResNet and VGGNet with self-parameterized U-Net, improving automated vein segmentation and visualization. Experimental results indicated that self-parameterized U-Net performs better at segmenting the unconstrained dataset in comparison with conventional CNN feature-based learning models, with a Dice score of 0.58 and displaying 96.7 % accuracy for real-time vein visualization, making it appropriate to locate veins in real-time under unconstrained conditions. Self-parameterized U-Net for vein segmentation and visualization has the potential to reduce risks associated with traditional venipuncture or CVD treatments by outperforming conventional CNN architectures, providing vascular assistance, and improving patient care and treatment outcomes.

Factors influencing integration of mental health screening and treatment at HIV clinic settings in Cameroon: a qualitative study of health providers’ perspectives

BackgroundMental disorders are common among people with HIV (PWH) and are associated with poor HIV outcomes. Despite high unmet mental health needs among PWH, use of evidence-based mental health screening and treatment protocols remains limited at HIV treatment facilities across low-resource settings. Integrating mental health services into HIV care can reduce this gap. This study’s objective was to explore factors that influence integration of mental health screening and treatment into HIV clinics in Cameroon.MethodsWe analyzed 14 in-depth interviews with clinic staff supporting PWH at three urban HIV treatment clinics in Cameroon. Interviews focused on current processes, barriers and facilitators, and types of support needed to integrate mental health care into HIV care. Interviews were recorded and transcribed. French transcripts were translated into English. We used thematic analysis to identify factors that influence integration of mental health screening and treatment into HIV care in these settings. Ethical review boards in the United States and Cameroon approved this study.ResultsRespondents discussed a lack of standardized mental health screening processes in HIV treatment facilities and generally felt ill-equipped to conduct mental health screening. Low community awareness about mental disorders, mental health-related stigma, limited physical space, and high clinic volume affected providers’ ability to screen clients for mental disorders. Providers indicated that better coordination and communication were needed to support client referral to mental health care. Despite these barriers, providers were motivated to screen clients for mental disorders and believed that mental health service provision could improve quality of HIV care and treatment outcomes. All providers interviewed said they would feel more confident screening for mental disorders with additional training and resources. Providers recommended community sensitization, training or hiring additional staff, improved coordination to manage referrals, and leadership buy-in at multiple levels of the health system to support sustainable integration of mental health screening and treatment into HIV clinics in Cameroon.ConclusionsProviders reported enthusiasm to integrate mental health services into HIV care but need more support and training to do so in an effective and sustainable manner.

Hospital Unit Type and Professional Roles as a Predictor of Relational Coordination in an Army Medical Center.

High-quality communication and relationships are associated with quality of care. Workflow differences across hospital units can impede communication and relationships among health care professionals. Relational coordination (RC) is a process of communication supported by shared goals, shared knowledge, and mutual respect and is associated with quality of care and better performance outcomes in civilian hospitals. However, RC has not been explored in military hospitals. The objective of our study was to determine whether RC differs between hospital units and professional roles. Specifically, we examined RC differences by unit type for nurses, resident physicians, and physicians working in an Army Medical Center. We conducted an exploratory analysis of a secondary question from a cross-sectional study using a convenience sample of active-duty and civilian licensed practical nurses (LPNs), registered nurses (RNs), physician residents, and physicians (n = 289). We received institutional review board approval from the study site. Data were collected from January 2020 to March 2020, and participants completed a 47-item survey regarding their experiences of RC in various hospital units. We used t tests and one-way analyses of variance to explore bivariate relationships between RC and other study variables, as well as multiple regression to explore whether RC varied by unit type. We controlled for education and experience by including them in the model because these variables may influence perceptions of nurse-physician RC and their interactions with each other. Seventy percent of participants were civilian (n = 203), 75% RNs (n = 217), and 78% female (n = 216). The mean age of respondents was 40 years (SD = 11.7), and the mean experience level was 11.9 years (SD = 9.5). RC was not associated with unit type. Total RC and between-role RC were associated with professional role. Physicians reported higher RC (β = .45, P = .01), and LPNs reported lower RC (β = -.06, P = .01). Education and experience were associated with RC. Participants with less experience reported higher RC (β = -.01, P = .00), and participants with graduate degrees reported lower RC (β = -.62, P = .00). We recommend hospital leaders consider interventions to build interprofessional relationships, including interdisciplinary meetings, huddles, and structured communication tools. Improving RC among health care professionals is a cost-effective and unique way to enhance communication and collaboration among health care professionals across hospital units.

Association of quality of nursing care with violence load, burnout, and listening climate

BackgroundViolence against nurses is common. Previous research has recommended further development of the measurement of violence against nurses and integration of the individual and ward-related factors that contribute to violence against hospital nurses. This study was designed to address these issues by investigating the associations between violence, the listening climate of hospital wards, professional burnout, and perceived quality of care. For this purpose, we used a new operationalization of the violence concept.MethodsWe sought nurses to participate in the study through social media which yielded 765 nurses working in various healthcare systems across Israel who volunteered to complete a self-administered online questionnaire. 80% of the sample were hospital nurses, and 84.7% were female. The questionnaire included validated measures of burnout, listening climate, and quality of care. Instead of using the traditional binary measure of exposure to violence to capture the occurrence and comprehensive impact of violence, this study measured the incremental load of violence to which nurses are subjected.ResultsThere were significant correlations between violence load and perceived quality of care and between constructive and destructive listening climates and quality of care. Violence load contributed 14% to the variance of burnout and 13% to the variance of perceived quality of care. The ward listening climate moderated the relationship between burnout and quality of care.ConclusionsThe results of this study highlight the impact of violence load among nurses and the ward listening climate on the development of burnout and on providing quality care. The findings call upon policymakers to monitor violence load and allocate resources to foster supportive work environments to enhance nurse well-being and improve patient care outcomes.

MORTALITY AND ASSOCIATED FACTORS AMONG INTENSIVE CARE UNIT ADMITTED ADULT PATIENTS WITH MECHANICAL VENTILATION IN ETHIOPIA: A SYSTEMATIC REVIEW AND META-ANALYSIS.

Introduction: The global demand for intensive care has risen, given its effectiveness in lowering mortality rates. Mechanical ventilation (MV) is integral to intensive care but introduces risks such as ventilator-associated complications. Ethiopia experiences a high intensive care unit (ICU) mortality rate. Objective: This systematic review and meta-analysis aim to comprehensively synthesize evidence on the mortality of adults undergoing MV in Ethiopia and identify associated factors. Methods: The study extensively searched databases and gray literature for research on MV outcomes, trends, and associated factors in adult ICUs. Adhering to the 2020 PRISMA checklist, a systematic review and meta-analysis sought to establish the mortality rate and key determinants among adult ICU patients on MV. The search incorporated keywords and MeSH terms, excluding studies with unsound methodologies or missing data. Data extraction, quality assessment, and analysis followed established protocols, including the JBI tool for methodological quality evaluation. STATA version 17.0 facilitated analysis, assessing heterogeneity, publication bias, and performing sensitivity and meta-regression analyses. Results: The pooled mortality rate among adult ICU patients undergoing MV was 48.61% (95% CI: 40.82, 56.40%). Significant mortality-contributing factors included medical diagnosis, Glasgow Coma Scale score, sepsis/septic shock, sedation use, multiple-organ dysfunction syndrome, and cardiovascular disease. Although some pooled odds ratios seemed insignificant, closer examination revealed significant associations in individual studies. Conclusion : The study underscores the urgent need for further research, improved ICU infrastructure, and healthcare personnel training in Ethiopia to enhance outcomes for mechanically ventilated patients. Identified factors offer valuable insights for targeted interventions, guiding tailored treatment strategies to reduce mortality. This study contributes to understanding mortality and associated factors in MV patients, informing initiatives to improve critical care outcomes in Ethiopia.

Implementation and early effects of medicaid policy interventions to promote racial equity in pregnancy and early childhood outcomes in Pennsylvania: protocol for a mixed methods study

BackgroundThere are large racial inequities in pregnancy and early childhood health within state Medicaid programs in the United States. To date, few Medicaid policy interventions have explicitly focused on improving health in Black populations. Pennsylvania Medicaid has adopted two policy interventions to incentivize racial health equity in managed care (equity payment program) and obstetric service delivery (equity focused obstetric bundle). Our research team will conduct a mixed-methods study to investigate the implementation and early effects of these two policy interventions on pregnancy and infant health equity.MethodsQualitative interviews will be conducted with Medicaid managed care administrators and obstetric and pediatric providers, and focus groups will be conducted among Medicaid beneficiaries. Quantitative data on healthcare utilization, healthcare quality, and health outcomes among pregnant and parenting people will be extracted from administrative Medicaid healthcare data. Primary outcomes are stakeholder perspectives on policy intervention implementation (qualitative) and timely prenatal care, pregnancy and birth outcomes, and well-child visits (quantitative). Template analysis methods will be applied to qualitative data. Quantitative analyses will use an interrupted time series design to examine changes over time in outcomes among Black people, relative to people of other races, before and after adoption of the Pennsylvania Medicaid equity-focused policy interventions.DiscussionFindings from this study are expected to advance knowledge about how Medicaid programs can best implement policy interventions to promote racial equity in pregnancy and early childhood health.

A review of distributed ledger technologies application in medical systems interoperability

This study of the literature delves into the complex area of medical systems interoperability, focusing on mitigating variables that impact security and data transfer at the structural and semantic levels. In the era of digital healthcare, the secure sharing of medical data is crucial, and this study looks at how Distributed Ledger Technologies (DLTs) can play a major role in addressing these challenges. Complex interoperability issues that come from differences in communication protocols, data formats, established data structures, data models, and data meaning and codification methodologies face the healthcare industry. These problems typically impede the seamless transmission of electronic medical records between healthcare systems. Because of their decentralized structure and cryptographic foundation, DLTs offer a workable solution to these issues. By critically evaluating previous research and case studies, DLTs may be able to lessen these interoperability issues, as this literature review illustrates. Since DLTs provide an immutable and secure platform for the transmission of medical data, guaranteeing data integrity and confidentiality, they are a natural fit for the sensitive nature of healthcare data. Their importance in creating safe communication protocols, enhancing the meaning of data, and defining models and formats for data is emphasized in this review. A comprehensive architecture for DLT interoperability in healthcare is also recommended by the research. This framework encourages the development of DLT integration, shared data models, standardized data formats, and governance and policy. By implementing this strategy and strengthening secure medical data sharing, healthcare organizations and governments may increase the efficiency, precision, and speed of healthcare delivery. The crucial role that DLTs play in removing the structural and semantic barriers to safe medical systems interoperability is highlighted in the conclusion of this literature review. By adopting DLTs, the healthcare sector may usher in a new era of standardized, safe, and efficient medical data transmission, which will ultimately benefit both patients and healthcare providers. This study shows how distributed ledger technologies (DLTs) have the potential to revolutionize the healthcare industry by enabling the secure and meaningful exchange of medical data between different systems, thereby improving patient care and healthcare outcomes.

Post-discharge Care Practices, Challenges, and Outcomes in Newborn Infants of Mothers With SARS-CoV-2 Infection: Insights From Public Hospitals

Post-discharge Care Practices, Challenges, and Outcomes in Newborn Infants of Mothers With SARS-CoV-2 Infection: Insights From Public Hospitals

Developing and validating the nurse-patient relationship scale (NPRS) in China

BackgroundPoor nurse-patient relationship poses an obstacle to care delivery, jeopardizing patient experience and patient care outcomes. Measuring nurse-patient relationship is challenging given its multi-dimensional nature and a lack of well-established scales.PurposeThis study aimed to develop a multi-dimensional scale measuring nurse-patient relationship in China.MethodsA preliminary scale was constructed based on the existing literature and Delphi consultations with 12 nursing experts. The face validity of the scale was tested through a survey of 45 clinical nurses. This was followed by a validation study on 620 clinical nurses. Cronbach’s α, content validity and known-group validity of the scale were assessed. The study sample was further divided into two for Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), respectively, to assess the construct validity of the scale.ResultsThe Nurse-Patient Relationship Scale (NPRS) containing 23 items was developed and validated, measuring five dimensions: nursing behavior, nurse understanding and respect for patient, patient misunderstanding and mistrust in nurse, communication with patient, and interaction with patient. The Cronbach’s α of the NPRS ranged from 0.725 to 0.932, indicating high internal consistency. The CFA showed excellent fitness of data into the five-factor structure: χ2/df = 2.431, GFI = 0.933, TLI = 0.923, CFI = 0.939, IFI = 0.923, RMSEA = 0.070. Good content and construct validity are demonstrated through expert consensus and psychometric tests.ConclusionThe NPRS is a valid tool measuring nurse-patient relationship in China.

Correction to "Achieving equity in reproductive care and birth outcomes for Black people in Canada".

Correction to "Achieving equity in reproductive care and birth outcomes for Black people in Canada".

Sex Differences in Outcomes of Hepatobiliary and Pancreatic Surgery with Accelerated Rehabilitation.

Sex, in the sense of gender, is a major social demographic characteristic that has been shown to affect health care outcomes. The concept of enhanced recovery after surgery (ERAS) is an effective perioperative management measure that can reduce the perioperative stress response in patients. However, there are few studies on the differences between male and female patients under this type of care. We aimed to analyze sex differences in clinical characteristics among patients undergoing hepatobiliary and pancreatic surgery with accelerated rehabilitation. We enrolled patients who underwent liver, biliary tract, and gallbladder operations in the Department of Hepatobiliary and Pancreatic Surgery of Taizhou Hospital, Zhejiang Province, China, from April 2021 to July 2021. Key measures were collected for patients undergoing perioperative accelerated rehabilitation (i.e., the case group). The study group was assembled by performing 1:1 matching for age, sex, chronic disease, and type of surgery. Postoperative risk assessment, postoperative recovery indicators, and postoperative length of hospital stay (days) were compared between male and female patients. A total of 226 surgical patients were enrolled, including 109 male (48.23%) and 117 female patients (51.77%). The outcomes, presented as the median (min, max), were as follows: pulmonary rehabilitation risk assessment in females (1(0,3)) and males (0(0,2)), postoperative nausea and vomiting in females (2(1,3)) and males (1(0,2)), and time to first defecation in females (31(4,61)) and males (36(10,78)). Significant differences were indicated by p values < 0.05. We identified sex differences in the clinical prognosis and performance of perioperative patients undergoing hepatobiliary and pancreatic surgery with accelerated rehabilitation. The perioperative pulmonary rehabilitation risk of male patients was higher than that of female patients, and the time to first defecation was longer in male than in female patients. The incidence of nausea and vomiting in women was higher than in men.

Knowledge, Attitude and Practice of Nurses Regarding Therapeutic Communication at Tertiary Care Hospital

Background: Effective communication in healthcare settings is pivotal for enhancing patient outcomes and fostering a cooperative environment between patients and healthcare providers. Therapeutic communication specifically plays a crucial role in establishing a rapport between nurses and patients, which can significantly impact the quality of care provided. Objective: The study aimed to evaluate the knowledge, attitudes, and practices of nurses regarding therapeutic communication within tertiary care hospitals in Lahore, identifying areas for potential improvement. Methods: A descriptive cross-sectional study was conducted over nine months using a validated questionnaire to assess the knowledge, attitudes, and practices of nurses. A total of 154 nurses were randomly selected using Slovin’s formula for sample size determination. Data collection involved demographic and professional experience details, followed by specific questions on therapeutic communication. The Statistical Package for the Social Sciences (SPSS) Version 25.0 was utilized for data analysis, employing descriptive and inferential statistics to interpret the data. Results: The results showed that 33.1% of nurses exhibited low knowledge levels, 39.0% moderate, and 27.9% high knowledge about therapeutic communication. Regarding attitudes, 57.1% of nurses displayed a positive attitude while 42.9% had a negative attitude towards therapeutic communication. In practice, 61.7% of nurses demonstrated good practice of therapeutic communication, whereas 38.3% displayed poor practices. Conclusion: The study concluded that while there is a moderate understanding and positive attitude towards therapeutic communication among nurses, significant portions still require further training and improvement. Enhanced educational programs focusing on therapeutic communication could bridge existing knowledge gaps and refine practices, thereby improving patient care outcomes.

Implementation of an audit and feedback module targeting low-value clinical practices in a provincial trauma quality assurance program: a cost-effectiveness study

BackgroundAudit and Feedback (A&F) interventions based on quality indicators have been shown to lead to significant improvements in compliance with evidence-based care including de-adoption of low-value practices (LVPs). Our primary aim was to evaluate the cost-effectiveness of adding a hypothetical A&F module targeting LVPs for trauma admissions to an existing quality assurance intervention targeting high-value care and risk-adjusted outcomes. A secondary aim was to assess how certain A&F characteristics might influence its cost-effectiveness.MethodsWe conducted a cost-effectiveness analysis using a probabilistic static decision analytic model in the Québec trauma care continuum. We considered the Québec Ministry of Health perspective. Our economic evaluation compared a hypothetical scenario in which the A&F module targeting LVPs is implemented in a Canadian provincial trauma quality assurance program to a status quo scenario in which the A&F module is not implemented. In scenarios analyses we assessed the impact of A&F characteristics on its cost-effectiveness. Results are presented in terms of incremental costs per LVP avoided.ResultsResults suggest that the implementation of A&F module (Cost = $1,480,850; Number of LVPs = 6,005) is associated with higher costs and higher effectiveness compared to status quo (Cost = $1,124,661; Number of LVPs = 8,228). The A&F module would cost $160 per LVP avoided compared to status quo. The A&F module becomes more cost-effective with the addition of facilitation visits; more frequent evaluation; and when only high-volume trauma centers are considered.ConclusionA&F module targeting LVPs is associated with higher costs and higher effectiveness than status quo and has the potential to be cost-effective if the decision-makers’ willingness-to-pay is at least $160 per LVP avoided. This likely represents an underestimate of true ICER due to underestimated costs or missed opportunity costs. Results suggest that virtual facilitation visits, frequent evaluation, and implementing the module in high-volume centers can improve cost-effectiveness.