Inpatient Practice Research Articles

Exploring Clinical Documentation Practices among Healthcare Staff: A Clinical Audit of National Hospital Galle, Sri Lanka

Introduction: Valid and trustworthy clinical documentation improves patient outcomes, boosts hospital data accuracy, and enhances reflective action to improve healthcare service quality and safety. In Sri Lanka, the bedhead ticket (BHT) is the legal documentation record for inpatients. In 2022, the Ministry of Health (MoH) issued new rules for the correct maintenance of BHTs.Objective: This clinical audit's objective was to assess the in-patient clinical documenting practices at National Hospital Galle (NHG), Sri Lanka.Methodology: A total of 384 randomly selected BHTs from the record room, which belonged to patients who received inward care from April 2023 to September 2023, were included in this clinical audit. A checklist and a marking scheme were prepared according to MoH guidelines and filled out after going through each BHT.Results: The level of completeness of the first page was good in 96% of BHTs. Maintenance of continuation sheets was average in 82%of BHTs and good in only 2%. Around 67% of BHTs obtained good marks for the level of completeness of entries. Only 1% of BHTs had entries with a signature placed at the end. The date and time of the entry were recorded in 73.5% and 64.3% consecutively.Conclusion: Adherence to the MoH guidelines for clinical documentation practices was satisfactory at NHG, and regular audits and staff awareness and training are required to maintain the standards.

Multimedia-Based Education Led to Improvement in Disease Knowledge Among Patients with Cirrhosis.

Current evidence shows limited patient understanding of liver disease, coupled with no standard guidelines or methods to offer patient education in a busy clinical environment. We developed multimedia-based education (MBE) for those with cirrhosis & tested its effectiveness in improving patient knowledge from baseline to 1 month. This prospective study enrolled cirrhotic patients who had a scheduled visit with a hepatologist at an ambulatory academic practice or were admitted to the liver inpatient service. Once consented, patients completed a baseline knowledge questionnaire, and were given a link to watch the videos (text or email). Four videos were developed by the study team with input from clinicians and patients (liver function, symptoms and complications, medical management and preventive actions & nutrition). At month 1, the study coordinator confirmed with the patient that they had watched the videos at least once, and patients completed the same knowledge questionnaire. The scores between pre- and post-intervention were compared using the Wilcoxon signed rank test. Of the 120 enrolled, 113 completed baseline and 75 completed follow-up. 48% had alcohol-related liver disease as the underlying cause of cirrhosis. Mean MELD score at enrollment was 14.7 ± 8.14. There was a statistically significant improvement in knowledge scores across all domains from baseline to month 1 (p < 0.05). The overall knowledge score improved from 65 to 83% (p < 0.001), with highest improvement by 40% in the domain of liver function and causes of cirrhosis. MBE can help improve patients' knowledge about liver function, management, and prevention and can be used in both ambulatory and inpatient hepatology practice.

Knowledge, attitude, and practice of inpatients with cardiovascular disease regarding obstructive sleep apnea

There is a significant interrelationship between cardiovascular disease and obstructive sleep apnea (OSA), as they share common risk factors and comorbidities. This study aimed to investigate the knowledge, attitude, and practice (KAP) of inpatients with cardiovascular disease towards OSA. This cross-sectional study was conducted between January, 2022 and January, 2023 at Zhongda Hospital Affiliated to Southeast University among inpatients with cardiovascular disease using a self-administered questionnaire. A self-designed questionnaire was used to assess KAP, and the STOP-Bang questionnaire was applied to evaluate participants’ OSA risk. Spearman correlation and path analyses were conducted to explore relationships among KAP scores and high OSA risk. Subgroup analyses were conducted within the high-risk population identified by the STOP-Bang questionnaire. In a study analyzing 591 questionnaires, 66.33% were males. Mean scores were 6.81 ± 4.903 for knowledge, 26.84 ± 4.273 for attitude, and 14.46 ± 2.445 for practice. Path analysis revealed high risk of OSA positively impacting knowledge (β = 2.351, P < 0.001) and practice (β = 0.598, P < 0.001) towards OSA. Knowledge directly affected attitude (β = 0.544) and practice (β = 0.139), while attitude influenced practice (β = 0.266). Among high OSA risk individuals, knowledge directly impacted attitude (β = 0.645) and practice (β = 0.133). Knowledge indirectly influenced practice via attitude (β = 0.197). Additionally, attitude directly affected practice (β = 0.305). These findings provide insights into the interplay between OSA risk, knowledge, attitude, and practice. Inpatients with cardiovascular disease demonstrated inadequate knowledge, moderate attitude, and practice towards OSA. The findings highlighting the need for targeted educational interventions to improve awareness and management of OSA.

Retrospective Evaluation of Inpatient Warfarin Management Practices in Patients Immediately Following Left Ventricular Assist Device Implantation.

Background: The International Society for Heart and Lung Transplantation recommends patients receive warfarin and aspirin following left ventricular assist device (LVAD) placement. Optimal warfarin management in this population has not been well established. Objectives: The objectives of this study were to evaluate warfarin practices in patients immediately post-LVAD implantation. Methods: This single-center, retrospective cohort study included patients 18 years and older following LVAD placement from August 1, 2012 to April 1, 2020. The primary outcome was to assess patient-specific risk factors affecting time to therapeutic range. Secondary outcomes included bleeding events, thrombotic events, and warfarin dosing patterns. Results: Of 104 included patients, 91% reached the therapeutic range at a median of 8 days. A higher proportion of patients started on 3.5 mg or higher reached therapeutic international normalized ratio (INR) and faster (96% vs 90%; 8 vs 5 days) compared to lower doses. Univariate analysis of associations with reaching therapeutic INR range included initial warfarin dose, cumulative warfarin, and warfarin dosing changes, whereas HAS-BLED and CHA2DS2VAC were associated with slower time to therapeutic INR. Overall, 44% of patients met Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) bleeding criteria. There were a total of 12 thrombotic events and no pump thrombotic events. Total weekly warfarin dosing was significantly lower post-LVAD (24.3 mg vs 35 mg, P = 0.0009). In addition, warfarin requirements were statistically higher after the first week of therapy (4.0 mg vs 2.89 mg, P < 0.0001). Conclusion: Based on the results, consider warfarin starting dose between 2.5 and 4 mg for patients on LVAD therapy, while balancing patient-specific risks for bleeding.

Autoimmune Neuromuscular Disorders Associated With Neural Antibodies.

This article reviews autoimmune neuromuscular disorders and includes an overview of the diagnostic approach, especially the role of antibody testing in a variety of neuropathies and some other neuromuscular disorders. In the past few decades, multiple antibody biomarkers associated with immune-mediated neuromuscular disorders have been reported. These biomarkers are not only useful for better understanding of disease pathogenesis and allowing more timely diagnosis but may also aid in the selection of an optimal treatment strategy. Recognition of autoimmune neuromuscular conditions encountered in inpatient or outpatient neurologic practice is very important because many of these disorders are reversible with prompt diagnosis and early treatment. Antibodies are often helpful in making this diagnosis. However, the clinical phenotype and electrodiagnostic testing should be taken into account when ordering antibody tests or panels and interpreting the subsequent results. Similar to other laboratory investigations, understanding the potential utility and limitations of antibody testing in each clinical setting is critical for practicing neurologists.

Prognoses Associated With Palliative Performance Scale Scores in Modern Palliative Care Practice

The Palliative Performance Scale (PPS) is one of the most widely used prognostic tools for patients with serious illness. However, current prognostic estimates associated with PPS scores are based on data that are over a decade old. To generate updated prognostic estimates by PPS score, care setting, and illness category, and examine how well PPS predicts short- and longer-term survival. This prognostic study was conducted at a large academic medical center with robust inpatient and outpatient palliative care practices using electronic health record data linked with data from California Vital Records. Eligible participants included patients who received a palliative care consultation between January 1, 2018, and December 31, 2020. Data analysis was conducted from November 2022 to February 2024. Palliative care consultation with a PPS score documented. The primary outcomes were predicted 1-, 6-, and 12-month mortality and median survival of patients by PPS score in the inpatient and outpatient settings, and performance of the PPS across a range of survival times. In subgroup analyses, mortality risk by PPS score was estimated in patients with cancer vs noncancer illnesses and those seen in-person vs by video telemedicine in the outpatient setting. Overall, 4779 patients (mean [SD] age, 63.5 [14.8] years; 2437 female [51.0%] and 2342 male [49.0%]) had a palliative care consultation with a PPS score documented. Of these patients, 2276 were seen in the inpatient setting and 3080 were seen in the outpatient setting. In both the inpatient and outpatient settings, 1-, 6-, and 12-month mortality were higher and median survival was shorter for patients with lower PPS scores. Prognostic estimates associated with PPS scores were substantially longer (2.3- to 11.7-fold) than previous estimates commonly used by clinicians. The PPS had good ability to discriminate between patients who lived and those who died in the inpatient setting (integrated time-dependent area under the curve [iAUC], 0.74) but its discriminative ability was lower in the outpatient setting (iAUC, 0.67). The PPS better predicted 1-month survival than longer-term survival. Mortality rates were higher for patients with cancer than other serious illnesses at most PPS levels. In this prognostic study, prognostic estimates associated with PPS scores were substantially longer than previous estimates commonly used by clinicians. Based on these findings, an online calculator was updated to assist clinicians in reaching prognostic estimates that are more consistent with modern palliative care practice and specific to the patient's setting and diagnosis group.

Inpatient Hospice Impact on Blood Culture Practices Near the Time of Death, Tertiary Center, Northern California, 2019–2023

Introduction: Many central line-associated bloodstream infections are identified in patients nearing the end of life. Stanford Health Care recently introduced the General Inpatient Hospice program. This program offers inpatient hospice care for patients who, due to uncontrolled symptoms, cannot be discharged to a hospice facility or receive home hospice care. We investigated whether this program would impact blood cultures practices near the time of death. Methods: We performed a retrospective cohort study at Stanford Health Care using records of blood culture events from May 2019 to October 2023. We defined a blood culture near-death as those collected within 2 days before the date of death. We performed an interrupted time series linear regression before and after the implementation of the General Inpatient Hospice program on July 1, 2022 to assess blood culture intensity near-death. Blood culture intensity was defined as the proportion of cultures collected near-death in relation to the total number of blood cultures. Additionally, we calculated blood culture positivity rate, which was defined as the proportion of positive blood cultures among all those collected during our study period. Results: Out of 220,269 blood cultures from 24,955 unique patients, a total of 6,147 cultures (9%) were obtained near the time of death. Among these subjects, the median age was 65 years (range 20–102), with 43% identifying as being of White race-ethnicity and 57% as male. Of these cultures, 3044 were positive (49.5%), with Escherichia coli (618, 24%), Klebsiella pneumoniae (341, 13%), and Staphylococcus aureus (166, 10%) being the most common organisms. After the implementation of the General Inpatient Hospice program, the median enrollment was 12 patients (range 3–18) and the median mortality rate was 2.3% (range 2–3%). The blood culture intensity near death decreased by 0.81%, a change that was not statistically significant (95% CI -2.4% to 0.8%, p=.32; Figure 1). Subsequently, the blood culture intensity showed a non-significant increasing trend of 0.05% (95% CI -0.1% to 0.2%, p=0.53). The blood culture positivity rate near the time of death increased by 16% following the intervention, but this increase was not statistically significant (95% CI – 11.8% to 43.3%, p=.26; Figure 2), and it was followed by a non-significant downtrend of 1.9% (95% CI -3.9% to 1.4%, p=.36). Conclusion: We found no significant association between the implementation of an inpatient hospice program and blood culture practices near the time of death, likely due to low patient enrollment.

Occupational therapy practice for post-acute COVID-19 inpatients requiring rehabilitation.

COVID-19 caused significant occupational disruption to people's life roles, with some people requiring an inpatient rehabilitation admission. Occupational therapists assessed and treated these patients using previous knowledge of similar conditions due to limited specificity in available guidelines to inform practice. The aim of this study was to investigate current practice with post-acute COVID-19 (PAC) patients within an inpatient rehabilitation setting in Australia, to better understand the role and impact of occupational therapy. A mixed-method study was conducted, including electronic medical record audits (October 2021 October 2022) and descriptive patient interviews at a large metropolitan subacute service. Descriptive statistics and qualitative analysis were used to summarise and interpret data. No involvement. A total of 24 patient electronic medical records were audited, and 10 patient interviews were completed. Three overarching categories were identified within the 685 occasions of occupational therapy service audited-occupational engagement, education provision and discharge planning. Patients identified the value of occupational therapy by reflecting on their lived experiences of engaging with occupational therapists and associated changes in occupational performance between COVID-19 diagnoses and discharge home. Occupational therapists possess a unique skill set that directly addresses the occupational needs and priorities of PAC patients. This study adds to the growing body of evidence supporting the contribution of occupational therapy to the management of COVID-19; however, further research is needed to develop evidence-based practice resources and advocate for system changes that improve quality of life for COVID-19 patients. During the COVID-19 pandemic, a lot of people got very sick. Some of these people needed more time and support to get better. Occupational therapists were important during this time because they helped these people to do their daily activities again. Because there were not many resources on how to do this, we looked into what occupational therapists were doing to help these people. We looked at patient hospital files and also talked to them to understand this better. We found that occupational therapists focused on three main areas: helping patients do activities that were important to them, teaching them about COVID-19 and helping them plan to leave the hospital. This study shows that occupational therapists are skilled at helping people with COVID-19. But more research is needed to make resources and also help with changing the healthcare system to further help people get better from COVID-19.

Heart failure phenotypes and clinical and laboratory features of patients with type 2 diabetes in inpatient endocrinology and cardiology practice

Introduction. Type 2 diabetes is a generally recognized risk factor for the development of not only ASCVD, microvascular complications, but also CHF.Aim. To evaluate the prevalence of CHF phenotypes and clinical and laboratory characteristics of patients with type 2 diabetes who are hospitalized in the endocrinology and cardiology departments.Materials and methods. A total of 107 patients with T2DM was included in the analysis. All patients were examined in accordance with the standards and procedures for providing medical care, followed by evaluation of clinical, laboratory and instrumental indicators.Results. The average age of these patients was 69.7 ± 9.12 years, the age of onset of type 2 diabetes was 58.9 ± 10 years, the duration of diabetes was 6.5 [4; 17] years. When analyzing the main metabolic parameters, the average HbA1c was 8.18 ± 1.72%, BMI 32 [29; 38] kg/m2. The predominant number of patients with type 2 diabetes had a CHF phenotype with preserved ejection fraction, the proportion of which was 68.22%, 19.63% had HF with mildly reduced ejection fraction and 12.15% – heart failure with reduced ejection fraction (HFrEF).Conclusions. The population of patients with type 2 diabetes and CHF, regardless of the specialty of the department, was characterized by a lack of targeted compensation for type 2 diabetes, IR, obesity and a high prevalence of hypertension and dyslipidemia. In the endocrinology department, patients significantly more often had a restrictive phenotype of HF and was characterized by a moderate increase in NTproBNP, with a reduced eGFR, were female, of an older age category, with longer duration of diabetes and higher HbA1c levels. All this dictates the high need for integrating SGLT2 inhibitors into patient management regimens. In the cardiology department, a high frequency of the dilated phenotype of CHF with low EF and ischemic heart disease was observed against the background of significantly increased NTproBNP values, significantly more often in males, middle age, with a short duration of diabetes. According to the standards of medical care, such patients require quadruple therapy, one of the mandatory components of which will be iSGLT 2 type.

A case of granulomatos is with polyangiitis (Wegener’s) after a patient’s suffering from a new coronavirus infection COVID-19

A case of granulomatos is with polyangiitis (Wegener’s) after a patient’s suffering from a new coronavirus infection COVID-19

The vital role of clinical pharmacy services within the hospital at home interdisciplinary team.

Hospital at home (HaH) program development, spurred by hospital congestion during the COVID-19 pandemic, is moving from a novel idea to a standard of inpatient practice. Understanding pharmacy's clinical role in the HaH patient care team is exceedingly important as programs across the country continue to develop, implement, and expand. The purpose of this study is to describe how clinical pharmacy services are currently provided for home hospital patients and to explain the vital role of pharmacists within the HaH care team. A descriptive study was designed to evaluate pharmacy services provided for home hospital patients from January 1, 2023, to February 28, 2023. Prior to the study period, a focused group of pharmacists routinely active in HaH patient care met to define a standard process for documenting pharmacy services using an electronic documentation system (i-Vent) within the EHR. During the study period, a total of 221 patients were admitted to home hospital at either site representing 3,258 inpatient medication orders with 2,997 medication administrations. Pharmacists signed 903 progress notes and documented 561 interventions across all types. The top 3 pharmacy intervention types were drug administration change (37%), medication reconciliation (29%), and antimicrobial stewardship (15%). Each of the top 3 types were further evaluated by subtype. Documented pharmacy services encompassed a variety of intervention types. The overwhelming majority of patients admitted to the program received pharmacy consultative services, demonstrating how pivotal pharmacists are to the operational success of these programs and clinical care of HaH patients. More research is needed to expose pharmacy potential and facilitate growth for pharmacists practicing in HaH programs.

Early enteral nutrition support for patients with acute pancreatitis in the inpatient setting: a best practice implementation project.

Acute pancreatitis is a major disease that endangers the health and lives of people. Historically, clinical therapy has recommended. that patients with acute pancreatitis remain nil by mouth. As one of the therapies recommended in recent guidelines, early enteral nutrition support reduces the incidence of infectious complications and reduces the risk of severe conditions. However, early enteral nutrition support has not been optimally implemented within clinical practice for acute pancreatitis inpatients. This evidence implementation project aimed to increase compliance with best practice recommendations for early enteral nutrition support, while standardizing the enteral nutrition support process and reducing the incidence of delayed enteral nutrition. The project was guided by the JBI Evidence Implementation Framework, which is grounded in the audit and feedback process, as well as a seven-stage structured approach to identifying and managing barriers to compliance with recommended practices. In the baseline audit, compliance rates were low for all evidence-based audit criteria. Four of the eight criteria showed 0% compliance. However, after implementation, all eight criteria achieved a minimum compliance rate of 60%, with Site 2 achieving 90% to 100% compliance. In addition, nurses improved their knowledge and skills in early enteral nutrition support. The incidence of delayed enteral nutrition also fell from 86.2% to 20.7% at both study sites. The implementation strategy included a training program, psychological interventions, and financial and human resource support. This project not only significantly improved early enteral nutrition support for acute pancreatitis patients, but also increased nurses' knowledge and practice skills, standardized the process of enteral nutrition support, and reduced the incidence of delayed enteral nutrition. http://links.lww.com/IJEBH/A177.

Implementing Telestroke in the Inpatient Setting: Identifying Factors for Success.

Inpatient telestroke programs have emerged as a solution to provide timely stroke care in underserved areas, but their successful implementation and factors influencing their effectiveness remain underexplored. This study aimed to qualitatively evaluate the perspectives of inpatient clinicians located at spoke hospitals participating in a newly established inpatient telestroke program to identify implementation barriers and facilitators. This was a formative evaluation relying on semistructured qualitative interviews with 16 inpatient providers (physicians and nurse practitioners) at 5 spoke sites of a hub-and-spoke inpatient telestroke program. The Integrated-Promoting Action on Research Implementation in Health Services framework guided data analysis, focusing on the innovation, recipients, context, and facilitation aspects of implementation. Interviews were transcribed and coded using thematic analysis. Fifteen themes were identified in the data and mapped to the Integrated-Promoting Action on Research Implementation in Health Services framework. Themes related to the innovation (the telestroke program) included easy access to stroke specialists, the benefits of limiting patient transfers, concerns about duplicating tests, and challenges of timing inpatient telestroke visits and notes to align with discharge workflow. Themes pertaining to recipients (care team members and patients) were communication gaps between teams, concern about the supervision of inpatient telestroke advanced practice providers and challenges with nurse empowerment. With regard to the context (hospital and system factors), providers highlighted familiarity with telehealth technologies as a facilitator to implementing inpatient telestroke, yet highlighted resource limitations in smaller facilities. Facilitation (program implementation) was recognized as crucial for education, standardization, and buy-in. Understanding barriers and facilitators to implementation is crucial to determining where programmatic changes may need to be made to ensure the success and sustainment of inpatient telestroke services.

Contemporary Decongestion Strategies in Patients Hospitalized for Heart Failure: A National Community-Based Cohort Study

BackgroundHeart failure (HF) is a leading cause of hospitalization in the United States. Decongestion remains a central goal of inpatient management, but contemporary decongestion practices and associated weight loss have not been well characterized nationally. ObjectivesThis study aimed to describe contemporary inpatient diuretic practices and clinical predictors of weight loss in patients hospitalized for HF. MethodsThe authors identified HF hospitalizations from 2015 to 2022 in a U.S. national database aggregating deidentified patient-level electronic health record data across 31 geographically diverse community-based health systems. The authors report patient characteristics and inpatient weight change as a primary indicator of decongestion. Predictors of weight loss were evaluated using multivariable models. Temporal trends in inpatient diuretic practices, including augmented diuresis strategies such as adjunctive thiazides and continuous diuretic infusions, were assessed. ResultsThe study cohort included 262,673 HF admissions across 165,482 unique patients. The median inpatient weight loss was 5.3 pounds (Q1-Q3: 0.0-12.8 pounds) or 2.4 kg (Q1-Q3: 0.0-5.8 kg). Discharge weight was higher than admission weight in 20% of encounters. An increase of ≥0.3 mg/dL in serum creatinine from admission to inpatient peak occurred in >30% of hospitalizations and was associated with less weight loss. Adjunctive diuretic agents were utilized in <20% of encounters but were associated with greater weight loss. ConclusionsIn a large-scale U.S. community-based cohort study of HF hospitalizations, estimated weight loss from inpatient decongestion remains highly variable, with weight gain observed across many admissions. Augmented diuresis strategies were infrequently used. Comparative effectiveness trials are needed to establish optimal strategies for inpatient decongestion for acute HF.

Adoption of a gastroenterology hospitalist model and the impact on inpatient endoscopic practice volume: a controlled interrupted time-series analysis

Background and AimsThe gastroenterology (GI) hospitalist staffing model has multiple potential benefits for the inpatient and outpatient care of GI patients. The GI hospitalist model may improve inpatient endoscopy efficiency via better provider familiarity with management of GI emergencies, hospital systems and workflow, and may also increase outpatient endoscopy capacity by decreasing the need for inpatient coverage by outpatient providers. However, the real-world impact of this model on inpatient and outpatient endoscopic volume remains uncertain. MethodsWe conducted a controlled interrupted time series analysis from September 2018 to March 2020 comparing inpatient endoscopy volume at two high-acuity hospitals within the same academic health system, one of which adopted a two-physician GI hospitalist model in July 2019. We also performed a single interrupted time series analysis of outpatient endoscopic volume of the practice employing GI hospitalists. ResultsAfter implementation of the GI hospitalist model, weekly volume of inpatient endoscopic procedures increased by 10.9 (95% CI: [0.6, 21.2]; p=0.024) compared to a hospital using traditional staffing. Outpatient endoscopic procedure volume also increased by 39.8 per week (95% CI: [-5.78, 85.44]; p=0.09), with no change in the number of physicians performing endoscopy. ConclusionsOur findings demonstrate that introduction of a GI hospitalist model increased inpatient and outpatient endoscopic volume in a large academic center.

Complex antidepressant therapy with the inclusion of various neuroprotectors in inpatient gerontopsychiatric practice

IntroductionDepressions are the most common mental disorders in elderly and senile patients. In these patients, there is a decrease in neurotrophic potential. Treatment of such patients with antidepressants alone does not always allow to achieve complete normalization of the secretion of neurotrophic factors and complete restoration of neurogenesis processes. In this regard, it is important to expand therapeutic opportunities to develop new therapeutic strategies for pharmacotherapy of late-age depression.ObjectivesComparative evaluation of the effectiveness of two types of complex antidepressant therapy with the inclusion of different neuroprotectors (actovegin or cerebrolysin) in the treatment of late-life depression in the therapeutic regimen.MethodsThe study included 2 groups of patients with mild and moderate depressive episode (DE), comparable in basic demographic and clinical parameters.The 1st group included 21 people, including 7 men (33.3%) and 14 women (66.7%), median age were 69 years [66; 76]. In 10 patients (47.6%), DE was diagnosed as part of recurrent depressive disorder (DDR), in 9 patients (42.9%) - as part of bipolar affective disorder (BAR), and in 2 patients (9.5%) is a single DE. Group 2 included 20 patients, 5 of them men (25%) and 15 women (75%), median age were 64 years [62; 70]. In 11 patients (55%), DE was diagnosed as part of DDR, in 6 patients (30%) - as part of BAR, and in 3 patients (15%) – single DE.The 1st group of patients received complex antidepressant therapy with the inclusion of actovegin for one month, the 2nd group - with the inclusion of cerebrolysin. The effectiveness of the therapy was assessed on the HAMD-17 and HARS scales.ResultsA comparative study demonstrated the effectiveness of both types of complex antidepressant therapy used.A comparative assessment of the effectiveness of the therapeutic response in two groups of patients showed no statistically significant differences in the reduction of depressive disorders after 2 weeks of therapy. Only by the end of the therapeutic course there was a more pronounced reduction of depressive disorders in the 1st therapeutic group (73.6% vs 63.6% (p &lt; 0.05)).Reduction of anxiety disorders, assessed on the HARS scale, was noted both by the 14th and 28th day of therapy in both therapeutic groups. However, it turned out to be more pronounced in the 1st therapeutic group: by the 14th day of therapy, the reduction of anxiety in the 1st and 2nd groups of patients was 36.4% and 30.0%, respectively (p &lt; 0.05), and by the end of therapy - 77.7% and 60.0%, respectively (p &lt; 0.01).ConclusionsThe augmentation of antidepressant therapy with drugs with multimodal activity, actovegin and cerebrolysin, should be considered as effective and it can be recommended for inclusion in the therapeutic regimen for the treatment of late-age depression in a psychiatric hospital.Disclosure of InterestNone Declared

Hyperkalemia treatment Standard.

Hyperkalemia is a common electrolyte disturbance in both inpatient and outpatient clinical practice. The severity and associated risk depends on the underlying cause and rate of K+ increase. Acute hyperkalemia requires immediate attention due to potentially life-threatening manifestations resulting from the rapid rise in plasma K+ concentration. Treatment is initially focused on stabilizing the cardiac membrane, followed by maneuvers to shift K+ into the cell, and ultimately initiating strategies to decrease total body K+ content. Chronic hyperkalemia develops over a more extended period of time and manifestations tend to be less severe. Nevertheless, the disorder is not benign since chronic hyperkalemia is associated with increased morbidity and mortality. The approach to patients with chronic hyperkalemia begins with a review of medications potentially responsible for the disorder, ensuring effective diuretic therapy, and correcting metabolic acidosis if present. The practice of restricting foods high in K+ potassium to manage hyperkalemia is being reassessed since the evidence supporting the effectiveness of this strategy is lacking. Rather, dietary restriction should be more nuanced focusing on reducing intake of non-plant sources of K+. Down titration and/or discontinuation of renin-angiotensin-aldosterone inhibitors should be discouraged since these drugs improve outcomes in patients with heart failure and proteinuric kidney disease. In addition to other conservative measures, K+ binding drugs and SGLT2 inhibitors can assist in maintaining use of these drugs.

Cellulitis : management recommendations

Cellulitis is a frequent pathology in both outpatient and inpatient clinical practice. This article reviews the pathophysiology of cellulitis, as well as the various complementary examinations useful in its diagnosis. It describes current recommendations for its management. Several differential diagnoses may also be considered, such as stasis dermatitis, lymphedema or deep vein thrombosis. These must be distinguished from cellulitis to avoid unnecessary antibiotic therapy. There are also a number of specific cases of cellulitis (necrotizing fasciitis, bites, diabetic foot) requiring special management. These are also discussed in this article.

Interdisciplinary cooperation in the outpatient practice: results from a focus group interview with occupational therapists, speech and language therapists and physiotherapists / Gestaltung der interdisziplinären Zusammenarbeit in der ambulanten Therapie: Resultate eines Fokusgruppeninterviews mit Ergotherapeut*innen, Logopäd*innen und Physiotherapeut*innen

Abstract The complexity and diversity of healthcare conditions, as well as the financial and personnel challenges requires effective interdisciplinary collaboration (IDC) among various healthcare professionals (Robert-Bosch-Stiftung, 2011; Robert Koch Institute, 2015). In contrast to the inpatient practice, IDC has not established yet in primary care settings. There is a lack of concrete solutions that illustrate how IDC can be implemented in outpatient practice (Schmitz, Atzeni &amp; Berchtold, 2020). The study aims to present realization possibilities of the IDC among occupational therapists, speech and language therapists and physiotherapists based on case examples from outpatient neurorehabilitation practices. Necessary framework conditions and support factors should be identified from successful applications. In an online focus group, five therapists from three outpatient therapy centers were interviewed about the interdisciplinary measures taking place at their workplace. The therapy centers implemented interdisciplinary team meetings, collaborative target setting and therapy planning as well as co-therapies in their everyday primary care practice. Digital communication channels and the use of digital practice software represent support measures that enable communication independent of location and time. Educational policy changes are needed to impart the corresponding attitudes, knowledge and skills to the healthcare professionals during the vocational training/study. The results of the study show that IDC can be implemented in the outpatient setting under appropriate conditions. Legal requirements are needed to enable the application of interdisciplinary measures through adequate remuneration systems and available time slots. Further calls address content in vocational trainings/studies to provide a basis for readiness and competencies for IDC.

Testing feasibility of relevant outcome measures in an inpatient setting to demonstrate the value of occupational therapy.

Measures of participation restrictions in daily life occupations are not typically used and may aid discharge planning and demonstrate the impact of occupational therapy services in inpatient settings. The overall aim of this mixed-methods study was to test the feasibility of relevant outcome measures by (1) investigating which of the three identified measures-the Home Support Needs Assessment, the Personal Care Participation Assessment and Resource Tool, and the Functional Autonomy Measurement System-best identifies meaningful changes in participation restrictions in daily life occupations required for community life; and (2) investigating the acceptability, usefulness, and feasibility of each measure to support inpatient practice. Occupational therapists (n = 3) completed the three measures with patient participants (n = 12) at admission and discharge. Each occupational therapist participated in a semi-structured interview. Outcome measure responses were summarised statistically. Qualitative data were analysed using reflexive thematic analysis. Total scores on all three measures changed significantly between admission and discharge (P < 0.002). Three themes reflected the occupational therapist participants' perceptions of the acceptability, usefulness, and feasibility of the outcome measures: 'Clinically and Professionally Meaningful Tools', 'Becoming Familiar', and 'Fostering My Daily Work'. Each measure demonstrated a meaningful change. Selection and successful implementation of an outcome measure depends on its local acceptability to occupational therapists and organisational practices. All three measures are promising tools to address a measurement gap in occupational therapy practice. Future research could embed one measure into practice using knowledge translation methods, with a large-scale evaluation of the value of occupational therapy.