General Ward Care Research Articles

Teamwork between registered nurses and unlicensed assistive personnel in acute care settings: A scoping review.

Unlicensed assistive personnel are increasingly employed to support the nursing workforce in providing bedside care. To scope the literature on the factors influencing teamwork between registered nurses and unlicensed assistive personnel in acute care settings. A scoping review was conducted using the Arksey and O'Malley (2005) framework. Eight electronic databases were searched from inception of each database to August 2024 to locate studies that reported issues relating to teamwork between registered nurses and unlicensed assistive personnel on patient care in general wards of acute care settings. Two reviewers independently screened titles, abstracts, and full text for eligibility. The data were extracted, analysed, and synthesised using the data-based convergent qualitative synthesis. Thirty-eight studies were included. Five themes were generated: (1) role clarity, (2) delegation, (3) communication, (4) ward culture and practice, and (5) interpersonal relationships. Challenges in registered nurses-unlicensed assistive teamwork include unclear roles and responsibilities, ineffective delegation, and communication barriers. Work culture that excludes unlicensed assistive personnel from shift handovers were found to hinder shared goals for patient care. The importance of interpersonal relationships between registered nurses and unlicensed assistive personnel was highlighted to aid in the power disparity between them. This review found suboptimal teamwork between registered nurses and unlicensed assistive personnel. Teamwork between registered nurses and unlicensed assistive personnel can be improved through clearly defined roles and responsibilities, better delegation practices, effective communication, and improved interpersonal relationships. Future research should focus on optimising communication processes and enhancing registered nurses' delegation skills through education.

Factors predictive of serum cortisol in pediatric patients with acute physiological stress: a cohort study

Measuring cortisol is crucial for assessing adrenal function in patients under stress; however, its value can fluctuate owing to various clinical factors. This study aimed to identify predictors of cortisol levels in pediatric patients with acute physiological stress. Children who were urgently admitted to the general ward or pediatric intensive care unit for acute illness or postoperative care were enrolled, while those with suspected adrenal function abnormalities or on current steroid therapy were excluded. Cortisol was measured in serum samples collected within 72 h of registration and its association with clinical factors was explored. A total of 397 samples from 217 patients were analyzed between August and November 2021 showing a median cortisol level of 375 nmol/L (interquartile range: 190-646 nmol/L). Multiple regression analysis with a mixed-effects model identified the following predictors of higher cortisol levels: heart rate z-score (+43.8 nmol/L/point), body temperature (+42.3 nmol/L/°C), Pediatric Early Warning System score (+44.3 nmol/L/point), age 3-6 yr (+68.8 nmol/L vs. < 1 yr), elapsed time < 4 h (+130.9 nmol/L vs. 4-12 h), and sampling time 6-10 AM (+96.4 nmol/L vs. 10 AM-2 PM). These variables independently predicted cortisol levels in pediatric patients during acute physiological stress.

Clinical features and prognostic risk factors of different sex with acute exacerbations of chronic obstructive pulmonary disease

The aim of this retrospective cohort study was to investigate the clinical characteristics and the outcomes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients between different sex. We aimed to collect the first hospitalization patients who were diagnosed as AECOPD between 1 January 2019 to 31 December 2021 from the general ward and intensive care unit in the hole hospital, Shanghai the Fifth People’s Hospital, Fudan University. Demographic data, initial clinical symptoms, on-admission vital signs, comorbidities, laboratory tests and imaging examination, treatment, and follow-up were compared between the two groups. The patients were followed up for 30 days, 90 days, 180 days after the discharge from the hospital, all these differences were not statistically significant in hospital readmissions and mortality (P > 0.05). The multivariate analysis incorporated seven factors according to the results of the univariate regression analysis. The results showed that readmission was independently associated with increased course of disease (P = 0.032), combined with chronic pulmonary heart disease (P = 0.011), and combined with peptic ulcer (P = 0.044). Conversely, there was no correlation between sex and readmission (P = 0.304). The short-term readmission was independently associated with increased course of disease, combined with chronic pulmonary heart disease, and combined with peptic ulcer, but not with sex.

A Machine Learning Approach for Predicting In-Hospital Cardiac Arrest Using Single-Day Vital Signs, Laboratory Test Results, and International Classification of Disease-10 Block for Diagnosis.

Predicting in-hospital cardiac arrest (IHCA) is crucial for potentially reducing mortality and improving patient outcomes. However, most models, which rely solely on vital signs, may not comprehensively capture the patients' risk profiles. We aimed to improve IHCA predictions by combining vital sign indicators with laboratory test results and, optionally, International Classification of Disease-10 block for diagnosis (ICD10BD). We conducted a retrospective cohort study in the general ward (GW) and intensive care unit (ICU) of a 680-bed secondary healthcare institution. We included 62,061 adults admitted to the Department of Internal Medicine from January 2010 to August 2022. IHCAs were identified based on cardiopulmonary resuscitation prescriptions. Patient- days within three days preceding IHCAs were labeled as case days; all others were control days. The eXtreme Gradient Boosting (XGBoost) model was trained using daily vital signs, 14 laboratory test results, and ICD10BD. In the GW, among 1,299,448 patient-days from 62,038 patients, 1,367 days linked to 713 patients were cases. In the ICU, among 117,190 patient-days from 16,881 patients, 1,119 days from 444 patients were cases. The area under the ROC curve for IHCA prediction model was 0.934 and 0.896 in the GW and ICU, respectively, using the combination of vital signs, laboratory test results, and ICD10BD; 0.925 and 0.878, respectively, with vital signs and laboratory test results; and 0.839 and 0.828, respectively, with only vital signs. Incorporating laboratory test results or combining laboratory test results and ICD10BD with vital signs as predictor variables in the XGBoost model potentially enhances clinical decision-making and improves patient outcomes in hospital settings.

Tackling respiratory failure in Guillain Barre’ syndrome: Burdens, management and prognosis

Guillain-Barré syndrome (GBS) is a rapidly progressive, inflammatory polyradiculoneuropathy with a heterogeneous presentation and pathogenesis. Diagnosis is clinical and electrophysiological, with supportive features in cerebrospinal fluid. Respiratory insufficiency is a life-threatening manifestation occurring in 20 to 30% of GBS patients associated with poor functional outcome. Progressive weakness of the respiratory muscles is the leading cause of acute respiratory distress, leading to respiratory failure with hypoxemia and hypercapnia. Bulbar weakness may compromise airway patency and predisposes patients to aspiration pneumonia. Mechanical ventilation (MV) is often necessary in patients with severe GBS. Prediction and early recognition of high respiratory failure risk is important to triage patients to the appropriate unit, that is, general ward or intensive care unit (ICU). MV needs to be applied when patients meet respiratory failure criteria and severe clinical signs, as bulbar weakness, ineffective cough and dysautonomia. Prompt initiation of immunotherapy with intravenous immunoglobulin or plasmapheresis, together with supportive care, are effective in GBS. There are challenging clinical questions related to the use of MV in GBS: when to initiate the ventilatory support, what to use, when and how to wean and when to perform tracheostomy. In this review, the authors summarize the up-to-date knowledge of pathophysiology and general management in the real- world clinical practice of the respiratory failure in GBS, focusing on time of MV, of weaning and of tracheostomy.

PRODIGY score predicts respiratory depression in the post-anesthesia care unit: A post-hoc analysis.

Surgical patients who experience respiratory depressive episodes (RDEs) during their post-anesthesia care unit (PACU) admission are at a higher risk of developing subsequent respiratory complications in general care wards. A risk assessment tool for PACU RDEs has not been previously assessed. The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) score is an assessment tool that uses baseline patient variables to categorize patients into low, intermediate, or high risk groups for RDEs in general care wards. This study assessed whether PRODIGY groups are associated with PACU RDEs. This analysis utilized data from a previous observational trial of PACU RDEs detected by capnography. PRODIGY scores were retrospectively calculated, and the number and duration of respiratory alerts were compared among PRODIGY groups. Twenty-six (29.9%) patients were classified as low risk, 29 (33.3%) as intermediate risk, and 32 (36.8%) as high risk. A total of 3,580 alerts were recorded in the PACU, 47% of which were apnea episodes lasting ≥ 10 seconds. The total number and duration of alerts were highest in high risk group patients (median 56 [IQR 12 - 87] alerts per patient vs 22 [9 - 37] in low risk and 26 [13 - 42] in intermediate risk patients, P = 0.035; 303 [123 - 885] seconds vs 177 [30 - 779] in low risk and 301 [168 - 703] in intermediate risk patients, P = 0.042). Poisson regression analysis indicated that the rate of RDEs in the high PRODIGY risk group was higher than in the intermediate (rate ratio estimate = 2.01 [95% CI 1.86 - 2.18], P < 0.001) and low (rate ratio estimate = 2.25 [95% confidence interval 2.07 - 2.45], P < 0.001) risk groups. This analysis suggests that the PRODIGY score may be useful in assessing the risk of PACU RDEs. Trial Registration: https://www.clinicaltrials.gov/ct2/show/NCT02707003.

Variation in nurses’ compliance with an Early Warning Score protocol: A retrospective cohort study

IntroductionEarly Warning Score (EWS) protocols are based on intermittent vital sign measurements, and aim to detect clinical deterioration in a timely manner. Despite its predictive value, its effectiveness remains suboptimal. An important limitation appears to be poor compliance with the EWS protocol and its variation between general wards. The current research does not yet provide an understanding of EWS compliance and variation in different nursing wards. AimTo explore the variation in nurses' compliance with the EWS protocol among patients with and without complications and between different nursing wards. MethodsIn a retrospective single-center cohort study, all patient files from three nursing wards of a tertiary teaching hospital in the Netherlands were reviewed over a 1-month period. Compliance was divided into three categories:1) calculation accuracy, 2) monitoring frequency end 3) clinical response. ResultsThe cohort of 210 patients contained 5864 measurements, of which 4125 (70.6 %) included EWS. Significant differences in the measured vital signs within incomplete measurements were found among nursing wards. Compliance to monitoring frequency was higher within EWSs of 0–1 (78.4 %) than within EWSs of ≥2 (26.1 %). The proportion of correct follow-up was significantly higher in patients with complications, as was the correct clinical response to an EWS of ≥3 (84.8 % vs. 55.0; p = .011). ConclusionOur results suggest suboptimal compliance with the EWS protocol, with large variations between patients with and without complications and between different general care wards. Nurses tended to be more compliant with the EWS protocol for patients with complications.

Postoperative Sedation in General Care Wards: A Retrospective Cohort Study.

We hypothesized that deeper sedation in the postanesthesia care unit (PACU) increases the risk of subsequent sedation in general care wards (ward sedation) and that patients with ward sedation have more postoperative adverse events than those without ward sedation. We reviewed the health records of adult patients who underwent procedures with general anesthesia at Mayo Clinic from May 5, 2018, through December 31, 2020, and were discharged from the PACU to the general care ward. Patient groups were dichotomized as with ward sedation (Richmond Agitation-Sedation Scale [RASS], ≤-2) and without ward sedation (RASS, ≥-1) within the first 24 hours after PACU discharge. Multivariable logistic regression was used to assess the association between clinical variables and ward sedation. A total of 23,766 patients were included in our analysis, of whom 1131 had ward sedation (incidence, 4.8 [Poisson 95% confidence interval, CI, 4.5-5.0]) per 100 patients after general anesthesia. Half of the ward sedation episodes occurred within 32 minutes after PACU discharge. The risk of ward sedation increased with the depth of PACU sedation. The odds ratios (95% CI) of ward sedation for patients with a PACU RASS score of -1 was 0.98 (0.75-1.27); -2, 1.87 (1.44-2.43); -3, 2.98 (2.26-3.93); and ≤-4, 3.97 (2.91-5.42). Adverse events requiring an emergency intervention occurred more often for patients with ward sedation (n = 92, 8.1%) than for those without ward sedation (n = 326, 1.4%; P < .001). Among patients who met our criteria for PACU discharge, deeper sedation during anesthesia recovery was associated with an increased risk of ward sedation. Patients who had ward sedation had worse outcomes than those without ward sedation.

Risk factors for chloral hydrate sedation failure in pediatric patients: a retrospective analysis.

This study aimed to investigate the risk factors for chloral hydrate sedation failure and complications in a tertiary children's hospital in South Korea. A retrospective analysis of pediatric procedural sedation with chloral hydrate between January 1, 2021, and March 30, 2022, was performed. The collected data included patient characteristics, sedation history, and procedure. Multivariable regression analysis was performed to identify the risk factors for procedural sedation failure and complications. A total of 6,691 procedural sedation were included in the analysis; sedation failure following chloral hydrate (50 mg/kg) occurred in 1,457 patients (21.8%) and was associated with a higher rate of overall complications compared to those with successful sedation (17.5% [225/1457] vs. 6.2% [322/5234]; P < 0.001, odds ratio: 3.236). In the multivariable regression analysis, the following factors were associated with increased risk of sedation failure: general ward or intensive care unit inpatient (compared with outpatient); congenital syndrome; oxygen dependency; history of sedation failure or complications with chloral hydrate; procedure more than 60 min; and magnetic resonance imaging, radiotherapy, or procedures with painful or intense stimuli (all P values < 0.05). Factors contributing to the complications included general ward inpatient, congenital syndromes, congenital heart disease, preterm birth, oxygen dependency, history of complications with chloral hydrate, and current sedation failure with chloral hydrate (all P values < 0.05). To achieve successful sedation with chloral hydrate, the patient's sedation history, risk factors, and the type and duration of the procedure should be considered.

Nurses' experiences of hospital‐acquired pressure injury prevention in acute healthcare services in Victoria, Australia: A qualitative study using the Theoretical Domains Framework

AbstractWe investigated nurses' experiences of hospital‐acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence‐based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital‐acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self‐blame related to PI identification, and exacerbating impacts of the COVID‐19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital‐acquired PI.

Comparison of Nursing Service Needs, Satisfaction, and Revisit Intention of Patients in Integrated Nursing Care and General Care Wards

Comparison of Nursing Service Needs, Satisfaction, and Revisit Intention of Patients in Integrated Nursing Care and General Care Wards

Neurological function before and after an in-hospital cardiac arrest – A nationwide registry-based cohort study

BackgroundAccording to the Utstein Registry Template for in-hospital cardiac arrest (IHCA), a good neurological outcome is defined as either Cerebral Performance Category (CPC) 1–2 at discharge from hospital or unchanged CPC compared to baseline. However, the latter alternative has rarely been described in IHCA. This study aimed to examine CPC at admission to hospital, the occurrence of post-arrest neurological deterioration, and the factors associated with such deterioration. MethodsWe studied adult IHCA survivors registered in the Swedish Registry of Cardiopulmonary Resuscitation between 2007 and 2022. The CPC was assessed based on information from admission and discharge from hospital. The data were analyzed using descriptive statistics and significance tests. ResultsOne in ten IHCA had a CPC score > 1 at admission to hospital. Out of 7,677 IHCA who survived until hospital discharge and had full CPC data, 6,774 (88%) had preserved CPC, 150 (2%) had improved CPC, and 753 (10%) had deteriorated CPC. Among the factors significantly associated with deteriorated neurological function are IHCA in a general ward or intensive care unit, non-shockable rhythm, no ECG surveillance, and a higher proportion of intra-arrest and post-resuscitation treatments (all p-values < 0,05). ConclusionMost patients had preserved neurological function compared to admission. Factors associated with deteriorated neurological function are mainly concordant with established risk factors for adverse outcomes and are primarily intra-arrest and post-resuscitation, making deterioration hard to predict. Further, every tenth survivor was admitted with CPC more than 1, stressing the use of unchanged CPC as an outcome in IHCA.

A retrospective validation of the effective and safe treatment of patients on general care wards with high velocity nasal insufflation therapy utilizing prognostic risk scores during COVID-19

Background Non-invasive positive pressure ventilation (NIPPV) has been a traditional therapy for acute respiratory failure (ARF). However, the use of NIPPV during the COVID-19 pandemic was challenging, while the use of invasive mechanical ventilation produced poor outcomes. An alternative to NIPPV, high velocity nasal insufflation (HVNI) has shown promise in treating ARF effectively. Objective This study evaluated whether HVNI can be used to treat ARF safely on the general care ward (GCW) during COVID-19 pandemic surges. Methods After introducing HVNI therapy to the facility, an evidence-based scoring system, Modified Early Warning Score (MEWS), was used to risk stratify patients and assist in assigning care level. Initial settings, demographic data, patient outcomes, and health care worker (HCW) virus conversion were measured throughout the study. Treatment failure was defined as the need for invasive mechanical ventilation (IMV) or NIPPV after HVNI therapy. MEWS and ROX index were compared retrospectively using the Pearson product-moment correlation coefficient to identify trends. The Welch two sample t-test (desired power of 90% with alpha=0.05) was used for demographic and outcome analysis. Results Two hundred thirty-four patients were treated with HVNI. The GCW failure rate of 18.56% (n=31/167) was lower than the ICU failure rate of 37.31% (n=25/67) but not statistically significant (P 0.175). No elevated risk to patients or HCW was observed. Respiratory rate (GCW 24.85 vs. ICU 30.14; P &lt;0.001), MEWS (GCW 2.34 vs. ICU 3.09; p=0.002), and ROX index (GCW 5.49 vs. ICU 4.68; P 0.002) assessments appear to be adequate predictors of HVNI failure. The Pearson product-moment coefficient comparing MEWS and ROX index identified a moderate negative correlation (-0.434; P &lt;0.001). Discussion HVNI therapy is an effective alternative to NIPPV for treating patients with COVID-19 associated ARF. Using measures such as MEWS and/or ROX, strict patient monitoring, and HCW surveillance, HVNI can be safely utilized on the GCW. This has a direct impact when dealing with patient surges where ICU beds and resources are limited. Additional studies are needed to further delineate these concepts. Keywords: COVID-19, Non-invasive Positive Pressure Ventilation, Acute Respiratory Failure, High Flow Nasal Oxygen, High Velocity Nasal Insufflation, ICU Admission, General Care Ward, MEWS, ROX

Evaluation of a Lung Ultrasound Score in Hospitalized Adult Patients with COVID-19 in Barcelona, Spain.

Background/Objectives: During the COVID-19 pandemic and the burden on hospital resources, the rapid categorization of high-risk COVID-19 patients became essential, and lung ultrasound (LUS) emerged as an alternative to chest computed tomography, offering speed, non-ionizing, repeatable, and bedside assessments. Various LUS score systems have been used, yet there is no consensus on an optimal severity cut-off. We assessed the performance of a 12-zone LUS score to identify adult COVID-19 patients with severe lung involvement using oxygen saturation (SpO2)/fractional inspired oxygen (FiO2) ratio as a reference standard to define the best cut-off for predicting adverse outcomes. Methods: We conducted a single-centre prospective study (August 2020-April 2021) at Hospital del Mar, Barcelona, Spain. Upon admission to the general ward or intensive care unit (ICU), clinicians performed LUS in adult patients with confirmed COVID-19 pneumonia. Severe lung involvement was defined as a SpO2/FiO2 ratio <315. The LUS score ranged from 0 to 36 based on the aeration patterns. Results: 248 patients were included. The admission LUS score showed moderate performance in identifying a SpO2/FiO2 ratio <315 (area under the ROC curve: 0.71; 95%CI 0.64-0.77). After adjustment for COVID-19 risk factors, an admission LUS score ≥17 was associated with an increased risk of in-hospital death (OR 5.31; 95%CI: 1.38-20.4), ICU admission (OR 3.50; 95%CI: 1.37-8.94) and need for IMV (OR 3.31; 95%CI: 1.19-9.13). Conclusions: Although the admission LUS score had limited performance in identifying severe lung involvement, a cut-off ≥17 score was associated with an increased risk of adverse outcomes. and could play a role in the rapid categorization of COVID-19 pneumonia patients, anticipating the need for advanced care.

Monitoring and analysis of pathogenic microorganisms and resistance genes.

The objectives are to improve the rapid identification method of microbial risk and cut off the route of transmission of resistance genes. When new pathogenic microorganisms are found, intervention can be carried out as early as possible to identify the risk of potential pathogen transmission, and timely cut off the transmission route. Hospital air samples were collected to analyse the distribution of environmental pathogenic microorganisms and the characteristics of ARGs resistance genes. The air samples were collected from 12 sampling sites in the Affiliated Hospital of Yangzhou University. In the infusion room, general ward and intensive care unit, no significant difference was found in microorganisms, and no significant difference was found in microbial resistance genes. There were some differences in resistance genes between east and west districts. Combined with the detection of pathogenic microorganisms and resistance genes in our hospital, it is necessary to improve the daily disinfection measures such as air conditioning and fresh air equipment, cut off the infection route, block the transmission of resistance genes, and monitor pathogens and resistance genes in airborne diseases.

Modelling COVID-19 Vaccination in the UK: Impact of the Autumn 2022 and Spring 2023 Booster Campaigns.

The delivery of COVID-19 vaccines was successful in reducing hospitalizations and mortality. However, emergence of the Omicron variant resulted in increased virus transmissibility. Consequently, booster vaccination programs were initiated to decrease the risk of severe disease and death among vulnerable members of the population. This study aimed to estimate the effects of the booster program and alternative vaccination strategies on morbidity and mortality due to COVID-19 in the UK. A Susceptible-Exposed-Infectious-Recovered (SEIR) model was used to assess the impact of several vaccination strategies on severe outcomes associated with COVID-19, including hospitalizations, mortality, National Health Service (NHS) capacity quantified by hospital general ward and intensive care unit (ICU) bed days, and patient productivity. The model accounted for age-, risk- and immunity-based stratification of the UK population. Outcomes were evaluated over a 48-week time horizon from September 2022 to August 2023 considering the actual UK autumn 2022/spring 2023 booster campaigns and six counterfactual strategies. The model estimated that the autumn 2022/spring 2023 booster campaign resulted in a reduction of 18,921hospitalizations and 1463 deaths, compared with a no booster scenario. Utilization of hospital bed days due to COVID-19 decreased after the autumn 2022/spring 2023 booster campaign. Expanding the booster eligibility criteria and improving uptake improved all outcomes, including averting twice as many ICU admissions, preventing more than 20% additional deaths, and a sevenfold reduction in long COVID, compared with the autumn 2022/spring 2023 booster campaign. The number of productive days lost was reduced by fivefold indicating that vaccinating a wider population has a beneficial impact on the morbidities associated with COVID-19. Our modelling demonstrates that the autumn 2022/spring 2023 booster campaign reduced COVID-19-associated morbidity and mortality. Booster campaigns with alternative eligibility criteria warrant consideration in the UK, given their potential to further reduce morbidity and mortality as future variants emerge.

Prevalence of hypophosphatemia in children with diabetic ketoacidosis and treatment with subcutaneous regular insulin. Observational study

To estimate the incidence of hypophosphatemia in children with DKA, treated with subcutaneous regular insulin (IRS), and to explore factors associated with this complication. Prospective, observational study. Patients diagnosed with DKA hospitalized in the general care ward were included. Data on phosphatemia, glycemia, acid-base status, and IRS amount (U/kg) received were recorded at baseline and after 24 h of treatment. Hypophosphatemia was defined as values below 2.5 mg/dl. The correlation between initial phosphate and at 24 h of treatment was evaluated; the incidence of hypophosphatemia at 24 h was expressed as a percentage of the total number of patients. 30 patients were included, 15 were female, mean age 11.4 ± 3.2 years. At 24 h of treatment with IRS, 36.7% (95%CI 22-55%) presented hypophosphatemia, mean value 1.9 ± 1.5 mg/dl. Initial bicarbonate < 10 mmol/L acted as a predictor of hypophosphatemia (OR 7.5; 95%CI 1.4-39.8%; p = 0.01). No patient required intravenous phosphate correction, and no associated clinical complications were observed. In the group studied, the incidence of hypophosphatemia reached 36.7% at 24 hours of treatment. Initial bicarbonate lower than 10 mmol/L was significantly associated with hypophosphatemia. No complications associated with hypophosphatemia were observed.

Analysis of factors influencing the risk of secondary infection in patients colonized or infected with multidrug-resistant Gram-negative bacteria following hospitalization

We seek to investigate the multifaceted factors influencing secondary infections in patients with multidrug-resistant Gram-negative bacteria (MDR-GNB) colonization or infection post-hospitalization. A total of 100 patients with MDR-GNB colonization or infection were retrospectively reviewed, encompassing those admitted to both the general ward and intensive care unit of our hospital from August 2021 to December 2022. Patients were categorized into the control group (non-nosocomial infection, n = 56) and the observation group (nosocomial infection, n = 44) based on the occurrence of nosocomial infection during hospitalization. Clinical data were compared between the two groups, including the distribution and antibiotic sensitivity of MDR-GNB before nosocomial infection. Significant differences were observed between the two groups in terms of age, underlying diseases, immune status, length of stay, and invasive medical procedures (P < 0.05). The observation group also had fewer patients practicing optimized hygiene, strict isolation, and antibiotic control than the control group (P < 0.05). Factors influencing the risk of secondary infection after hospitalization in patients colonized or infected with MDR-GNB included patient age, underlying diseases, immune status, length of hospitalization, medical invasive procedures, optimized hygiene, strict isolation, and antibiotic control (P < 0.05). The length of hospitalization and treatment cost in the observation group were higher than those in the control group (P < 0.05). This study comprehensively analyzes the intricate mechanisms of secondary infections in patients with MDR-GNB infections post-hospitalization. Key factors influencing infection risk include patient age, underlying diseases, immune status, length of hospitalization, medical invasive procedures, optimized hygiene, strict isolation, and antibiotic control.

Biomarker Analysis Provides Evidence for Host Response Homogeneity in Patients With COVID-19

BackgroundThe exploration of subphenotypes in hospitalized COVID-19 patients has garnered substantial attention. Most existing studies operate under the assumption of heterogeneity in COVID-19 patient populations and this assumption can lead to erroneous conclusions. Research QuestionDo plasma biomarker profiles reflective of various pathophysiological pathways provide evidence for heterogeneity in hospitalized patients with COVID-19? Study Design and MethodsThis is a secondary analysis of two prospective observational studies of adult patients hospitalized with COVID-19 related respiratory failure in the general ward and intensive care unit (ICU) of two medical centers and with 44 host response biomarkers available. Parsimonious models were used to allocate and validate ARDS inflammatory subphenotypes. Novel biological subphenotypes were identified using latent profile analysis (LPA) and hierarchical clustering. Heterogeneity of treatment effect (HTE) for corticosteroids was assessed using an interaction term in a logistic regression model. ResultsThe cohort consisted of 162 patients admitted to the ICU and 464 to the ward. Using the parsimonious models in ICU patientsonly 3.1-13% of patients were classified as hyperinflammatory subphenotype. Using de novo subphenotyping techniques, neither clustering or LPA revealed significant evidence for heterogeneity in the ward (p = 0.11-0.13), ICU (p = 0.23-0.88) or combined cohort (p = 0.05-0.88). Adding clinical variables did not alter results in the ICU or combined cohort. Using the combined approach in the ward cohort, indices provided borderline significance for two subphenotypes, and there was good agreement between clustering and LPA (87.9%), but no HTE for corticosteroids was observed between these two classes (p = 0.198). InterpretationSystemic inflammatory subphenotypes derived from ARDS patients do not reflect the variation in severity of COVID-19. Empirical evidence, derived from cluster analysis or latent profile analysis, offers limited support for biological heterogeneity in COVID-19.

Reverse shock index multiplied by simplified motor score as a predictor of clinical outcomes for patients with COVID-19

BackgroundThe reverse shock index (rSI) combined with the Simplified Motor Score (sMS), that is, the rSI-sMS, is a novel and efficient prehospital triage scoring system for patients with COVID-19. In this study, we evaluated the predictive accuracy of the rSI-sMS for general ward and intensive care unit (ICU) admission among patients with COVID-19 and compared it with that of other measures, including the shock index (SI), modified SI (mSI), rSI combined with the Glasgow Coma Scale (rSI-GCS), and rSI combined with the GCS motor subscale (rSI-GCSM).MethodsAll patients who visited the emergency department of Taipei Tzu Chi Hospital between January 2021 and June 2022 were included in this retrospective cohort. A diagnosis of COVID-19 was confirmed through a SARS-CoV-2 reverse-transcription polymerase chain reaction test or SARS-CoV-2 rapid test with oropharyngeal or nasopharyngeal swabs and was double confirmed by checking International Classification of Diseases, Tenth Revision, Clinical Modification codes in electronic medical records. In-hospital mortality was regarded as the primary outcome, and sepsis, general ward or ICU admission, endotracheal intubation, and total hospital length of stay (LOS) were regarded as secondary outcomes. Multivariate logistic regression was used to determine the relationship between the scoring systems and the three major outcomes of patients with COVID-19, including. The discriminant ability of the predictive scoring systems was investigated using the area under the receiver operating characteristic curve, and the most favorable cutoff value of the rSI-sMS for each major outcome was determined using Youden’s index.ResultsAfter 74,183 patients younger than 20 years (n = 11,572) and without COVID-19 (n = 62,611) were excluded, 9,282 patients with COVID-19 (median age: 45 years, interquartile range: 33–60 years, 46.1% men) were identified as eligible for inclusion in the study. The rate of in-hospital mortality was determined to be 0.75%. The rSI-sMS scores were significantly lower in the patient groups with sepsis, hyperlactatemia, admission to a general ward, admission to the ICU, total length of stay ≥ 14 days, and mortality. Compared with the SI, mSI, and rSI-GCSM, the rSI-sMS exhibited a significantly higher accuracy for predicting general ward admission, ICU admission, and mortality but a similar accuracy to that of the rSI-GCS. The optimal cutoff values of the rSI-sMS for predicting general ward admission, ICU admission, and mortality were calculated to be 3.17, 3.45, and 3.15, respectively, with a predictive accuracy of 86.83%, 81.94%%, and 90.96%, respectively.ConclusionsCompared with the SI, mSI, and rSI-GCSM, the rSI-sMS has a higher predictive accuracy for general ward admission, ICU admission, and mortality among patients with COVID-19.