Hospital Unit Research Articles

Stewardship Prompts to Improve Antibiotic Selection for Pneumonia

Pneumonia is the most common infection requiring hospitalization and is a major reason for overuse of extended-spectrum antibiotics. Despite low risk of multidrug-resistant organism (MDRO) infection, clinical uncertainty often drives initial antibiotic selection. Strategies to limit empiric antibiotic overuse for patients with pneumonia are needed. To evaluate whether computerized provider order entry (CPOE) prompts providing patient- and pathogen-specific MDRO infection risk estimates could reduce empiric extended-spectrum antibiotics for non-critically ill patients admitted with pneumonia. Cluster-randomized trial in 59 US community hospitals comparing the effect of a CPOE stewardship bundle (education, feedback, and real-time MDRO risk-based CPOE prompts; n = 29 hospitals) vs routine stewardship (n = 30 hospitals) on antibiotic selection during the first 3 hospital days (empiric period) in non-critically ill adults (≥18 years) hospitalized with pneumonia. There was an 18-month baseline period from April 1, 2017, to September 30, 2018, and a 15-month intervention period from April 1, 2019, to June 30, 2020. CPOE prompts recommending standard-spectrum antibiotics in patients ordered to receive extended-spectrum antibiotics during the empiric period who have low estimated absolute risk (<10%) of MDRO pneumonia, coupled with feedback and education. The primary outcome was empiric (first 3 days of hospitalization) extended-spectrum antibiotic days of therapy. Secondary outcomes included empiric vancomycin and antipseudomonal days of therapy and safety outcomes included days to intensive care unit (ICU) transfer and hospital length of stay. Outcomes compared differences between baseline and intervention periods across strategies. Among 59 hospitals with 96 451 (51 671 in the baseline period and 44 780 in the intervention period) adult patients admitted with pneumonia, the mean (SD) age of patients was 68.1 (17.0) years, 48.1% were men, and the median (IQR) Elixhauser comorbidity count was 4 (2-6). Compared with routine stewardship, the group using CPOE prompts had a 28.4% reduction in empiric extended-spectrum days of therapy (rate ratio, 0.72 [95% CI, 0.66-0.78]; P < .001). Safety outcomes of mean days to ICU transfer (6.5 vs 7.1 days) and hospital length of stay (6.8 vs 7.1 days) did not differ significantly between the routine and CPOE intervention groups. Empiric extended-spectrum antibiotic use was significantly lower among adults admitted with pneumonia to non-ICU settings in hospitals using education, feedback, and CPOE prompts recommending standard-spectrum antibiotics for patients at low risk of MDRO infection, compared with routine stewardship practices. Hospital length of stay and days to ICU transfer were unchanged. ClinicalTrials.gov Identifier: NCT03697070.

Revisiting the potential value of vital signs in the real-time prediction of mortality risk in intensive care unit patients

BackgroundPredicting patient mortality risk facilitates early intervention in intensive care unit (ICU) patients at greater risk of disease progression. This study applies machine learning methods to multidimensional clinical data to dynamically predict mortality risk in ICU patients.MethodsA total of 33,798 patients in the MIMIC-III database were collected. An integrated model NIMRF (Network Integrating Memory Module and Random Forest) based on multidimensional variables such as vital sign variables and laboratory variables was developed to predict the risk of death for ICU patients in four non overlapping time windows of 0–1 h, 1–3 h, 3–6 h, and 6–12 h. Mortality risk in four nonoverlapping time windows of 12 h was externally validated on data from 889 patients in the respiratory critical care unit of the Chinese PLA General Hospital and compared with LSTM, random forest and time-dependent cox regression model (survival analysis) methods. We also interpret the developed model to obtain important factors for predicting mortality risk across time windows. The code can be found in https://github.com/wyuexiao/NIMRF.ResultsThe NIMRF model developed in this study could predict the risk of death in four nonoverlapping time windows (0–1 h, 1–3 h, 3–6 h, 6–12 h) after any time point in ICU patients, and in internal data validation, it is suggested that the model is more accurate than LSTM, random forest prediction and time-dependent cox regression model (area under receiver operating characteristic curve, or AUC, 0–1 h: 0.8015 [95% CI 0.7725–0.8304] vs. 0.7144 [95%] CI 0.6824–0.7464] vs. 0.7606 [95% CI 0.7300–0.7913] vs 0.3867 [95% CI 0.3573–0.4161]; 1–3 h: 0.7100 [95% CI 0.6777–0.7423] vs. 0.6389 [95% CI 0.6055–0.6723] vs. 0.6992 [95% CI 0.6667–0.7318] vs 0.3854 [95% CI 0.3559–0.4150]; 3–6 h: 0.6760 [95% CI 0.6425–0.7097] vs. 0.5964 [95% CI 0.5622–0.6306] vs. 0.6760 [95% CI 0.6427–0.7099] vs 0.3967 [95% CI 0.3662–0.4271]; 6–12 h: 0.6380 [0.6031–0.6729] vs. 0.6032 [0.5705–0.6406] vs. 0.6055 [0.5682–0.6383] vs 0.4023 [95% CI 0.3709–0.4337]). External validation was performed on the data of patients in the respiratory critical care unit of the Chinese PLA General Hospital. Compared with LSTM, random forest and time-dependent cox regression model, the NIMRF model was still the best, with an AUC of 0.9366 [95% CI 0.9157–0.9575 for predicting death risk in 0–1 h]. The corresponding AUCs of LSTM, random forest and time-dependent cox regression model were 0.9263 [95% CI 0.9039–0.9486], 0.7437 [95% CI 0.7083–0.7791] and 0.2447 [95% CI 0.2202–0.2692], respectively. Interpretation of the model revealed that vital signs (systolic blood pressure, heart rate, diastolic blood pressure, respiratory rate, and body temperature) were highly correlated with events of death.ConclusionUsing the NIMRF model can integrate ICU multidimensional variable data, especially vital sign variable data, to accurately predict the death events of ICU patients. These predictions can assist clinicians in choosing more timely and precise treatment methods and interventions and, more importantly, can reduce invasive procedures and save medical costs.

An integrated multiple-criteria decision-making and data envelopment analysis framework for efficiency assessment in sustainable healthcare systems

Efficiency is critical in allocating sustainable healthcare resources to ensure that hospitals can effectively care for patients while maintaining high-quality care delivery. Hence, it is necessary to monitor efficiency carefully. This study aims to assess hospital unit effectiveness through a novel comprehensive approach integrating Multiple-Criteria Decision Making (MCDM) with Data Envelopment Analysis (DEA). The proposed MCDM-DEA framework involves allocating varying weights to distinct data categories. It harnesses the capabilities of the q-rung orthopair fuzzy (q-ROF) methodology to address the inherent uncertainties in healthcare performance assessment. The experimental results provide a comprehensively structured ranking system for specific hospital departments. This ranking system allows decision-makers to identify the strengths and weaknesses of each department, enabling them to make informed decisions regarding resource allocation and improvement strategies. Furthermore, the integration of MCDM-DEA provides a robust and objective assessment tool for monitoring and evaluating the performance of hospital departments over time. These rankings offer invaluable insights to decision-makers, equipping them with the strategic information needed to enhance the overall performance of hospital units.

Effect of implementation of the WHO intrapartum care model on maternal and neonatal outcomes: a randomized control trial

BackgroundIn 2018, the World Health Organization published a set of recommendations for further emphasis on the quality of intrapartum care to improve the childbirth experience. This study aimed to determine the effects of the WHO intrapartum care model on the childbirth experience, fear of childbirth, the quality of intrapartum care (primary outcomes), as well as post-traumatic stress disorder symptoms, postpartum depression, the duration of childbirth stages, the frequency of vaginal childbirth, Apgar score less than 7, desire for subsequent childbearing, and exclusive breastfeeding in the 4 to 6 weeks postpartum period (secondary outcomes).MethodsThis study was a randomized controlled trial involving 108 pregnant women admitted to the maternity units of Al-Zahra and Taleghani hospitals in Tabriz-Iran. Participants were allocated to either the intervention group, which received care according to the ' ‘intrapartum care model, or the control group, which received the’ ‘hospital’s routine care, using the blocked randomization method. A Partograph chart was drawn for each participant during pregnancy. A delivery fear scale was completed by all participants both before the beginning of the active phase (pre-intervention) and during 7 to 8 cm dilation (post-intervention). Participants in both groups were followed up for 4 to 6 weeks after childbirth and were asked to complete questionnaires on childbirth experience, postpartum depression, and post-traumatic stress disorder symptoms, as well as the pregnancy and childbirth questionnaire and checklists on the desire to have children again and exclusive breastfeeding. The data were analyzed using independent T and Mann-Whitney U tests and analysis of covariance ANCOVA with adjustments for the parity variable and the baseline scores or childbirth fear.ResultsThe average score for the childbirth experience total was notably higher in the intervention group (Adjusted Mean Difference (AMD) (95% Confidence Interval (CI)): 7.0 (0.6 to 0.8), p < 0.001). Similarly, the intrapartum care quality score exhibited a significant increase in the intervention group (AMD (95% CI): 7.0 (4.0 to 10), p < 0.001). Furthermore, the post-intervention fear of childbirth score demonstrated a substantial decrease in the intervention group (AMD (95% CI): -16.0 (-22.0 to -10.0), p < 0.001). No statistically significant differences were observed between the two groups in terms of mean scores for depression, PTSD symptoms, duration of childbirth stages, frequency of vaginal childbirth, Apgar score less than 7, and exclusive breastfeeding in the 4 to 6 weeks postpartum (p > 0.05).ConclusionThe intrapartum care model endorsed by the World Health Organization (WHO) has demonstrated effectiveness in enhancing childbirth experiences and increasing maternal satisfaction with the quality of obstetric care. Additionally, it contributes to the reduction of fear associated with labor and childbirth. Future research endeavors should explore strategies to prioritize and integrate respectful, high-quality care during labor and childbirth alongside clinical measures.

Time to death and its predictors among neonates admitted with sepsis in neonatal intensive care unit at comprehensive specialized hospitals in Northeast Ethiopia.

In impoverished nations like Ethiopia, neonatal sepsis contributes significantly to neonatal mortality. Despite variations in the specific timing of death and predictors of neonatal mortality associated with sepsis across different settings, there's limited documented information in the Neonatal Intensive Care Units of northeastern Ethiopia. Consequently, the aim of this study was to determine time to death and its predictors among neonates with sepsis admitted to Neonatal Intensive Care Units in comprehensive specialized hospitals in northeastern Ethiopia. A prospective cohort study conducted at the institution level involved 306 neonates diagnosed with sepsis. Data collection utilized face-to-face interviews and chart reviews. Subsequently, the data were inputted into Epi-data version 4.6 and later analyzed using STATA version 17. The median time to death was determined, and both the Kaplan-Meier curve and log-rank test were applied. Furthermore, a Cox proportional hazard regression model was utilized to identify predictors of neonatal mortality associated with sepsis. The cumulative incidence of mortality among neonates admitted with sepsis was 34% (95% CI: 28.9%-39.5%). The neonatal mortality rate stood at 51 (95% CI: 42.1, 62) per 1,000 neonates admitted to the intensive care units with sepsis over a total of 1,854 person-days of observation. Additionally, the median time to death was 13 days (IQR = 5-23 days). Tachypnea [AHR 6.2 (95% CI: 1.5-9.7)], respiratory distress syndrome [AHR 2.1 (95% CI: 1.3-3.5)], lethargy [AHR 1.8 (95% CI: 1.2-2.6)], preterm birth [AHR 1.8 (95% CI: 1.2-2.7)], continuous positive airway pressure use [AHR 2.1 (95% CI: 1.3-3.4)], home delivery [AHR 2.63 (95% CI: 1.1-6.4)], Subgalea hemorrhage [AHR 1.8 (95% CI: 1.1-3.9)], and low platelet count [AHR 5.9 (95% CI: 2.3-8.6)] were found to be predictors of time to death in neonates with sepsis. The study revealed an alarmingly high neonatal mortality rate among septic neonates, underscoring the urgency for intervention. Enhancing the quality of care in neonatal intensive care units, bolstering infection prevention during procedures such as continuous positive airway pressure, exercising caution with locally made accessories, and reinforcing a culture of institutional delivery are critical in curbing neonatal sepsis-related mortalities.

Is Incentive Spirometry Superior to Standard Care in Postoperative Cardiac Surgery on Clinical Outcomes and Length of Hospital and Intensive Care Unit Stay? A Systematic Review with Meta-Analysis.

Cardiac surgery is a frequent surgical procedure and may present a high risk of complications. Among the prophylactic strategies studied to decrease the rates of negative outcomes, respiratory care seems to reduce pulmonary complications. Incentive spirometry (IS) is a low-cost, respiratory exercise technique, used for the prevention and treatment of postoperative pulmonary complications (PPC). The aim of this review was to evaluate whether IS is superior to respiratory care, mobilization exercises, and noninvasive ventilation on PPC, and clinical outcomes. Systematic review. Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase®, Cochrane Central Register of Controlled Trials (or CENTRAL), Physiotherapy Evidence Database (or PEDro), Cumulative Index of Nursing and Allied Health (or CINAHL®), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Allied, Scopus®, and OpenGrey databases, clinical trial registration sites, conferences, congresses, and symposiums were searched. Twenty-one randomized trials and one quasi-randomized trial (1,677 participants) were included. For partial pressure of oxygen (PaO2), IS was inferior to respiratory care (mean difference [MD] -4.48; 95% confidence interval [CI] -8.32 to -0.63). Flow-oriented IS was inferior to respiratory care on PaO2 (MD -4.53; 95% CI -8.88 to -0.18). However, compared to respiratory care, flow-oriented IS was superior on recovery vital capacity. This meta-analysis revealed that IS was not superior to standard respiratory care for PPCs and clinical outcomes, therefore its use should not be widely recommended until further studies with high quality be performed to ensure this clinical guidance.

Colchicine for the treatment of patients with COVID-19: an updated systematic review and meta-analysis of randomised controlled trials

ObjectivesWe conducted an updated systematic review and meta-analysis to investigate the effect of colchicine treatment on clinical outcomes in patients with COVID-19.DesignSystematic review and meta-analysis.Data sourcesWe searched PubMed, Embase, the...

A prospective study on clinical profile, severity, microbiology, and outcome of patients with ventilator associated infective complications admitted in intensive care unit of a tertiary care hospital

: Mechanical ventilation epitomizes intensive care medicine. Ventilator‑associated complications are mainly Ventilator associated respiratory infections (VARI); These are a major cause of concern in the intensive care units (ICUs) worldwide, especially in developing countries. VARI includes patients with ventilator‑associated tracheobronchitis (VAT) and ventilator‑associated pneumonia (VAP).The clinical profile, severity, microbiology, and outcomes of such infections is not well described in Eastern India. The primary objective of the study was to study the risk factors, severity scoring, microbiological profile and 28 days outcome of patients admitted in intensive care unit of our hospital.Secondary objective of our study was to find out any correlation between risk factors, severity scoring, microbiological profile, and outcome of patients with VAT and VAP admitted in intensive care unit of our hospital.: This was a prospective observational study done in the ICU of a tertiary care centre in eastern India. A total 50 patients of clinically, microbiologically and/or radiologically diagnosed case of VAP and VAT were included in the study. A structured data collection proforma was prepared and data collection was done. Raw data was tabulated and analysed: 66% of our patients were male, Smoking was the commonest addiction(24%), VARI developed early with 17% on Day 3, 72% developed VARI within 5 days of ventilation. 16% had history of recent admission, Diabetes and hypertension were the commonest comorbidities. 58% of the patients developed VAP, the median SOFA score in VAP was 6 also similar in VAT. Patients with neurological diseases had the maximum number of VAT and VAP. Klebsiella pneumoniae was the commonest organism causing VAT (42%) while Acinetobacter Baumanii was commonest to cause VAP (44%). 51% of VAP patients were on volume control mode, while it was 52% of VAT patients. Most isolates are MDR pathogens with intermediate sensitivity to Polymyxin being most common (66%) 1 isolate was pan resistant. Mortality was 58% for VAP and 19% in VAT. Both Klebsiella and Acinetobacter accounts for 41% death in VAP group, in VAT group Klebsiella was commonest however no statistical significance with other organism.: Gram negative bacteria were the predominant cause of VAT and VAP, Acinetobacter and Klebsiella are the commonest organisms. Most Isolates are MDR with intermediate sensitivity to Polymyxins. Median SOFA scores were the same in both. Mortality was high in VAP group. Volume control mode was predominant mode of ventilation, Neurological causes was predominant cause that leads to ventilation and subsequent VARI.

Microbial profile and antimicrobial susceptibility pattern in paediatric intensive care unit of a tertiary care hospital, North East India

Microbial profile and antimicrobial susceptibility pattern in paediatric intensive care unit of a tertiary care hospital, North East India

Length of Hospitalization and Mortality among Stroke Patients before and after the Implementation of a Specialized Unit: A Retrospective Cohort Study Using Real-World Data from One Reference Hospital in Southern Brazil.

Stroke constitutes a significant global cause of mortality and disability. The implementation of stroke units influences hospital quality indicators, guiding care management. We aimed to compare hospital length of stay (LOS), in-hospital mortality, and post-discharge mortality between stroke patients admitted in the pre- and post-implementation periods of a stroke unit in a public hospital in southern Brazil. This retrospective cohort study used real-world data from one reference hospital, focusing on the intervention (stroke unit) and comparing it to the general ward (control). We analyzed the electronic medical records of 674 patients admitted from 2009 to 2012 in the general ward and 766 patients from 2013 to 2018 in the stroke unit. Admission to the stroke unit was associated with a 43% reduction in the likelihood of prolonged hospitalization. However, there was no significant difference in the risk of in-hospital mortality between the groups (Hazard ratio = 0.90; Interquartile range = 0.58 to 1.39). The incidence of death at three, six and twelve months post-discharge did not differ between the groups. Our study results indicate significant improvements in care processes for SU patients, including shorter LOS and better adherence to treatment protocols. However, our observations revealed no significant difference in mortality rates, either during hospitalization or after discharge, between the SU and GW groups. While SU implementation enhances efficiency in stroke care, further research is needed to explore long-term outcomes and optimize management strategies.

Results of Surgical Treatment of Patients with Symptomatic Abdominal Aortic Aneurysms

Relevance Abdominal aortic aneurysm is a common disease, manifested by an expansion of the abdominal aorta of more than 3 cm and accompanied by the development of serious complications with high mortality. There are symptomatic aneurysms, asymptomatic aneurysms and ruptured aneurysms. The timing of surgical intervention for symptomatic aneurysms still causes some controversy.Aim of study To determine the tactics and timing of surgery in patients with symptomatic abdominal aortic aneurysms.Material and methods The medical histories of 188 patients with symptomatic abdominal aortic aneurysms admitted to the Department of Vascular Surgery of N.V. Sklifosovsky Research Institute for Emergency Medicine. There were 152 men (80.8%) and 36 women (19.2%). The average age of those admitted was 69.8±2.5 years (from 53 to 84 years).Results All patients were divided into three groups, depending on the time of operation from the moment of admission: those operated in the first 24 hours (n=27); those operated from 24 to 72 hours from the moment of admission (n=20) and those operated later than 72 hours (n=136). The mortality by group was 14.8% in the first group, 20.0% in the second group, 7.3%in the third group.Conclusions Patients with symptomatic abdominal aortic aneurysm should be admitted to the intensive care unit for evaluation and preparation for delayed surgery. In cases where hospitalization in the intensive care unit is impossible or pain persists, the patient should be operated on urgently. When the pain syndrome is relieved and blood pressure is normalized, the patient can be further examined and operated on in a delayed manner.

Implementation of a Suicide Risk Screening Clinical Pathway in a Children's Hospital: A Feasibility Study.

Youth suicide is a pressing global concern. Prior research has developed evidence-driven clinical pathways to screen and identify suicide risk among pediatric patients in outpatient clinics, emergency departments (ED) and inpatient hospital units. However, the feasibility of implementing these pathways remains to be established. Here, we share the results of a hospital-wide "youth suicide risk screening pathway" implementation trial at an urban academic pediatric hospital to address this gap. A 3-tier "youth suicide risk screening pathway" using The Ask Suicide-Screening Questions (ASQ) was implemented for patients aged 10 to 26 years who received care at an urban academic pediatric hospital's emergency department or inpatient units. We retrospectively reviewed implementation outcomes of this pathway from January 1 to August 31, 2019. The feasibility of this implementation was measured by assessing the pathway's degree of execution, fidelity, resource utilization, and acceptability. Of 4108 eligible patient encounters, 3424 (83%) completed the screen. Forty-eight (1%) screened acute positive, 263 (8%) screened nonacute positive and 3113 (91%) screened negative. Patients reporting positive suicide risk were more likely to be older and female, although more males required specialty mental health evaluations. Pathway fidelity was 83% among all positive screens and 94% among acute positive screens. The clinical pathway implementation required 16 hours of provider training time and was associated with slightly longer length of stay for inpatients that screened positive (4 vs 3 days). Sixty-five percent of nurses and 78% of social work providers surveyed supported participation in this effort. It is feasible to implement a youth suicide risk screening pathway without overburdening the system at an urban academic pediatric hospital.

Survivorship After Neurocritical Care: A Scoping Review of Outcomes Beyond Physical Status.

Following intensive care unit hospitalization, survivors of acute neurological injury often experience debilitating short-term and long-term impairments. Although the physical/motor impairments experienced by survivors of acute neurological injury have been described extensively, fewer studies have examined cognitive, mental health, health-related quality of life (HRQoL), and employment outcomes. This scoping review describes the publication landscape beyond physical and/or motor sequelae in neurocritical care survivors. Databases were searched for terms related to critical illness, intensive care, and outcomes from January 1970 to March 2022. English-language studies of critically ill adults with a primary neurological diagnosis were included if they reported on at least one outcome of interest: cognition, mental health, HRQoL or employment. Data extraction was performed in duplicate for prespecified variables related to study outcomes. Of 16,036 abstracts screened, 74 citations were identified for inclusion. The studies encompassed seven worldwide regions and eight neurocritical diagnosis categories. Publications reporting outcomes of interest increased from 3 before the year 2000 to 71 after. Follow-up time points included ≤ 1 (n = 15 [20%] citations), 3 (n = 28 [38%]), 6 (n = 28 [38%]), and 12 (n = 21 [28%]) months and 1 to 5 (n = 19 [26%]) and > 5years (n = 8 [11%]), with 28 (38%) citations evaluating outcomes at multiple time points. Sixty-six assessment tools were used to evaluate the four outcomes of interest: 22 evaluating HRQoL (56 [76%] citations), 21 evaluating cognition (20 [27%] citations), 21 evaluating mental health (18 [24%] citations), and 2 evaluating employment (9 [12%] citations). This scoping review aimed to better understand the literature landscape regarding nonphysical outcomes in survivors of neurocritical care. Although a rising number of publications highlight growing awareness, future efforts are needed to improve study consistency and comparability and characterize outcomes in a disease-specific manner, including outlining of a minimum core outcomes set and associated assessment tools.

Central Venous Access Device–Associated Skin Complications in Adults with Cancer: A Prospective Observational Study

To identify the prevalence and type of central venous access device-associated skin complications for adult cancer patients, describe central venous access device management practices, and identify clinical and demographic characteristics associated with risk of central venous access device-associated skin complications. A prospective cohort study of 369 patients (626 central venous access devices; 7,682 catheter days) was undertaken between March 2017 and March 2018 across two cancer care in-patient units in a large teaching hospital. Twenty-seven percent (n = 168) of participants had a central venous access device-associated skin complication. In the final multivariable analysis, significant (P < .05) risk factors for skin complications were cutaneous graft versus host disease (2.1 times greater risk) and female sex (1.4 times greater risk), whereas totally implanted vascular access device reduced risk for skin complications by two-thirds (incidence risk ratio 0.37). Central venous access device-associated skin complications are a significant, potentially avoidable injury, requiring cancer nurses to be aware of high-risk groups and use evidence-based preventative and treatment strategies. This study has confirmed how common these potentially preventable injuries are. Therefore, the prevalence of these complications could be reduced by focusing on improvements in skin assessment, reductions in central venous access device dressing variation and improving clinician knowledge of this injury.

Characterizing nursing time with patients using computer vision.

Compared to other providers, nurses spend more time with patients, but the exact quantity and nature of those interactions remain largely unknown. The purpose of this study was to characterize the interactions of nurses at the bedside using continuous surveillance over a year long period. Nurses' time and activity at the bedside were characterized using a device that integrates the use of obfuscated computer vision in combination with a Bluetooth beacon on the nurses' identification badge to track nurses' activities at the bedside. The surveillance device (AUGi) was installed over 37 patient beds in two medical/surgical units in a major urban hospital. Forty-nine nurse users were tracked using the beacon. Data were collected 4/15/19-3/15/20. Statistics were performed to describe nurses' time and activity at the bedside. A total of n = 408,588 interactions were analyzed over 670 shifts, with >1.5 times more interactions during day shifts (n = 247,273) compared to night shifts (n = 161,315); the mean interaction time was 3.34 s longer during nights than days (p < 0.0001). Each nurse had an average of 7.86 (standard deviation [SD] = 10.13) interactions per bed each shift and a mean total interaction time per bed of 9.39 min (SD = 14.16). On average, nurses covered 7.43 beds (SD = 4.03) per shift (day: mean = 7.80 beds/nurse/shift, SD = 3.87; night: mean = 7.07/nurse/shift, SD = 4.17). The mean time per hourly rounding (HR) was 69.5 s (SD = 98.07) and 50.1 s (SD = 56.58) for bedside shift report. As far as we are aware, this is the first study to provide continuous surveillance of nurse activities at the bedside over a year long period, 24 h/day, 7 days/week. We detected that nurses spend less than 1 min giving report at the bedside, and this is only completed 20.7% of the time. Additionally, hourly rounding was completed only 52.9% of the time and nurses spent only 9 min total with each patient per shift. Further study is needed to detect whether there is an optimal timing or duration of interactions to improve patient outcomes. Nursing time with the patient has been shown to improve patient outcomes but precise information about how much time nurses spend with patients has been heretofore unknown. By understanding minute-by-minute activities at the bedside over a full year, we provide a full picture of nursing activity; this can be used in the future to determine how these activities affect patient outcomes.

Survival analysis of Intensive Care Units (ICUs) of field hospitals in the Federal District - Brazil during the COVID 19 pandemic using Kaplan Meier curves.

The COVID-19 pandemic is one of the most impactful public health emergencies the world has ever seen. A classic epidemiological analysis tool that can be used is the Kaplan-Meier (KM) survival model, which calculates the probability of survival for a group of patients. This study aims to describe the Estimated Survival of patients admitted to the ICUs of Field Hospitals in the Federal District during the COVID 19 Pandemic. Methodology: It is a non-concurrent cohort study of patients with COVID-19 consecutively admitted to the ICUs of field hospitals. The variables collected upon admission to the ICU were evaluated using KM curves and the non-parametric log-rank test. Results: For all patients admitted to the ICUs of field hospitals, the median length of stay was 10 days. Patients have a 94.95%, 58.45% and 19.92% probability of surviving 1 day, 10 days and 30 days of hospitalization respectively. Conclusion: The Kaplan-Meier curve is a strategic tool, it provides a clear view of how long the healthcare system needs to treat a person.

Comparison of Length of Stay Between Children Admitted to an Observation Versus Inpatient Unit.

Many children who require hospitalization are ideal candidates for care in pediatric observation units (POUs) rather than inpatient pediatric units. Differences in outcomes between children cared for in these 2 practice settings have not been thoroughly evaluated. In this retrospective cohort study, children aged 0 to 18 years admitted to a POU at a community hospital or inpatient unit at a children's hospital were enrolled if they met specific clinical criteria. Information regarding the current illness, medical history, and hospital course was collected. Hospital length of stay (LOS) was analyzed as the primary outcome; secondary outcomes included conversion to inpatient care for the POU group and return to pediatric emergency department within 7 days. Subgroup analysis was conducted on children presenting with respiratory illnesses. Propensity scores were used as a predictor in the final model. One hundred eighty-one admissions, 92 to POU and 89 to an inpatient unit, were analyzed. Mean LOS was 24.4 hours (95% confidence interval [CI], 21.7-27.1) for observation and 43.2 hours (95% CI, 37.8-48.6) for inpatient (P < 0.01). Among the 126 children admitted for respiratory illnesses, the mean LOS was 32.3 hours (95% CI, 26.0-38.6) for observation and 48.1 hours (95% CI, 42.2-54.0) for inpatient (P < 0.01). Survival analysis demonstrated a 1.61 (95% CI, 1.07-2.42) fold shorter time to discharge among children admitted to observation compared with inpatient (P = 0.02) and a 1.70 (95% CI, 1.07-2.71) fold shorter time to discharge from observation compared with inpatient for respiratory illnesses (P = 0.03). Within 7 days of discharge, 2 (2%) patients from the observation group and 1 (1%) from the inpatient group returned to the pediatric emergency department. These findings suggest that POU may provide the means toward efficient care for children in community settings with illnesses requiring brief hospitalizations. Future work including prospective investigations is needed to ascertain the generalizability of these findings.

Unrestricted Learning Opportunities for Trainees in Behavior Analysis: A Survey of Current Practices

AbstractIndividuals seeking certification as a board certified behavior analyst (BCBA) by the Behavior Analyst Certification Board (BACB) must meet certain eligibility requirements. In addition to passing the BCBA examination, such requirements include completion of a master’s degree, behavior-analytic coursework, and supervised practical fieldwork. In accruing fieldwork hours, trainees must be provided with the opportunity to complete unrestricted activities. The BACB defines unrestricted activities as “. . . those that are most likely to be performed by a BCBA,” and requires that 60% of fieldwork hours are comprised of these activities (BACB, 2022b). Fieldwork hours may be accrued across a number of different host sites (e.g., hospital units, schools, community locations), with each host site having different day-to-day responsibilities affecting how these opportunities are provided. Therefore, exploration of the provision of these opportunities and the barriers to providing these opportunities is warranted. The current study sought to determine the current practices involved in provision of opportunities to gain fieldwork experience hours towards BCBA certification; in particular, practices related to unrestricted fieldwork activities. Results indicate that, although unrestricted learning opportunities are often provided to trainees, contingencies present within the day-to-day operations of a clinical environment can be hampering. A discussion of the implications of these barriers and potential solutions are included.

Radiation and Radiation Protection Awareness among Medical Imaging Program Students

With the technological developments in the field of health, the use of radiation in medicine is increasing day by day. The radiation awareness of healthcare personnel working in radiation is also very important in terms of both their own protection and the protection of patients from radiation. The aim of this study is to reveal the level of knowledge about radiation and radiation protection of students from Çanakkale Onsekiz Mart University Vocational School of Health Services, which provides Medical Imaging and Radiology education in Çanakkale province, who are doing practice/internship/skill training in diagnostic radiology units of hospitals and whether this awareness differs according to various individual and demographic characteristics. For this purpose, a questionnaire including both demographic characteristics and the scale was applied to 189 university students to obtain the data set. For the statement "I have knowledge about X-rays", 3.2% of the 1st grade students strongly disagreed, 8.4% were undecided, 69.5% agreed, 4.2% disagreed and 14.7% strongly agreed, while 1.1% of the 2nd grade students strongly disagreed, 2.1% were undecided, 75.5% agreed and 20.1% strongly agreed (p=0.04). In general, no difference was found between the 1st and 2nd grades when the level of knowledge about radiation and radiation protection was evaluated. In order to reinforce the topics related to radiation, it would be useful to repeat the topics frequently in the courses and to prepare current presentations by experts in the field and to present them as seminars within the scope of in-service training for both students and Radiology Technicians professionally.

Stability of the Motor Optimality Score Revised (MOS-R) in medically complex infants

BackgroundThe Motor Optimality Score-Revised (MOS-R) is a clinical test of infant spontaneous movement at 3–5 months of age and has been associated with neurodevelopmental outcomes in infants with medical complexity. However the stability of the MOS-R tested at different developmental ages is not yet known. AimTo determine if the repeated scoring of the MOS-R remained consistent when tested at two developmental ages in young infants. Study designIn this prospective cohort study, infants were tested twice with the MOS-R between 12 and 13 weeks corrected age (CA) and 14–16 weeks CA. Bland Altman Plots were used to calculate agreement between the scores. Infants were grouped as having higher or lower medical complexity. MOS-R threshold scores were analyzed to assess changes over time within each group using Fisher's exact test. Subjects85 infants with history of hospitalization in a neonatal intensive care unit (NICU). ResultsThe MOS-R scores had a high agreement with negligible bias (0.058) between timepoints (95 % CI -1.10, 1.22). Using a MOS-R cut point of 19, infants with higher medical complexity were more likely to change groups between timepoints than infants with lower medical complexity (p = 0.008), but this was not significantly different using cut points of 20 or 21. ConclusionThe MOS-R scores were stable when measured repeatedly in infants who were hospitalized in a NICU. Infants with high medical complexity had less stable MOS-R scores using certain cut points than infants with lower medical complexity.