Quality Of Patient Care Research Articles

Healthcare Information Technology: Bridging the healthcare access gap in underserved communities

This comprehensive article explores the transformative impact of Healthcare Information Technology (HIT) in addressing global healthcare access disparities, particularly in underserved and rural communities. The article examines various aspects of digital health interventions, including telemedicine implementation, mobile health applications, electronic health records integration, and virtual clinical trials. The article highlights how these technological advancements have revolutionized healthcare delivery by improving patient access, reducing costs, enhancing clinical outcomes, and enabling more efficient care coordination. Special attention is given to the role of emerging technologies such as artificial intelligence and blockchain in shaping the future of healthcare delivery, demonstrating their potential to further bridge the healthcare access gap and improve patient care quality across diverse populations.

Enhancing the understanding of safety and the quality of patient care among medical and health sciences students in interprofessional climate: an interventional study

BackgroundInterprofessional education (IPE) plays an essential role in improving healthcare outcomes through achieving shared understanding. Unfortunately, most healthcare professionals have not received training for patient safety (PS) in an interprofessional setting, which can meet the societal medical needs. This study aimed to foster the understanding of senior medical, dental, pharmacy and health sciences students about PS and quality of care at the University of Sharjah (UoS) in UAE.MethodsUsing a convenience sampling technique, we recruited students from the College of Medicine (CoM), College of Pharmacy (CoP), College of Dental Medicine (CDM), and College of Health Sciences (CHS) of UoS. The study was conducted in spring 2023, and an ethical approval was obtained from the UoS Research Ethics Committee (REC-21–12-12). After a thorough literature search, a bespoke English language questionnaire was developed covering three domains—medical professionalism, leadership in healthcare, and precision medicine. To ensure its validity across different settings, cultural adaptation was ensured with reiterative revision among the panel of experts. The online synchronous real-time workshop included interactive resource sessions, breakout room discussions using real clinical cases, and pre-post surveys using the questionnaire.ResultsA total of 248 students and 20 facilitators participated in the workshop. CoM had the highest representation (47.5%), followed by CoP (36.5%), CHS (13.3%), and CDM (2.7%). There was a statistically improved understanding of the participants, as reflected by significantly high scores of post-test survey in all domains of PS across all colleges (p < 0.001). Notably, students in years four and five from CoM and CoP showed significant improvement in their perceptions than other colleges (p < 0.001). The participants encountered challenges of weak internet connections, software issues, technical failures, and power outages during the workshop.ConclusionThis study highlights the positive impact of an IPE-based interventional workshop on students' attitudes, perceptions, and insights about PS and quality of care. Students' understanding and insights of PS and quality of care underscore the paramount role of IPE in improving perceptions and approaches towards PS in the context of healthcare education.

European Society of Cardiology quality indicators for the management of acute coronary syndrome.

Closing the evidence-practice gap for the treatment of acute coronary syndrome (ACS) is central to improving quality of care. Under the European Society of Cardiology (ESC) framework, we aimed to develop updated quality indicators (QIs) for the evaluation of quality of care and outcomes for patients with ACS. A Working Group of experts including members of the ESC Clinical Practice Guidelines Task Force for ACS, Acute CardioVascular Care Association and European Association of Percutaneous Cardiovascular Interventions followed the ESC methodology for QI development. This methodology involved (i) the identification of the domains of ACS care for the diagnosis and management of ACS; (ii) the construction of candidate QIs through a systematic review of the literature; and (iii) the selection of the final set of QIs (using a modified Delphi method). Five domains of care for the diagnosis and management of ACS were identified: (1) structural framework and logistics, (2) in-hospital non-invasive care, (3) invasive strategy and periprocedural management, (4) secondary prevention interventions, and (5) outcomes. In total, 21 main QIs were selected, covering all five domains of care for the diagnosis and management of ACS. This document defines five domains of ACS care, and provides 21 QIs for the diagnosis and management of ACS. The updated ESC QIs for ACS may be used for quality improvement initiatives.

Race and Ethnicity as Factors in Healthcare Discrimination in the United States: A Cross-Sectional Study.

Discrimination is the unfair or prejudicial treatment of people and groups based on certain characteristics. Discrimination in health care can impede access to quality care for patients and lead to poor health outcomes. This study aimed to investigate factors, including race and ethnicity, associated with discrimination in health care in the United States. A cross-sectional study utilizing the 2021 Medical Expenditure Panel Survey (MEPS) was conducted. Adults (≥ 18years old) who responded to questions about discrimination in health care were identified. Population characteristics were summarized using weighted mean, standard deviation, and percentages. A weighted t-test for continuous variables and a chi-square test for categorical variables were used to compare subject characteristics. Weighted logistic regression was used to explore factors associated with discrimination in health care, while controlling for important covariates. A total of 238,097,086 participants (unweighted n = 17,239) were included in the study. Average (SD) age of the population was 48 (18) years old in 2021 and 52% were female. Compared to non-Hispanic White population, non-Hispanic Black and non-Hispanic other races were more likely to experience discriminated when receiving health care by 285% (OR = 3.85, p < 0.001) and 207% (OR = 3.07, p < 0.001), respectively. Females were also more likely to experience discrimination than males (OR = 1.97, p < 0.001). Other factors associated with discrimination in health care were asthma diagnosis, being a smoker and poverty. Discrimination in health care is associated with being part of a minority racial and ethnic groups, being female, being an older individual, being a smoker and living in poverty. These associations may contribute to inequitable health outcomes in the United States.

Nursing Shortage in India: Are There Solutions for Policymakers?

Abstract Investment in nursing is important to achieve Sustainable Development Goals and universal health coverage. Nurses play a critical role in achieving health goals, they ensure the continuum of care by providing comprehensive and integrated care 24 × 7. They are the largest workforce and it is essential to invest to take care of the shortage of nurses as it is a global crisis. India and other low- and middle-income countries have been struggling with this ubiquitous issue of nursing shortage for decades, preventing them from meeting their national health targets, with the majority of states failing to meet the World Health Organization standard of 4 nurses/1000 population. There are multiple factors leading to the shortage impacting the quality of patient care, patient safety and nurses. Since the nursing shortage is multifaceted, effective interventions necessitate a more in-depth comprehension of the issue. This article aims to give a glimpse of the nursing workforce’s current state in India, the reasons for the shortage, its impact on patient care, and the potential strategies to address the emerging challenges it entails. To achieve the objectives of this review article, a detailed literature review was conducted using published research articles, dissertations, review articles, newspaper articles and governmental, non-governmental and international agency reports.

SQUARE-IT: a proposed approach to square the identified research problem in the literature with the objectives, the appropriate clinical research question, and the research hypothesis

The purpose of this article is to design and introduce the SQUARE-IT approach to help scientists and clinicians in research to align important research problems with the objectives, the appropriate clinical research questions to be answered, and the research hypotheses to be investigated in medical and therapeutic specialties. Research ideas can be generated primarily through simple methods such as brainstorming and mind mapping. However, transforming ideas into a valid research question is not as easy as it may seem, as the mere presence of an idea does not guarantee that the researcher has already uncovered existing knowledge on a particular topic or identified the actual research problem. Therefore, the SQUARE-IT items are developed, described, and critically discussed with reference to the scientific literature. They ask whether the identified research problem is ‘Specific’, ‘Quantifiable’, ‘Usable’, ‘Accurate’, ‘Restricted’, ‘Eligible’, ‘Investigable’, and ‘Timely’. Before formulating the focused clinical question, SQUARE-IT can be used as a preparatory step to enable researchers to organize the relevant information that has been explored to date and to assess whether additional information is needed, thereby identifying current research gaps. In addition, it should facilitate the effectiveness and efficiency of evidence-based practice to ensure high quality patient care. Using SQUARE-IT as a framework, further elaboration of the approach and addition of other aspects are warranted to advance the discussion and improve methods of evidence-based practice in medical and therapeutic specialties for quality improvement of patient care.

Honduran nursing care to pressure injuries in patients with invasive mechanical ventilation: A qualitative study.

Although substantial evidence exists regarding the treatment of pressure ulcers, there is a lack of studies demonstrating a comprehensive nursing approach for managing pressure ulcers in the ICU, particularly among patients with invasive mechanical ventilation from developing countries like Honduras. This gap in research is significant as the risk and impact of pressure ulcers on health recovery cannot be disregarded. This study aimed to analyze Honduran nursing care for pressure ulcers in patients with invasive mechanical ventilation admitted to Intensive Care Units. A qualitative study approach was used, with in-depth interviews conducted with 12 critical care nurses from July to September 2022. The interviews were recorded, and data analysis was performed using the participants' narratives following Colaizzi's steps. Three themes were obtained, which provide insight into the phenomenon: "The strengths in Honduran nursing interventions," "Negligence in the Honduran nursing care processes," and "Vulnerabilities in the organizational structures." Nurses' experiences highlighted their timely reports and comprehensive, holistic care. However, they undergo negligence in their caring processes, such as low frequency of repositioning, lack of caring plans, and absence of self-training, leading to interdisciplinary work codependency for decision-making. Allocating resources toward nursing care and their professional growth is an investment in providing humane treatment and ensuring the prevention and management of pressure injuries in critical care patients. This study highlights the importance of comprehensive training and standardized protocols for intensive care nurses to improve pressure injury prevention and management in mechanically ventilated patients, emphasizing the need for regular patient repositioning, effective communication, and adequate resources to enhance patient care quality.

NURSES COMING TO WORK DESPITE ILLNESS: THE ROLE OF ETHICAL LEADERSHIP BY NURSE MANAGERS

Presenteeism, the act of coming to work while ill, is a prevalent issue among nurses, potentially affecting both nurse health and the quality of patient care. Ethical leadership by nurse managers may play a critical role in reducing presenteeism among nurses. However, studies investigating the impact of ethical leadership on presenteeism are limited, and there is a lack of clear understanding of this relationship in the existing literature. This study aimed to determine the extent to which nurses' perceptions of their managers' ethical leadership influence presenteeism behavior among nurses. Additionally, the study explored how these two concepts are affected by socio-demographic characteristics. A cross-sectional research design was employed, and 307 nurses from a public hospital participated in the study. Data were collected using a descriptive form, the Ethical Leadership Scale, and the Sickness Presenteeism Scale. Hierarchical regression analysis was conducted to determine the impact of ethical leadership on presenteeism. The findings indicated that ethical leadership was the only significant predictor of presenteeism, with higher levels of ethical leadership associated with lower levels of presenteeism. The study also found that other socio-demographic variables (gender, age, marital status, education level, years of service, working unit) did not have a significant impact on presenteeism. This study demonstrated that ethical leadership significantly reduces presenteeism among nurses. This finding contributes to a better understanding of the impact of ethical leadership on presenteeism, which has been underexplored in the literature. It is recommended that healthcare organizations consider ethical leadership practices to support nurse health and performance. Future research should examine the effects of ethical leadership in different healthcare settings and among various professional groups to validate these findings.

Quality of referrals and adherence to guidelines for adult patients with minimal to moderate head injuries in a selection of Norwegian hospitals

PurposeThis study aimed to assess adherence to the Scandinavian guidelines, the justification of referrals, and the quality of referrals of patients with mild, minimal, and moderate head injuries in a selection of Norwegian hospitals.MethodsWe collected 283 head CT referrals for head trauma patients at one hospital trust in Norway in 2022. The data included the patients’ sex, age, and the referral text. Six radiologists independently assessed all referrals using a registration form developed based on the Scandinavian guidelines for patients with mild, minimal, and moderate head injuries and general referral guidelines. Descriptive statistics was used to analyze data on adherence to guidelines, while Gwet’s AC1/2 was used to test the agreement between the raters.ResultsThis study found that 65% of referrals were assessed to be justified according to the guideline by at least one rater, while 17% were rated justified outside the guideline. In 52%, at least one rater required more information. There was good to moderate interrater agreement.ConclusionsAdherence to the Scandinavian guidelines and the quality of referrals of patients with mild, minimal, and moderate head injuries are low. Training and using S100B is recommended to improve the justification rate and quality of patient care.

Delirium and Cognitive Screening in National Hip Fracture Registries: Scoping Review Protocol.

Delirium and cognitive impairment are common in hip fracture populations and are associated with significant adverse patient outcomes. National hip fracture registries facilitate improvements in patient outcomes and care quality, such as reduced mortality and the development of specialist multidisciplinary services. However, there is substantial variation in the data collected and reported in relation to delirium and cognition, which impedes international comparison and may reduce quality of care. This scoping review aims to identify delirium and cognition data items currently collected by hip fracture registries internationally, to identify associated registry guidance that exists for the administration of delirium and cognitive screening tools, and report outcomes of these data items across the most recently published annual reports of identified hip fracture registries. This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR). We will search the following databases: Medline Ovid; Embase; CINAHL EBSCOHost. Relevant websites such as the Fragility Fracture Network (FFN) will also be searched. Study selection and review will be carried out independently by two research team members, with discrepancies resolved by a third member of the research team. Data extraction and synthesis will be conducted by one reviewer and checked for accuracy and omissions by another. The scoping review findings will be informed and validated through engagement with the FFN Hip Fracture Audit Special Interest Group, who will share their knowledge, expertise, and research to achieve consensus over core aspects of the scoping review findings. By identifying existing heterogeneity in delirium and cognitive screening tool use and administration, it is hoped that administration and specific screening tool use will become standardised to optimise comparability across countries and ensure that high quality and reliable data are included across international registry reports.

Automated Machine Learning in Dentistry: A Narrative Review of Applications, Challenges, and Future Directions

The adoption of automated machine learning (AutoML) in dentistry is transforming clinical practices by enabling clinicians to harness machine learning (ML) models without requiring extensive technical expertise. This narrative review aims to explore the impact of autoML in dental applications. A comprehensive search of PubMed, Scopus, and Google Scholar was conducted without time and language restrictions. Inclusion criteria focused on studies evaluating autoML applications and performance for dental tasks. Exclusion criteria included non-dental studies, single-case reports, and conference abstracts. This review highlights multiple promising applications of autoML in dentistry. Diagnostic tasks showed high accuracy, such as 95.4% precision in dental implant classification and 92% accuracy in paranasal sinus disease detection. Predictive tasks also demonstrated promise, including 84% accuracy for ICU admissions due to dental infections and 93.9% accuracy in orthodontic extraction predictions. AutoML frameworks like Google Vertex AI and H2O AutoML emerged as key tools for these applications. AutoML shows great promise in transforming dentistry by facilitating data-driven decision-making and improving patient care quality through accessible, automated solutions. Future advancements should focus on enhancing model interpretability, developing large and annotated datasets, and creating pipelines tailored to dental tasks. Educating clinicians on autoML and integrating domain-specific knowledge into automated platforms could further bridge the gap between complex ML technology and practical dental applications.

Improvement Plan for the Pre-Analytical Process of the SEMEDICLAB Laboratory Period 2022

Objective: SEMEDIC is a clinical laboratory that performs tests in the areas of hematology, biochemistry, urinalysis, immunology, coprology, and immunochemistry. This work aims to implement a continuous improvement plan for the pre-analytical process of the SEMEDICLAB laboratory in 2022. Theoretical Framework: The research focuses on pre-analytical errors in clinical laboratories and their impact on the quality of results. It is based on the premise that, despite technological advances and automation, the pre-analytical phase remains a weak link in the clinical analysis process. Method: The present study adopts an observational and descriptive methodology, as it allows for the visualization of the environment in which the research is carried out. It should be noted that no population or sample was considered; it was based on the identification, definition, and standardization of sub-processes of the SEMEDICLAB company process. Clause 5.4 of the ISO 15189:2012 checklist was used to identify the gap between the sub-processes currently completed. Results and Discussion: The causes of the problem in the pre-analytical phase of the workers in the SEMEDICLAB laboratory were described, which were caused by non-compliance or omission of the ISO 15189: 2012 standard, related to clauses 5.4.2. "Information for patients and users," 5.4.4.2. "Instructions for pre-analytical activities," and 5.4.6 "Sample reception," where irregularities were observed. Implications of the research: Research on pre-analytical errors has a direct impact on the quality of patient care, the efficiency of clinical laboratories, and the sustainability of health systems. By identifying the causes of these errors and developing strategies to prevent them, it contributes to improving patient safety and the reliability of laboratory results. Originality/Value: The value of this type of research is multifaceted. Firstly, it contributes to improving the quality of patient care by reducing the incidence of erroneous laboratory results, which in turn reduces the risk of misdiagnosis and inappropriate treatment. Secondly, it optimizes processes in clinical laboratories, increasing efficiency and reducing costs associated with the repetition of tests and error management. Thirdly, this research promotes the development of standards and clinical practice guidelines for the prevention and management of pre-analytical errors, which helps to ensure the quality and safety of laboratory services at the national and international level.

Using space technology approach to improve quality in emergency departments in India: a quality improvement program.

Introduction Human errors are a leading cause of disability and death among hospitalized patients. Globally, various strategies have been employed to reduce errors and to improve the quality of patient care. One such novel effort never attempted before is the Health-QUEST (Quality Upgradation Enabled by Space Technology) initiative which aims at translating the best quality and safety practices of the Indian Space Research Organization (ISRO) into the realm of emergency care. The objective of this quality improvement initiative was to understand the performance of ED across India using key performance indicators (KPI) specified in HQ (Health Quest) document, adoptability of HQ based practices in hospitals and their effect on KPI. Methods A pre- and post-intervention study design was used where each hospital served as its own control. Preintervention phase captured the time-based key performance indicators based on their existing practice, followed by implementation and training on QUEST recommendations and the post intervention phase assessed any improvement in the KPIs. Data was collected in real-time using REDCap mobile application by scanning the patient wrist bands. The time based KPIs include Door to triage time, Door to doctor time, Door to needle time, Door to pain assessment time, Door to ordering of investigation time, Time from ordering to first review of investigation, Door to discharge/disposition time. Results Seventeen hospitals were invited to participate in this quality improvement initiative, with 14 hospitals completing pilot training for real time data collection. Among them, 10 hospitals participated in the pre and post intervention data collection contributing to 10,332 patients (5296 patients during the pre-intervention and 5036 during the post intervention phase). All the hospitals had a median triage time of less than 5 minutes. Nine out of the ten hospitals recorded a baseline median discharge time of around 2 hours. The most significant reductions in time (mean difference between pre- and post-intervention) were observed in triage time (11 minutes, p < 0.05), door-to-pain assessment time (23 minutes, p < 0.05), time from ordering to first review of investigation (26 hours, p < 0.05), and disposition time (1 hour and 30 minutes, p < 0.05) Conclusion This study evaluated real-time, time-based KPIs in patient management across emergency departments in India. The Health-QUEST program proved to be a straightforward and effective model, achieving significant improvements in multiple time-based KPIs across participating EDs.

Understanding Staff Needs for Improving End-Of-Life Care in Critical Care Units: A Qualitative Focus Group Analysis and Service Evaluation.

Objectives: Critical care is a place of frequent death, up to a quarter of those admitted die during admission. Caring for dying people provides many challenges, practically, professionally and personally. The aim of this study was to better understand the perspectives of staff caring for dying people in critical care and identify their priorities for improvement. Method: Three multidisciplinary focus groups of critical care staff at a large central London hospitals trust were facilitated with a semi structured format and digitally transcribed. Inductive thematic analysis was conducted to extract themes. Results: N = 34 (18 nursing, 7 allied health professionals, 6 medical, 3 clerical/administrative). The five themes were structured as priority statements: "We need to recognise" included the subthemes of being "sick enough to die" and potential rapid deteriorations in this setting; "We need to understand" with subthemes of perspectives on dying and prioritising time for conversations; "We need to connect" with subthemes of therapeutic relationship and physical presence; "We need to collaborate" with subthemes of critical care working and empowerment, and cross teams working; "We need support" with themes of experiencing support and making time to support others. Conclusion: We present an approach to identifying critical care departmental priorities for an end-of-life care improvement programme. The themes extracted will be used to evaluate systems for dying in critical care, aiming to empower staff to provide excellent care every time they look after a dying person. Relevance to Practice: This service evaluation identifies key priorities among critical care staff regarding end-of-life care. The insights can guide service improvements, such as tailored training and enhanced support for staff, to ensure better communication, collaboration, and quality care for patients at the end of life.

N22 Exploring the Competencies of IBD Nurses in Italy: A Cross-sectional Survey

Abstract Background Nurses are essential for caring for patients with inflammatory bowel diseases (IBD)1. Their responsibilities encompass patient education, therapeutic management, and emotional support. However, the competencies of IBD Nurses in Italy still need to be studied2. This research assessed Italian IBD Nurses’ fundamental and advanced skills, providing a baseline for future professional development. Methods This cross-sectional study used an online survey developed by a multidisciplinary expert panel, including gastroenterologists and IBD nurse specialists. The 53-item survey covered sociodemographics, professional characteristics, institutional context, and competencies (fundamental and advanced) assessed via a 5-point Likert scale based on N-ECCO guidelines. Distributed nationwide from June to August 2024, descriptive statistics summarised participants' profiles, and inferential analyses, including Pearson’s correlations and ANOVA, explored associations between competencies and variables like experience, education, and institutional factors. Results The study analysed responses from 50 IBD Nurse, predominantly female (92%), with a mean age of 48.38 years (SD ± 9.7). Fundamental competencies showed consistently higher mean scores compared to advanced competencies. High proficiency was noted in establishing empathetic relationships and recognising the emotional impact of IBD (mean score: 4.06/5). Advanced competencies with the highest scores included caregiver education and multidisciplinary support (3.56/5 and 3.40/5, respectively). However, gaps were identified in paediatric care management (2.30/5) and transitional care (2.46/5). Significant correlations were observed between years of IBD-specific experience and competencies such as therapeutic management and stress handling. Conclusion Italian IBD Nurses demonstrate fundamental solid and moderate skills in advanced competencies. Gaps in paediatric and transitional care underscore the need for targeted training. Enhancing educational programs and multidisciplinary collaboration can improve the quality of care for IBD patients. Future studies should address integrating digital health tools to support self-management and patient outcomes.

Artificial Intelligence and Algorithmic Approaches of Health Security Systems: A Review

This paper explores the overall picture regarding healthcare security systems through an extensive literature review. As the healthcare sector has now become digitalized, the security of healthcare systems and, by extension, the protection of patient data is a key concern in the modern era of technological advances. Therefore, a secure and integrated system is now essential. Thus, to evaluate the relationship between security systems and healthcare quality, we conducted literature research to identify studies reporting their association. The timeline of our review is based on published studies covering the period from 2018 to 2024, with entries identified through a search of the relevant literature, focusing on the most recent developments due to advances in artificial intelligence and algorithmic approaches. Thirty-two studies were included in our final survey. Our findings underscore the critical role of security systems in healthcare that significantly improve patient outcomes and maintain the integrity of healthcare services. According to our approach, the studies analyzed highlight the growing importance of advanced security frameworks, especially those incorporating artificial intelligence and algorithmic methodologies, in safeguarding healthcare systems while enhancing patient care quality. According to this study, most of the research analyzed uses algorithmic technology approaches, many researchers prove that ransomware is the most common threat to hospital information systems, and more studies are needed to evaluate the performance of the systems created against this kind of attack.

Current Rehabilitation Practices of Physiotherapists in Intensive Care Units in the UAE: A National Survey

Abstract* Background Intensive care units (ICUs) are essential for patient recovery, but prolonged stays often result in complications like reduced mobility and muscle weakness. Aims This study examines current ICU rehabilitation practices in the United Arab Emirates (UAE) through a web-based cross-sectional survey involving 80 physiotherapists from both public and private sectors. Methods The questionnaire, validated by experts with a Cronbach’s alpha of 0.84, explored various rehabilitation strategies. Most participants held bachelor’s degrees and had 2-5 years of experience. Results Over 96% required physician referrals for ICU physiotherapy sessions, and 75% noted that hospitals provided development programs to enhance skills. Respiratory therapy, joint mobilization, and electrical stimulation were the most commonly used interventions, while massage, continuous passive motion machines, and taping were less frequently applied. Among neonatal ICU patients, 85.7% of physiotherapists regularly performed passive range of motion exercises, and 69% consistently involved parents in the treatment plan. The results indicate a variety of practices among ICU physiotherapists in the UAE, with no clear adherence to standardized protocols. This lack of consistency may negatively affect patient care quality. Conclusion The study underscores the importance of implementing standardized rehabilitation protocols and enhancing patient education to improve outcomes in ICU settings.

Evolution of the Quality of Care in Patients with Decompensated Heart Failure in a Venezuelan Hospital.

Background/Objectives: Several parameters have been proposed for the objective measurement of the quality of care (QoC) and breaches of care in patients with heart failure (HF). Therefore, the objective of this study was to evaluate the measures of QoC in inpatients with decompensated HF in the cardiology department of a tertiary Venezuelan hospital. Methods: An observational, descriptive, ambispective study was conducted with adults of all genders diagnosed with decompensated HF between 2022 and 2024. Sociodemographic, clinical, and therapeutic variables were assessed, as well as psychobiologic habits, measures of QoC, readmissions, and in-hospital mortality within the first 6 months of care. Results: Among the 131 subjects evaluated, the average age was 63.6 ± 14.1 years, with 58% (n = 76) being male. Among the in-hospital measures of QoC, the most common was the programming for follow-up consultations (98.5%; n = 129), followed by the prescription of beta-blockers (90.1%; n = 118). An upwards trend was also observed in the later years regarding the frequency of left ventricle ejection fraction (LVEF) assessment (p < 0.001), and the use of iSGLT2 (p = 0.03). During follow-up, 36.6% of the patients died within 6 months, with those in NYHA class IV showing a higher probability of death (OR: 3.84; CI95%: 0.89-16.55; 0.04). Conclusions: The in-hospital measures for QoC in this population were similar to those in previous reports, with LVEF assessment and iSGLT2 prescription showing a particularly significant increase in recent years.

Change Over Time in Hospital Care for Medicaid Beneficiaries: Analysis of Hospitalizations from 2016-2019.

Historically, access to high-quality care has been a central challenge for Medicaid programs. Prior single-year analyses demonstrated that Medicaid beneficiaries account for disproportionately high patient volumes at low-quality hospitals. Given major Medicaid shifts including expansion and increased managed care, we examined recent trends in low-quality hospital use for Medicaid beneficiaries. Using Healthcare Cost and Utilization Project State Inpatient Databases, we compiled adult hospital discharges from 15 states in years 2016-2019 (N=32,788,446). Hospital quality was assessed with the Agency for Healthcare Research and Quality (AHRQ) Composite Inpatient Quality Indicator, reflecting risk-adjusted mortality for prevalent conditions. We constructed a logistic regression modeling odds of discharge from a low-quality hospital (bottom 20th percentile by year), with payer-year interactions and covariates for patient demographics (sex, age, race/ethnicity, income), comorbidities, state, and hospitalization type. Overall, patients with Medicaid [adjusted odds ratio (aOR)=1.11, P<0.01] or Medicare (aOR=1.03, P<0.01) were more likely to be hospitalized in low-quality hospitals, compared with private insurance (reference). The likelihood of admission to low-quality hospitals over time varied by payer. Patients insured by Medicaid were 2% less likely to be admitted to low-quality hospitals each additional year (aOR=0.98, P<0.01). Medicare-insured patients did not show significant changes longitudinally, and privately insured patients were 3% more likely to be admitted to low-quality hospitals each year (aOR=1.03, P<0.01). This is one of the first studies examining associations between payer and inpatient care quality over time, critical for our rapidly changing payment environment. Although Medicaid-insured patients remain more likely to be discharged from low-quality hospitals as compared with other payers, we find promising recent trends of improving hospital quality over time for Medicaid beneficiaries.

Nursing Students' Attitudes Towards Research at College of Nursing, Allama Iqbal Medical College, Jinnah Hospital Lahore

Background: Nursing research advocates for the highest quality of patient care by emphasizing evidence-based nursing practices. The attitude of students towards research serves as a driving force, inspiring them to actively participate in research endeavors, cultivate essential research skills, and implement research discoveries within clinical environments, ultimately enhancing positive patient outcomes. Aim: This study aims to examine undergraduate nursing students' attitudes toward the research component to identify implications for enhancing teaching and learning practices. Materials and Methods: From March to August 2023, a descriptive cross-sectional study was conducted at the College of Nursing, AllamaIqbal Medical College, Jinnah Hospital Lahore, involving a convenient sample of n = 100 undergraduate students. Participants signed informed consent and completed a self-administered questionnaire consisting of 25 items rated on a Likert scale. Data analysis was conducted using SPSS version 23. Results: The majority of nursing students hold a positive attitude towards research, as evidenced by a mean score of 74.05% with a standard deviation of 6.580. A vast majority (91.2%) acknowledge the utility of research in their profession. Specifically, 86.88% of nursing students demonstrate a positive attitude towards research, while 72.75% recognize its significance in both professional and personal life. However, a notable proportion (41.2%) finds research challenging, viewing it as difficult, complicated, and stressful, with 55.3% expressing difficulty with statistical aspects. Conclusion: While a significant portion of students recognize the value of research in nursing and maintain a positive attitude towards it, some find the research course stressful. Many students express negative feelings and anxiety about the research process. To improve student experiences, it's suggested to integrate research courses into pre-university curricula and involve statistical experts from research centers to teach effective learning strategies.