Health Care Hospital Research Articles

Health Promotion Practices among Pregnant Women Attending Antenatal Clinics at a Tertiary Hospital in Nigeria.

A cross-sectional study conducted in a semi-urban tertiary healthcare hospital in South western Nigeria to assess health promotion practices and associated sociodemographic factors among pregnant women attending antenatal clinics. A total of 220 pregnant women were studied. Results showed that 95.0% of the participants had good health promotion practices with physical activities having the lowest while spiritual values had the highest score. Moreover, age, religion, education, and occupation were significantly associated with health promotion practices among the pregnant women.

Study of histopathological spectrum of ovarian tumors in a tertiary care hospital in India

Abstract Background: Ovarian tumors rank as the third leading cause of mortality among female genital tract malignancies. This study examined the histopathological spectrum of ovarian neoplasms based on our center’s 2020 World Health Organization (WHO) classification. Materials and Methods: This descriptive study was carried out over 5 years at our tertiary healthcare hospital, including 406 cases of ovarian neoplasms. After proper fixation and gross examination, sections were routinely processed and examined. The histopathological spectrum of ovarian neoplasms was analyzed according to the 2020 WHO classification. Results: Out of the 406 cases studied, 329 (81.03%) were benign, 65 (16.01%) were malignant, and 12 (2.95%) were borderline. The cases included 326 (80.29%) surface epithelial tumors, 58 (14.28%) germ cell tumors, 19 (4.68%) sex cord-stromal tumors, and 2 (0.49%) metastatic tumors. The majority of ovarian tumors (n = 340, 83.74%) occurred in the 20–60 years age group. Conclusion: The study reveals that benign tumors were more prevalent than malignant ones, with serous tumors being the most common among the benign cases. We observed a higher incidence of malignancy in women over the age of 40. Therefore, early and accurate histological diagnosis is crucial for initiating an appropriate management plan.

Household Health Care Payments Under Rate Setting, Spending Growth Target, and Single-Payer Policies

Households have high burden of health care payments. Alternative financing approaches could reduce this burden for some households. To estimate the distribution of household health care payments across income under health care reform policies. Cross-sectional study with microsimulation used nationally representative data of the US population in 2030. Civilian, noninstitutionalized population from the 2022 Current Population Survey linked to expenditures from the 2018 and 2019 Medical Expenditure Panel Survey and 2022 National Health Expenditure Accounts were included. Rate regulation of hospital, physician, and other health care professional payments equal to the all-payer mean in the status quo, spending growth target at 4% annual per capita growth, and single-payer health care financed through taxes. Household health care payments (out-of-pocket expenses, premiums, and taxes) as a share of compensation. The synthetic population contained 154 456 records representing 339.5 million individuals, with 51% female, 7% Asian, 14% Black, 18% Hispanic White, 56% non-Hispanic White, and 5% other races and ethnicities (American Indian or Alaskan Native only; Native Hawaiian or other Pacific Islander only; and 2 or more races). In the status quo, mean household health care payments as a share of compensation was 24% to 27% (standard error [SE], 0.2%-1.2%) across income groups (median [IQR] 22% [4%-52%] below 139% of the federal poverty level [FPL]; 21% [4%-34%] for households above 1000% FPL [11% of the population]). Under rate setting, mean (SE) payments by households above 1000% FPL increased to 29% (0.6%) (median [IQR], 22% [6%-35%]) and decreased to 23% to 25% for other income groups. Under the spending growth target, mean (SE) payments decreased from 23% to 26% (SE, 0.2%-1.2%) across income groups. Under the single-payer system, mean (SE) payments declined to 15% (0.7%) (median [IQR], 4% [0%-30%]) for those below 139% FPL and increased to 31% (0.6%) (median [IQR], 23% [3%-39%]) for those above 1000% FPL. Uninsurance fell from 9% to 6% under rate setting due to improved Medicaid access, and to zero under the single-payer system. Single-payer financing based on the current federal income tax schedule and a payroll tax could substantially increase progressivity of household payments by income. Rate setting led to slight increases in payments by higher-income households, who financed higher payment rates in Medicare and Medicaid. Spending growth targets reduced payments slightly for all households.

Anti-Hypertension Drugs Classes of Prevention and Side Effects Diseases Efficiency Analysis in Association Rule Mining Techniques

Purpose: The Healthcare department, pharmaceutical department, Hospital and Clinical sector find out and explore the diseases of status, where it has been spreaded the communicable and non-communicable diseases among the society. The healthcare department conducting different awareness of programming about the different diseases how is affected people and how is prevented the diseases in society. Accordingly, all the healthcare awareness of information passed through the different media channel, even though high and low blood pressure is pressing public health challenges and it is recognized as the biggest contributor to the global burden of diseases. Presently people health is silently affected by blood pressure low and high level and they unable to recognize that something is amiss, high blood pressure is known as the "silent killer” and If blood pressure is excessively elevated, it may have an impact on organ damage or health issues like coronary arteries, heart valve dysfunction, diabetes, kidney diseases, heart attack and stroke this all are risk factors of blood pressure abnormal status. Hypertension diseases affected the patients need to the best prevention and feature safety. The Doctors, Pharmacist and Nurse are using Anti - hypertension drugs classes of medicines for patients. Which anti-hypertension drug classes of medicine good efficacy for patients and anti-hypertension drugs classes of medicine prevention diseases, side effects diseases knowledge is important for healthcare professional. Machine learning and Data mining knowledge discovery techniques need to understand how different classes of anti-hypertensive drugs might interact with the patient’s and medications. If the healthcare professional has access to a predictive data mining technique model, they could use this to anticipate how the patient’s condition might change over time and adjust the treatment plan proactively. This kind of analytical data mining knowledge can lead to more effective treatment and better patient outcomes. Design/Methodology/Approach: Developing machine learning concept for different anti-hypertension drugs classes of medicine efficiency analysis in hypertension prevention diseases and side effects diseases and Healthcare professional to take right decision for future adjusts treatment plan to the hypertension affected patients. Findings/Result: Orange data mining analytical tool to identify the anti-hypertension drugs classes of medicines efficacy and Doctors can take right decision to better treatment for the patients. Originality/Value: Data mining association rules of support, confidence and lift correlation analysis system helps to identified about the drug of new knowledge efficiency. Paper Type: Analytical research methods applied for analysis the different types of anti-hypertension drugs classes of association correlation efficacy in data mining machine learning system.

Systemic Regulatory Abnormalities in Glycemic Control and its Relation with Depression - A Cross-Sectional Study

Globally, depression is the 3rd leading cause of disability-adjusted life years. The presence of depression and its symptoms has been associated with improper control of glucose and poor glycemic index and a bidirectional relationship was seen between depressive disorders and diabetes mellitus. Depression, even at subclinical levels, has the tendency to increase the risk of incident type 2 diabetes by 25–60%. This study aims to find the prevalence of Type 2 diabetes mellitus(T2DM) in depression patients and to find the relationship between the severity of depression and the severity of T2DM in a Cross-sectional study. A total of 178 patients who attended psychiatry OPD of a tertiary healthcare hospital for a study period of 6 months were recruited into the study after considering inclusion and exclusion criteria evaluated by an experienced psychiatrist. Details like sociodemographic profiles and clinical data related to Major depression and T2DM were collected through self-structured proforma. To assess the severity of depression, HAM-D scale was used and the glycemic severity measure was used to assess the severity of T2DM by a well-trained psychiatrist. Statistical analysis was done and results were framed. The prevalence of Type 2 Diabetes mellitus in depressive disorder patients was found to be 25.2%. A significant association was seen between the severity of T2DM and the severity of depression, with a p-value of 0.013 and a chi-square value of 12.699. Significance with certain clinical factors like insulin usage (F=5.635; p = 0.019) and drug compliance (F=16.841; p <0.001) was seen in T2DM patients with depression. Nearly ¼th of the patients with depression had T2DM and the severity of hyperglycaemia was also found to be high as those patients were on insulin administration, other medical comorbidity disorders were present and drug compliance was found to be poor. Triglyceride glucose index was also found to be high in patients with severe depression, which contributes to improper blood glucose balance. Treating and reducing both the severity of T2DM and depression simultaneously is needed to improve the functioning of the patients and improve the retention in treatment and drug compliance, thereby preventing morbidity and mortality.

Effect of electronic records on mortality among patients in hospital and primary healthcare settings: a systematic review and meta-analyses.

Electronic medical records or electronic health records, collectively called electronic records, have significantly transformed the healthcare system and service provision in our world. Despite a number of primary studies on the subject, reports are inconsistent and contradictory about the effects of electronic records on mortality. Therefore, this review examined the effect of electronic records on mortality. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guideline. Six databases: PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, and Google Scholar, were searched from February 20 to October 25, 2023. Studies that assessed the effect of electronic records on mortality and were published between 1998 and 2022 were included. Joanna Briggs Institute quality appraisal tool was used to assess the methodological quality of the studies. Narrative synthesis was performed to identify patterns across studies. Meta-analysis was conducted using fixed effect and random-effects models to estimate the pooled effect of electronic records on mortality. Funnel plot and Egger's regression test were used to assess for publication bias. Fifty-four papers were found eligible for the systematic review, of which 42 were included in the meta-analyses. Of the 32 studies that assessed the effect of electronic health record on mortality, eight (25.00%) reported a statistically significant reduction in mortality, 22 (68.75%) did not show a statistically significant difference, and two (6.25%) studies reported an increased risk of mortality. Similarly, among the 22 studies that determined the effect of electronic medical record on mortality, 12 (54.55%) reported a statistically significant reduction in mortality, and ten (45.45%) studies didn't show a statistically significant difference. The fixed effect and random effects on mortality were OR = 0.95 (95% CI: 0.93-0.97) and OR = 0.94 (95% CI: 0.89-0.99), respectively. The associated I-squared was 61.5%. Statistical tests indicated that there was no significant publication bias among the studies included in the meta-analysis. Despite some heterogeneity among the studies, the review indicated that the implementation of electronic records in inpatient, specialized and intensive care units, and primary healthcare facilities seems to result in a statistically significant reduction in mortality. Maturity level and specific features may have played important roles. PROSPERO (CRD42023437257).

Management practices that promote preventive measures compliance: A comparative analysis between hospital healthcare workers and teachers

Frontline workers were at significant risk during the COVID-19 pandemic; as a result, several recommendations were implemented to protect the health and safety of frontline professions. Despite guidelines issued by the relevant authorities, several observations have emerged that workplaces do not always implement the wearing of personal protective equipment and compliance with other preventive measures. This study investigates healthcare workers and teachers’ compliance with these measures in Quebec, Canada. Specifically, this study aims to examine the application of preventive measures among hospital healthcare workers and elementary and high school teachers, identify the factors associated with the application of preventive measures in the context of the COVID-19 pandemic, and understand the differences in the dynamics of applying preventive measures in hospitals and educational institutions. This study is based on a proposed new model for preventive measure compliance, which classifies the factors that could influence the dependent variable of compliance with preventive measures into three variables: organizational context, organizational incentives, and individual social responsibility. Data were collected using an observational cross-sectional design through an online questionnaire survey of teachers and hospital healthcare workers in Canada. The results highlight that the three variables can impact the application of preventive practices; however, these variables did not intervene in the same manner in hospitals and educational institutions. Indeed, the results show that management practices differ in the two sectors of activity, with practices being more favorable for hospital healthcare workers.

Patterns of health service use for children with mental disorders in an Australian state population cohort.

The rate of mental health services provided to children and young people is increasing worldwide, including in Australia. The aim of this study was to describe patterns of hospital and ambulatory mental health service use among a large population cohort of adolescents followed from birth, with consideration of variation by age, sex and diagnosis. Characteristics of services provided for children with mental disorder diagnoses between birth and age 17.5 years were ascertained for a population cohort of 85,642 children (52.0% male) born between 2002 and 2005, from 'Admitted Patients', 'Emergency Department' and 'Mental Health Ambulatory' records provided by the New South Wales and Australian Capital Territory Health Departments. A total of 11,205 (~13.1%) children received at least one hospital or ambulatory health occasion of service for a mental health condition in the observation period. More than two-fifths of children with mental disorders had diagnoses spanning multiple categories of disorder over time. Ambulatory services were the most heavily used and the most common point of first contact. The rate of mental health service contact increased with age across all services, and for most categories of mental disorder. Girls were more likely to receive services for mental disorders than boys, but boys generally had an earlier age of first service contact. Finally, 3.1% of children presenting to mental health services experienced involuntary psychiatric inpatient admission. The extent of hospital and ambulatory-based mental healthcare service among children emphasises the need for primary prevention and early intervention.

Evaluating the knowledge of stroke management among Nigerian medical doctors

BackgroundStroke is a leading cause of death and disability in Nigeria. Effective stroke management is essential to reduce morbidity and mortality. Few trained neurologists in Nigeria are mostly concentrated in the cities, making non-specialists the backbone of acute stroke management in Nigeria. Physicians-related factors have been identified as one of the factors leading to sub-optimal stroke care. This study aimed to describe the knowledge of medical doctors in acute stroke care and the factors responsible for the disparity in their skills. MethodsA descriptive cross-sectional survey was conducted among 404 medical doctors across all the six geo-political zones in Nigeria using the Acute Stroke Management Questionnaire (ASMaQ). Data were analysed using descriptive statistics and simple logistics regression to predict the relationship between independent variables and the outcome variable (good knowledge vs poor knowledge). Results67 % (95 % CI =63–72 %) of respondents had good overall knowledge of stroke management. Most respondents [88.6 %, 95 % CI =85–92 %] had good knowledge of General Stroke Knowledge (GSK) followed by Hyperacute Stroke Management (HSM) [52.5 %, 95 % CI=47.3–57.7 %] and Advanced Stroke Management (ASM) [49.5 %, 95 %CI= 49.5–54.4 %]. Working in a primary healthcare center (PHCs) and government hospital were significant predictor of overall poor knowledge of stroke. Physicians at PHCs had 2.29 times the odds of poor knowledge compared to those in tertiary hospital ConclusionsIt is essential to retrain doctors on stroke management regularly, as part of their professional development.

Perceptions of patients, nurses, other healthcare workers, and general hospital managers about the content and challenges of transforming the clinical pathway into an integrated clinical pathway: a qualitative pilot study

Abstract Aim. Hospital health care of a patient represents a part of the patient’s “journey” through the healthcare system and as such is not delivered independently, but in a personalized integrated manner. To achieve a better outcome of personalized medical health care of patients in hospital, it is necessary to systematically transform the existing clinical pathways (CPs) into integrated clinical pathways (ICPs). The aim of the study was to investigate stakeholder’s perceptions of the content and barriers to transforming CPs into ICPs on the example of a general hospital in Slovenia. That is how we obtained microdata for systemic measures at the level of general hospitals in Slovenia. Material and methods. The cross-sectional study used a qualitative method with interviews and focus groups with patients, nurses, other healthcare workers and managers working in ICPs for chronic kidney disease and hip replacement in a typical Slovenian hospital. Results. The results showed that ICPs could be divided into five basic phases. In all phases, additions to the existing CPs in order to turn them into ICPs were necessary, which was an additional burden, especially for the nurses. Conclusions. Personalized health care through ICPs is patient-centered, shorter, holistic, coordinated, continuous, of higher quality for patients and sustainably more efficient for providers.

Health care workers hospitalized for COVID-19 in Liberia: who were they, and what were their outcomes?

Background Sustaining a ‘fit-for-purpose’ health workforce requires a better understanding of the health care worker cadres that are affected during pandemics and their outcomes. In hospitalized health care workers with confirmed COVID-19 between March 2020 and May 2023 in Liberia, we determined the hospitalization and case fatality rates, type of health care worker cadres affected, their demographic and clinical characteristics and hospital exit outcomes. Methods This was a cohort study using routine data extracted from hospitalization forms for health care workers in 24 designated COVID-19 treatment facilities in Liberia. Results Of the 424 health care workers with COVID-19, hospitalization rates progressively declined between 2020 and 2023, with the highest rates in 2020 (24/1,000 health care workers) and 2021 (14/1,000 health care workers). Case fatality was 2% in both 2020 and 2021 with no deaths thereafter. Among those hospitalized, the highest proportions were nursing cadres with 191(45%), physicians with 63 (15%) and laboratory technicians with 42 (10%). The most frequent reported site for COVID-19 infection was the health facility (326, 89%). COVID-19 vaccination coverage in health care workers was 20%. The majority (91%) of hospitalizations were for mild symptomatic infections. Even in referral centres (n-52), 18 (35%) were for mild infections. Of the 424 who were hospitalized, 412 (97%) recovered, 9 (2%) died and 3 (1%) either left against medical advice or absconded. Of the nine deaths, none were vaccinated, seven had moderate-to-severe disease but were not referred to specialized COVID-19 treatment centers. Conclusions The hospitalized health care workers for COVID-19 were predominantly clinical and laboratory personnel who were mostly unvaccinated, and health facilities were hot-spots for contracting infections. The triage and referral system was weak with unnecessary hospitalization of mild infections. This study provides useful insights for outbreak preparedness including priority vaccination and improving health care worker safety in Liberia.

A study on Hematological and Biochemical Parameters of Dengue Fever Patients in Janakpurdham, Madhesh Province, Nepal

Background: Over 350 million people are estimated to get the counter with flavivirus each year, causing dengue one of the most common arboviral diseases. Following the COVID-19 outbreak, there has been a recorded rise in the prevalence of dengue fever in the South Asian countries. In 2022, there was a significant dengue outbreak in Nepal. Data on haematological and biochemical parameters, which are crucial for the clinical management of dengue patients, are lacking in Nepal's Madhesh Province. The purpose of this study was to present the first baseline data on the haematological and biochemical parameters of dengue virus-infected patients. Methods: The data was extracted from admitted patients at Janaki Medical College, Teaching Hospital (JMCTH) and Janaki Health Care and Teaching Hospital (JHCTH) diagnosed with dengue fever between August to November-2023. Hematological and biochemical parameters were recorded from the medical records and analyzed. Results: There were 74 serologically positive dengue cases in all, with 32.4% being female and 67.6% being male. Of the 74 patients, one-fourth had NS1 positive, 24.3% had IgM, and 21.6% had IgG. Leucopenia (87.2%) and thrombocytopenia (66.2%) were the most frequent haematological findings, whereas serum glutamic-oxaloacetate transaminase (76.6%) and Serum glutamic pyruvic transaminase (58.1%) were the biochemical markers with higher levels. Conclusion: The study explores the most common haematological and biochemical parameters of the patients diagnosed with dengue that may alarm clinicians of the possibility of dengue virus infection in the study region.

Reproductive concerns and its correlation with fear of recurrence and level of family support in patients of childbearing age with gynecologic malignancies

BackgroundTo discuss the current status of reproductive concerns and its correlation with fear of recurrence and level of family support in patients of childbearing age with gynecologic malignancies.MethodsA convenient sampling method was used to enroll 188 patients with gynecologic malignancies in Nanjing Maternity and Child Health Care Hospital, Nanjing Drum Tower Hospital, General Hospital of Ningxia Medical University, and Haian Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from September 2022 to April 2023. Patients were assessed using general information questionnaire, Reproductive Concerns After Cancer Scale (RCAC), Fear of Cancer Recurrence Inventory (FCRI) questionnaire, and Perceived Social Support-Family (PSS-FA) Scale.ResultsAmong patients of childbearing age with gynecologic malignancies, the total RCAC score was (54.35 ± 7.52), indicating a moderate level of reproductive concerns. Patients scored (20.98 ± 4.51) on FCRI, implying a moderate level of fear of recurrence. The PSS-FA score was (9.57 ± 2.76), denoting a moderate level of family support. The total score and each dimensional score of RCAC were positively correlated with FCRI total score (P < 0.05), and negatively correlated with PSS-FA total score (P < 0.05). Fear of recurrence, family support level, number of children, educational background, treatment modality, and fertility intention were influencing factors for reproductive concerns in patients of childbearing age with gynecologic malignancies (all P < 0.05).ConclusionThe reproductive concerns, fear of recurrence and family support are all at moderate levels in patients of childbearing age with gynecologic malignancies, and reproductive concerns are positively correlated with fear of recurrence and negatively correlated with family support.

Retaining Healing Hands: A Transnational Study on Job Retention Interventions for the Healthcare Workforce

Healthcare organizations worldwide face challenges in retaining their healthcare workforce, with individual and organizational factors influencing their intentions to leave. This study conducted eight online co-creation workshops and four Delphi sessions to gain qualitative and in-depth insights into job retention interventions, involving healthcare workers, hospital managers, and policymakers. A thematic analysis was conducted, resulting in multiple interventions that were clustered in four pre-defined themes: professional and personal support, education, financial incentives, and regulatory measures. Professional and personal support interventions included regular interprofessional team meetings, leadership training programs, self-scheduling and sabbaticals, support for administrative and non-clinical work, and the provision of psychological counselling. Educational interventions encompassed facilitating development opportunities, periodic evaluations, onboarding, mentorship programs, and peer support groups. Financial incentives included the provision of competitive salaries, adequate infrastructure, extra benefits, transport possibilities, and permanent employment contracts. Regulatory measures addressed the need for complementary legislation across various levels, fixed healthcare worker-to-patient ratio, and instruments to monitor workload. To optimize retention strategies, healthcare organizations should tailor these interventions to address the unique factors influencing their workforce’s intentions to leave within their specific context. The study concludes that combining personal and professional support, educational opportunities, financial incentives, and regulatory measures is necessary because there is no one-size-fits-all solution.

Impact of health spending on hospitalization rates in Baltic countries: a comparative analysis

IntroductionThis study examines the association between healthcare indicators and hospitalization rates in three high-income European countries, namely Estonia, Latvia, and Lithuania, from 2015 to 2020.MethodWe used a sex-stratified generalized additive model (GAM) to investigate the impact of select healthcare indicators on hospitalization rates, adjusted by general economic status—i.e., gross domestic product (GDP) per capita.ResultsOur findings indicate a consistent decline in hospitalization rates over time for all three countries. The proportion of health expenditure spent on hospitals, the number of physicians and nurses, and hospital beds were not statistically significantly associated with hospitalization rates. However, changes in the number of employed medical doctors per 10,000 population were statistically significantly associated with changes of hospitalization rates in the same direction, with the effect being stronger for males. Additionally, higher GDP per capita was associated with increased hospitalization rates for both males and females in all three countries and in all models.ConclusionsThe relationship between healthcare spending and declining hospitalization rates was not statistically significant, suggesting that the healthcare systems may be shifting towards primary care, outpatient care, and on prevention efforts.

Does hospital competition improve the quality of outpatient care? - empirical evidence from a quasi-experiment in a Chinese city

BackgroundAlthough countries worldwide have launched a series of pro-competition reforms, the literature on the impacts of hospital competition has produced a complex and contradictory picture. This study examined whether hospital competition contributed to an increase in the quality of outpatient care.MethodsThe dataset comprises encounter data on 406,664 outpatients with influenza between 2015 and 2019 in China. Competition was measured using the Herfindahl-Hirschman index (HHI). Whether patients had 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department were the three quality outcomes assessed. Binary regression models with crossed random intercepts were constructed to estimate the impacts of the HHI on the quality of outpatient care. The intensity of nighttime lights was employed as an instrumental variable to address the endogenous relationship between the HHI and the quality of outpatient care.ResultsWe demonstrated that an increase in the degree of hospital competition was associated with improved quality of outpatient care. For each 1% increase in the degree of hospital competition, an individual’s risk of having a 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department fell by 34.9%, 18.3%, and 20.8%, respectively. The impacts of hospital competition on improving the quality of outpatient care were more substantial among females, individuals who used the Urban and Rural Residents Basic Medical Insurance to pay for their medical costs, individuals who visited accredited hospitals, and adults aged 25 to 64 years when compared with their counterparts.ConclusionThis study demonstrated that hospital competition contributed to better quality of outpatient care under a regime with a regulated ceiling price. Competition is suggested to be promoted in the outpatient care market where hospitals have control over quality and government sets a limit on the prices that hospitals may charge.

Nurses’ attitudes to family importance in nursing care: A two-sited cross-sectional study

AimThis study aimed to describe nurses’ attitudes and beliefs towards the importance of family in nursing care and explore differences in nurses’ attitudes and beliefs towards family-centered care between different healthcare institutions, such as community healthcare centers and hospitals. BackgroundFamily significantly affects the well-being and health of individuals. Therefore, nurses should support family engagement in nursing care. In recent years, family nursing research has emphasized the importance of teaching family nursing skills in continued education in healthcare institutions. Research has indicated that nurses who believe that illness concerns the family as a whole are more likely to involve the family in patient care. DesignA cross-sectional research design was used. MethodData were collected at one timepoint between March and September 2019 from 425 nurses working at the Primary Health Care Centers of the Capital Area (n=112) and in clinical settings at the University Hospital in Iceland (n=313). ResultsThe main findings indicated that nurses working in the women-and-child division at the University Hospital reported significantly more positive attitudes towards family evolvement in patient care than nurses working in the intensive care or surgical units. For nurses working at healthcare centers, a significant difference was also found in the nurses’ attitudes towards involving families in patient care. The nurses who were working in home care had significantly more positive attitudes when compared to those working in the infant and young children health promotion units. ConclusionsGreater collaboration is required between healthcare providers and families to improve the quality of care and health-related outcomes. Therefore, it is crucial to enhance nurses' knowledge about the importance of families during patient care. Tweetable abstractThis study aimed to describe nurses’ attitudes and beliefs towards family care. Differences were found between nurse’s attitudes by units but not by institutions.

To study the impact of expressing breastmilk inside the neonatal intensive care unit (NICU) besides a neonate, in comparison to expression outside the NICU: A quasi experimental study

Introduction: The proximity of the mother to the newborn following delivery is essential for the early initiation and establishment of exclusive breast feeding. It leads to the conditioning of the oxytocin reflex, allowing the expression of breast milk. However, preterm and sick babies are nursed in an environment away from their mothers in the NICU, thus leading to delayed initiation and inadequate expression of breast milk. Objective: To estimate the volume of breastmilk expressed close to the baby in comparison to breastmilk expressed away from her baby. Method: This quasi-experimental study was conducted in a tertiary healthcare hospital in Hyderabad over a duration of one month. Postpartum mothers of newborns delivered in this hospital and admitted to the NICU were included in the study. The enrolled mothers were shown a video and poster on manual expression of breast milk and were assisted by lactational counselors for support. The enrolled mothers initially expressed milk in the mother’s room, and an average of three expressions was taken. The next day, the mother was asked to go near the baby in the NICU and express milk in front of her baby, and the average of three feeds was determined in a similar fashion. Data analysis was done using a paired t-test. Results: A total of 30 postnatal mothers were enrolled in the study. The mean volume of breast milk expressed by the mother in the mother’s room was 9.9 ± 2.5ml and the mean volume of breast milk obtained when expressed close to her baby in the newborn care unit was 11.2 ± 2.7ml. The volume of milk expressed near the baby was significantly higher when compared to milk expressed away from the newborn (p&lt;0.001). Conclusions: This study showed that mothers who expressed their feed near their admitted newborns in the newborn care unit had a significant increase in the volume of expressed breastmilk in comparison to expressing the milk away from their babies.

Stepped, evidence-based and integrated care service model vs. usual care for mental disorders: A randomized controlled trial (RECOVER)

Stepped, evidence-based and integrated care service models have the potential to be used as a reference for mental health services. RECOVER aimed to evaluate cost savings, effectiveness, and cost-effectiveness of such a model within a two arm, assessor- and data analysist-blinded RCT in Hamburg, Germany. Participants aged 16–79 years with mental disorders were randomly assigned either to RECOVER or treatment as usual (TAU). Primary outcomes comprised costs, effectiveness (combined symptoms, functioning, quality of life), and cost-effectiveness, hierarchically ordered. Outcomes were evaluated according to the ITT principle, group differences regarding costs with adjusted generalized linear models, effectiveness with ANCOVA models, and cost-effectiveness with the incremental cost-effectiveness ratio (ICER) and cost-effectiveness acceptability curves (CEACs). Between 1/1/2018 and 12/31/2020, n = 891 were finally included (n = 477 in RECOVER, n = 444 in TAU). RECOVER was associated with significantly lower annual total costs (-22 %), health and social care costs (-25 %) and hospital costs (-50 %). Effectiveness analyses showed a significantly better outcome for RECOVER with the fully imputed data . The CEACs descriptively demonstrated that RECOVER was cost-effective with a probability of >95 %. Treatment in RECOVER resulted in substantial cost reductions with better cost-effectiveness. RECOVER can be recommended as a reference model for comprehensive and integrated mental health services.

Trends in Veteran hospitalizations and associated readmissions and emergency department visits during the MISSION Act era.

To examine changes in hospitalization trends and healthcare utilization among Veterans following Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act implementation. VA Corporate Data Warehouse and Centers for Medicare and Medicaid Services datasets. Retrospective cohort study to compare 7- and 30-day rates for unplanned readmission and emergency department visits following index hospital stays based on payor type (VHA facility stay, VA-funded stay in community facility [CC], or Medicare-funded community stay [CMS]). Segmented regression models were used to compare payors and estimate changes in outcome levels and slopes following MISSION Act implementation. Veterans with active VA primary care utilization and ≥1 acute hospitalization between January 1, 2016 and December 31, 2021. Monthly index stays increased for all payors until MISSION Act implementation, when VHA and CMS admissions declined while CC admissions accelerated and overtook VHA admissions. In December 2021, CC admissions accounted for 54% of index admissions, up from 25% in January 2016. From adjusted models, just prior to implementation (May 2019), Veterans with CC admissions had 47% greater risk of 7-day readmission (risk ratio [RR]: 1.47, 95% confidence interval [CI]: 1.43, 1.51) and 20% greater risk of 30-day readmission (RR: 1.20, 95% CI: 1.19, 1.22) compared with those with VHA admissions; both effects persisted post-implementation. Pre-implementation CC admissions were also associated with higher 7- and 30-day ED visits, but both risks were substantially lower by study termination (RR: 0.90, 95% CI: 0.88, 0.91) and (RR: 0.89, 95% CI: 0.87, 0.90), respectively. MISSION Act implementation was associated with substantial shifts in treatment site and federal payor for Veteran hospitalizations. Post-implementation readmission risk was estimated to be higher for those with CC and CMS index admissions, while post-implementation risk of ED utilization following CC admissions was estimated to be lower compared with VHA index admissions. Reasons for this divergence require further investigation.