Care Unit Patients Research Articles

Investigating a pulmonary Mycobacterium abscessus infection outbreak among elderly inpatients in the intensive care ward.

Mycobacterium abscessus is an opportunistic nontuberculous mycobacteria pathogen; however, the prevalence of nosocomial and community infections is increasing. In January 2016, several bedridden inpatients in the intensive care unit of a hospital had positive sputum smears for acid-fast bacilli, suggesting a mycobacteria outbreak. Acid-fast bacilli smear microscopy, isolation, and culturing were performed twice using sputa from each suspected intensive care unit inpatient (n = 13); in addition, medical history was obtained for each inpatient with suspected infection. Furthermore, environmental specimens were surveyed, collected, and cultured. We used DNA microarray chip analysis to identify positive mycobacterial isolates at the species level and performed whole-genome sequencing and phylogenetic tree construction. Seven inpatients had M. abscessus pulmonary infection, confirmed by 2 positive cultures; five of the inpatients had only one positive culture, while one had two negative cultures. Six of 13 ventilator condensate samples were mycobacterial culture-positive, identified as M. abscessus; the other environmental samples were negative. The M. abscessus isolates (15 sputa and 4 environmental samples) clustered together in the phylogenic analysis with only one single-nucleotide polymorphism difference. All patients were symptom-free after 8 months of multi-drug treatment. We confirmed a pulmonary M. abscessus outbreak among 12 bedridden patients in the intensive care unit through microbiological, molecular epidemiological, and environmental investigations. The possible infection source was contaminated ventilator condensate. This outbreak reemphasizes the importance of standardized ventilator maintenance and disinfection for preventing ventilator-associated pneumonia and is a reminder that nontuberculous mycobacteria-related ventilator-associated pneumonia is possible.

Predictors of Professional Quality of Life, Stress and Coping Styles Among Frontline Nurses During Covıd-19: A Cross-Sectional Study

COVID-19 may cause traumatic experiences and create stressful work environments for nurses, adversely affecting their psychosocial status. This study analyzes the professional quality of life, perceived stress levels, and coping styles of frontline nurses during the COVID-19 pandemic. Web-based survey using a descriptive cross-sectional design and a convenience sampling were used to select 244 nurses working with COVID-19 patients in inpatient, emergency, or intensive care units in Istanbul, Turkey. All participants completed a research questionnaire via Google Forms between August 7 and December 25, 2020. Multiple stepwise linear regression was used to analyze data. Participants experienced moderate levels of burnout, compassion satisfaction and stress, and high levels of compassion fatigue. They mostly used the self-confident approach coping style. Lack of training on the use of personal protective equipment, inadequate social support and the demands of emergency unit work were associated with compassion fatigue, burnout, and decreased level of compassion satisfaction. Organizational support was a predictor of seeking social support coping style and perceived stress was a predictor of a submissive and helpless coping style. This study demonstrates that interventions and coping programs are needed to improve frontline nurses’ ability to cope with stress.

At-Home Foscarnet Administration in Patients with Cytomegalovirus Infection Post-Allogeneic Stem Cell Transplantation: A Unicentric, Safe, and Feasible Program.

Cytomegalovirus (CMV) infection is a relevant cause of morbimortality in patients receiving allogeneic stem cell transplantation (allo-HCT). Foscarnet (FCN) is an effective drug against CMV administered intravenously and usually on an inpatient basis. The Home Care Unit (HCU) for hematologic patients at our hospital designed an at-home FCN administration model to avoid the hospitalization of patients requiring FCN treatment. This study analyzes whether the at-home administration of FCN is as safe and effective as its hospital administration. We collected and compared demographic, clinical, analytical, and economic data of patients with CMV infection post-allo-HCT who received FCN in the hospital (n = 16, 17 episodes) vs. at-home (n = 67, 88 episodes). The proportions of patients with cured CMV infections were comparable between the two groups (65.9% vs. 76.5%, p = 0.395). The median duration of FCN treatment was 15 (interquartile range [IQR] 9-23) and 14 (IQR 11-19) days in the HCU and inpatient cohorts, respectively (p = 0.692). There were no significant differences in the FCN toxicities between groups except for hypocalcemia (26.1% vs. 58.8%, p = 0.007), which was more prevalent in the inpatient cohort. A significant cost-effectiveness was found in the HCU cohort, with a median savings per episode of EUR 5270. It may be concluded that home administration of FCN is a safe, effective, and cost-efficient therapeutic option for patients with CMV infection and disease.

Prediction of Th17/Treg cell balance on length of stay in intensive care units of patients with sepsis

BackgroundProlonged length of stay (LOS) of sepsis can drain a hospital's material and human resources. This study investigated the correlations between T helper type 17 (Th17) and regulatory T (Treg) balance with LOS in sepsis. MethodsA prospective clinical observational study was designed in Changhai Hospital affiliated to Naval Medical University in Shanghai, China, from January to October 2020. The patients diagnosed with sepsis and who met the inclusion and exclusion criteria were recruited and whether the levels of cytokines, procalcitonin, subtypes, and biomarkers of T cells in the peripheral blood were detected. We analyzed the correlation between these and LOS. ResultsSixty septic patients were classified into two groups according to whether their intensive care unit (ICU) stay exceeded 14 days. The patients with LOS ≥14 days were older ([72.6±7.5] years vs. [63.3±10.4] years, P=0.015) and had higher Sequential Organ Failure Assessment (SOFA) (median [interquartile range]: 6.5 [5.0–11.0] vs. 4.0 [3.0–6.0], P=0.001) and higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores (16.0 [13.0–21.0] vs. 8.5 [7.0–14.0], P=0.001). There was no difference in other demographic characteristics and cytokines, interleukin-6, tumor necrosis factor-α, and interleukin-10 between the two groups. The Th17/Treg ratio of sepsis with LOS <14 days was considerably lower (0.48 [0.38–0.56] vs. 0.69 [0.51–0.98], P=0.001). For patients with LOS ≥14 days, the area under the receiver operating characteristic curve for the Th17/Treg ratio was 0.766. It improved to 0.840 and 0.850 when combined with the SOFA and APACHE II scores, respectively. ConclusionsThe Th17/Treg ratio was proportional to septic severity and can be used as a potential predictor of ICU stay in sepsis, presenting a new option for ICU practitioners to better care for patients with sepsis.

Nurses quality of life, sleep disturbance, and intention to leave critical care units: A cross-sectional moderated mediation analysis

ObjectivesThis study aims to explore the complex relationships between personal and demographic factors, intermediary factors such as quality of life (depression, anxiety, stress, burnout), and the mediating impact of sleep disturbance on nurses' intention to leave critical care units. DesignCross-sectional quantitative survey. SettingData were collected from registered nurses at a major university hospital in southern Italy. Seven inpatient critical care units were sampled. Main outcome measuresIntention to leave critical care units. ResultsWe included 160 participants recruited over five weeks in May and June 2023. The data showed that most were female, married, and possessed a bachelor's degree in nursing. The mean quality of life score was moderate, while stress, anxiety, and burnout were mild. A significant percentage of nurses reported poor sleep quality. Logistic regression indicates that service length did not significantly impact the intention to leave. The structural equation model showed that stress positively correlated with emotional exhaustion, whereas job quality was negatively associated with emotional exhaustion and the intention to leave. Sleep disturbance did not explain the relationship between stress and emotional fatigue; however, the results revealed that male gender moderated sleep mediation. ConclusionsThis study investigated factors influencing intention to leave among critical care unit nurses. The results suggest that the role of sleep disturbance should always be considered when assessing the issue. In this chain of causes, sleep disturbance explains the relationship between stress and emotional exhaustion. Furthermore, the strength of this mediation was influenced by gender, particularly by the male gender. Implications for Clinical PracticeStress and emotional exhaustion significantly impact nurses' working quality of life, particularly when sleep quality is taken into account. This leads to a higher intention to leave critical care units. To reduce this tendency, healthcare managers could implement specific evidence-based interventions to promote a good climate of work, which would positively affect stress, emotional exhaustion and sleep disturbance. The likelihood of intention to leave decreased with achieving personal self-fulfilment among nurses.

Outcomes of traumatic brain injury patients in an adult intensive care unit of a South African regional hospital, without on-site neurosurgical service: A retrospective quantitative study on the neurological improvement at discharge.

Traumatic brain injury (TBI) is a major cause of mortality and disability. The South African (SA) province of Kwazulu-Natal faces challenges in providing appropriate care for TBI patients owing to limited resources and delayed access to healthcare services. We aimed to assess the outcomes of patients with TBI who were treated at a hospital without a neurosurgical unit (NSU). The primary objective was to compare the Glasgow Coma Scale (GCS) scores at admission and discharge from the intensive care unit (ICU) for patients with TBI receiving neuroprotection. Secondary objectives included analysing demographics and identifying predictive factors associated with GCS score improvement. This retrospective study analysed data from the already established ICU Integrated Critical Care Electronic Database. Data on patient demographics, mechanisms of injury and GCS scores were collected and analysed. The analysis included 95 TBI patients, most of whom were young males. Interpersonal violence and transport-related trauma were the main causes of injury among patients. Approximately 63% of patients had a GCS score improvement >1 upon discharge from the ICU. Patients who received >12 hours of neuroprotection in the emergency department had significantly lower rates of improvement. Sixty-three percent of TBI patients had improved GCS scores by >1 on discharge from the ICU, but outcomes varied. Delayed ICU admission from the emergency department of >12 hours might contribute to worse outcomes. Timely neuroprotection, improved access to neurosurgical care and better understanding of the factors affecting outcomes are needed. This study explores the outcomes of patients with TBI admitted to a non-neurosurgical ICU. Factors contributing to a worse outcome are identified, highlighting the need for adequate numbers of ICU beds and prompt admission from the emergency department.

Long COVID-associated symptoms prevalent in both SARS-CoV-2 positive and negative individuals: A prospective follow-up study

BackgroundResearch into persistent symptoms among SARS-CoV-2-positive i.e. CoV(+) patients mostly focuses on hospitalized individuals. Our prospective follow-up study compares long COVID-associated symptoms among laboratory-confirmed CoV(+) and SARS-CoV-2 negative [CoV(−)] individuals. MethodsSARS-CoV-2 RT-PCR-tested volunteers were recruited into four cohorts: 1) CoV(+) outpatients, 2) CoV(−) outpatients, 3) CoV(+) intensive care unit (ICU) inpatients, and 4) CoV(+) non-ICU inpatients. Neutralizing antibodies were assessed and questionnaires filled in at enrolment and days 90–120, 121–180, 181–270, 271–365, and 365–533. ResultsOf the 1326 participants, 1191 were CoV(+): 46 ICU, 123 non-ICU, and 1022 outpatients; 135 were CoV(−) outpatient controls. Both CoV(+) outpatients and CoV(−) controls showed high overall symptom rates at all time points. More prevalent among CoV(+) than CoV(−) outpatients were only impaired olfaction and taste; many others proved more frequent for CoV(−) participants. At ≥181 days, fatigue, dyspnoea, various neuropsychological symptoms and several others were recorded more often for CoV(+) inpatients than outpatients. ConclusionsLong COVID-associated symptoms were more frequent among hospitalized than non-hospitalized CoV(+) participants. As for outpatients, only impaired olfaction and taste showed higher rates in the CoV(+) group; some symptoms proved even more common among those CoV(−). Besides suggesting low long COVID prevalences for outpatients, our results highlight the weight of negative controls.

Performance of severity indices for admission and mortality of trauma patients in the intensive care unit: a retrospective cohort study

BackgroundLittle is known about the performance of severity indices for indicating intensive care and predicting mortality in the Intensive Care Unit (ICU) of trauma patients. This study aimed to compare the performance of severity indices to predict trauma patients’ ICU admission and mortality.MethodsA retrospective cohort study which analyzed the electronic medical records of trauma patients aged ≥ 18 years, treated at a hospital in Brazil, between 2014 and 2017. Physiological [Revised Trauma Score (RTS), New Trauma Score (NTS) and modified Rapid Emergency Medicine Score (mREMS)], anatomical [Injury Severity Score (ISS) and New Injury Severity Score (NISS)] and mixed indices [Trauma and Injury Severity Score (TRISS), New Trauma and Injury Severity Score (NTRISS), Base-deficit Injury Severity Score (BISS) and Base-deficit and New Injury Severity Score (BNISS)] were compared in analyzing the outcomes (ICU admission and mortality) using the Area Under the Receiver Operating Characteristics Curves (AUC–ROC).ResultsFrom the 747 trauma patients analyzed (52.5% female; mean age 51.5 years; 36.1% falls), 106 (14.2%) were admitted to the ICU and 6 (0.8%) died in the unit. The ISS (AUC 0.919) and NISS (AUC 0.916) had better predictive capacity for ICU admission of trauma patients. The NISS (AUC 0.949), TRISS (AUC 0.909), NTRISS (AUC 0.967), BISS (AUC 0.902) and BNISS (AUC 0.976) showed excellent performance in predicting ICU mortality.ConclusionsAnatomical indices showed excellent predictive ability for admission of trauma patients to the ICU. The NISS and the mixed indices had the best performances regarding mortality in the ICU.

Impact of dementia special care units for short-stay nursing home patients.

Improving quality of care provided to short-stay patients with dementia in nursing homes is a policy priority. However, it is unknown whether dementia-focused care strategies are associated with improved clinical outcomes or lower utilization and costs for short-stay dementia patients. We performed a national survey of nursing home administrators in 2020-2021, asking about the presence of three dementia-focused care services used for their short-stay patients: (1) a dementia care unit, (2) cognitive deficiency training for staff, and (3) dementia-specific occupational therapy. Using Medicare claims, we identified short-stay episodes for beneficiaries residing in surveyed skilled nursing facilities (SNFs) with and without dementia. We compared clinical, cost, and utilization outcomes for dementia patients in SNFs, which did and did not offer dementia-focused care services. As a counterfactual control, we compared these differences to those for non-dementia patients in the same facilities. Our primary quantity of interest was an interaction term between a patients' dementia status and the presence of a dementia-focused care tool. The study population included 102,860 Medicare episodes of care from 377 SNF survey respondents in 2018-2019. In adjusted comparisons of the interaction between dementia status and the presence of each dementia-focused care tool, dementia care units were associated with a 1.5-day increase in healthy days at home in the 90 days following discharge (p = 0.01) and a 3.1% decrease in the likelihood of a subsequent SNF admission (p = 0.001). Cognitive deficiency training was also associated with a 2.0% increase in antipsychotics (p = 0.03), whereas dementia-specific occupational therapy was associated with a 1.2% increase in falls (p = 0.01) per patient episode. Self-reported use of dementia care units for short-stay patients was associated with modestly better performance in some, but not all, outcome measures. This provides hypothesis-generating evidence that dementia care units could be a promising mechanism to improve care delivery in nursing homes.

COVID-19 Admission Rates and Changes in US Hospital Inpatient and Intensive Care Unit Occupancy

The COVID-19 pandemic had unprecedented effects on hospital occupancy, with consequences for hospital operations and patient care. Previous studies of occupancy during COVID-19 have been limited to small samples of hospitals. To measure the association between COVID-19 admission rates and hospital occupancy in different US areas and at different time periods during 2020. This cross-sectional study used data from the Healthcare Cost and Utilization Project State Inpatient Databases (2019-2020) for patients in nonfederal acute care hospitals in 45 US states, including the District of Columbia. Data analysis was performed between September 1, 2022, and April 30, 2023. Each hospital and week in 2020 was categorized based on the number of COVID-19 admissions per 100 beds (<1 [low], 1-4.9, 5-9.9, 10-14.9, or ≥15 [high]). The main outcomes were inpatient and intensive care unit (ICU) occupancy. We used regression analysis to estimate the average change in occupancy for each hospital-week in 2020 relative to the same hospital week in 2019. This study included 3960 hospitals and 54 355 916 admissions. Of the admissions in the 40 states used for race and ethnicity analyses, 15.7% were for Black patients, 12.9% were for Hispanic patients, 62.5% were for White patients, and 7.2% were for patients of other race or ethnicity; 1.7% of patients were missing these data. Weekly COVID-19 admission rates in 2020 were less than 4 per 100 beds for 63.9% of hospital-weeks and at least 10 in only 15.9% of hospital-weeks. Inpatient occupancy decreased by 12.7% (95% CI, 12.1% to 13.4%) during weeks with low COVID-19 admission rates and increased by 7.9% (95% CI, 6.8% to 9.0%) during weeks with high COVID-19 admission rates. Intensive care unit occupancy rates increased by 67.8% (95% CI, 60.5% to 75.3%) during weeks with high COVID-19 admissions. Increases in ICU occupancy were greatest when weighted to reflect the experience of Hispanic patients. Changes in occupancy were most pronounced early in the pandemic. During weeks with high COVID-19 admissions, occupancy decreased for many service lines, with occupancy by surgical patients declining by 43.1% (95% CI, 38.6% to 47.2%) early in the pandemic. In this cross-sectional study of US hospital discharges in 45 states in 2020, hospital occupancy decreased during weeks with low COVID-19 admissions and increased during weeks with high COVID-19 admissions, with the largest changes occurring early in the pandemic. These findings suggest that surges in COVID-19 strained ICUs and were associated with large decreases in the number of surgical patients. These occupancy fluctuations may have affected quality of care and hospital finances.

The Use of Medical Chaperones During Physical Examinations: The Perceptions of Adolescents and Their Caregivers.

A medical chaperone serves as a witness for a patient and health care practitioner during a medical examination. We sought to better understand the preferences of parents and children toward the use of chaperones during pediatric physical examinations. This cross-sectional study surveyed patients aged 8 to 18 years and their parents presenting primarily to the emergency department as well as primary care ambulatory clinic and inpatient units. Participants were asked which individuals (patient alone, parent, or medical chaperone) should be present for each aspect of the child's physical examination. The survey was completed by 121 patients (mean age 14 years, 58.5% girls) and 122 parents (mean age 42 years, 82.8% women) in a variety of clinical settings (17 in inpatient, 17 in outpatient clinic, and 87 emergency department admissions). Significant differences existed between male and female patients regarding preferred presence for every body part being examined ( P ≤ 0.002). Female patients preferred to have a same-sex parent in the room, particularly for examination of the breasts, genitalia, or rectum and when the examination was performed by a male provider. Male patients preferred to be alone or with either parent for any body part being examined, regardless of provider sex. Adolescents have significant differences in who they prefer to be in the room for the physical examination based on patient and provider sex in settings where they are unfamiliar with the health care examiner. Few patients and parents preferred a medical chaperone; most preferred a parent to be in the room. Patient and parent considerations should be prioritized when creating policies for the use of medical chaperones.

Evaluating the effect of masks on the vocal health and speech intelligibility of healthcare workers in various hospital unit

The COVID-19 pandemic has enforced mandatory mask usage, particularly in hospitals, and its impact on the vocal problems and speech intelligibility of healthcare workers was examined in this study. A total of 76 healthcare workers from various units, including emergency, inpatient, outpatient, and intensive care, participated in an online questionnaire survey to assess vocal issues experienced while wearing masks. The participants' self-assessed vocal handicaps were quantified using the Vocal Handicap Index (VHI) score. The findings revealed that healthcare workers in emergency units faced the most severe vocal problems, followed by those in outpatient units. The most reported vocal symptoms were clearing the throat and throat dryness. Additionally, noise levels were measured continuously for four hours in each unit, and sources of noise were identified. The measured sound pressure levels (SPL) in emergency, inpatient, outpatient, and intensive care units were 68.64, 63, and 72 dBA, respectively. These values exceeded the World Health Organization's recommended limit of 30-40 dBA, indicating significant discomfort. Lastly, to delve deeper into the increased vocal effort required when wearing masks, the Speech Transmission Index (STI) parameter was analyzed using the recorded SPL as background noise and audio recordings of healthcare workers in different mask-wearing conditions. The study discovered that using a mask considerably reduced speech intelligibility compared to not wearing a mask. Keyword: healthcare workers, vocal problems, noise level, pandemic

Should a forgotten guidewire be removed after years? An undesirable complication of hemodialysis catheter wire left in the body

Today, one of the most common methods used in the emergency room or intensive care unit (ICU) in patients is the Seldinger technique to access the central venous system, shunting for hemodialysis, intra-aortic balloon pump, or arterial insertion. Accidental leaving of the guide wire is an uncommon but important complication that can occur as a result of an incorrect technique, and it is sometimes found accidentally or due to complications years after the procedure. The case is a 53-year-old patient who underwent aortic valve replacement with a mechanical valve and mitral valve repair with a ring 12 years ago and was treated with warfarin. Two years after the heart surgery, due to chronic renal failure, the patient underwent dialysis, and after the preparation of an arteriovenous fistula, he underwent stenting. After approximately ten years, the patient developed fever, chills, and shortness of breath. During the examination, endocarditis was diagnosed, and a part of the aortic valve was released. There was a severe paravalvular leak in the aortic valve, and an abscess was formed in the aorta root. We also noticed a forgotten guide wire in the superior vena cava, right atrium, inferior vena cava, and hepatic vein, and echogenic masses were located on the guidewire. The diagnosis was confirmed by echocardiography, chest x-ray, and phenocopy. After antibiotic therapy, the patients underwent heart surgery, aortic valve replacement, and aortic root repair, and the guidewire was removed (70 cm long). Unfortunately, despite all measures, the patient died a few days after the surgery. Due to complications, a forgotten guidewire should be removed immediately after diagnosis. The preferred intervention is the removal of the guidewire by endovascular interventions, but surgical treatment should also be considered in some cases.

Validation of Risk Scale in Febrile Neutropenic Patients with Cancer in Guatemala

Abstract Background In National Unit of Pediatric Oncology (UNOP) located in Guatemala City an average of 150 patients are treated per day in outpatient and emergency consultation. The episodes of neutropenia post chemotherapy were recognized as predisposing factors for infections. Methods Prospective analytical observational study of pediatric cancer patients with episodes of febrile neutropenia, attended at the National Pediatric Oncology Unit (UNOP) in Guatemala. The following inclusion criteria apply: Patients age under 18 years old and diagnosis of cancer and febrile neutropenia defined by temperature above 38.3 C, ANC ≤ 500 secondary to chemotherapy in the past 7 days. Exclusion criteria apply patients with fever and neutropenia but not received chemotherapy and patients with an infectious focus. The primary endpoint was evaluated the performance of the risk categorization scale in febrile neutropenic patients. Secondary end points were admission to paediatric intensive care unit, death, reactive protein C value (CRP) and bacterial infection. Results A total of 28 episodes of fever and neutropenia recruited between November 2021 and July 2022 were classified 14 (50%) in low risk and 14 (50%) in high risk. Blood cultures were positive in 5 patients (17.9%). The risk scale was not statistically significative to predict bacteremia because two low risk patients have positive blood cultures, X2 was 0.243 (p=0.622) RR 0.917 95% CI (0.648 – 1.30). The majority of pathogens (4/5) were Gram- negative. Admission at intensive care unit in patients with high risk was statistically not significant x2 1.17 (p = 0.280). The calculated relative risk is 3.01 95% CI (0.621-1.15) without any deaths. According to the risk classification CRP ≥ 90 mg/L at 72 hours was 21.4% and 64.3% in patients with low and high risk respectively, X2 5.25 (p = 0.022). Conclusion The scale performance in the study was not statistically significative to predict bacteriemia in patients with febrile neutropenia, however it was clinically relevant to predict admission at unit intensive care for high risk patients. The early detection of a bacteremia and the rapid therapeutic intervention are crucial to improve the outcome

Association Between Temperature During Intensive Care Unit and Mortality in Patients With Acute Respiratory Distress Syndrome

Association Between Temperature During Intensive Care Unit and Mortality in Patients With Acute Respiratory Distress Syndrome

Prognostic scores in predicting 90-day mortality in the cardiac intensive care units

Abstract Introduction During the last years the Coronary Care Units (CCU) have evolved into Cardiac Intensive Care Units (CICU) for patients with acute cardiovascular diseases. The prognostic scores were developed in general Intensive Care Units with the aim of evaluating the severity of the disease and predicting the short-term outcome of the critically ill patients. Although a number of prognostic scores have also been used in the CICU, none of them has been proposed, so far, for prediction of the 90-day mortality which is considered a more reliable outcome metric. Purpose To evaluate the predictive ability for 90-day mortality of five prognostic scores in patients admitted to the CICU due to various cardiovascular etiologies. Methods This is a single-center, prospective cohort study in a CICU admitting patients with acute cardiovascular diseases. APACHE II, SOFA, FRAILTY and MCARS scoring systems as well as CHARLSON comorbidity index (CCI) were calculated on CICU admission. Results A total of 527 patients [mean (SD) age 70 (15) years, 69% males] were included (NSTEMI 23%, STEMI 22%, Heart Failure 10%). Crude 90-day mortality was 16%. The univariate analyses showed that all five scores (FRAILTY, MCARS, SOFA, APACHE II, and CCI) were significantly higher in non-survivors as compared to survivors. The area under the receiver operating characteristic curve (AUC) for FRAILTY, MCARS, SOFA, APACHE II, and CHARLSON’s scores was 0.83, 0.91, 0.92, 0.90, and 0.74, respectively. A multivariate logistic regression including all five prognostic scores revealed FRAILTY, MCARS and SOFA scores as independent predictors of 90-day mortality (OR, CI: 0.57, 0.42-0.77; 0.70, 0.53-0.90; 0.83, 0.70-0.99, respectively). Conclusion MCARS, SOFA, and FRAILTY scores at CICU admission were independent risk factors for 90-day mortality. Therefore, they could be recommended as tools for accurate risk stratification in patients admitted to the CICU.

Managing understandings of palliative care as more than care immediately before death: Evidence from observational analysis of consultations.

Evidence suggests that public, and some professional, understandings of palliative care are limited to care provided immediately before death, which contrasts palliative care's scope as care provided across a range of illness stages. To examine how clinicians manage patients'understandings of palliative care during initial consultations. Initial palliative care consultations were video-recorded and analysed using conversation analytic methods. Consultations were recorded in a specialist palliative care outpatient unit within an Australian public hospital. Participants included 20 newly referred patients and their families, and three palliative care clinicians. During initial consultations, it was observed that specialist palliative care clinicians frequently managed the possibility that patients may understand palliative care as limited to care provided immediately before death. Clinicians used recurrent practices that seemed designed to pre-empt and contradict patients'possible narrow understandings. When discussing the palliative care inpatient unit, clinicians recurrently explained inpatient care could include active treatment and referred to the possibility of being discharged. These practices contradict possible understandings that future admission to the inpatient unit would be solely for care immediately before death. The findings demonstrate that palliative care clinicians are aware of possible narrow understandings of their discipline among members of the public. The practices identified show how clinicians pre-emptively manage these understandings to patients newly referred to palliative care. These findings highlight scope for greater partnership with teams referring patients to palliative care, to assist patients in understanding the range of reasons for their referral. The observational method of conversation analysis provides direct insight into matters that are relevant for patients, as raised in their consultations with clinicians. This direct evidence enables analysis of their lived experience, as it occurs, and grounds analysis in observable details of participants'conduct, rather than interpretations of subjective experiences. The patients'contributions, therefore, were to allow observation into their initial palliative care consultations.

Continuing Monitoring in Respiratory Intensive Care Unit and Mortality in Patient Post Bronchoscopy Procedure

Background: Bronchoscopy is a relatively safe procedure in the diagnosis and therapy of lung disease, however in some cases complications can occur which lead to further monitoring in the intensive care or respiratory intensive care unit (RICU) and even lead to mortality. This study aimed to determine the need for intensive care unit monitoring and the risk factors that increase the need for intensive care unit monitoring followed by mortality after bronchoscopy procedure. Method: A retrospective data of consecutive bronchoscopy procedures in Persahabatan Hospital between July to December 2021. Results: From 410 patients underwent bronchoscopy procedures, there were 52 patients (12.6%) were admitted to RICU after bronchoscopy. From patients who were treated in RICU 3 (5.8%) of them died. Patients who died during monitoring in intensive care unit had an older mean age of 60.3 years. There were 2 (12.5%) died after bronchoscopy procedures with two or more intervention, 1 patients (3%) died in the group with one intervention. There were 2 patients (13.3%) died with two or more comorbidities and 1 patient (5.9%) died with one comorbid. In the group with diagnosis of malignancy, 3 patients (7.5%) died. Whereas in patients who were performed surgery during bronchoscopy there were 2 patients (20%) died and only 1 patient (2.4%) died without any surgery during bronchoscopy. Conclusion: Although bronchoscopy is a relatively safe procedure but the need of monitoring in intensive care after bronchoscopy procedures were relatively high and mortality quite high compare to previous study. Further research is needed to determine the risk factors that increase the need of continuing monitoring in intensive care unit followed by mortality after bronchoscopy procedure.

The Influence of the Information System Success Model and the Technology Acceptance Model on the Behavioral Intention of Specialist Doctors to use Electronic Medical Records For Inpatient Care Unit

The acceleration of technological developments affects the management of information systems within the hospital, especially in using of Electronic Medical Records (EMR). Behavioral intention to use EMR is the essential factor, the role of user is one of the keys to successful EMR implementation. This study aims to analyze the factors that influence behavioral intention of specialist doctors to use inpatient EMR. Data were obtained through questionnaires using the Likert measuring scale and data analysis was processed using SEM (Structural Equation Modelling). Quantitative analytical research method with cross-sectional design using a total sampling of 144 specialists. Of the total 144 respondents, the majority of respondents were male (59%), aged 40-50 years (30.6%) and had a working period of more than 20 years (25.7%). Hypothesis analysis found that there was an effect of system and information quality on perceived ease of use and usefulness. System quality, perceived ease of use and usefulness influence behavioral intention, while information quality has no effect, but indirectly influences behavioral intention through perceived ease of use and usefulness. Service quality has no effect on perceived ease of use, perceived usefulness, and behavioral intention. Perceived usefulness has the greatest influence on behavioral intentions to use inpatient EMR. As an implication of this study, it was found that it is necessary to optimize the inpatient EMR system in the aspects of reliability and connectivity.

Sample sizes for estimating the sensitivity of a monitoring system that generates repeated binary outcomes with autocorrelation.

Sample size formulas are provided to determine how many events and how many patient care units are needed to estimate the sensitivity of a monitoring system. The monitoring systems we consider generate time series binary data that are autocorrelated and clustered by patient care units. Our application of interest is an automated hand hygiene monitoring system that assesses whether healthcare workers perform hand hygiene when they should. We apply an autoregressive order 1 mixed effects logistic regression model to determine sample sizes that allow the sensitivity of the monitoring system to be estimated at a specified confidence level and margin of error. This model overcomes a major limitation of simpler approaches that fail to provide confidence intervals with the specified levels of confidence when the sensitivity of the monitoring system is above 90%.