General Ward Research Articles

The effect of surgical inguinal hernia repair on testicular blood supply: A prospective superb microvascular imaging ultrasonography study.

In this study, we aimed to evaluate the differences in vascularity between the testis on the inguinal hernia (IH) side and the contralateral healthy testis by performing preoperative and postoperative (first month) examinations with superb microvascular imaging ultrasonography (SMI USG), and to compare results with power Doppler (PD) USG. In this prospective cohort study, 35 patients diagnosed with IH between April 2023 and July 2023 who were hospitalized in the general surgery ward of a tertiary hospital for IH surgery were evaluated. The postoperative vascular index (VI) values obtained by SMI were found to be significantly lower than preoperative VI values in both operated and non-operated testes (p < 0.001). The VI values obtained with PD in the postoperative period were significantly lower in the operated and nonoperated testes on both sides compared with the VI values obtained in the preoperative period (p < 0.001 and p = 0.029, respectively). There was a significant difference between preoperative and postoperative VI difference values obtained by SMI and PD on the operated side (p = 0.015). In our study examining patients who had undergone IH surgery, testicular vascularity was assessed more precisely with the SMI USG method compared with the PD method.

Evaluating Antibiotic Misuse and Cost Analysis Among Hospitalized Dengue Virus-Infected Adults: Insights From a Retrospective Cohort Study.

Dengue is a prevalent cause of acute febrile illness, predominantly in Asia, where it necessitates supportive care without the need for antibiotics. This study aimed to evaluate antibiotic usage and analyze hospitalization costs among adults infected with the dengue virus. This retrospective cohort study was conducted at the Hospital for Tropical Diseases, Thailand, in 2022. Two independent reviewers assessed all adult cases with confirmed dengue from 2016 to 2021. Determinants of inappropriateness were analyzed using Poisson regression. The study included 249 participants with over half presenting with severe dengue or dengue with warning signs upon admission. The cumulative incidence of antibiotic use was 9.3% (95% CI, 8.23-10.47), predominantly involving empirical treatment strategies. Ceftriaxone and doxycycline were the most frequently prescribed antibiotics. Notably, patients who received empirical antibiotics showed no definite or presumed bacterial infections. Among those who received definite strategies, inappropriate durations, including both short treatments and the overuse of broad-spectrum antibiotics, were observed. A private ward admission was identified as a significant predictor of inappropriate use, with an incidence rate ratio of 4.15 (95% CI, 1.16-14.82) compared with intensive care unit admission. Direct medical costs did not differ significantly between appropriate and inappropriate uses. The incidence of antibiotic use among dengue cases was moderate; however, inappropriate use by indication was observed. Antimicrobial stewardship strategies should be encouraged, particularly in patients with dengue with warning signs admitted to a general or private ward. Direct medical costs between appropriate and inappropriate use were comparable.

EP465 - Transfusion Associated Circulatory Overload (TACO) Audit - A prospective analysis of adherence to standards ensuring safe transfusions

Abstract Aims TACO is defined as acute or worsening respiratory compromise during or up to 12 hours of transfusion, with additional features including cardiovascular system changes not explained by the patient’s underlying medical condition. In the UK, TACO remains a major cause of Morbidity in surgical post operative patients. The aim of this audit was to assess whether the current trust transfusion practices are synchronous with the NICE guidelines and SHOT recommendations. Methods We reviewed 27 incidences of transfusion during the whole month in acute general surgical ward. Patient’s notes, trust intranet and EPMA were used for data collection. The adherence to Ng24 as well as latest SHOT recommendations was checked. Following standards were taken into account: A formal pre-transfusion risk assessment for transfusion-associated circulatory overload (TACO) should be undertaken for all patients receiving blood transfusion and mitigating actions taken. (Serious hazards of transfusion SHOT recommendation) Patients who develop respiratory distress during or up to 24 hours following transfusion where transfusion is suspected to be the cause must be reported to SHOT. A structured incident review should be undertaken for every case of TACO. Weight-adjusted red cell dosing should be used. (NICE Guidelines Ng24) Result TACO assessment checklist was only completed for 15% of transfusions (compared to 35% nationally) while mitigation actions were only considered for 4% of patients. There appeared discordance among junior doctors regarding TACO Management. Conclusions Interventions like teaching sessions, information leaflets and posters, presentation for induction pack and liaison with Transfusion practitioner team to modify transfusion pathway significantly reduced inconsistencies regarding safe transfusions and immensely improved patient management.

SP5.6 - Sleep Quality and Barriers to Sleep on a Postoperative Surgical Ward

Abstract Aim Sleep is an essential part of recovery post-operatively and poor sleep quality has been linked to increased patient pain, increased rates of post-operative complications such as delirium and to longer hospital stays. It is widely accepted that adults need at least seven hours of sleep at night. Surgery can induce a degree of insomnia and thus we sought to identify quality of sleep on a postoperative general surgical ward and to identify common barriers to sleep and reasons patients experience interruptions to sleep. Methods Using patient questionnaires, we investigated quality of sleep and explored factors, both intrinsic and extrinsic, which influenced patients both falling asleep and being woken throughout the night. Results Average age of participants was 73yrs. Average length of sleep was only 5.4 hours. 89% patients reported having sleep interrupted throughout the night and on average patients were awoken 2.4 times throughout the night. Only 11% reported feeling refreshed in the morning after sleep. Noise and pain were the most common barriers identified to falling asleep affecting 73% of patients. The predominant reasons for being awoken from sleep were noise (94%), interruptions for observations/bloods (67%) and thirst (33%). Conclusions This study has identified a high prevalence of poor sleep quality in postoperative surgical patients. Common factors influencing this are noise, pain and interruptions by medical staff. Many of these can be addressed through simple interventions to promote better recovery of patients by recognising and supporting the need for high quality sleep.

WP7.2 - The Role of a Frailty Team to improve Perioperative Care for ELLSA Patients

Abstract Aim Frailty assessment amongst emergency laparotomy patients is essential. The 8th NELA report highlighted that only 31.8% of patients who were frail and over 65 years received geriatrician input. Within our organisation, patients who undergo emergency laparotomy are included in the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). The consultant geriatrician led Surgical Acute Frailty Team (SAFT) works collaboratively with the emergency general surgery team and ELLSA specialist nurse to review ELLSA patients within our hospital. Our aim was to establish outcomes of ELLSA patients reviewed by SAFT. Methods Data collected routinely via Redcap as part of our organisation’s ELLSA was reviewed. All ELLSA patients aged ≥65 years admitted between November 2022 and November 2023 were included. Data included frailty assessment, discharge destination and 30 day mortality. Results 152 patients aged ≥ 65 years underwent operative intervention as defined by ELLSA. 100% of patients had a documented Clinical Frailty Scale (CFS) score. 72 patients (47.4%) had a pre-operative frailty review. 68.4% of patients had their initial frailty assessment by a consultant geriatrician. 19.7% of patients were reviewed by frailty ANPs or clinical fellow. Only 7.9% of patients required care support on discharge. 30 day mortality was 17.1%. Conclusions Embedding a dedicated frailty team within our general surgery wards has been incredibly successful; frailty assessment is significantly above that of the 8th NELA report. The majority of ELLSA patients aged ≥65 years are discharged home independently. Collaborative working and early identification of frailty in ELLSA patients is essential to improve patient outcomes.

EP3 - Reducing general surgical inpatient falls: an allied health professionals’ perspective

Abstract Aims Understand the current view of inpatient falls on a general surgical ward from allied health professionals. Identifies ways to reduce inpatient falls in general surgery. Methods Staff from two acute surgical wards were surveyed in December 2023. Seven questions used Likert scales (1-to-5, 1=Not preventable at all/significantly reduces the risks of falls/not confident at all/unimportant 5= Entirely preventable /significantly increases the risks of falls/very confident/important). One question focused on recent fall involvement. Modal values were taken. Data was inputted using Google Docs and analysed in Microsoft Excel. Results 13 responded (5 nurses, 4 health care support workers, 4 sisters). 7/13 had been involved in a fall in the last six months. Staff felt that the current post-inpatient fall proforma slightly reduces further falls risk. Factors that staff felt significantly increases the risks of falls were reduced mobility, delirium, falls history and impaired cognition. Factors that staff felt significantly reduces the risk of falls were, identifying patients at risk of falls, measuring lying and standing blood pressure, identifying the level of supervision for patient mobilisation, therapy assessment, initiating geriatric/falls review of high-risk falls patients, medication review, education of patients on avoiding falls and early senior clinician involvement in falls. Most staff felt mostly confident (4) knowing how to reduce the risk of falls and managing falls. Conclusions Most staff are comfortable managing falls. The falls proforma needs further development incorporating areas identified in this study to help reduce inpatient falls.

FP1.14 - A Re-audit of the prevalence of faecal incontinence in hospital inpatients

Abstract Introduction Faecal incontinence (FI) is a common and under-reported problem, with many patients too embarrassed to seek help. Patients often do not receive optimal care due to lack of identification. In-hospital identification when they are admitted for other reasons may be one method of improving the care of such patients. Aims &amp; Methods We had assessed the identification of continence problems in our hospital inpatients via a simple ‘spot check’ audit of the different wards in 2015; we used the case notes for checking the documentation by both nursing and medical staff. We looked at care plans, stool charts, follow up plans etc. We repeated this audit in 2023 to check for any improvement. Results Overall,132 (163 in 2015) patient case notes were examined. 94%(previously 90) had nursing documentation about bowels documented in comparison to 47% (48) for medical documentation. 5.3% (10.8) were found to have FI. Only 28% (31) of these patients would have been identified by medical documentation. Most of the patients identified with FI were elderly, as expected; surprisingly, 28.57% were on general surgical wards. All patients (100%) in 2015 were then referred appropriately for further management. In 2023, though some action for FI was taken in 71.42 % patients, no referral was apparently arranged in any. Conclusion It is important to identify patients with FI, establish cause and initiate appropriate management. The impact on the individual patient’s QOL needs assessment prior to planning management/specialist referral etc. We found that our nursing documentation was still better than medical documentation which needs to be improved; however, onward referral/management needs improving significantly.

Efficacy of Cytokine Hemoadsorption with Efferon CT in Severe Acute Pancreatitis

The aim of the study was to evaluate the effect of cytokine hemoadsorption on clinical manifestations and laboratory parameters in patients with severe acute pancreatitis (SAP).Materials and methods. The single-center, observational, controlled pilot study included 34 patients, 25 men (73.4%) and 9 women (26.4%), treated for severe acute pancreatitis (SAP) at the N. V. Sklifosovsky Emergency Care Research Institute from May 2022 to August 2023 (ClinicalTrials.gov ID NCT05695001). The mean age of the patients was 42.7±12.6 years. Participants were divided into two groups. In the main group (8 men and 1 woman], mean age 37.2±9.4 years), standard care was supplemented by selective cytokine hemoadsorption (SCH) and renal replacement therapy (RRT) using continuous veno-venous hemofiltration (CVVH) in the first 72 hours after the onset of abdominal pain syndrome (APS). In the control group (N=25, 18 men and 7 women], mean age 44.7±13.2 years), patients were managed similarly except for SCH.Results. After 24 hours in the ICU, the study group had significantly lower levels of lactate (P=0.045) and IL-6 (P&lt;0.001) than the control group. Lactate and IL-6 concentrations remained significantly different between groups at 72 hours (P&lt;0.001 and P&lt;0.05, respectively). ICU stay was significantly shorter in the study group, with a median of 6 days [95% CI, 4–25] before transfer to the general ward, whereas patients in the control group spent 37 days [95% CI, 22–73] in the ICU (P&lt;0.001).Conclusion. CVVH is an effective method of extracorporeal detoxification in the management of SAP, but it is less specific than cytokine adsorption in terms of elimination of proinflammatory markers. The data obtained provide sufficient evidence to consider the combination of these two modalities as the most effective approach for the management of SAP.

Prevalence of hyponatremia among medically hospitalized patients and associated outcomes: a retrospective cohort study.

Hyponatremia is a common electrolyte disturbance among hospitalized patients and is linked to increased mortality as well as poor outcomes. Study the prevalence of hyponatremia among medically admitted patients and the outcomes associated with hyponatremia. Retrospective cohort. Medical ward at tertiary hospital setting. The study included adult (≥18 years) hospitalized patients in general medical wards. Three readings of serum sodium level were taken (initial sodium level, nadir during admission, and before discharge). The sample size of 350 was determined based on a presumed 35% incidence of hyponatremia among hospitalized patients, with a 5% error margin. The prevalence of hyponatremia among medically hospitalized patients and association with health outcomes including length of hospital stay, inpatient mortality, 90-days readmission and 1-year mortality. In this study, 736 patients met the inclusion criteria. Of these, 377 (51.2%) had hyponatremia on admission, increasing to 562 (76.35%) during hospitalization. Mild hyponatremia was observed in 49.6% (n=365), moderate in 13.6% (n=100), and severe in 13.2% (n=97). Severe hyponatremia patients were significantly older (P<.01), predominantly female (P=.014), and had lower serum magnesium and albumin levels (P<.01). Hypertension, ischemic heart disease, heart failure, and diabetes were more prevalent in severe hyponatremia cases (P<.01, P<.01, P=.045, P<.01, respectively). Hospital stays were significantly shorter for patients with normal sodium levels (P<.01). Patients with severe hyponatremia had a shorter time for first hospital readmission (HR=0.80, P<.01 [95% CI; 0.69-0.94]). Hyponatremia was prevalent among medically hospitalized patients and more common among old patients, women, and patients with comorbidities. Hyponatremia was associated with increased length of stay in hospital and increased risk of 90-day re-admission. Single-centre design and retrospective nature.

Comprehensive tracheostomy care: from ICU to the general ward

Comprehensive tracheostomy care: from ICU to the general ward

A comparative study of Appendicitis inflammatory response (AIR) score with Alvarado score in diagnosis of acute appendicitis at KCMC Hospital

Background: Acute appendicitis is an acute inflammation of the appendix, most resulted from obstruction of the lumen of the appendix. It is one of the most common causes of acute abdomen. Although a very common and long-known phenomenon, appendicitis remains a diagnostic challenge for most surgeons. Objective: To compare the validity of Appendicitis Inflammatory Response Score with Alvarado score in diagnosis of acute appendicitis at KCMC Hospital. Methods: A prospective hospital based cross sectional study done over a period of six months (September 2016 to March 2017). Patients were admitted to general surgical ward after the diagnosis of acute appendicitis reached and all parameters included in the AIR score and Alvarado score were prospectively recorded on patients presenting symptoms of acute appendicitis. All removed appendix specimens were sent for histopathological examination. Data was entered and analyzed using statistical package of social sciences version 20. Results: A total of 35 patients enrolled in this study, 57% male, male to female ratio 1.3:1, mean age of 27(14-49) years. 31 patients confirmed histologicaly to have features of acute appendicitis, among these inflamed appendicitis were 51.6%. And advanced appendicitis 48.4% and negative appendicectomy rate was 11.4%. The sensitivity and specificity of both AIR and Alvarado score were 54.4%, 77.4% and 75%, 75%. PPV and NPV were 94.4%, 96% and 17.6%, 30% respectively. Conclusion: From our study we have seen Alvarado score is a better assessment tool that is accurate helping in diagnosis of acute appendicitis. Its high sensitivity and ROC is greater than that of the AIR score. We conclude that AS has outperform AIR score in accuracy in diagnosis of AA.

Early detection of deteriorating patients in general wards through continuous contactless vital signs monitoring.

To assess the efficacy of continuous contactless vital signs monitoring with an automated Early Warning System (EWS) in detecting clinical deterioration among patients in general wards. A prospective observational cohort study was conducted in the medical unit of a tertiary care hospital in India, involving 706 patients over 84,448 monitoring hours. The study used a contactless ballistocardiography system (Dozee system) to continuously monitor heart rate, respiratory rate, and blood pressure. The study assessed total, mean, and median alerts at 24, 48, 72, 96, 120 h, and length of stay (LOS) before patient deterioration or discharge. It analyzed alert sensitivity and specificity, average time from initial alert to deterioration, and healthcare practitioners (HCP) activity. Study was registered with the Clinical Trials Registry-India CTRI/2022/10/046404. Out of 706 patients, 33 (5%) experienced clinical deterioration, while 673 (95%) did not. The deterioration group consistently had a higher number of alerts compared to those who were discharged normally, across all time-points. On average, the time between the initial alert and clinical deterioration was 16 h within the last 24 h preceding the event. The sensitivity of the Dozee-EWS varied between 67% and 94%. HCP spend 10% of their time on vital signs check and documentation. This study suggests that utilizing contactless continuous vital signs monitoring with Dozee-EWS in general ward holds promise for enhancing the early detection of clinical deterioration. Further research is essential to evaluate the effectiveness across a wider range of clinical settings.

Trends in the hand hygiene practices using alcohol-based hand rubs in Japanese hospitals before and after the novel coronavirus pandemic: an observational study using national surveillance data

Healthcare-associated infections (HAIs) are a global concern in healthcare facilities, and hand hygiene (HH) using alcohol-based hand rubs (ABHR) is fundamentally crucial for their prevention. While previous studies report improvements in HH compliance amid the COVID-19 pandemic, the real situation in Japanese medical settings remains unclear. This observational study sought data from the Japanese national surveillance, focusing on ABHR use in hospitals before and after the COVID-19 pandemic. Data were retrieved from facilities certified to receive the Additional Healthcare Reimbursements for Infection Prevention and Control I. The study spanned five years (2019-2023), segmented quarterly, and employed Joinpoint regression analysis to assess the annual percentage change (APC). Overall, ABHR use per patient per day significantly increased both in critical care units and general wards amid the pandemic. However, the APC in the critical care units demonstrated a downward trend from Q4 of 2021 to Q1 of 2023, and ABHR use in general wards remained below the amount of WHO recommendations. This trend analysis highlighted recent patterns of ABHR use in Japanese hospitals by comparing pre- and post-COVID-19 periods. Although increases in ABHR use were observed over time, sustained efforts to promote HH compliance are necessary, particularly in general wards.

Predictive validity of resource-adjusted Korean Triage and Acuity Scale in pediatric gastrointestinal tract foreign body patients

Although paediatric patients with gastrointestinal (GI) foreign bodies require multiple resources, they often present with few or no discernible symptoms and are typically assigned a low acuity level during triage. We compared the predictive accuracy of the revised Korean Triage and Acuity Scale (rKTAS), which elevates acuity by one step in relation to anticipated resource utilization, with that of the conventional KTAS for clinical outcomes. This was a retrospective study of National Emergency Department Information System data. Data on patient and ED characteristics, resources used, and clinical outcomes were collected from January 2018 to December 2021 for patients with GI foreign bodies aged under 19. The primary outcome was rKTAS accuracy in predicting hospitalization, ICU admission, operating room (OR) use, and ED length of stay (EDLOS). The AUROC was used to evaluate the performance via of the KTAS and rKTAS. In total, 25,324 paediatric patients visited the ED for GI tract foreign bodies. The mean age was 3.8 years, and 51% (12,923) were between 1 and 4 year old. Although most (23,658; 93.4%) were discharged, 4.9% required hospitalization. Two or more resources were utilized in 2514 (9.9%) cases, and 3,514 individuals had their triage levels increased by one step. Compared with those of the KTAS, the AUROCs of the rKTAS for predicting overall hospitalization (p < 0.05), admission to general wards (p < 0.05), ICU admission (p = 0.01), and admission via the OR (p < 0.05)were higher than KTAS. Compared with that with the KTAS, the EDLOS with the rKTAS was longer at levels 1, 2, and 3. The adjusted rKTAS is a better predictor of clinical outcomes for paediatric patients with GI tract foreign bodies than the KTAS.

Admission, discharge, and transfer control in patient flow logistics: Overview and future research

Patient flow logistics involves managing and coordinating the movement of patients within a healthcare system. It aims to optimize the patients’ flow from their arrival to discharge or transfer, ensuring efficient and effective use of resources while minimizing delays and bottlenecks. Key components of patient flow logistics include capacity planning, resource allocation, appointment scheduling, and notably, admission, discharge, and transfer control. Our focus is on admission, discharge, and transfer control policies, which manage and regulate the flow of individual patients into and out of various facilities delivering care. We review a selection of 37 analytical, empirical, and experimental papers in this area published in leading operations research, operations management, and medical journals. These papers are categorized based on the specific department they target and the type of policies they consider. In particular, we identify: (i) four types of policies for intensive care units, (ii) three types of policies for emergency departments, and (iii) four types of policies for general wards. For each paper, we provide an overview of the research questions, formulations, solution methodologies, and results. This comprehensive review culminates in identifying future research directions for academics in this field.

Intrahospital Handovers before and after the Implementation of ISBAR Communication: A Quality Improvement Study on ICU Nurses' Handovers to General Medical Ward Nurses.

Research finds a lack of structure as well as varying and incomplete content in intrahospital handovers. This study aimed to improve intrahospital handovers by implementing structured ISBAR communication (identification, situation, background, assessment and recommendation). This quality improvement study was conducted observing 25 handovers given by nurses from the intensive care unit to nurses from general medical wards at baseline and after the implementation of the ISBAR communication tool. The 26-item ISBAR scoring tool was used to audit the handovers. In addition, the structure of the ISBAR communication and time spent on the handovers were observed. There were no significant improvements from baseline to post-intervention regarding adherence to the ISBAR communication scoring tool. The structure of the handovers improved from baseline to post-intervention (p = 0.047). The time spent on handovers declined from baseline to post-intervention, although not significantly. The items in the ISBAR communication scoring tool can act as a guide for details that need to be reported during intrahospital handovers to strengthen patient safety. Future research calls for studies measuring satisfaction among nurses regarding using different handover tools and studies using multifaceted training interventions.

Outcomes of the My Therapy self-management program in people admitted for rehabilitation: A stepped wedge cluster randomized clinical trial

BackgroundSelf-management programs can increase the time spent on prescribed therapeutic exercises and activities in rehabilitation inpatients, which has been associated with better functional outcomes and shorter hospital stays. ObjectivesTo determine whether implementation of a self-management program (‘My Therapy’) improves functional independence relative to routine care in people admitted for physical rehabilitation. MethodsThis stepped wedge, cluster randomized trial was conducted over 54 weeks (9 periods of 6-week duration, April 2021 - April 2022) across 9 clusters (general rehabilitation wards) within 4 hospitals (Victoria, Australia). We included all adults (≥18 years) admitted for rehabilitation to participating wards. The intervention included routine care plus ‘My Therapy’, comprising a sub-set of exercises and activities from supervised sessions which could be performed safely, without supervision or assistance. The primary outcomes were the proportion of participants achieving a minimal clinically important difference (MCID) in the Functional Independence Measure, (FIM™) and change in total FIM™ score from admission to discharge. Results2550 participants (62 % women) were recruited (control: n = 1458, intervention: n = 1092), with mean (SD) age 77 (13) years and 37 % orthopedic diagnosis. Under intervention conditions, participants reported a mean (SD) of 29 (21) minutes/day of self-directed therapy, compared to 4 (SD 14) minutes/day, under control conditions. There was no evidence of a difference between control and intervention conditions in the odds of achieving an MCID in FIM™ (adjusted odds ratio 0.93, 95 % CI 0.65 to 1.31), or in the change in FIM™ score (adjusted mean difference: -0.27 units, 95 % CI -2.67 to 2.13). ConclusionsMy Therapy was delivered safely to a large, diverse sample of participants admitted for rehabilitation, with an increase in daily rehabilitation dosage. However, given the lack of difference in functional improvement with participation in My Therapy, self-management programs may need to be supplemented with other strategies to improve function in people admitted for rehabilitation. Trial registrationAustralian New Zealand Clinical Trials Registry (ACTRN12621000313831), https://www.anzctr.org.au/

Translation and psychometric validation of the Patient Participation Culture Tool for healthcare workers in Chinese nursing context

BackgroundPromoting patient participation stands as a global priority in nursing care. Currently, there is a lack of a standardized tool to assess the culture of patient participation from the perspective of nurses in China.AimsTo translate and examine the validity and reliability of the Patient Participation Culture Tool for healthcare workers (PaCT-HCW) on general hospital wards in Chinese nursing context.MethodsA cross-sectional research study was conducted among 812 nurses. Brislin's recommendations were adhered to during the translation of the scale. Validity was assessed using construct validity, content validity, and face validity. Split-half reliability, test–retest reliability, and internal consistency reliability were used to evaluate dependability. The study was guided and reported following the STROBE checklist and recommendations for reporting the results of studies of instrument and scale development and testing.ResultsThe Chinese version of PaCT-HCW (the PaCT-HCW-C) exhibits good face validity and content validity. A rigorous exploratory factor analyse verified a six-factor (competence, support, perceived lack of time, information sharing and dialogue, response to questions and acceptance of a new role) scale structure with a cumulative variance contribution of the factors with 44 items of 68.840%. With a Cronbach's α coefficient of 0.962, split-half reliability of 0.866, and intraclass correlation coefficients of 0.989, the instrument demonstrates great reliability. Confirmatory factor analysis results validated the consistency of the six factors with the structure of the PaCT-HCW-C scale.ConclusionsThe 44-item PaCT-HCW-C is a valid and reliable instrument with satisfactory psychometric properties. It could serve as a tool for assessing the effectiveness of international programs aimed at fostering patient participation from the perspective of nurses, while also providing insights from China's practical experiences.

Prevalence and causes of medication transcription errors among hospitalized patients: An observational study and survey of nurses at a faith-based hospital in Cameroon

Medication errors are a leading cause of death globally; with the burden on resource-limited countries more than double that in high-income countries. Errors can occur at all stages of the medication use process; however, there is limited information on medication transcription errors (MTEs) among hospitalized patients in Africa. This study sought to determine the prevalence and types of MTEs and to assess nurses&amp;rsquo; perceptions of the likely causes of MTEs within the pediatric and general wards at a faith-based hospital in Cameroon. A prospective chart review of medication orders transcribed for patients admitted from April 1 to April 30, 2021, was conducted. Data analyzed included patient demographics, prevalence and types of MTEs, medication classes involved in MTEs, and nurse&amp;rsquo;s perceptions of the causes of MTEs. A total of 578 medication orders were reviewed for 75 patients, of whom 40 (53%) were female, and 30 were admitted to the pediatric ward. The results revealed that 38 MTEs were recorded, with 47% occurring on the medication administration sheet and dispensing cards. The most frequent MTEs were the omission of new and stop medication orders, involved in 28.9% and 26% of all MTEs, respectively. Antibacterials for systemic use were involved in the majority (55.3%) of MTEs. Illegible prescriptions (90.7%), distractions (87.0%), and high workload (77.8%) were ascribed as the most likely causes of MTEs. In conclusion, MTEs are common and pose a potential risk of patient harm in hospitalized patients. The adoption of a computerized provider order entry system could eliminate illegible prescriptions, reduce transcription processes, and alleviate workload, thereby improving patient safety.

Feasibility of deescalating postoperative care in enhanced recovery after cardiac surgery.

Enhanced Recovery After Surgery (ERAS) prioritizes faster functional recovery after major surgery. An important aspect of postoperative ERAS is decreasing morbidity and immobility, which can result from prolonged critical care. Using current clinical data, our aim was to analyze whether a six-hour monitoring period after Minimally Invasive Cardiac Surgery (MICS) might be sufficient to recognize major postoperative complications in a future Fast Track pathway. Additionally, we sought to investigate whether it could be possible to deescalate the setting of postoperative monitoring. 358 patients received MICS and were deemed suitable for an ERAS protocol between 01/2021 and 03/2023 at our institution. Of these, 297 patients could be successfully extubated on-table, were transferred to IMC or ICU in stable condition and therefore served as study cohort. Outcomes of interest were incidence and timing of Major Adverse Cardiac Events (MACE; death, myocardial infarction requiring revascularization, stroke), bleeding requiring reexploration and Fast Track-associated complications (reintubation and readmission to ICU). Patients' median age was 63 years (IQR 55-70) and 65% were male. 189 (64%) patients received anterolateral mini-thoracotomy, primarily for mitral and/or tricuspid valve surgery (n = 177). 108 (36%) patients had partial upper sternotomy, primarily for aortic valve repair/replacement (n = 79) and aortic surgery (n = 17). 90% of patients were normotensive without need for vasopressors within 6 h postoperatively, 82% of patients were transferred to the general ward on postoperative day 1 (POD). Two (0.7%) MACE events occurred, as well as 4 (1.3%) postoperative bleeding events requiring reexploration. Of these complications, only one event occurred before transfer to the ward - all others took place on or after POD 1. There was one instance of reintubation and two of readmission to ICU. If MICS patients can be successfully extubated on-table and are hemodynamically stable, major postoperative complications were rare in our single-center experience and primarily occurred after transfer to the ward. Therefore, in well selected MICS patients with uncomplicated intraoperative course, monitoring for six hours, possibly outside of an ICU, followed by transfer to the ward appears to be a feasible theoretical concept without negative impact on patient safety.