General Ward Research Articles

‘I didn’t want to go home’ patient-identified modifiable risk factors associated with hospital readmission: a qualitative study

Background Hospital readmissions are costly for patients, their families and healthcare systems. Identifying and addressing risk factors can reduce the number of people who experience readmission. Few studies have explored modifiable risk factors such as health beliefs from patients’ perspective to explore the complexity of risk factors for readmission. This study aimed to identify modifiable readmission risk factors from the perspectives of patients who have experienced readmission and their families. Methods Adults (≥18 years) readmitted within 30 days of discharge to a general medical or surgical ward at a large urban hospital in New Zealand were invited to participate in a semi-structured interview to explore their readmission experience. Interviews were conducted during the readmission and were analysed using inductive thematic analysis. Results A total of 30 participants were interviewed. Six themes relating to readmission were identified: inadequate communication between health professionals and patients, misalignment between patient illness perceptions and treatment, unclear or missing information, poor health literacy, poor medication mismanagement, and health system factors. Conclusions These findings highlight the importance of considering patient experiences, such as their expectations, illness and treatment beliefs, to reduce readmissions. Ensuring communication is patient centred and quality professional-patient relationships could reduce readmissions.

Perioperative dexmedetomidine-induced delirium in a patient with schizophrenia: a case report

BackgroundDexmedetomidine is a selective α2 receptor agonist with sedative, analgesic, anxiolytic, and anti-sympathetic effects. Dexmedetomidine is widely used for various surgical procedures performed under general anaesthesia and sedation in the intensive care unit. Dexmedetomidine was known to relieve or improve the symptoms of delirium. Schizophrenia is a common psychiatric disease, and the number of surgical patients with schizophrenia is increasing gradually. Dexmedetomidine-induced delirium in patients with schizophrenia is a particular case.Case presentationThis patient was a 75-year-old woman (height: 156 cm; weight: 60 kg) with a 5-year history of schizophrenia. Her schizophrenia was well controlled with medications. She was scheduled for open reduction and internal fixation for a patellar fracture. Spinal anaesthesia was administered for surgery, and dexmedetomidine was administered intravenously to maintain sedation. The patient became delirious half an hour after the surgery began. The intravenous infusion of dexmedetomidine was discontinued immediately, intravenous propofol was subsequently administered, and the patient stopped experiencing dysphoria and fell asleep. After surgery, the patient stopped using propofol and recovered smoothly. She was transferred back to the general ward and was discharged from the hospital without any abnormal conditions on the 9th day after surgery.ConclusionsTo the best of our knowledge, this is the first report of a patient with schizophrenia who developed delirium during the infusion of a normal dose of dexmedetomidine without an intravenous injection of any other sedative. The exact mechanism causing dexmedetomidine-induced delirium remains unclear, and this adverse reaction is rare and easy to ignore. Clinicians and pharmacists should be vigilant in identifying this condition.

2269 Preventing frailty crises: improving the care of frail patients in an acute hospital Ward setting

Abstract Introduction Frailty is common in hospitalised older patients and hospitalisation can lead to negative outcomes. Our study aimed to provide insights into current decision-making processes on treatment, care and discharge by clinical teams. Methods We conducted a prospective cohort study in frail older patients ≥65 years old admitted to acute medical and surgical wards. Clinical Frailty Scale ≥5 was used to identify frail patients and process mapping was undertaken to identify common themes, trajectories and potentially modifiable factors. We followed patient journeys from admission to discharge and examined factors contributing to longer hospitalisation. We documented existing processes, environmental, system and clinical factors influencing patient care. Comprehensive geriatric assessments identified underlying geriatric syndromes and where gaps in management were identified, we recommended frailty interventions. Results Fifteen patients provided informed consent, of whom 73% were female and average age 80 years, ranging 69–95 years. 67% were frail (CFS 5–6) and 33% were severely frail (CFS 7–9). Most patients were sarcopenic with a SARC-F score of ≥4 and had functional and gait impairment. 60% were underweight (BMI <22). Process mapping revealed gaps in frailty-focused care and included delayed transfer to acute wards, delayed investigations, and multiple unidentified geriatric syndromes which were prevalent in this cohort. Patients fell into three broad groups, short (1–6 days), intermediate (7–14 days), or long (>14 days) length of stay and delays in discharge-planning were common, mean of 4.17 days, as were delays in identification of a caregiver. Recommendations for community support services were provided to >50% patients. Conclusion Our study shows that mapping the frail patient’s journey can identify gaps in existing processes and opportunities for improvement and collaboration. Integrating geriatric care into general wards could improve patient outcomes. We aim to use this work to guide frailty-attuned care for hospitalised older patients.

The median effective concentration of epidural ropivacaine with different doses of dexmedetomidine for motor blockade: an up-down sequential allocation study.

Recent studies have shown that dexmedetomidine can be safely used in peripheral nerve blocks and spinal anesthesia. Epidural administration of dexmedetomidine produces analgesia and sedation, prolongs motor and sensory block time, extends postoperative analgesia, and reduces the need for rescue analgesia. This investigation seeks to identify the median effective concentration (EC50) of ropivacaine for epidural motor blockade, and assess how incorporating varying doses of dexmedetomidine impacts this EC50 value. Prospective, double-blind, up-down sequential allocation study. Operating room, post-anesthesia care unit, and general ward. One hundred and fifty patients were allocated into five groups in a randomized, double-blinded manner as follows: NR (normal saline combined with ropivacaine) group, RD0.25 (0.25 μg/kg dexmedetomidine combined with ropivacaine) group, RD0.5 (0.5 μg/kg dexmedetomidine combined with ropivacaine) group, RD0.75 (0.75 μg/kg dexmedetomidine combined with ropivacaine) group, RD1.0 (1.0 μg/kg dexmedetomidine combined with ropivacaine) group. The concentration of epidural ropivacaine for the first patient in each group was 0.5%. Following administration, the patients were immediately placed in a supine position for observation, and the lower limb motor block was assessed every 5 min using the modified Bromage score within 30 min after drug administration. According to the sequential method, the concentration of ropivacaine in the next patient was adjusted according to the reaction of the previous patient: effective motor block was defined as the modified Bromage score > 0 within 30 min after epidural administration. If the modified Bromage score of the previous patient was >0 within 30 min after drug administration, the concentration of ropivacaine in the next patient was decreased by 1 gradient. Conversely, if the score did not exceed 0, the concentration of ropivacaine in the next patient was increased by 1 gradient. The up-down sequential allocation method and probit regression were used to calculate the EC50 of epidural ropivacaine. Adverse events, hemodynamic changes, demographic data and clinical characteristics. The EC50 of epidural ropivacaine required to achieve motor block was 0.677% (95% CI, 0.622-0.743%) in the NR group, 0.624% (95% CI, 0.550-0.728%) in the RD0.25 group, 0.549% (95% CI, 0.456-0.660%) in the RD0.5 group, 0.463% (95% CI, 0.408-0.527%) in the RD0.75 group, and 0.435% (95% CI, 0.390-0.447%) in the RD1.0 group. The EC50 of the NR group and the RD0.25 group were significantly higher than that of the RD0.75 and the RD1.0 groups, and the EC50 of the RD0.5 group was significantly higher than that of the RD1.0 group. The EC50 of epidural ropivacaine required to achieve motor block was 0.677% in the NR group, 0.624% in the RD0.25 group, 0.549% in the RD0.5 group, 0.463% in the RD0.75 group, and 0.435% in the RD1.0 group. Dexmedetomidine as an adjuvant for ropivacaine dose-dependently reduce the EC50 of epidural ropivacaine for motor block and shorten the onset time of epidural ropivacaine block. The optimal dose of dexmedetomidine combined with ropivacaine for epidural anesthesia was 0.5 μg/kg.

A Study of Polypharmacy and its Consequences in Geriatric Patients

The term polypharmacy is the concurrent use of five or more drug by a patient. In older persons, the cutoff threshold of five medicines is linked to the unfavourable outcomes such falls, disability, and mortality one of the crucial components. The main components of polypharmacy therapy in the clinical setting are reviewed in this study. Potential Drug-Drug Interactions (pDDIs) and Potentially Inappropriate Medications (PIMs) are threatening and contribute to increased rate of morbidity and mortality rate. The present study was performed on the prevalence of pDDIs and PIMs among the geriatric patients at a tertiary care hospital. Methodology: The study was Prospective, Cross-sectional study carried out for a period of six months in General Medical Ward at Akash hospital, Bangalore PIMs were analyzed using Beer’s criteria and pDDIs were analyzed using online data base system (Micromedex 2.2) Results: In this study, a total of 110 patients were enrolled, out of which 69 (62.72%) were males and 41 (37.28%) were females. Out of which 21 (19.10%) prescription showed PIMs and 66 (56%) prescription showed pDDIs. A total of 180 pDDIs were observed, 3 interactions (1.7%) come under the classification of contraindication, 87 (48.3%) fall under major severity, 85 (47.29%) were of moderate severity and 5 (2.8%) were of minor severity. Among 180 pDDIs, 13 (7.2%) were of rapid, 21 (11.6%) were delayed and 146 (81.6%) were not specified. 97 (57.30%) were of synergism, 49 (27.40%) were antagonism and 34 (18.80%) were unknown. 13 (7.2%) were of excellent, 29 (16.20%) were good and 138 (76.60%) were fair. Conclusion: This study concluded that awareness on the most prevalent pDDIs can help the practitioners to prescribe drugs with a low risk for pDDIs and prevent the concomitant use of various drug combinations.

Intensive care of a patient undergoing combined multi-organ cluster ("larynx-trachea-thyroid-hypopharynx-esophagus") transplantation: A case report.

The aim of this study was to summarize the intensive care experience of a patient undergoing combined multi-organ cluster ("larynx-trachea-thyroid-hypopharynx-esophagus") transplantation. The intensive care management plan for this case was developed by a multidisciplinary team, with focus on 6 aspects: (1) stabilizing the circulation and reducing anastomotic tension by position management to improve the survival chances of transplanted organs, (2) adopting goal-directed analgesia and sedation protocols, as well as preventing anastomotic fistula, (3) implementing a bedside ultrasound-guided nutrition plan, (4) employing "body-mind" synchronous rehabilitation to facilitate functional recovery, (5) taking antirejection treatment and protective isolation measures, (6) monitoring and nursing thyroid function. During the intensive care, the patient's vital signs were stable. The patient was successfully weaned from the ventilator and transferred to the general ward for further treatment at 9 days postoperatively, and discharged upon recovery at 58 days postoperatively. The patient was in good condition during follow-up. This study provides reference for the care of patients who undergo similar transplantation in the future.

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.

Nutritional gap after transfer from the intensive care unit to a general ward – A retrospective quality assurance study

BackgroundAdequate nutrition is important for recovery after critical illness. Even so, our knowledge of patients' nutritional intake after intensive care unit (ICU) discharge is scarce. ObjectivesWe aimed to explore nutritional planning and achieved nutritional intake in ICU patients who transfer from the ICU to general wards. MethodsA retrospective quality assurance study. Inclusion criteria: adult ICU patients transferring to a general ward at Copenhagen University Hospital-Herlev from May to August 2021. Primary outcomes were as follows: having a nutritional plan on the day of ICU transfer. A nutritional plan was defined as follows: (i) individual assessment of energy and protein requirement; (ii) intake, documented as achieved percentage of energy and protein requirements; (iii) prescribed type of nutrition. If using enteral or parenteral nutrition; (iv) the prescribed doses; and (v) the prescribed product. Secondary outcomes were as follows: achieved percentage of energy and protein requirements from day -1 before ICU transfer until day +1 and day +3 after ICU transfer. ResultsWe included 57 patients; the mean age was 64 years (±11.1); 43 (75%) patients were male; the median ICU stay was 6 days (interquartile range: 3–11). One (2%) patient had a full nutritional plan according to listed criteria. Patients' median percentage of requirements met declined significantly from the day before to the day after ICU discharge (energy: from 94% to 30.5%; p = 0.0051; protein: from 73% to 27.5%; p = 0.0117). The decline in percentage of requirements met remained unchanged from day 1 to 3 after ICU transfer. ConclusionsIn conclusion, few patients had a nutritional plan when transferring from the ICU to a general ward. After ICU discharge, percentage of energy and protein requirements met declined significantly and remained insufficient during the first 3 days at the general ward.

Distinguishing Childhood Asthma Exacerbations from Stable Asthma: The Utility of Inflammatory White Blood Cell Biomarkers.

Asthma is a chronic inflammatory condition characterized by episodes of acute asthma exacerbations (AAEs), in addition to chronic airway inflammation, which has a huge impact on both the affected patients and their parents. The main objective of this study was to explore the utility of available white-blood-cell-derived inflammatory markers in diagnosing AAEs and identifying children at risk for severe exacerbations requiring admission to the pediatric intensive care unit (PICU). This study was a retrospective cohort study. The medical records of 128 children diagnosed with asthma exacerbation and 131 children with stable asthma between the ages of 2 and 12 years were reviewed. A total of 259 participants were enrolled. Children with AAE demonstrated significantly higher white blood cell counts (WBC: 10.0 ± 4.2 × 103/μL vs. 7.1 ± 2.2 × 103/μL, p < 0.001), absolute neutrophil counts (ANC: 7398.5 ± 4600 cells/μL vs. 2634.8 ± 1448 cells/μL, p < 0.001), and neutrophil-to-lymphocyte ratios (NLR: 7.0 ± 6.8 vs. 0.9 ± 0.7, p < 0.001) but significantly lower absolute lymphocyte counts (ALC: 1794.1 ± 1536 × 103/μL vs. 3552.9 ± 1509 × 103/μL, p < 0.001). Interestingly, blood eosinophil count displayed an opposite trend: children with stable asthma had significantly more eosinophils compared to those experiencing an exacerbation (370.1 ± 342.7 cells/mm3 vs. 0.9 ± 1.9 cells/mm3, p < 0.001). Two criteria that are indicative of AAE were identified: NLR values greater than 1.2, with good discriminative ability (area under the curve [AUC] 0.90; 95% confidence interval [CI] 0.85-0.94; sensitivity 82.5%; specificity 79.5%), and ANC values exceeding 3866, with moderate discriminative ability (AUC 0.86; 95% CI 0.81-0.91; sensitivity 75.0%; specificity 82.3%). Moreover, a comparative analysis of these markers (NLR, ANC, PLR, WBC, AEC, and ALC) in patients with AAE did not demonstrate significant differences between those requiring PICU admission and those who did not require it. This study contributes two major findings. The first is that NLR, ANC, WBC, and PLR are significantly higher in AAE patients compared to those with stable asthma. The second is that children with stable asthma have higher AEC and ALC levels compared to those with AAE. Furthermore, this study has revealed that the studied markers (NLR, ANC, PLR, WBC, AEC, and ALC) did not differentiate between AAE patients requiring PICU admission and those managed in the general ward, suggesting a need for alternative predictive factors.

A Study of the Clinical Profiles of Patients With Hepatorenal Syndrome.

Background and objective Hepatorenal syndrome (HRS)is a systemic disorder that affects both the kidneys and the liver. HRSrefers to the occurrence of kidney failure in individuals with advanced liver cirrhosis, portal hypertension, and ascites, without any underlying kidney disease. The interplay of systemic and portal hemodynamics causes severe constriction of blood vessels in the kidneys, which defines HRS. The study aims to illuminate the demographic profiles, etiology, and outcomes of patients with HRS. Material and methods The study was designed as a prospective, cross-sectional, hospital-based observational studyconducted at Dr. D.Y. Patil Medical College, Hospital, and Research Centre in Pimpri, Pune. The study period spans from September 2022 to June 2024. Before commencement, approval was obtained from the institutional ethics committee, and informed written consent was secured from all participating patients. The sample size consists of 100 patients diagnosed with HRS, selected from the general medicine outpatient department, wards, and ICU of Dr. D.Y. Patil Hospital and Research Centre. A comprehensive clinical history was recorded for all patients, focusing on the symptoms of cirrhosis and HRS, followed by a thorough examination for related signs and symptoms. Results Among the 100 patients included in this study on HRS, 25% (N=25) fell within the age range of 18-30 years, and 76% (N=76)were identified as male. Alcoholic cirrhosis accounted for 78% (N=78)of cases, with hepatitis B infection being the subsequent leading cause. The mortality rate was 12% (N=12)while the survival rate was 88% (N=88). Conclusion This study provides insights into the demographic profile, etiology, and outcomes of HRS. The results of this study contribute valuable insights into the complex nature of HRS, highlighting the importance of early detection and monitoring to optimize patient care.

Pharmacists' Medication Reconciliation Interventions During Admission and Transfer from an Emergency Department at a Tertiary Care Hospital: A Randomized Pilot Study and Evaluation of Physician and Patient Perceptions.

The study aimed to assess the impact of pharmacist interventions during the transition of care. Medication discrepancies can occur at various levels of transition, such as during admission, the transition from emergency to special wards or from special to general wards, and during discharge. Discrepancies can be detected through the process of medication reconciliation. The objective of the study was to compare discrepancies among patients exposed to pharmacist intervention groups and those who were not and assess the perception of healthcare professionals and patients towards integrating pharmacists in the transition care process. A pharmacist-led interventional study was conducted for six months on patients above 18 years of age and either sex who were admitted to the emergency department, had chronic diseases, and subsequently transferred to another department (any). The patients were randomized into intervention and control groups. The pharmacist performed a medication reconciliation and medication review to identify discrepancies in every transition in both the groups, and then reported to the treating physician to resolve in the intervention group. Among the 73 patients recruited in the study, 152 discrepancies were identified. The total discrepancies observed in the control and intervention groups were 78 (51.3%) and 74 (48.6%), respectively. The majority, 35.53%, were found during the transition from emergency to special wards. The physician, upon pharmacist recommendations, accepted and resolved 48 discrepancies in the intervention group. The healthcare professional acceptance rate of pharmacist interventions was 64.86%. The transitions of care are at risk for errors due to medication discrepancies, and pharmacists could potentially identify and resolve discrepancies. Healthcare professionals and patients reported to be satisfied by the involvement of clinical pharmacists in the healthcare team.

Application of an Automatic Suction Device to a Patient with A Tracheostomy Tube in the General Ward: A Case Report

The A-1000 (Elmeca, Co. Ltd., Seoul, Korea) electrical automatic airway suction device, was designed to operate as a customizable repeated closed suction device. It can be used for patients with intubation or tracheostomy tubes. This is the first recorded case of the use of the A-1000 in a general ward patient with a tracheostomy tube. A 91-year-old man presented having attempted suicide by hanging and was admitted to this institution. Although extubation was performed in the intensive care unit, the patient required 2 reintubations. The tracheostomy was performed, and the A-1000 was applied. After weaning from mechanical ventilation, the patient was transferred to the General Ward with a tracheostomy tube in place for effective removal of sputum by the A-1000. The tracheostomy tube was successfully removed, and the patient was discharged. The effectiveness and safety of the A-1000 needs further study by expanding the applications of this device.

Economic burden of respiratory syncytial virus disease in Latin America: A systematic review

ABSTRACT This Systematic Review assesses the economic impact of Respiratory Syncytial Virus (RSV) in Latin America and the Caribbean (LAC) in relation to healthcare resource utilization and associated costs. We searched online databases from January 2012 to November 2022 to identify eligible publications. We identified 12 publications that reported direct costs, indirect costs, and resources associated with RSV and its complications. The primary direct medical resources reported were medical services, diagnostics tests and procedures, and length of stay (LOS). Direct total costs per patient ranged widely from $563 to $19,076. Direct costs are, on average, 98% higher than indirect costs. Brazil reported a higher total cost per patient than Colombia, El Salvador, México, Panamá, and Puerto Rico, while for indirect costs per patient, El Salvador and Panamá had higher costs than Brazil, Colombia, and Mexico. The mean LOS in the general ward due to RSV was 6.9 days (range 4 to 20 days) and the mean Intensive Care Unit LOS was 9.1 days (range 4 to 16 days). In many countries of the LAC region, RSV represents a considerable economic burden on health systems, but significant evidence gaps were identified in the region. More rigorous health economic studies are essential to better understand this burden and to promote effective healthcare through an informed decision-making process. Vaccination against RSV plays a critical role in mitigating this burden and should be a priority in public health strategies.

Effect of Perioperative Blood Transfusion on Complications Following Emergency Non-trauma Laparotomy in Mulago Hospital: A Prospective Cohort Study.

Background Although blood transfusion may be required during emergency non-trauma laparotomy, several retrospective cohort studies have identified blood transfusion as a significant predictor of postoperative infections and mortality. However, no study has explored such an association in a resource-limited setting. This study aims to determine the effect of perioperative blood transfusion on the 30-day risk of surgical site infections (SSIs) and mortality among patients undergoing emergency non-trauma laparotomy in a large urban tertiary hospital in a resource-limited setting. Methodology In this prospective, single-center, cohort study, we recruited 160 consecutive adult patients admitted to the general surgery wards 48 hours after emergency non-trauma laparotomy. We grouped them based on transfusion exposure status. Transfusion exposure and possible confounders were recorded on entry, while the presence or absence of SSIs and mortality were obtained over 30 days of follow-up. The data were analyzed using Epi Info version 7 and Stata version 14. P-values <0.05 indicated statistical significance. Results All 160 participants recruited, 28 (17.5%) transfusion-exposed and 132 (82.5%) non-exposed, were included in the final analysis. Transfusion exposure (relative risk = 8.16; 95% confidence interval (CI) = 2.73-24.37; p < 0.001) was an independent risk factor for SSI after multivariate logistic regression analysis adjusted for confounders. Inverse probability weighting with regression adjustment (IPWRA) revealed that transfusion exposure significantly increased the incidence of SSI by 36.2% (95% CI = 14.2%-58.2%; p = 0.001). Furthermore, transfusion exposure (hazard ratio (HR) = 3.62; 95% CI = 1.28-10.27; p = 0.015) and age ≥60 years (HR = 5.97; 95% CI = 1.98-18.01; p = 0.002) were independent risk factors for 30-day mortality after multivariate Cox regression analysis adjusted for confounders. IPWRA revealed that transfusion exposure significantly increased the incidence of mortality by 17.6% (95% CI = 1.4%-33.8%; p = 0.033). Conclusions This study suggests an independent association between perioperative blood transfusion and the occurrence of SSIs and mortality among patients undergoing emergency non-trauma laparotomy. A larger multicenter prospective cohort study considering more confounders and the use of established restrictive transfusion protocols is recommended.

Bereaved family members’ perspectives on quality of death in deceased acute cardiovascular disease patients compared with cancer patients – a comparison of the J-HOPE3 study and the quality of palliative care in heart disease (Q-PACH) study

BackgroundOutcome measures during acute cardiovascular disease (CVD) phases, such as quality of death, have not been thoroughly evaluated. This is the first study that compared the family members’ perceptions of quality of death in deceased CVD patients and in deceased cancer patients using a bereaved family survey.MethodsRetrospectively sent questionnaire to consecutive family members of deceased patients with CVD from ten tertiary hospitals from October 2017 to August 2018. We used the short version of the Good Death Inventory (GDI) and assessed overall care satisfaction. Referencing the GDI, the quality of death was compared between CVD patients admitted to a non-palliative care unit (non-PCU) and cancer patients in palliative care units (PCU) and non-PCUs in the Japan Hospice and Palliative Care Evaluation Study (J-HOPE Study). Additionally, in the adjusted analysis, multivariable linear regression was performed for total GDI score adjusted by the patient and participant characteristics to estimate the difference between CVD and other patients.ResultsOf the 243 bereaved family responses in agreement (response rate: 58.7%) for CVD patients, deceased patients comprised 133 (54.7%) men who were 80.2 ± 12.2 years old on admission. The GDI score among CVD patients (75.0 ± 15.7) was lower (worse) than that of cancer patients in the PCUs (80.2 ± 14.3), but higher than in non-PCUs (74.4 ± 15.2). After adjustment, the total GDI score for CVD patients was 7.10 points lower [95% CI: 5.22–8.97] than for cancer patients in PCUs and showed no significant differences compared with those in non-PCUs (estimates, 1.62; 95% CI [-0.46 to 5.22]).ConclusionsThe quality of death perceived by bereaved family members among deceased acute CVD patients did not differ significantly from that of deceased cancer patients in general wards, however, was significantly lower than that of deceased cancer patients admitted in PCUs.

Frequency and potential causes of non-beneficial Code Blue activations at a metropolitan teaching hospital.

Code Blue activations in patients who are not for resuscitation (NFR) may be regarded as non-beneficial and may cause harm to patients, relatives and hospital staff. To estimate the prevalence of non-beneficial Code Blue calls in a metropolitan teaching hospital and identify modifiable factors that could be utilised to reduce these events. The study consisted of two parts: (i) a retrospective analysis of all Code Blue activations over a 12-month period using prospectively collected data. Non-beneficial activations were defined as calls made in patients with a NFR order in either the current or any previous hospital admissions and (ii) an anonymous voluntary survey of staff who were present at a Code Blue activation. There were 186 Code Blue activations over the study period, with 48 (25.8%) defined as non-beneficial. Such patients had more comorbidities, previous hospitalisations and greater levels of frailty. Most non-beneficial calls occurred on general wards and more than three-quarters of patients had been reviewed by a consultant prior to the call. The survey determined that despite ward staff having a considerable degree of resuscitation experience, there were deficiencies in understanding of Code Blue criteria, the resuscitation status of patients under their care and the interpretation of goals of care. Over a quarter of Code Blue calls were deemed non-beneficial. Improving the visibility of NFR status and staff understanding of patient goals of care are needed, along with timely, proactive documentation of NFR status by experienced clinicians.

Optimizing Data-Centric Healthcare: A Novel Monitoring Framework for High-Risk General Ward Patients.

The digital transformation of healthcare in South Korea, accelerated by COVID-19, has led to increased focus on critically ill patients in large hospitals. To address this, a monitoring system was developed to ensure safe inpatient treatment and improve staff efficiency. This aligns with the Medical Data-Centric Hospitals initiative, which leverages data for healthcare innovation. The case study highlights the implementation of a ward critical care monitoring system, which has improved patient safety, work efficiency, and expanded patient monitoring scope. Key lessons include the importance of addressing technical and user challenges, aligning innovations with national policies, and the potential of data-driven solutions to tackle healthcare challenges.

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.

COVID-19 Vaccine Effectiveness on the Severity of Disease: A Case-control Study in Southeastern Iran

Background: Considering the importance of the effectiveness of vaccination in terms of reducing the severity of COVID-19 and mortality, knowledge of the effect of the vaccine on the severity of COVID-19 in communities is essential. Therefore, the purpose of this study was to evaluate the effect of the COVID-19 vaccine on the severity of COVID-19 in southeastern Iran (Bam region). Methods: A case-control study of a total of 2,082 adults aged &gt;18 years was conducted to evaluate the association between hospitalization due to COVID-19 and previous vaccination with existing vaccines (including Sinopharm, AstraZeneca, and CovIran Barkat) in the country. Multinomial logistic regression was used, and relative risk (RR) and 95% confidence intervals (CIs) were calculated Results: After controlling for potential confounders, multinomial logistic regression revealed that COVID-19 vaccination reduced the likelihood of hospitalization for males and females in temporary wards (RRmen=0.22 vs. RRwomen=0.34), general wards (RRmen=0.25 vs RRwomen=0.31), and intensive care units (RRmen=0.47 vs RRwomen=0.77) (p &lt; 0.001). The relative risk of hospitalization in all wards decreased for men and women who received Sinopharm or AstraZeneca and for women who received the Barkat vaccine, but only a significant difference was detected in the reduction in patients who received the Sinopharm vaccine (p &lt; 0.001). Conclusion: The results showed that vaccination is related to reducing the severity of the disease in the hospital. Therefore, efforts to increase the vaccinated population can reduce the severity of COVID-19 and might reduce the need for intensive care in hospitals.

Impact of Protein Intake after Intensive Care Unit on Discharge Destination for Critically Ill Patients: A Single-Center Prospective Observational Study

Introduction: Although nutritional therapy may be able to enable intensive care unit (ICU) survivors to return home instead of being discharged to a rehabilitation facility, post-ICU discharge nutritional therapy lacks investigation. This study evaluated the impact of nutritional therapy after ICU on discharge destination in critically ill patients. Methods: We enrolled consecutive adult patients who spent >72 h in the ICU from December 2020 to March 2023. The primary outcome was discharge destination. Energy and protein intake during the ICU stay and on days 7 and 14 after ICU discharge were evaluated. The target protein intake during the intensive treatment and general ward phases were 0.8 and 1.0 g/kg/day, respectively. Patients were categorized into home discharge (group A) and rehabilitation transfer (group B) groups. Factors affecting the discharge destination were evaluated using logistic regression analysis. Results: Of the 183 patients included, 134 belonged to group A and 49 to group B. In group A, more patients reached the protein intake target than in group B. Logistic regression analysis identified achieving the protein intake target as an independent predictor of home discharge. Conclusion: Further studies are required to confirm the relationship between nutritional therapy during general ward and patient outcomes.