Hospital Setting Research Articles

Two-step GLIM approach using NRS-2002 screening tool vs direct GLIM criteria application in hospital malnutrition diagnosis: A cross-sectional study.

The two-step Global Leadership Initiative on Malnutrition (GLIM) approach was recently introduced to malnutrition diagnosis in a hospital setting. This study compares the diagnostic performance of this approach that uses the Nutritional Risk Screening-2002 (NRS-2002) as a screening tool and the direct application of GLIM malnutrition diagnostic criteria in hospitalized patients. This cross-sectional study involved 290 adult and older adult patients who were hospitalized. A trained nutritionist implemented the two-step GLIM approach, including NRS-2002 (in the first step) and GLIM criteria (in the second step) for each patient. Then, the accuracy, kappa index, area under the receiver operating characteristic curve (AUC ROC), sensitivity, and specificity of malnutrition diagnostic performance of the two-step GLIM approach and NRS-2002 were evaluated compared to thedirect use of GLIM criteria. The NRS-2002 identified 145 (50.0%) patients as at risk of malnutrition. The prevalence of malnutrition using the two-step GLIM approach and GLIM malnutrition diagnosis criteria were 120 (41.4%) and 141 (48.6%), respectively. The kappa index showed substantial and almost perfect agreement for NRS-2002 (κ = 68%) and the two-step GLIM approach (κ = 85%) with GLIM malnutrition diagnostic criteria, respectively. Furthermore, the AUC ROC (0.926; 95% confidence interval (CI): 0.89-0.96) and accuracy (92.8%) of the two-step GLIM approach compared to the GLIM criteria indicated an acepptable ability to distinguish between malnourished and well-nourished patients. The two-step GLIM approach using NRS-2002 as a screening tool (in step one) had acceptable malnutrition diagnostic performance compared to the direct application of GLIM criteria in hospitalized patients.

Exploring Implementation of Reasonable Adjustments in Hospitals for People With Intellectual Disability: Using a Realist Lens.

To explore the factors influencing the implementation of reasonable adjustments in hospitals for people with intellectual disability: using a realist lens. A qualitative study using a realist lens. Data collection involved one focus group interview and three semi-structured interviews with healthcare professionals working in hospital or community settings in September 2023. Data were analysed using qualitative content analysis and findings were mapped to the Context and Implementation of Complex Interventions (CICI) framework across the dimension's context, implementation and setting. Healthcare professionals support the provision of reasonable adjustments in acute hospitals as a person-centred approach to caring for people with intellectual disability. While reasonable adjustments are evident in practice, they are mostly individual-level cases with little evidence of strategic system-level implementation. The factors influencing the implementation of reasonable adjustments in practice were conceptualised using the CICI framework. Context factors spanned the domains of epidemiological (e.g., ageing population), socio-cultural (e.g., historical healthcare), political (e.g., lack of integrated care pathways) and ethical (e.g., provision of person-centred care). Implementation factors spanned the domains of strategies (e.g., leadership strategies), agents (e.g., liaison and advocacy roles) and outcomes (e.g., individual-level reasonable adjustments). The setting for the complex intervention was the acute hospital. System-level indicators for successful implementation include intellectual disability specific policies/procedures for integrated care pathways, education and awareness training for hospital staff, and leadership strategies such as the development of liaison nursing roles and the appropriate allocation of physical and human resources. A radical change is needed where implementation of reasonable adjustments in acute hospitals are broadened beyond isolated individual-level cases to system-level healthcare. This research highlights the importance of exploring the integrated dimensions of context, implementation and setting in complex interventions such as reasonable adjustments and sets foundation for further implementation research in this area. Reasonable adjustments at the system-level within acute hospitals would promote person-centred care and help address the inequities and health disparities experienced by people with intellectual disability. This research uses a realist lens to explore the factors influencing the implementation of reasonable adjustments in acute hospitals for people with intellectual disability. The factors influencing the implementation of reasonable adjustments in practice were conceptualised using the CICI framework across the dimensions of context (domains epidemiological, socio-cultural, political and ethical), implementation (domains strategies, agents and outcomes) and setting. System-level indicators for successful implementation include intellectual disability specific policies/procedures for integrated care pathways, education and awareness training for hospital staff, and leadership strategies such as the development of liaison nursing roles and the appropriate allocation of physical and human resources. This research highlights the importance of exploring the integrated dimensions of context, implementation and setting of complex interventions such as reasonable adjustments and sets a foundation for further implementation research in this area. This research adhered to the Equator research reporting guideline: standards for reporting qualitative research. A parent of a child with intellectual disability was involved in the conduct of this research, specifically in the design, data collection and preparation of the manuscript.

Enhancing food sustainability in the acute hospital setting - a nurse-led study of patient food.

Intensive global food production causes soil, water and air pollution, which has a negative impact on our health and future ability to produce sufficient nutritious food. Plant-based diets have the potential to reduce the environmental damage associated with the global food chain. The project sought to understand drivers of food waste and to improve food sustainability in a busy, tertiary referral hospital in England. Ward-level food waste was quantified. Qualitative data were collected using informal interviews with staff and additional data utilised the patient feedback survey. Ward-level food packaging waste and patient food choices were quantified using data on patient menu choices. The carbon footprint of patient food choices was calculated. Beef was the most popular menu choice, and was the main contributing factor to the high environmental impact of the hospital food chain. Increasing the visibility of vegetarian options on the menu led to a four-fold rise in these meals being chosen, which reduced the carbon footprint of the patient meal service. Recycling food packaging was also started, but there are challenges to widespread implementation. The project was successful, but it remains a starting point from which to increase food sustainability across the NHS and care sector catering provision.

61 The HEADS-ED under 6: Validation of a mental health and developmental screening and triage tool

Abstract Background The HEADS-ED screening and triage tool was developed for children 6 years to young adults as a communimetric mental health (MH) and addictions screener to help clinicians identify and communicate areas of need and recommended clinical care. Few clinician-administered tools identify both MH and developmental needs in young children under 6. From a review of milestone tools and in consultation with paediatricians, psychiatrists, and family physicians, the HEADS-ED Under 6 is a MH and developmental screening and triage tool that was developed to screen and flag functional impairment and action required in several areas, including: Home & caregivers, Eating & sleeping, Activities & peers, Development /speech/language/motor, Safety, Emotions & behaviours and Discharge & current resources (see http://heads-ed.com for more background and access to both tools available in English and French). Objectives Our objectives were to examine: 1) feasibility of implementing the new HEADS-ED Under 6 screening and triage tool in community and hospital settings, 2) clinical utility of the tool to assist with clinical decision making, and 3) validity of the tool against a comprehensive assessment. Design/Methods We conducted two implementation and validation studies to examine uptake of the tool and how the tool assists in clinical referral decisions to more specialized and intensive services at 2 sites. For our initial validation study, we piloted and validated the tool at a community MH agency in Ontario for children under the age of 6 from November 2019- March 2021 (N=566). For our cross-validation study, we examined how the tool was implemented within a regional coordinated access service housed in a paediatric hospital in Ontario from June 2021- August 2023 (N=589). Results For our initial validation study, the HEADS-ED Under 6 was widely used by intake workers (95%, N = 536/566) to communicate children’s MH and developmental needs (Figure 1) and assisted in recommending services of varying intensity. The tool showed good concordance with the InterRAI Early Years assessment in similar domains requiring no action (61.1% to 81.6%), requiring action but not immediate (49.2% to 88.0%) and requiring immediate action (66.7% to 100%) for children under 4 years old (p's <.001). Three clinical domains (Eating & sleeping, Development/speech/language/motor, and Emotions & behaviours) also independently predicted an urgent care recommendation (p's < .001). For our cross-validation study, the tool was used for all 589 intake appointments, and 96.4% (N = 568/589) had a level of need documented. HEADS-ED Under 6 clinical domains (.24-.38) and total scores (.52) were significantly correlated with level of need (p<.001). Higher HEADS-ED Under 6 total scores helped intake workers decide on more intense services based on level of need (p<.001; Figure 2). ROC analyses (AUC = .807, SE = 68.5% sensitivity, 79.5% specificity) confirmed a total score of 6 or above helped triage to more targeted and intense services. Conclusion The HEADS-ED Under 6 is a brief, straight-forward, and valid screening and triage tool that can be used by intake workers, physicians, and paediatricians to guide their interview in several areas of MH and development, communicate the severity of the child’s MH and developmental needs, and assist with determining level of need for services. When a HEADS-ED Under 6 total score reaches ≥6, clinicians should advocate for more intensive services when making MH service referrals.

CRISPR-Cas systems in enterococci.

Enterococci are members of the microbiota of humans and other animals. They can also be found in the environment, associated with food, healthcare infections, and hospital settings. Due to their wide distribution, they are inserted in the One Health context. The selective pressure caused by the extensive use of antimicrobial agents in humans, animals, and agriculture has increased the frequency of resistance to various drugs among enterococcal species. CRISPR-Cas system, an important prokaryotic defense mechanism against the entry of mobile genetic elements, may prevent the acquisition of genes involved in antimicrobial resistance and virulence. This system has been increasingly used as a gene editing tool, which can be used as a way to recognize and inactivate genes of interest. Here, we conduct a review on CRISPR systems found in enterococci, considering their occurrence, structure and organization, mechanisms of action and use as a genetic engineering technology. Type II-A CRISPR-Cas systems were shown to be the most frequent among enterococcal species, and the orphan CRISPR2 was the most commonly found system (54.1%) among enterococcal species, especially in Enterococcus faecalis. Distribution of CRISPR systems varied among species. CRISPR systems had 1 to 20 spacers, with size between 23 and 37bp and direct repeat sequences from 25 to 37bp. Several applications of the CRISPR-Cas biotechnology have been described in enterococci, mostly in vitro, using this editing tool to target resistance- and virulence-related genes.

Prevalence of Kidney Dysfunction and Its Relationship with Components of Metabolic Syndrome in a Hospital Setting

Metabolic syndrome (MetS) is defined by a set of components including hyperglycemia, dyslipidemia, hypertension, and central obesity. Despite the well-established association between MetS and chronic kidney disease (CKD) whose prevalence is on the increase, significant gap remains in our understanding of the relationship between kidney dysfunction and individual components of MetS, particularly in Nigeria. The objectives were to determine the prevalence of kidney dysfunction among adults with MetS and to examine the relationship of key components of MetS with kidney dysfunction using a cross-sectional study of randomly selected hospital outpatients with MetS. Kidney function was assessed using estimated glomerular filtration rate (eGFR). Descriptive and inferential statistical analyses were performed and statistical significance was set at p < .05. The mean age of the 75 study participants with MetS was 53.33 ± 13.94 years. Females constituted 65.3% and males, 34.7%. The prevalence of kidney dysfunction (eGFR < 60 mL/min/1.73 m²) was 36.0%, with no significant difference between genders. The key components of MetS that significantly correlated with kidney function were blood pressure, serum high density lipoprotein-cholesterol, and triglyceride. The same components independently predicted kidney function. To conclude, the study highlights the considerable burden of kidney dysfunction among adults with metabolic syndrome in Nigeria. Hypertension and dyslipidemia were the components of metabolic syndrome significantly associated with kidney dysfunction. Screening, early detection and targeted interventions including lifestyle modification and appropriate drug management are crucial to mitigate the impact of metabolic syndrome on kidney health, to improve health outcomes and to reduce CKD burden.

40 Trust, belonging and understanding - The experiences of families who use languages other than English (LOE) that are hospitalized on general paediatric inpatient units

Abstract Background Despite recognition that social determinants are critical to health outcomes, many groups, including those with lower incomes, racial/ethnic minorities, and other historically marginalized populations, continue to experience significant social and structural barriers to care. There is need for research that incorporates patient and stakeholder engagement in developing, testing, and disseminating interventions to improve outcomes for patient populations that have been marginalized in the health system. Patients who use a language(s) other than English (LOE) for healthcare communication are at increased risk for experiencing adverse events and worse health outcomes in healthcare settings, including in paediatric hospitals. Canadian census data indicates 12.7% of Canadians predominantly speak a language other than French or English. This work aims to generate knowledge to improve health outcomes for children and families who speak LOE. Objectives (1) To understand the lived experience of families who speak LOE around the hospitalization of their child and (2) To understand the perspectives of patients and families who speak LOE on how the healthcare system can improve care during hospitalization. Design/Methods The premise of this study is participatory research. We designed a qualitative study involving children hospitalized in the General Paediatric Inpatient Unit at the Hospital for Sick Children. The study includes family caregivers of children age 0 to 18 years who identify as speaking LOE. Children and families could speak any language that we were able to obtain interpreter support for. We excluded patients that spoke a traditional Indigenous language as we noted this work required a separate study in partnership with the Indigenous community. We conducted semi-structured virtual individual interviews with children and families post-discharge with a medical interpreter. An interview guide was developed and transcripts were analyzed using thematic analysis. We took several steps to ensure an effective study design given our goals of participatory research including ensuring patient and family engagement throughout the design process. Results 19 families participated in the interviews and 16 different languages were represented amongst our participant groups. Our study is unique in especially unique in it's ability to recruit and interview individuals with so many different primary languages. Our study provides rich insight into opportunities within the paediatric inpatient setting for quality improvement to address the health disparities experienced by patients and families who use LOE for healthcare communication. Our analysis of the interviews identify several themes that provide insight into the lived experience of patients and families who use LOE for healthcare communication. 1) Inconsistent interpreter use affects communication “in the moment” and the ability to develop an “overall understanding” of the current clinical situation and broader healthcare context. Our participants note a "snowball effect" when interpreters are not consistently utilized. 2) In addition to language, multiple additional social factors contribute to an increased sense of vulnerability and modulates how families “trust” the healthcare system. 3) Despite families expressing positive experiences, they noted that they did not, nor expect to feel like they “belonged” within the healthcare system. It is critical to recognize the complex interplay between many factors surrounding our participants’ identities. Though they use a LOE for healthcare, the intersectional marginalization they experience was thoroughly represented during our conversations Conclusion Our research aimed to take a participatory approach to consider the lived experience of patients and families who use LOE for healthcare communication. This work builds on the current literature on patient and family centered care, experiences of families who speak LOE and participatory community-based research in the paediatric hospital settings. Our study's findings support the development of a research and intervention agenda in Canada to improve health outcomes for patients and families with LOE.

Construction and practice of a novel pharmaceutical health literacy intervention model in psychiatric hospital.

Pharmaceutical health literacy intervention (PHLI) plays a crucial role in influencing patients' medical decision-making, particularly concerning medication use. However, PHLI has not been widely implemented in China. This study aims to develop a novel PHLI model within a psychiatric hospital setting and evaluate its effectiveness. A PHLI model encompassing four modes-covering inpatients, outpatients, Internet+ and community-was established at The Affiliated Mental Health Center of Jiangnan University. The model's operation was detailed, and its performance data from 2022 and 2023 were evaluated. In 2022 and 2023, a total of 636 PHLI cases were reported. Of these, 386 cases (60.69%) were identified through the inpatient mode. The proportion of PHLI delivered via inpatient and Internet information subscription modes gradually increased, while interventions through other methods decreased. The age group of 18-30 accounted for 21.97% of cases, with 116 instances reported. Various types of PHLI were provided, including adverse reactions (18.87%), dosage and administration (11.64%), and therapeutic drug monitoring (9.43%). In addition, intervention strategies primarily focused on adverse reaction identification (10.22%), interpretation of pharmaceutical reports (7.23%), and routine examination reminders (6.45%). The PHLI model developed at our hospital offers an effective approach to health literacy intervention and represents an innovation advancement in pharmaceutical health literacy management. It can also serve as a reference framework for other hospitals.

54 Efficacy of a quality improvement project in paediatric procedural pain management during needle procedures

Abstract Background In paediatric hospital settings, needle procedures significantly contribute to children’s experiences of pain and distress. A structured approach integrating preparation, comfort positions, distraction, relaxation techniques, and topical anesthetics can enhance children’s ability to cope with procedural discomfort. We developed a quality improvement (QI) initiative aiming to alleviate procedural pain and distress through a staggered implementation approach over a 3-year period. Objectives This study aimed to evaluate the impact of the first 2 years of an institutional QI initiative on managing procedural pain and distress in children undergoing needle procedures. The primary objective was to evaluate the use of multimodal strategies to reduce needle-related procedural pain/distress following the QI initiative. The secondary objective was to compare pain scores for needle procedures before and after the QI initiative. Design/Methods This observational study was conducted in a tertiary care university-affiliated paediatric hospital with an ongoing hospital-wide QI initiative aiming to alleviate procedural pain and distress in children undergoing needle procedures. The QI initiative consisted of mandatory sector-by-sector training of healthcare providers (HCP) on procedural pain/distress strategies to increase the use of multimodal pain care. Pain scores were measured during needle procedures (i.e. Numerical Rating Scale (NRS), Faces Pain Scale-R (FPS-R) or the FLACC scales, according to patient age) pre and 3-6 months post implementation of the QI initiative. Scheduled audits were conducted using a standardized questionnaire by a deployment champion nurse during needle procedures to document pain scales and pain/distress strategies used by the HCP during needle procedures in each of the hospital services. Results Throughout the first two implementation years (June 2021-June 2023), 363 audits were conducted on needle procedures for 363 children (Median age 7 yo (0month-18yo□). At this stage, audits took place in 14 different hospital services. The most frequent procedures were IV-line insertions (34%), venous blood draws (27%), and capillary blood sampling (26%). Parental presence and the use of distraction techniques were frequently used (90% and 80% of procedures, respectively). Of the 363 audits, 221 were pre-implementation and 142 post-implementation. Post QI initiative, an increased number of procedures were realized using multimodal strategies (4 or more strategies) to reduce pain/distress (from 60% to 78%). Pain scores were recorded for 203/221 audits pre and 134/142 post with a reduction in severe pain scores (7 or more) from 25% pre to 5% post-implementation. Conclusion The institutional QI initiative demonstrated both an increase in the number of strategies used to prevent pain/distress and a reduction in severe pain scores associated with paediatric needle procedures. This project emphasizes the significance of employing a multifaceted approach to managing procedural pain/distress in children undergoing needle procedures.

COVID-19 and Health-care Business Continuity in Africa: Perceptions of Risks and Vulnerabilities by Mid-level Management Staff in a Tertiary Care Hospital.

The novel SARS-CoV-2 outbreak disrupted businesses globally and created fears in the general public and among health-care professionals. Almost universally, considerations about the coronavirus pandemic and its effects became priority in the daily operations of businesses, leaving hitherto pressing concerns in the back stage. Early in the pandemic, the management of University of Benin Teaching Hospital set up a Business Continuity Team which undertook an evaluation of the perceptions of mid-level hospital managers about their departments' and units' risks and vulnerabilities in the face of the ongoing pandemic. A modified International Labour Organization (ILO) risk profile self-assessment tool which focused on "people," "processes," "profits," and "partnerships" was used to assess mid-level managers' perceptions of their respective departments' and units' risks and vulnerabilities, consequent on the COVID-19 pandemic. Responses were obtained from heads of departments and units using an online survey. Final scores were divided into terciles (three equal groups) in respect of perceived risks and adverse outcomes of the COVID-19 pandemic. Scores in the lower tercile were grouped as low risk/vulnerability, the middle group of scores as medium risk/vulnerability, and scores in the upper tercile as high risk/vulnerability. Responses were obtained from 35 (49.3%) of the 71 clinical and nonclinical departments and units in the hospital. Fifteen of these (42.9%) were clinical. Nineteen (54.2%) departments were assessed to be at high risk/vulnerability, 9 (47.4%) of which were clinical. Twelve (34.3%) departments were assessed to be at medium risk/vulnerability - 4 (33.3%) of them, clinical. No department was assessed to be at low risk. The highest risk ratings were in the domains of "profits" and "partnerships:" 54 (84.4%) mid-level managers assessed their departments and units to be at high risk of the negative impacts of the coronavirus pandemic with respect to "profits" and 51 (79.7%) with respect to "partnerships." Mid-level managers in clinical and nonclinical departments and units assessed their departments and units to be at medium and high risk of the negative impacts of the COVID-19 pandemic, using the ILO's modified tool. Our findings enabled the management of the hospital and the Business Continuity Team to address the specific areas of concerns that were highlighted, develop contingency plans, and frame risk communication during the pandemic, with a view to fostering increased sense of safety in the workforce. This approach to risk assessment is repeatable, and we recommended it to other hospitals in Africa.

Comparative Analysis of Inflammatory Bowel Disease Management: Hospital-based Versus Community-based Care.

Inflammatory bowel disease (IBD) encompasses chronic gastrointestinal disorders characterized by recurrent inflammation. Achieving mucosal healing and preventing disease progression are primary treatment goals. This study aimed to compare disease characteristics, medication utilization, procedures performed, and hospitalizations between IBD patients treated in hospital and community settings using the Leumit Health Service database. A retrospective cohort study was conducted using data from the Leumit Health Service, comprising 3020 patients diagnosed with IBD from January 2010 to December 2019. Patients were divided based on primary care setting: hospital-based or community-based. Data included demographic characteristics, disease type, medication usage, procedures, and outcomes. Statistical analyses assessed differences between groups. Hospital-treated patients were significantly younger (49.4±18.4 vs. 40.4±18.7, P<0.001 ), had higher rates of Crohn's disease (45.9% vs. 71.4%, P<0.001), exhibited higher inflammatory markers (calprotectin 768±2182 vs. 1305±2526, P<0.001), lower albumin (4.23±0.27 vs. 4.12±0.32, P<0.001), hemoglobin levels (13.4±1.6 vs. 12.9±1.6, P<0.001), and lower BMI (26.2±5.3 vs. 24.6±5.6, P<0.001) compared with community-treated patients. Hospital-treated patients had more endoscopic procedures, higher medication utilization rates, shorter treatment durations, and increased hospitalization occurrence (12.1% vs. 23.6%, P<0.001), length (0.67±3.34 vs. 1.45±5.88, P<0.001), and colectomies (4.73% vs. 15.8%, P<0.001). Disparities exist in IBD management between hospital and community settings, influenced by disease severity and treatment approaches. Hospital-based care is associated with more aggressive disease and intensive interventions, while community-based care may reflect milder disease and conservative management. Integrating specialized care models and personalized approaches across settings can optimize patient outcomes and health care delivery for IBD management. Further research is needed to understand these disparities' underlying mechanisms and develop comprehensive care strategies.

An Assessment of an Inpatient Robotic Nurse Assistant: A Mixed-Method Study

The worldwide nursing shortage has led to the exploration of using robotics to support care delivery and reduce nurses’ workload. In this observational, mixed-method study, we examined the implementation of a robotic nurse assistant (RNA) in a hospital ward to support vital signs measurements, medication, and item delivery. Human–robot interaction was assessed in four domains: usability, social acceptance, user experience, and its societal impact. Patients in a general medicine ward were recruited to participate in a one-time trial with the RNA and a post-trial 75-question survey. Patients’ interactions with the RNA were video recorded for analysis including patients’ behaviours, facial emotions, and visual attention. Focus group discussions with nurses elicited their perceptions of working with the RNA, areas for improvement, and scalability. Sixty-seven patients aged 21–79 participated in the trial. Eight in 10 patients reported positive interactions with the RNA. When the RNA did not perform to expectations, only 25% of patients attributed fault to the RNA. Video analysis showed patients at ease interacting with the RNA despite some technical problems. Nurses saw potential for the RNA taking over routine tasks. However, they were sceptical of real time savings and were concerned with the RNA’s ability to work well with older patients. Patients and nurses suggested greater interactivity between RNA and patients. Future studies should examine potential timesaving and whether time saved translated to nurses performing higher value clinical tasks. The utility of improved RNA’s social capability in a hospital setting should be explored as well.

Improving the nursing quality of non-pharmacological interventions for elderly constipation patients in the hospital: a best practice implementation project.

Non-pharmacological interventions are the preferred treatment for constipation; however, health care professionals in clinical settings tend to focus more on pharmacological treatments. This best practice implementation project aimed to integrate the best evidence on non-pharmacological interventions for elderly patients with constipation in clinical care practice and to promote the use of non-pharmacological interventions for such patients in the hospital setting. This project is based on the JBI Evidence Implementation Framework, which follows three stages. The first stage involved a baseline audit using two audit criteria derived from the best available evidence. This audit evaluated current clinical scenarios, guided by the i-PARIHS framework. The second stage involved analyzing the results of the baseline audit, identifying barriers to compliance, and developing and implementing strategies to overcome those barriers. Strategies included nursing education, development of constipation information booklets for nurses and patients, establishment of a nursing workflow, and modification of the department environment. In the third stage, a follow-up audit was conducted to evaluate the implementation, using the same data collection indicators and methods as in the baseline audit. Sixty patients participated in the project. Compliance for Criterion 1 (patient education) increased from 0% to 60% (P < 0.001), while compliance for Criterion 2 (monitoring patients' bowel health) increased from 0% to 100% (p < 0.001). The results indicate that this evidence-based implementation project facilitated the application of non-pharmacological interventions for elderly patients with constipation. Nurses played a significant role in developing regular defecation habits in patients and monitoring their defecation. http://links.lww.com/IJEBH/A284.

Prevalence &amp; clinical outcome of autoimmune encephalitis versus viral encephalitis in children with acute encephalitis syndrome: A prospective observational study

Background &amp; objectives Acute encephalitic syndrome (AES), encompasses a wide spectrum of potential causes, clinical presentations, and outcomes. While infectious encephalitis is generally considered more prevalent, autoimmune encephalitis is emerging as a significant aetiology. Neuronal autoantibodies have been identified independently or in association with acute viral encephalitis. The primary objective of this study was to ascertain the prevalence and clinical manifestation of autoimmune encephalitis as well as of coexisting viral markers in children with AES. Methods This study was a prospective observational investigation conducted in a hospital setting. It involved enrolling children with AES who were admitted to specific tertiary hospitals. Children were subjected to examinations to detect the presence of viral markers and neuronal autoantibodies in both their blood and cerebrospinal fluid (CSF). All the participants received treatment based on established guidelines and was followed for six months for outcome assessment. Results During the study period, 867 children with AES were examined. Among these cases, 37 children (4.2%) were diagnosed with autoimmune encephalitis, and all of them tested positive for anti-NMDAR (N-methyl-D-aspartate receptor) antibodies. Evidence of viral infection was seen in 409 (47.1%) of cases, out of which nearly 254 (29.2%) children had detectable HSV IgM antibodies. Among the 37 children with autoimmune encephalitis, 25 (67.5%) had evidence of a viral trigger, with eight of them tested positive for HSV IgM antibodies. The clinical presentation of autoimmune-associated AES was similar to those with viral aetiology. Interpretation &amp; conclusions Autoimmune encephalitis triggered by neurotropic (HSV) viral infection was more prevalent in this study than in the earlier reports. Typically, these children show positive responses to immunosuppressive treatments if administered promptly. It is hence advisable to assess children who exhibit behavioural issues and movement disorders for possible autoimmune encephalitis.

Mathematical Model for Antimicrobial Resistance Transmission Dynamics in Hospitals

In this study, we formulate and analyze a mathematical model to describe the possible transmission routes of Antimicrobial Resistance (A.M.R) in a hospital setting. We have examined the significant means of transmission of resistance in hospitals and found that the significant means of transmission is the use of antibiotics and through the contamination by health care workers. It has been shown that the resistance free equilibrium point is locally asymptotically stable. We have also shown that the model has a unique positive endemic equilibrium point which is locally asymptotically stable.

Current oral care practices in an acute aged care setting: An Australian metropolitan hospital perspective

Purpose To evaluate current oral care practices in an acute aged care hospital setting, and staff perceptions of the barriers and enablers to delivery of evidence-based oral care practices. Method A mixed method study comprised of retrospective file audit and cross-sectional survey was conducted within a single acute aged care unit. Medical records of patients aged ≥ 65 years admitted over a 6 month period were retrospectively audited. A clinician survey was used to explore barriers to and enablers of the delivery of oral care practices using the Capability, Opportunity, Motivation, Behaviour (COM-B) questionnaire. Result were analysed using descriptive statistics. Result Patient file audits (n = 206) found 13.6% (n = 28) of patients had oral care completed, despite 23% (n = 47) of patients being recommended by a speech language pathologist to receive oral care. Staff survey respondents (n = 31) reported they do not have the physical or social opportunities to provide oral care (i.e. adequate resources, time, and social support), however, they were motivated and reported they have the required knowledge and skills to provide oral care. Conclusion There is a need for implementation strategies to enable an interprofessional response to improve the delivery of evidence-based oral care practices and optimise patient outcomes.

The role of socioeconomic status in resolution of type 2 diabetes mellitus following longitudinal sleeve gastrectomy.

The role socioeconomic status (SES) on outcomes following bariatric surgery has been heavily investigated in previous studies. The goal of this study is to determine the association between Area Deprivation Index (ADI), a multidimensional indicator of socioeconomic conditions, and remission of type 2 diabetes mellitus following longitudinal sleeve gastrectomy (SG). This is a retrospective analysis of 312 patients undergoing LSG at a single-center in a metropolitan hospital setting over two years. Socioeconomic disadvantage was assessed by ADI, a model that incorporates education, income, employment and housing stock to rank neighborhoods both on the state and the national level. Type 2 diabetes mellitus (T2DM) was defined as utilization of diabetes medication or HgA1C of greater than 6.5% within a 3 months period, and was assessed at three time points: pre-op, 6-month follow-up and 1-year follow-up. In this cohort of individuals presenting for LSG, 72 (23.1%) had T2DM. The mean ADI of patients with T2DM (41.1 ± 17.1) was not statistically different from the group without T2DM (45.0 ± 16.4; p = 0.08631). By one year follow-up, 39 (60.0%) of individuals with T2DM had achieved remission. The ADI for individuals that achieved T2DM resolution was not different from the ADI of the group that did not (38.1 ± 15.4 vs 45.3 ± 17.7; p = 0.0958). In individuals with T2DM at baseline, 47 (65%) had A1C pre-op and A1C at 1 year follow-up; there was a significant reduction in Hgb-A1c (-0.71; -12.3%; p < 0.01). There was no correlation between change in A1C at 1year and ADI national rank (p = 0.26). We did not find a significant association between ADI and resolution of T2DM following sleeve gastrectomy. Resolution of T2DM following SG can be achieved by individuals regardless of SES. This supports the continued use of SG for socioeconomically deprived populations. In addition, we did not find an association between resolution of T2DM and weight loss, the most commonly used outcome metric following bariatric surgery.

Assay variables and early clinical evaluation of low-angle light scattering for platelet function analysis.

The recently developed platelet aggregation technique based on low-angle light scattering (LaSca) in diluted platelet-rich plasma (PRP) requires only a small sample volume and provides information about platelet aggregation and shape change. This study aimed to investigate the influence of preanalytical and analytical variables and to validate the method in a real-life pediatric hematology hospital setting. Platelet aggregation was induced by ADP in diluted PRP in the presence of 2mM calcium at 23°C. The study included healthy adults (n = 30), healthy children (n = 20), and pediatric patients with suspected or diagnosed platelet function abnormalities (n = 25). The assay parameters were stable for at least 3h after isolation of PRP and were sensitive to plasma dilution in the range of 2-8%. The initial aggregation velocity was significantly reduced in pediatric patients compared with healthy children (p < 0.05). ADP-induced light transmission amplitude was moderately correlated with LaSca amplitude of aggregation in healthy children (p = 0.52, p < 0.05) but not in pediatric patients. We standardized the protocol for platelet aggregation assessment by LaSca and characterized the influence of preanalytical and analytical variables on it.

Eosinophilic granulomatosis with polyangiitis associated with malignant arrhythmias: a case report

Abstract Background Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare vasculitis associated with significant cardiac morbidity and mortality. This case report presents the diagnostic and management challenges of EGPA-related arrhythmias in a remote general hospital setting. Case summary A 64-year-old Caucasian male presented with an indolent prodrome of fatigue, shortness of breath and anorexia, that culminated in an acute presentation with pulmonary embolism. His complicated clinical course included intracranial haemorrhage and refractory ventricular arrhythmias. Eosinophilia and subendocardial hypoattenuation observed on chest computed tomography were key findings that led to the diagnosis of EGPA. Multiple antiarrhythmic therapies were required as temporary measures whilst control of the underlying eosinophilic inflammation was achieved. Once stable, the patient was transferred to a tertiary cardiac centre for further investigation and cardioverter-defibrillator implantation. With EGPA now well controlled, he has experienced no further ventricular arrhythmias and has fully recovered. Conclusion Cardiac complications of EGPA, including ventricular arrhythmias, are difficult to manage without concurrent immunosuppression, which may itself further destabilise cardiac electrophysiology. The role of multiple imaging modalities in the diagnosis and monitoring of EGPA is emphasised, with cardiac magnetic resonance imaging playing a crucial role in detecting subendocardial fibrosis.

Critical resistance to carbapenem and aminoglycosides in Pseudomonas aeruginosa: spread of blaNDM/16S methylase armA harboring isolates with intrinsic resistance mechanisms in Kerman, Iran

BackgroundCarbapenem-resistant Pseudomonas aeruginosa (CRPA) is one of the main Gram-negative bacterium causes of infections in hospital settings, and the spread of them is a significant challenge to public health.MethodsA total of 30 non-duplicate isolates of CRPA were collected. Antibacterial susceptibility of isolates to antibiotic agents, AmpC β-lactamase production, and biofilm formation were determined. Minimum biofilm inhibitory concentrations (MBIC) of isolates to cefepime (FEP), imipenem (IPM), ceftazidime (CAZ), and meropenem (MEM) were evaluated with/without cloxacillin (CLX). The carbapenemase and 16 S rRNA methylase genes were identified by PCR, and the transcription levels of oprD, ampC, and mexA genes were determined by quantitative real-time PCR (qPCR). ERIC-PCR was used to detect genetic relationships among isolates.ResultsAll isolates were multidrug resistant (MDR) and strong biofilm producers. The resistance genes including blaNDM, blaIMP, blaVIM, blaSIM, blaGES, and armA were detected in 21 (70%), 6 (20%), 3 (10%), 2 (6.6%), 1 (3.3%), and 17 (56.6%) of the isolates, respectively. CLX at 500 and 1000 µg/mL significantly reduced the level of MIC to MEM, IPM, CAZ, and FEP, also at 2000 µg/mL significantly reduced the level of MBIC to MEM, IPM, CAZ, and FEP. In all isolates, the transcription levels of oprD were significantly downregulated as well as significantly increased for ampC and mexA. ERIC-PCR typing results divided 30 isolates into four clusters A to D.ConclusionIn this study, we reported the spread of different clones of CRPA harboring co-existence of various carbapenemase genes with armA 16 S rRNA methylase for the first time in Kerman, Iran. Also, our isolates had several mechanisms of resistance to carbapenems as well as ability biofilm formation along with resistance to aminoglycosides, the further spread of which could cause serious challenges in our hospital settings. Therefore, serious monitoring is necessary to reduce their prevalence.