Care Unit Of Hospital Research Articles

Effect of an oral stimulation protocol on breastfeeding among preterm infants: a randomised controlled trial

ObjectivesThe objectives are to assess the effectiveness of a modified and adapted oral sensorimotor intervention (MA-OSMI) protocol for infants in India on the rate and performance of breastfeeding among preterm...

Comparing gastrointestinal dysfunction score and acute gastrointestinal injury grade for predicting short-term mortality in critically ill patients

BACKGROUND The prognosis of critically ill patients is closely linked to their gastrointestinal (GI) function. The acute GI injury (AGI) grading system, established in 2012, is extensively utilized to evaluate GI dysfunction and forecast outcomes in clinical settings. In 2021, the GI dysfunction score (GIDS) was developed, building on the AGI grading system, to enhance the accuracy of GI dysfunction severity assessment, improve prognostic predictions, reduce subjectivity, and increase reproducibility. AIM To compare the predictive capabilities of GIDS and the AGI grading system for 28-day mortality in critically ill patients. METHODS A retrospective study was conducted at the general intensive care unit (ICU) of a regional university hospital. All data were collected during the first week of ICU admission. The primary outcome was 28-day mortality. Multivariable logistic regression analyzed whether GIDS and AGI grade were independent risk factors for 28-day mortality. The predictive abilities of GIDS and AGI grade were compared using the receiver operating characteristic curve, with DeLong’s test assessing differences between the curves’ areas. RESULTS The incidence of AGI in the first week of ICU admission was 92.13%. There were 85 deaths (47.75%) within 28 days of ICU admission. There was no initial 24-hour difference in GIDS between the non-survival and survival groups. Both GIDS (OR 2.01, 95%CI: 1.25-3.24; P = 0.004) and AGI grade (OR 1.94, 95%CI: 1.12-3.38; P = 0.019) were independent predictors of 28-day mortality. No significant difference was found between the predictive accuracy of GIDS and AGI grade for 28-day mortality during the first week of ICU admission (Z = -0.26, P = 0.794). CONCLUSION GIDS within the first 24 hours was an unreliable predictor of 28-day mortality. The predictive accuracy for 28-day mortality from both systems during the first week was comparable.

The impact of an emercency form on the place of death of palliative care patients

Apilot study conducted by our research group in 2019 showed that adecision made in advance about the transfer of palliative care patients documented within the emergency information was associated with the actual place of death, thus realizing the patient's wishes regarding the place of death. There were also details on how the scope, duration, and frequency of home visits by mobile palliative care teams should be designed in order to fulfill patients' wishes regarding the place of death. Systematic reviews point to adiscrepancy between preferred and actual places of death and alack of prospective studies and data to support patients and their caregivers.The current observational study lasted one year, included all mobile palliative care teams for adults working in Styria and collected data from atotal of 1425 patients (52.6% men). The median age at the time of death was 78.1 years (IQR = 17.4). 76.9% of the sample were cancer patients. Other diseases included cardiovascular (6.3%), neurological (4.1%) and respiratory diseases (2.3%).The emergency information used in this study was an optimized version of the emergency information used in the 2019 pilot, based on input from all palliative care teams who participated in 2019.Atotal of 109 patients (7.6%) of the entire sample took part in the intervention (emergency information). Of these, 85individuals (78.9% of the intervention group) indicated apreference for on-side treatment, i.e., without transfer. Only 8patients (7.3%) indicated apreference for transfer and 16 (14.7%) did not indicate apreference. Of the 85patients who did not wish to be transferred, 75 (88.2%) died at home, i.e., in around 9out of 10cases the patient's wishes were complied with. In contrast, of the 8people who requested transfer, only 3 (37.5%) died at home, i.e., the majority (5or 62.5%) died in hospital or apalliative care unit, indicating that the patient's wishes were complied with in the majority of cases.The preference expressed in the emergency information for on-site treatment and against transfer was associated with amore than five times higher odds (p < 0.001) of actually dying at home. The preference expressed in the emergency information increased the probability of dying at home from 63% in the control group to 89% in the intervention group.There was also asignificant difference according to the number of medical contacts, i.e. patients who took part in the intervention and did not wish to be transferred had twice as many contacts with physicians (p = 0.031).The results of the logistic regression model also suggested an influence of age, disease and intensity of care by physicians on the odds of dying at home: Older people and the minority of palliative care patients who did not suffer from cancer had higher odds of dying at home than those with cancer. While there was no correlation between the duration of care and the total number of care contacts, the odds of dying at home increased with the number of medical contacts (+7% per contact).

Striving for excellence in ventilator bundle compliance through continuous quality improvement initiative in the intensive care unit of a tertiary care hospital in India

Striving for excellence in ventilator bundle compliance through continuous quality improvement initiative in the intensive care unit of a tertiary care hospital in India

A "Wise" Intervention to Increase Hand Hygiene Compliance of Nurses in Acute Care Units in US Hospitals: A Multiple Baseline Interrupted Time-Series Evaluation.

Objective: This study tested a 'wise' intervention (quick prompt of a specific psychological mec) in acute care hospital units to improve nurses' hand hygiene compliance (HHC). Design: A multiple baseline design in two medical-surgical teaching hospitals in the United States. Measurements: Hand hygiene data was collected using an electronic compliance monitoring system with sensors placed in doorways and on corresponding soap and alcohol-based hand rub dispensers. The outcome measure was the proportion of opportunities in which HH was undertaken by staff per week in each unit. Intervention: A quick-and-easy psychological prime to reinvigorate professional identity. Methods: Interrupted time series analysis using a quasi-Poisson regression model with statistical process control charts for each unit. Results: A statistically significant increase in HHC rates that was sustained for months post-intervention. However, the patterns by unit were not statistically significant once temporal trends were considered. Other factors, such as the unit type and the use of incentives could have impacted the results. Conclusions: These analyses suggest that the aggregate impact should not be taken as evidence of intervention effectiveness. This study therefore cannot be considered to have provided a strong foundation for use of a 'wise' intervention, despite its relatively small financial, logistical and psychological cost.

Length of hospital and intensive care unit stay in patients with invasive candidiasis and/or candidemia treated with rezafungin: a pooled analysis of two randomised controlled trials.

Invasive candidiasis/candidemia (IC/C) is associated with a substantial health economic burden driven primarily by prolonged hospital stay. The once-weekly IV echinocandin, rezafungin acetate, has demonstrated non-inferiority to caspofungin in the treatment of IC/C. This paper reports a post hoc pooled exploratory analysis of length of stay (LoS) for hospital and intensive care unit (ICU) stays in two previously published clinical trials (ReSTORE [NCT03667690] and STRIVE [NCT02734862], that compared rezafungin with daily IV caspofungin (stable patients in the caspofungin group who met relevant criteria could step down to fluconazole after 3days or more). LoS outcomes were analysed descriptively in the pooled modified intention to treat (mITT) population (all patients who had a documented Candida infection in line with trial requirements and received at least one dose of study drug). In addition, to adjust for an imbalance between treatment groups in the proportion receiving mechanical ventilation at baseline, a generalised linear model with mechanical ventilation as a binary covariate was applied. Responses to an exploratory question in the phase 3 trial on possible earlier discharge with weekly rezafungin are also reported. 294 patients were included (rezafungin 139, caspofungin 155), of whom 126 (43%) had ICU admission. Patients treated with rezafungin had a numerically shorter LoS than with caspofungin in all analyses. Mean total LoS was 25.2days, vs 28.3days with caspofungin, and mean ICU LoS was 16.1 vs 21.6days for rezafungin and caspofungin, respectively. After adjustment for mechanical ventilation status the difference in ICU LoS was 4.1days, a relative difference of 24% (95% CI -11%, 72%). Physicians would have considered earlier discharge for 16% of patients (30/187) with weekly rezafungin, an average of 5-6days earlier. Rezafungin may enable shorter hospital and ICU LoS in IC/C compared with daily IV caspofungin, with accompanying savings in resource use. Further research is needed to confirm this in the real-world setting. NCT03667690 (ReSTORE; September 12, 2018); NCT02734862 (STRIVE; April 12, 2016).

Elevated Interleukin-6 Levels as a Potential Marker of Neonatal Morbidity in Full-term Infants With Polycythemia: A Prospective Study.

To research and show that interleukin-6 (IL-6) and c-reactive protein (CRP), which can be used as infection markers, are also higher among newborns with polycythemia. The study took place in the neonatal intensive care unit of Zekai Tahir Burak Maternity Teaching and Research Hospital. Infants with a gestational age of >37 weeks were included in the study. Infants with chorioamnionitis, perinatal asphyxia, and positive blood culture were excluded from the study. Blood samples were obtained six hours after the delivery from the peripheral vein of the infants for measurements of central hematocrit, blood culture, IL-6, and CRP. Infants with a venous hematocrit value of >65% were grouped as the "polycythemia group," and the ones with a venous hematocrit value of <65% were designated as the "control group." Observation of significantly higher levels of CRP and IL-6 among newborns admitted to the neonatal intensive care unit due to different causes (such as respiratory distress, hypoglycemia, and feeding intolerance), but significantly higher IL-6 levels in newborns with polycythemia. Thirty-five newborns (18 infants in the polycythemia group and 17 infants in the control group) were enrolled in the study. The IL-6 values for the polycythemia group were higher than the upper normal limits (mean ± 2SD, 37.6 ± 55 vs 12 ± 5pg/dL, respectively; P = 0.00). The IL-6 values of the polycythemia group were found to be higher than the IL-6 values of the control group, with a mean ± 2SD of 37.6 ± 55 vs 6.3 ± 3.4pg/dL, respectively; this was significant (P = 0.00). Although the CRP values of the polycythemia group were found to be slightly higher than those of the control group (a mean ± 2SD of 3.06 ± 4.07 vs 1.54 ± 2.21mg/dL, respectively, P > 0.05), this was not significant. This study found a significant and robust statistical correlation between IL-6 and v. Hct values (P = 0.01, rs = 0.641). Contrary to IL-6 levels, however, a meaningful relationship was not found between CRP and v.htc values (P = 0.286; rs = 0.184).

Association of advance care planning with hospital use and costs at the end of life: a population-based retrospective cohort study

ObjectiveTo investigate associations between the availability and timing of digitally available advance care planning (ACP) documents and hospital use and costs during the last 6 months of life.DesignRetrospective population-based cohort...

Preoperative anemia is associated with increased length of stay in adult spinal deformity surgery: evaluation of a large single-center patient cohort and future suggestions for patient optimization.

This study aimed to investigate the relationship of preoperative hemoglobin levels as an independent prognostic factor for hospital and intensive care unit (ICU) length of stay (LOS) in patients undergoing surgery for adult spinal deformity (ASD), with the intent of determining whether there exists a correlation and enhancing patient preoperative optimization protocols. The authors reviewed consecutive patients who underwent elective thoracolumbosacral posterior spinal fusion (PSF) involving six or more vertebrae for ASD from January 1, 2013, to December 13, 2021, with a minimum follow-up period of two years. This study primarily investigated the association of preoperative hemoglobin levels with hospital and ICU LOS. To analyze the data, both unadjusted and adjusted generalized linear models (GLM), incorporating cubic splines for non-linear variables, were applied. A total of 598 patients were included. GLMs for hospital and ICU LOS demonstrated nonlinear relationships with preoperative hemoglobin levels. Specifically, hospital LOS decreased with increasing preoperative hemoglobin until a significance threshold of 13.5g/dl. Similarly, ICU LOS significantly decreased with increasing preoperative hemoglobin until 13.0g/dl. Lower preoperative hemoglobin was associated with more perioperative transfusions, less likely discharge to home, and greater risk of reoperation. Preoperative anemia is an independent non-linear risk factor that significantly affects LOS, disposition, and outcomes after surgery for ASD. These findings advocate for a systemic preoperative approach and highlight the need for future research to improve postoperative outcomes and reduce hospital resource utilization. IV.

Study of the Microbiological Efficiency of a Hospital Ventilation System With Hepa Filtration in the Prevention of Airborne Pathogens

Objective: To evaluate the microbiological efficiency in air conditioning systems with HEPA filtration in an infectious disease hospital. Theoretical Framework: Air conditioning in intensive care units and wards must consider the spread of microorganisms through respiratory pathways, as both patients and healthcare professionals are exposed to infectious agents transmitted by bioaerosols. Due to the possibility of environmental infection, there is a growing recognition that poorly designed air conditioning systems enhance the transmission of pathogens in areas with constant flow of individuals, particularly immunocompromised patients, who are more susceptible to infections. Air conditioning with HEPA filtration is a hospital engineering technique that shows great potential for filtering airborne contaminants, thereby reducing their dispersion in the environment. Method: Air samples were collected using the active impaction method over a 32-week period in the intensive care unit and wards of a reference hospital for infectious diseases. Results and Discussion: In the hospital environment, 67% of fungi and 33% of bacteria were identified, along with their respective subcategories. The colony-forming unit count exceeded the standards established by current regulations. The study highlights that hospital air is a pathway for the transmission and persistence of pathogenic microorganisms. Research Implications: The importance of ensuring a safe and healthy hospital environment is emphasized. Originality/Value: There are few studies addressing pathogens transmitted by bioaerosols. This study contributes to expanding knowledge on this topic and suggests the need for a review of current regulatory standards.

The effect and safety of corticosteroid treatment for severe community-acquired pneumonia: a meta-analysis of randomized controlled trials

BackgroundThere is ongoing debate on the efficacy and safety of corticosteroid therapy for severe community-acquired pneumonia (sCAP). Our aim was to investigate the safety and therapeutic effectiveness of corticosteroids in the sCAP therapy.MethodsElectronic databases (Cochrane Library, PubMed, Web of Science and Embase) were searched from inception to January 10, 2024. We examined for randomized controlled studies assessing the effectiveness and safety of corticosteroid therapy in individuals with sCAP. The primary outcome was short-term mortality. Subgroup analyses were carried out according to the corticosteroid type. Additionally, trial sequential analysis (TSA) was carried out.ResultsIn total, 11 trials, including 1959 patients, met the predetermined standards and underwent analysis. Overall, our meta-analysis exhibited that corticosteroids may considerably lower short-term mortality when compared to control treatment [6 studies (1,582 patients); odds ratio (OR), 0.65; 95% confidence interval (CI) 0.49–0.88; p = 0.005] and C-reactive protein (CRP) levels [5 studies (359 patients); mean difference (MD), −6.97; 95% CI −12.33 to −1.60; p = 0.01], but TSA revealed that the sample size needs to be larger. Moreover, we observed that corticosteroids reduced the hospital length of stay [7 studies (999 patients); MD, −3.56; 95% CI, −4.28 to −2.84; p &amp;lt; 0.001], need for mechanical ventilation (MV) [7 studies (1,328 patients); OR, 0.60; 95% CI, 0.45–0.79; p = 0.001] and MV duration [4 studies (736 patients); MD, −5.62; 95% CI, −7.31 to −3.94; p &amp;lt; 0.001], which was in agreement with TSA. However, adverse events, length of hospital and intensive care unit (ICU) stay were not evidently shortened when TSA was utilized. Furthermore, subgroup analysis revealed that all of the above studies benefited from hydrocortisone treatment in comparison to the control group.ConclusionOur meta-analysis revealed that corticosteroids, especially hydrocortisone, could decrease the mortality of individuals with sCAP.Systematic review registration[https://clinicaltrials.gov/], identifier [CRD42023415555].

The mental state inferences in healthcare professionals scale: a psychometric study.

Empathizing with patients is an essential component of effective clinical care. Yet, a debate persists regarding how healthcare professionals' emotions and performance are impacted when they engage in empathetic behaviors and attempt to discern patients' mental states during clinical interactions. To approach this issue, this study explores the psychometric properties of the Mental State Inferences in Healthcare Professionals Scale (MSIHPS), a novel eight-item scale to evaluate healthcare professionals' perceptions of their own disposition to infer patients' mental states during clinical interactions. The study was conducted across various units within a regional hospital and primary care units affiliated with the Canarian Public Health Service in Spain. Data collection took place over the course of 2022, spanning from February to November. The psychometric properties of the scale were analyzed, including an exploratory and a confirmatory factor analysis, to test reliability and validity. Additionally, an item response model was run to test potentially biased items. The study collected data from a sample of 585 healthcare professionals. Overall, the results indicate that the psychometric properties of the tool are adequate. Furthermore, the unidimensionality of the scale was confirmed using the item response model, wherein the eight-items significantly contribute to predicting the latent construct. The MSIHPS offers the opportunity to explore the role of mentalizing in a diversity of healthcare settings. This measure can be useful to explore the relationship between healthcare professionals' disposition to infer patients' mental states and other relevant variables in clinical interactions, such as empathy and clinical performance.

Clinical characteristics of COVID-19 patients admitted to the intensive care unit of the largest public-sector hospital in Karachi: A retrospective, observational study.

Objective: To characterize the clinical features of critically ill COVID-19 patients admitted to COVID-ICU and describe their outcomes. Study Design: Retrospective Observational study. Setting: Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. Period: May 2020 to September 2021. Methods: The study aimed to investigate the clinical characteristics and outcomes of patients with confirmed or suspected COVID-19 who were admitted to the ICU. Patients in the study period confirmed or suspected COVID-19, admitted to the ICU for more than 24 hours, and committed to full treatment were included this study. Patients with COVID-19 discharged or died within 24 hours of admission were excluded. Results: The most commonly observed symptoms among the patients were shortness of breath (92.5%), fever (91.2%), cough without sputum (39.2%), altered consciousness (11.9%), and muscle aches (8.8%). Acute respiratory distress syndrome (ARDS) was identified as the most prevalent complication among COVID-19 patients, impacting 40.8% of the study population. A significant proportion of COVID-19 patients required mechanical ventilation and cardiac support. Specifically, (41.4%) of the patients required invasive mechanical ventilation, (47.4%) required non-invasive ventilation, and (26.3%) received cardiac support. Laboratory assessment showed that platelet counts varied significantly between survivors and non-survivors, with non-survivors exhibiting lower platelet counts. Gender differences were also observed among COVID-19 patients by age, with males having a higher mean age than females in all age categories, and the difference was statistically significant (p &lt; 0.001) in all age categories except for the 30-44 years age category (p = 0.087). Age-wise recovery and mortality rates were analyzed, and the results showed that among both deceased and recovered patients, the proportion of deceased patients increased with age, while the proportion of recovered patients increased until the age range of 45-59 years for both males and females. The study found that 136 of the patients survived while 275 of the patients succumbed to the disease. Among the survivors, (31.3%) were male, and (36.2%) were female. Conclusion: The study emphasizes the importance of monitoring patients for potential complications and providing them with supportive care. Early detection and management of severe cases of COVID-19 are critical in preventing complications and improving patient outcomes.

The Relationship Between Ethical Attitudes and Compassion Fatigue in Nurses Working in Surgical Intensive Care Units

Aim This study aimed to explore the relationship between ethical attitudes and compassion fatigue experienced by nurses in surgical intensive care units. Methods It is mixed-design research. The study was conducted with 38 nurses working in the surgical intensive care units of a university hospital who agreed to participate in the study. Quantitative data were collected using the Nurse Information Form, the Ethical Attitude Scale for Nursing Care, and the Compassion Fatigue–Short Scale. Qualitative data were collected using a semistructured questionnaire, through individual interviews with 9 volunteer nurses in surgical intensive care units. Results The study revealed that nurses exhibited high levels of ethical attitudes in nursing care along with high levels of compassion fatigue. During the qualitative data analysis, 4 key themes emerged: ethical approaches in surgical intensive care units, professional quality of life in nurses, the reflections of compassion fatigue on ethical behavior, and nurses’ well-being. Conclusions It was concluded that when compassion fatigue increased in nurses in surgical intensive care units, ethical attitudes in nursing care decreased. Therefore, compassion fatigue can be addressed by programs that support nurses’ well-being, such as meditation, deep breathing, self-compassion exercises, and so on. It can be reduced.

Investigating Inappropriate Discontinuations of Enteral Nutrition Related to Gastric Residual Volume in Critically Ill Patients: A Retrospective Observational Descriptive Study

Background: Gastric residual volume (GRV) is measured by nurses in clinical practice as a simple method to assess gastrointestinal intolerance. Nutrition therapy guidelines recommend avoiding enteral tube feeding (ETF) discontinuation if GRV is &lt; 500 mL. Aim: This study aimed to clarify the status of inappropriate ETF discontinuation related to GRV in critically ill patients. Methods: Patients who were ventilated for more than 48 hours in the intensive care unit of a university hospital in 2021 were retrospectively surveyed, and data were collected up to 2 weeks after admission. ETF discontinuation data were collected and categorized as planned or unplanned. The reasons for unplanned discontinuation were further categorized into high GRV, symptoms, and conditions. The reasons and the amount of GRV were analyzed descriptively. Inappropriate ETF discontinuation related to GRV was defined as ETF discontinuation for a GRV of &lt; 500 mL. Results: ETF was discontinued in 10% (270 events / 2,600 orders) of critically ill patients. Unplanned discontinuations accounted for 37% (99/270) of discontinuations, with GRV being the most common reason (43%), followed by nausea and vomiting (8%), and hemodynamic instability (8%). Conclusions: Thirty-seven percent of ETF discontinuations in critically ill patients were unplanned, and 42% of these were inappropriate ETF discontinuations related to GRV. Research results and guideline recommendations need to be disseminated clearly to make more healthcare providers aware of the GRV criteria for discontinuing ETFs.

Mortality prediction model from combined serial lactate, procalcitonin and calprotectin levels in critically ill patients with sepsis: A retrospective study according to Sepsis-3 definition

Objective1) To evaluate the ability of baseline and on 24 h serum calprotectin, in comparison to canonical biomarkers (lactate and procalcitonin), for prognosis of 28-day mortality in critically ill septic patients; and 2) To develop a predictive model combining the three biomarkers. DesignA single-center, retrospective study. SettingIntensive Care Unit of a university hospital. Patients or participantsOne hundred and seventy three septic pacientes were included. InterventionsMeasurement of baseline lactate, procalcitonin and calprotectin level and procalcitonin and calprotectin levels on 24 h. Main variables of interestDemographics and comorbidities, SOFA score on ICU admission, baseline lactate, procalcitonin and calprotectin on admission and on 24 h and 28-day mortality. Results1) On ICU admission, lactate was the only biomarker achieving a significant accuracy (AUC: 0.698); 2) On 24 h, no differences were found on procalcitonin and calprotectin levels. Procalcitonin and calprotectin clearances were significantly lower in non-survivors and both achieved a moderate performance (AUCs: 0.668 and 0.664, respectively); 3) A biomarker based-model achieved a significant accuracy (AUC: 0.766), trending to increase (AUC: 0.829) to SOFA score alone; y 4) Baseline lactate levels and procalcitonin and calprotectin clearance were independent predictors for the outcome. Conclusions1) Baseline and on 24 h calprotectina and procalcitonin levels lacked ability in predicting 28-day mortality; 2) Accuracy of clearance of both biomarkers was moderate; and 3) Combination of SOFA score and the predictive biomarker based-model showed a high prognostic accuracy.

Increasing the uptake of advance care directives through staff education and one-on-one support for people facing end-of-life.

An advance care plan outlines a patient's wishes regarding medical treatment or goals of care in the case that they become unable to communicate or to make decisions. An advance care directive (ACD) is an advance care plan that has been formally recorded and has legal status. Despite ACDs playing an important role in person-centred end-of-life care, an earlier retrospective medical records audit demonstrated that only 11% (58/531) of people who died due to a terminal illness had an ACD.The aim of this project was to increase the proportion of patients with a terminal illness completing an ACD. A secondary outcome was to measure the impact of ACDs on hospital and intensive care unit (ICU) admissions in the last 6 months of life.This multifaceted project comprised (1) education for health professionals and the public; (2) individual support for patients on request; (3) development of online resources for health professionals and the general public; and (4) monthly team meetings. The proportion of ACDs completed and hospital and ICU admissions during the last 6 months of life, were extracted via medical record audits.Written consent was required for patients to participate, including being contacted by the project team and accessing their medical records. 112 patients consented to participate in the project and 109 (97%) completed an ACD. There was no reduction in the average number of hospital admissions, while ICU admissions reduced from 14% (n=74) to 0%. The targeted, multifaceted approach to education and support for completion of ACDs, resulted in a significant increase in ACD completion and a major reduction in ICU admissions.

Acinetobacter baumannii: Epidemiological profile and antibiotic resistance in patients from the intensive care unit of Avicenne military hospital in Marrakech

Acinetobacter baumannii: Epidemiological profile and antibiotic resistance in patients from the intensive care unit of Avicenne military hospital in Marrakech

Timing of Palliative Care, End-of-Life Quality Indicators, and Health Resource Utilization

Despite research supporting the benefits of early palliative care, timely initiation by gynecologic oncology patients is reportedly low, which may limit the effectiveness of palliative care. To investigate the association of the timing of palliative care initiation with the aggressiveness of end-of-life care using established quality indicators among patients with ovarian cancer. This population-based retrospective cohort study of ovarian cancer decedents used linked administrative health care data to identify palliative care provision across all health care sectors and health care professionals (specialist and nonspecialist) and end-of-life quality indicators in Ontario, Canada, from 2006 to 2018. Data analyses were performed July 12, 2024. The primary outcome was the associations between the timing of palliative care and end-of-life quality indicators, including emergency department use, hospital or intensive care unit admission in the last 30 days of life, chemotherapy in last 14 days of life, death in the hospital, and a composite measure of aggressive care. Late palliative care was defined as 3 months or less prior to death. There were 8297 ovarian cancer decedents. Their mean (SD) age at death was 69.6 (13.1) years, and their mean (SD) oncologic survival was 2.8 (3.9) years. Among 3958 patients with known cancer stage, 3495 (88.3%) presented with stage III or IV disease. One-third of patients (2667 [32.1%]) received late palliative care in the final 3 months of life. Results of multivariable regression analysis indicated that any palliative care initiated earlier than 3 months before death was associated with lower rates of aggressive end-of-life care (odds ratio [OR], 0.47 [95% CI, 0.37-0.60]), death in hospital (OR, 0.54 [95% CI, 0.45-0.65]), and intensive care unit admission (OR, 0.46 [95% CI, 0.27-0.76]). Specialist palliative consultation from 3 months up to 6 monts before death was associated with decreased likelihood of late chemotherapy (OR, 0.46 [95% CI, 0.24-0.88]). Findings from this cohort study suggested that early palliative care may be associated with less-aggressive end-of-life care than late palliative care. Implementation strategies for early palliative care initiation are needed to optimize care quality and health resource utilization at the end of life.

Comparison of Short-Term Outcomes of DSA and ALMIS Approach for Bipolar Cemented Hemiarthroplasty in Patients with Neck of Femur Fracture.

Background/Objectives: A neck of femur (NOF) fracture is one of the most common fractures, and its treatment in the geriatric population using cemented bipolar hemiarthroplasty (HA) is a standard procedure worldwide. Various surgical approaches have been described for this operation, aiming to reduce complications and improve early mobilization. The present study compares two minimally invasive approaches, the anterolateral minimally invasive approach (ALMIS) and the direct superior approach (DSA), with respect to their intraoperative and early postoperative complications in cemented bipolar HA. Methods: The medical records of all patients undergoing cemented bipolar HA for a NOF fracture between January 2017 and December 2023 were analyzed. The aim of the study was to compare the two surgical approaches. The evaluation focused on intraoperative parameters and early complications. Results: A total of 226 patients were included in the analysis, with 62 undergoing DSA and 164 ALMIS, with an average age of 83.5 years. The two approaches did not differ significantly in terms of stem implantation quality, length of hospital or intensive care unit stay, postoperative mobilization, or the need for transfusions. However, the ALMIS was associated with a significantly shorter operative time (DSA: 89.7 min vs. ALMIS: 77.2 min; p < 0.01). On the other hand, the DSA had a significantly lower complication rate (DSA: 0/61 vs. ALMIS: 11/163; p = 0.04). Conclusions: In a comparison of the two minimally invasive approaches, DSA and ALMIS, for treating a NOF fracture with cemented bipolar HA, the DSA demonstrated a lower complication rate, though it had a slightly longer operating time.