Large Hospital Research Articles

Examining Systemic and Interpersonal Bias in Violence Risk Assessments of Patients in Acute Psychiatric Care.

The assessment and management of inpatient risk for violence in acute psychiatric care are challenges that introduce the potential for bias. This study aimed to examine inequities based on social determinants of health (SDoH) (e.g., race-ethnicity, gender, or mode of admission to acute care) that may lead to unfair assessment of psychiatric patients. The authors analyzed electronic health records of 7,424 acute care patients across 12,650 stays (2016-2022) at a large Canadian psychiatric hospital. Risk ratios (RRs) were calculated by SDoH for staff assessments of high risk (perceived risk), for violent incidents (actual risk), and for potentially biased risk assessment (particularly when a patient was assessed as high risk but did not become violent). In univariate analyses, patients assessed as high risk who did not become violent were more likely to be male than female and to be Black, Indigenous, or Middle Eastern than White. When RRs were mutually adjusted for all variables, the associations for gender and race-ethnicity were attenuated or were no longer statistically significant. Associations with potentially biased risks that remained significant included most psychiatric diagnoses (vs. a depressive or anxiety disorder), supportive or unstable housing (vs. owning a home), and admission by police (vs. self-admission; RR=2.14, 95% CI=1.92-2.40). Systemic factors, such as admission by police and housing status, and having severe mental illness were the primary drivers of observed inequities in risk assessments of patients from racial-ethnic minority groups. Addressing these systemic factors might be key to improving acute psychiatric care.

Horst Oertel and the Russell Sage Institute of Pathology: Impacts on vital statistics and the origins of the short-lived heyday of autopsies in America.

Horst Oertel was an early 20th century pathologist who began his career as an instructor of clinical pathology at the New York University and Bellevue Hospital Medical College in 1899. In 1903, he was appointed pathologist for City Hospital, an institution for indigent patients on New York City's Blackwell's Island. In 1907, Oertel became the first director of the Russell Sage Institute of Pathology, a unique new blended public-private entity based at City Hospital, that was named after a wealthy benefactor. The Institute was established to utilize the Island's indigent population to perform anatomical pathology research on diseases of aging. Oertel and the Institute thrived until 1911, when a newly-appointed New York City bureaucrat seeking patronage and graft began meddling in the Institute's governance. After press coverage of a vitriolic one-week-long exchange of charges and counter-charges between the Institute's Board of Directors and the bureaucrat, the Institute imploded. While these events meant that the Institute's tenure on Blackwell's Island would soon be coming to an end, Oertel continued to work and submit articles from the Institute throughout 1912. In May 1913, he published "The Inaccuracy of American Mortality Statistics" in American Underwriter, a bombshell article documenting low autopsy rates and high clinical diagnostic error rates at Bellevue Hospital during 1912. This, along with similar studies by Richard Cabot at Massachusetts General Hospital in Boston, highlighted fundamental problems in hospital care and medical education across America. Simultaneously, Oertel led the Public Health, Hospital and Budget Committee of the New York Academy of Medicine which reported that, in a selected series of large American hospitals, the autopsy percentage when compared to the number of deaths was one-eighth the rates in Canada, Great Britain, Austria, and Germany. This paper addresses how American autopsy rates skyrocketed and then plummeted again during the mid-20th century.

Epidemiological pattern of injuries among road traffic crash victims: the first experience of a large tertiary care hospital in the West Bank of Palestine

BackgroundRoad traffic injuries are a global public health challenge. This study was conducted to describe the epidemiological patterns of road traffic injuries in a large tertiary care hospital in the West Bank of Palestine. In addition, associations between the different variables of the victims and the patterns of road traffic injuries were also assessed.MethodsThis study was conducted in a retrospective cohort observational design between January 2021 and July 2023 at a large tertiary care hospital in Nablus, Palestine. The data were collected from the electronic medical record system of the large tertiary care hospital using a data collection form.ResultsA total of 1,544 victims of traffic road injuries were included in this study. Lower limb (43.0%), neck (41.2), and upper limb (39.8%) injuries were the most common types of road traffic injuries sustained by the victims admitted to the large tertiary care hospital.The victims who were 30 years or older were more likely to sustain back injuries (aOR = 1.71, 95% CI: 1.20–2.45) pelvic injuries (aOR = 1.84, 95% CI: 1.08–3.12), chest injuries (aOR = 1.59, 95% CI: 1.06–2.38), and neck injuries (aOR = 2.54, 95% CI: 1.68–3.82) compared to the victims who were younger than 30 years.The victims who did not use seatbelts were more likely to sustain abdominal injuries (aOR = 1.88, 95% CI: 1.34–2.63) and head injuries (aOR = 1.49, 95% CI: 1.06–2.10) compared to the victims who used seatbelts. The victims who did not have the airbag deployed were more likely (aOR = 1.85, 95% CI: 1.31–2.63) to sustain neck injuries compared to the victims who had the airbag deployed.ConclusionThe epidemiological patterns of road traffic injuries in a large tertiary care hospital in Nablus, Palestine were described and the associations between the different variables of the victims and the patterns of road traffic injuries were assessed. The findings indicated a need to design measures to prevent/minimize these injuries. Future studies are still needed to determine the best measures to avoid/minimize the incidence of serious road traffic injuries.

Individual and clinical factors associated with patient acceptance of referrals to social services and community resources at a multi-purpose resource hub.

Emerging evidence suggests that bi-directional communication and referral pathways, when employed strategically, can lead to favorable health outcomes by connecting patients with complex, multi-faceted health and social needs to appropriate services and resources. However, despite these benefits, patient acceptance of referrals via these pathways remains suboptimal. In this study, we describe individual and clinical factors associated with patient acceptance of these referrals. We extracted individual-level demographic and clinical data for patients referred primarily from a large safety-net health system to a multi-purpose resource hub co-located on the campus of its largest hospital, for the period October 2019 to June 2023. Descriptive statistics, Chi-square analyses, and multinomial regression modeling were performed to examine these data. Of 1865 patients in the study sample, 54.2% accepted a referral, 27.4% were lost to follow-up, and 18.4% declined. Most patients who accepted referrals were female (67.1%), Latino (81.5%), and had hypertension and/or prediabetes or diabetes (84.1%). In modeling analyses, those who accepted referrals tended to be female, and were referred from primary care clinics; many were referred for multiple service/resource categories. We found associations between patient acceptance of referrals and gender and source of referral. Drawing upon these results as well as experience implementing these systems, we propose several practical strategies for increasing successful referrals, including identifying and addressing barriers for patients who declined or were lost to follow-up; using standardized screening tools to routinely assess for multi-faceted health and social needs; increasing provider awareness about the benefits and functioning of these pathways; and monitoring progress so mid-course adjustments can be made when necessary.

Alleviating the medical strain: a triage method via cross-domain text classification

It is a universal phenomenon for patients who do not know which clinical department to register in large general hospitals. Although triage nurses can help patients, due to the larger number of patients, they have to stand in a queue for minutes to consult. Recently, there have already been some efforts to devote deep-learning techniques or pre-trained language models (PLMs) to triage recommendations. However, these methods may suffer two main limitations: (1) These methods typically require a certain amount of labeled or unlabeled data for model training, which are not always accessible and costly to acquire. (2) These methods have not taken into account the distortion of semantic feature structure and the loss of category discriminability in the model training. To overcome these limitations, in this study, we propose a cross-domain text classification method based on prompt-tuning, which can classify patients' questions or texts about their symptoms into several given categories to give suggestions on which kind of consulting room patients could choose. Specifically, first, different prompt templates are manually crafted based on various data contents, embedding source domain information into the prompt templates to generate another text with similar semantic feature structures for performing classification tasks. Then, five different strategies are employed to expand the label word space for modifying prompts, and the integration of these strategies is used as the final verbalizer. The extensive experiments on Chinese Triage datasets demonstrate that our method achieved state-of-the-art performance.

Hand hygiene, knowledge and training motivational drives: findings from a survey in a university hospital

This study assessed healthcare workers’ (HCWs) knowledge and adherence to hand hygiene principles in a large Italian university hospital, focusing on identifying knowledge gaps and evaluating training effectiveness. A specifically designed 17-item questionnaire, based on the World Health Organization (WHO) Hand Hygiene Knowledge Questionnaire, was used to measure theoretical knowledge, the role of training, and the impact of experience. The survey had an 8% participation rate (542 responses from a total of 6,749 HCWs), with higher responses among nurses and doctors. Results showed moderate knowledge of hand hygiene protocols, averaging 74%, but revealed gaps in comprehension, particularly in the correct use of hand rub and post-contact sanitation. Logistic regression analysis identified significant predictors of knowledge and adherence, with professional characteristics such as professional qualifications and length of service influencing outcomes (p < 0.05). The findings confirm the strong correlation between hand hygiene knowledge and compliance in reducing healthcare-associated infections (HAIs). Continuous education and customized interventions, including targeted training and feedback, are essential for targeting weak points and improving adherence. These insights emphasize the importance of ongoing training and monitoring to enhance hand hygiene practices, promote a culture of patient safety, and, as a consequence, reduce the incidence of HAIs.

Lumen-Apposing Metal Stents in the Management of Complex Pelvic Abscesses

Background: Lumen-apposing metal stents (LAMS) are utilized in a wide range of therapeutic gastrointestinal applications. We present our experience with LAMS-assisted drainage of complex pelvic abscesses at a large safety-net hospital. Methods: EUS-guided LAMS placements for pelvic abscesses from July 2020 to June 2024 were analyzed. Data were collected on patient demographics, procedure indications, fluid collection size, stent characteristics, stent dwell time, and complications. All cases underwent multidisciplinary review with Surgery and Interventional Radiology (IR) prior to LAMS-assisted drainage; all were deemed not amenable to drainage by IR. Results: Eleven patients underwent EUS-guided drainage of complex pelvic abscesses with cautery-enhanced LAMS. Diverticulitis was the most common cause of abscesses (n = 6; 55%). The average time from presentation to drainage was 7 days (1–18). The average abscess size was 7.2 cm (3.9–12.0 cm). The most common LAMS size was 15 mm × 10 mm; each was placed through the left colon and rectum with both technical and clinical success. All abscesses completely resolved with a mean stent dwell time of 28 days (17–42 days). After stent removal, the fistula was not routinely closed. No complications such as stent migration, bleeding, or perforation occurred. There were no recurrences and no patients required additional surgical or IR procedures with a mean follow-up of 25 weeks (SD 35.6). Conclusions: Adequate drainage is the cornerstone of pelvic abscess management, but IR or surgical access can be challenging, with inadequate drainage and prolonged hospitalization leading to significant morbidity. In our experience, EUS-guided, LAMS-assisted drainage provides a safe and effective alternative for managing pelvic abscesses.

Put Down the ACE: Low Clinical Utility for Angiotensin-Converting Enzyme Levels in Sarcoidosis: A Single-Center Retrospective Cohort Study

Background/Objectives: ACE (angiotensin-converting enzyme) is considered a serological marker of sarcoidosis as elevated levels have been reported in 30–80% of patients. However, elevated ACE levels are also encountered in other medical conditions, and the clinical correlation between ACE levels and disease activity in sarcoidosis is disputable as well. To determine the significance of elevated ACE levels in the diagnosis and follow-up of sarcoidosis patients. Methods: All electronic patient records in which an ACE level was recorded in a large tertiary hospital were identified using a computerized algorithm. Medical diagnoses, ACE numerical values, and clinical data were also automatically extracted. Furthermore, all records with a diagnosis of sarcoidosis were manually reviewed for ascertainment of the diagnosis and searched for additional clinical manifestations and treatment responses. Results: A total of 1416 records with a documented ACE level were found in the database, and 146 of the records had a diagnosis of sarcoidosis in the medical record. However, the diagnosis was excluded in 27 of these cases after a manual review of the records. Elevated ACE levels were most commonly encountered among patients with sarcoidosis, non-Hodgkin’s lymphoma, cirrhosis, and interstitial lung disease. Elevated ACE levels had a positive predictive value of 12.76% and a negative predictive value of 94.6% for the diagnosis of sarcoidosis in our cohort, with a sensitivity of 63.5% and a specificity of 59.5%. Among patients with sarcoidosis, ACE levels around the time of diagnosis were higher than ACE levels in remission. However, a paired analysis did not find a statistically significant difference in ACE levels between the two timepoints. A positive correlation between lack of cardiac involvement and elevated ACE levels was found on multivariate analysis. Conclusions: ACE levels are a non-specific serological marker with low specificity and sensitivity for sarcoidosis and a poor positive predictive value, but with a negative predictive value of 94.6%. Furthermore, elevated ACE levels correlated poorly with disease activity in our cohort.

Specialty-specific hand hygiene compliance: 5-year study from a large public sector teaching hospital, South India

: Hand hygiene (HH) is essential for preventing healthcare-associated infections (HAIs), especially in ICUs and cancer care centers. These settings often involve immunocompromised patients and invasive devices, making HH critical for patient safety. Despite its recognized importance, consistent adherence to HH practices by healthcare workers (HCWs) remains a significant challenge. This study aimed to evaluate HH compliance in a tertiary care hospital in South India using a customized Android application aligned with WHO guidelines. : This observational study was conducted across high-risk areas of a tertiary care hospital from June 2019 to May 2024. The hospital's high-risk units, under medical, surgical, and pediatric alliances, were included. An Android application based on the Ibhar platform and WHO hand hygiene audit guidelines was used for data collection. The study recorded HH opportunities, Complete HH Adherence (HHCAR), Partial HH Adherence (HHPAR), and Total HH Adherence (HHTAR). The data were analyzed for location-specific, profession-specific, and moment-specific compliance rates. : A total of 196,252 HH opportunities were recorded, with the surgical alliance accounting for the highest number. Pediatric units had the highest compliance, with an HHTAR of 89% and an HHCAR of 66%. Nurses demonstrated the highest compliance among professions, with an HHTAR of 82.8%. Compliance was higher after patient care moments compared to before. Statistically significant differences were noted across different specialties and moments. : This large-scale study highlights the variation in HH compliance across different specialties and the need for targeted training sessions. Given the resource constraints in many tertiary care centers, focusing audits on high-risk areas is practical. The use of software-based applications like Ibhar enhances data collection and analysis, making the audit process more efficient. Regular HH audits and behavioral changes are essential to improve and sustain high standards of HH compliance, ultimately contributing to better infection control practices.

The increasing burden of group B Streptococcus from 2013 to 2023: a retrospective cohort study in Beijing, China.

Group B Streptococcus (GBS) is a leading pathogen responsible for fatal infections in newborns primarily due to vertical transmission from colonized mothers. Cases of invasive GBS infections in adults have also increased and attracted attention recently. To comprehensively understand the evolving burden of vaginal GBS carriage in pregnant and non-pregnant women, as well as the trends in invasive GBS diseases and antibiotic resistance in China, we conducted a retrospective study using data from a large tertiary hospital in Beijing from 2013 to 2023. Over the past decade, improvements in GBS screening methods for pregnant women have significantly increased the GBS recovery rate. The detection rate of GBS and its proportion among vaginal pathogens have shown a gradual increase in GBS colonization in both pregnant and non-pregnant women. An analysis of vaginal pathogen composition revealed variations in GBS prevalence across different age groups, as well as a potential competitive relationship between GBS and Enterococcus faecalis in the vaginal environment. Additionally, we analyzed 165 invasive GBS cases, including three in newborns. The incidence of invasive GBS cases has risen since 2016, particularly among individuals over the age of 40. The 5,858 GBS isolates exhibited notably high resistance rates to erythromycin (72.2%), clindamycin (60%), and levofloxacin (50.1%), with 30.8% classified as multidrug-resistant. Importantly, invasive GBS strains exhibited a higher resistance rate to levofloxacin (61.2%) compared to colonizing strains (49.8%). This study highlights the importance of continuous screening and monitoring for GBS, especially given the concerning antibiotic resistance rates of GBS.IMPORTANCEGroup B Streptococcus (GBS) is an important pathogen that commonly causes infections in newborns and the elderly. This retrospective study provides a comprehensive analysis of GBS strains isolated from a large tertiary hospital in Beijing between 2013 and 2023, revealing an increasing colonization rate of GBS in both pregnant and non-pregnant women. Analysis of vaginal pathogens indicates a growing proportion of GBS among vaginal pathogens. Additionally, the high resistance rates of GBS to erythromycin, clindamycin, and levofloxacin, as well as the prevalence of multidrug resistance, are issues that merit attention. We also examined the differences in resistance rates of GBS strains from various sample types, finding that the levofloxacin resistance rate in GBS strains causing invasive infections was significantly higher than in colonizing strains. This study provides new data and insights for clinical research on GBS.

Professional Isolation: Impact on Rural Nurses Resuscitation Practices and Experiences.

The aim of this discussion paper is twofold: (1) To critically examine the challenges related to resuscitations among rural nurses and how these contribute to a sense of professional isolation and (2) To discuss practical solutions and strategies that could be implemented to mitigate the effects of professional isolation. Professional isolation is not unique to rural nursing practice. It is a complex issue often observed in low-resourced environments that are geographically distant from larger hospitals, such as small rural emergency departments. With a greater research focus placed on the recruitment and retention challenges associated with professional isolation, studies often overlook the intermediary factors contributing to this issue, such as the effect of resuscitations on rural nurses. In addition, there are few studies that have evaluated interventions or strategies to address professional isolation. A critical discussion paper. This discussion paper is based on data drawn from current evidence and is guided by the authors research experience as part of a doctoral study. Professional isolation negatively affects rural nurses' experiences of resuscitation by creating barriers to skill acquisition and professional growth and reducing career intent in rural areas. Strategies such as leadership training, rural mentorship, debriefing and cognitive aids are possible strategies that could address these challenges. The trajectory of professional isolation is contingent upon the capacity of rural nurses to have access to professional avenues that enhance connection, sharing of knowledge, skills and experiences. Addressing professional isolation is crucial for the well-being of rural nurses and the overall sustainability and growth of the rural healthcare workforce.

The use of chlorhexidine mouthwash and diagnosis of primary hypertension in a large hospital cohort.

Small-scale studies reported increased blood pressure in patients using chlorhexidine mouthwash with the rationale that the rinse mitigates nitric oxide production by oral bacteria. The present study evaluated whether prior use of chlorhexidine mouthwash can be associated with an increased odds ratio for primary hypertension in a large hospital cohort. The i2b2 NIH-established platform was used to search for deidentified medical information coded by ICD-10 for subjects with a hypertension diagnosis who have used chlorhexidine rinses before between October 2015 and May 2024. Binary statistics and logistic regression were used to calculate the odds ratio for hypertension in the group that used chlorhexidine mouth rinse before and after adjustments for demographic data, diabetes, and periodontal disease. The unadjusted odds ratio for primary hypertension in subjects who used chlorhexidine gluconate mouthwash before was significantly elevated (OR 3.09, 95%CI 3.03 - 3.16, p<0.0001). It remained significant after adjusting for male gender (OR,1.44,95%CI 1.42 - 1.47, p<0.0001), age <45 years (OR 1.90 95%CI 1.86 - 1.93, p<0.0001), White race (OR 2.3, 95%CI 2.27 - 2.37, p<0.0001, diabetes (OR 1.99, 95%CI 1.93 -2.05, p< 0.001, and periodontal disease. (OR 3.28, 95%CI 3.21 - 3.34, p< 0.0001). The odds ratio for hypertension for subjects with gingivitis or periodontal disease after adjustment for chlorhexidine mouthwash was elevated. (OR 20.11, 95%CI 20.11 -21.44, p<0.0001) Conclusions: With the cavitate of a retrospective study design, the results indicate an increased odds ratio for primary hypertension for subjects with prior use of chlorhexidine mouthwash.

Impact of pay-for-performance on hospital readmissions in Lebanon: an ARIMA-based intervention analysis using routine data

BackgroundThe objective of this paper was to estimate the impact of country-wide hospital pay-for-performance on readmissions for a set of common conditions in Lebanon.MethodsThis retrospective cohort study included all hospitalizations under the coverage of the Ministry of Public Health in Lebanon between 2011 and 2019. We calculated 30-day all-cause readmissions following general, pneumonia, cholecystectomy and stroke cases. We used an interrupted time series design, including the use of AutoRegressive Integrated Moving Average models. This nationwide study including 1,333,691 hospitalizations was undertaken in Lebanon, using hospitalizations at about 140 private and public hospitals contracted by the Ministry. The participants included citizens across all ages under the Ministry’s coverage (52% of citizens). The intervention was the engagement of hospital leaders by the Ministry, informing them of the addition of a readmissions component to the ongoing pay-for-performance initiative. Engagement participants included hospital directors and managers, and the leadership of the Syndicate of Private Hospitals. The main outcome measure was age-adjusted monthly all-cause readmission rates for each of general, pneumonia, cholecystectomy and stroke cases. We also assessed for change in readmissions for three conditions not included in the intervention (myocardial infarction, cataract surgery and appendectomy).ResultsAcross 2011–2019, the overall readmission rates were 6.00% (SD 0.24%) for general readmissions, 5.06% (SD 0.22%) for pneumonia, 2.54% (SD 0.16%) for cholecystectomy, and 6.55% (SD 0.25%) for stroke. Using ARIMA models we found a relative percentage decrease in mean monthly readmissions in the post-intervention period for cholecystectomy (5.9%; CI 0.1%-11.8%) and stroke (13.6%; CI 3.1%-24.2%). There was no evidence of intervention impact on pneumonia and general readmissions, both overall and among small, medium and large hospitals. There was also no evidence of change in non-P4P readmissions of myocardial infarction, cataract surgery and appendectomy.ConclusionsIncluding readmissions within pay-for-performance has the potential to improve hospital performance and patient outcomes, even in countries with more limited resources. Effects may vary across conditions, indicating the need for careful design and understanding of the particular context, both with respect to implementation and to evaluation of impact.

Incorporating clinical and demographic data into the Elixhauser Comorbidity Model: deriving and validating an enhanced model in a tertiary hospital’s internal medicine department

Background and objectivesThe Elixhauser Comorbidity Model is a prominent, freely-available risk adjustment model which performs well in predicting outcomes of inpatient care. However, because it relies solely on diagnosis codes, it may not capture the full extent of patient complexity. Our objective was to enhance and validatethe Elixhauser Model by incorporating additional clinical and demographic data to improve the accuracy of outcome prediction.MethodsThis retrospective observational cohort study included 55,945 admissions to the internal medicine service of a large tertiary care hospital in Jerusalem. A model was derived and validated to predict four primary outcomes. The four primary outcomes measured were length of stay (LOS), in-hospital mortality, readmission within 30 days, and increased care.ResultsInitially, the Elixhauser Model was applied using standard Elixhauser definitions based on diagnosis codes. Subsequently, clinical variables such as laboratory test results, vital signs, and demographic information were added to the model. The expanded models demonstrated improved prediction compared to the baseline model. For example, the R2 for log LOS improved from 0.101 to 0.281 and the c-statistic to predict in-hospital mortality improved from 0.711 to 0.879.ConclusionsAdding readily available clinical and demographic data to the base Elixhauser model improves outcome prediction by a considerable margin. This enhanced model provides a more comprehensive representation of patients’ health status. It could be utilized to support decisions regarding admission and to what setting, determine suitability for home hospitalization, and facilitate differential payment adjustments based on patient complexity.

Establishment of recurrent exposures reference levels for repeated computed tomography examinations in adult patients on a nationwide level in Slovakia.

The study aims were: (1) to assess the incidence in 1 year, the cumulative incidences and the period prevalence in 3/5 years of the condition of patients accruing cumulative effective dose (CED) ≥ 100 mSv in health care centres providing CT examinations in Slovakia; and (2) to quantify their variability among different centres, to test the feasibility of establishing recurrent exposure reference levels (RERL) on a nationwide level. The data were tracked during five consecutive years using the CT dose index and dose-length-product along with the patient's ID. ED was calculated using conversion factors. Hospitals were stratified according to the number of beds in clinics (0), small (< 200), medium (201-500), or large (> 500) hospitals. The database included 1,278,928 patients who underwent 2,157,508 CT exams in 5 years. The I100;1 (%), I100;3 (%), I100;5 (%) ranged from 0% to 6.2%, from 0.3% to 23.2% and from 0.3% to 36.9%, respectively. The P100;3 (%), P100;5 (%) ranged from 0.17% to 13.3% and from 0.19% to 17.8%, respectively. No significant differences were found in epidemiological indexes among different hospital sizes. A strong positive correlation was found between the third quartile values of yearly CED and I100;1 (%) (r = 0.84; R2 = 0.70; p < 0.0001). RERL value, set as the 75th percentiles of the distributions of the 3rd quartiles of the yearly CED, amounted to 25.7 mSv. The management of patients with recurrent CT exposures is highly variable among hospitals and unrelated to the size of the institution. Incidence should be reported instead of prevalence. Question Beyond just reporting statistics on recurrent imaging, the question which needs to be addressed is how to use such information to optimise patient protection. Findings In Slovakia the 5-year incidence of patients with CED ≥ 100 mSv average 6% and range from 0.3% to 36.9% among different hospitals. Clinical relevance The incidence of patients with CED ≥ 100 mSv is highly variable among hospitals and unrelated to their size. The heterogeneity in the radiation exposure of recurrent patients prompts the introduction of RERL to aid in the optimisation of patient protection.

Two-phase analysis of blood in microchannel architecture on plasma separation ability with dimensional variance

Purpose This paper aims to study the effects of varying inlet channel angle in a novel microfluidic architecture blood plasma separation ability over range of hematocrit values (5–45%) at multiple flowrates. Design/methodology/approach CAD designs for both micro architectures were designed in SOILWORKS. In the second step, these designs were imported into ANSYS to perform where meshing, model selection, defining blood as two-phase material and boundary conditions are performed. Findings Separation efficiency values close to 100% with diluted blood and 65.2% with whole blood were observed. Straight channel inlet design has significantly better performance at high hematocrit levels, whereas at lower hematocrit levels, both designs had almost same outcome. Furthermore, lower flowrates have shown the highest separation efficiency for lower hematocrit levels, whereas at higher hematocrit percentages, higher flowrates have shown better separation effects for both designs. Furthermore, trends obtained for flow ratio and flowrates against separation efficiency are demonstrated. Research limitations/implications This study is based on blood modeled as two-phase flow, with the phases consisting of blood plasma as primary phase and red blood cells as secondary particulate phase. Practical implications Implications of this study are far reaching for point-of-care health-care systems. A practical system of this numerical study can provide a microchannel device which take very small amount of blood sample to separate it into constituents which can be coupled with detection module to detect a particular disease for which it is designed for. This microsystem can be very beneficial for remote areas where a large hospital facility is far away. Originality/value This study has carried out a detailed analysis on the ability of a novel microchannel architecture to separate blood plasma from other blood constituents. Inlet channel angle variation effects are observed over a range of hematocrit percentages. These trends are further investigated for three different flowrates to assess the microchannel design behavior.

Iranian mothers’ perceptions of contextual factors helping them manage pain in labor

BackgroundThe rate of caesarean section in Iran has significantly increased. The main reason cited by Iranian mothers for it is labor pain and fear of it. However, the experience of pain during childbirth has different meanings for mothers in various conditions. Therefore, this study aims to examine the components from the mothers’ perspective that helped them manage pain in labor. The findings of this article may help prevent unnecessary medical interventions.MethodsThe current article is one component of a mixed-method study conducted in Iran. Its primary objective was to develop protocols for maternity unit design to enhance maternal satisfaction, promote husbands’ involvement, and improve pain management. The current study focuses on examining contextual components that are effective in managing pain among 25 mothers selected through stratified purposive sampling. Data collection from mothers who gave birth in four large hospitals in Iran was carried out through unstructured in-depth interviews. The data were analyzed using interpretative phenomenological analysis.FindingsThe data show that two major environmental factors affect mothers’ perception of pain and their ability to control it: (1) Internal and (2) External environments. The main components of the internal factor are identified as “Personal beliefs”, “Self-confidence and lack of fear”, and the external environment includes three subfactors: “Spatial environment”, “Social environment”, and “Interactive environment”. The overall meaning attributed to pain caused by these factors determines how mothers can cope with it.ConclusionIn this study, self-confidence and a positive mindset were significant factors in managing pain during labor among this group of mothers. Furthermore, each mother’s perception of pain was shaped by a combination of physical, social, and interactive influences. The research identified the importance of support during labor according to mothers’ individual, subjective needs, while improving the physical environment, with a view to reducing interventions and promoting positive experiences for mothers and husbands. Consequently, enhancing internal resources and the birthing environment during labor which involve identifying the optimal blend of physical, mental, and emotional strategies tailored to the specific needs of mothers, can be considered to a potential reduction in the perceived intensity of pain in future.

Drug utilisation study in hospitalised chronic kidney disease patients, using World Health Organisation prescribing indicators: an observational study.

Chronic kidney disease (CKD) is associated with comorbidities and altered pharmacokinetics, making appropriate prescribing, and monitoring necessary to minimise drug-related problems (DRPs). Therefore, this study aimed to describe the drug-utilisation pattern in hospitalised CKD patients. An observational study was conducted in hospitalised adult (≥18 years old) CKD patients in the UK using WHO prescribing indicators, from November 2021 to April 2022 in a large teaching hospital in England from admission until discharge. This study used STATA version 16 for analysis. The mean number of drugs per prescription was 11.1(±5), the percentage of encounters resulting in the prescription of an antibiotic was 62%, the percentage of drugs prescribed by generic name was 90%, the percentage of encounters resulting in the prescription of an injection was 94%, and the percentage of drugs prescribed from essential drugs list or formulary was 89%. The most frequent drug group prescribed Alimentary Tract and Metabolism was 22%. Longer hospital stays, admission to a renal ward, and the number of comorbidities were independently associated with polypharmacy. Not all prescribing indicators evaluated in this study were in full compliance with WHO recommendations. Polypharmacy was found in most participants which might require interventions to avoid DRPs. Further research is needed to evaluate factors associated with prescribing in the CKD population and prescriber perspectives on decision-making in the context of available guidelines and patient factors.

Redesigning the Hospital Environment to Improve Restfulness

Hospital wards are often not conducive to patient sleep, negatively affecting patient health and experience. To assess determinants of in-hospital restfulness and to design and test rest-promoting interventions on the wards in partnership with clinicians, staff, and patients. This rapid-sequential mixed-methods quality improvement study was performed at a large urban academic hospital in St Louis, Missouri, from May 1, 2021, to December 31, 2022, with follow-up through hospitalization. Mixed-methods activities involved purposively selected hospitalized adults on the wards, nurses, hospitalists, and hospital staff. Interventions included all adult hospitalizations on the study wards. Sequential stacked bundles of multimodal rest-promoting interventions (general education, focused education on light or noise, safely reducing overnight monitoring or testing, and environmental personalization). Pre-post comparisons of perceived nighttime quietness (via surveys) and sleep opportunity (coprimary outcomes) as well as clinical interruptions overnight, environmental noise, and adoption and satisfaction. Nine patients (4 female) and 14 staff members (10 female; 3 nurse managers or administrators, 10 nurses, and 1 physician) were interviewed, 38 surveys were collected, and more than 100 hours of observation were performed. Interventions were evaluated for 671 patients (mean [SD] age, 60 [16] years; 336 [50%] female). Determinants of in-hospital rest included infrastructure, staff attitudes, priorities, culture, and patient experiences of anxiety, uncertainty, and loss of control. Informed by these determinants, codesign workshops yielded 39 potential interventions, from which 9 were selected for testing. Related interventions were organized into bundles, which were tested in sequential 2-week sprints. Perceived nighttime quietness improved nonsignificantly during the project (wards "always" quiet at night: 51% preintervention vs 86% postintervention; P = .09), with excessive noise events decreasing from 0.65 (95% CI, 0.53-0.77) to 0 per 100 patient-nights before the intervention (P = .02). Sleep opportunity improved significantly (mean, 4.94 [95% CI, 4.82-5.06] hours per patient-night before the intervention vs 5.10 [95% CI, 5.00-5.20] hours per patient-night after the intervention; P = .01). In this quality improvement study, a set of feasible, acceptable, and beneficial rest-promoting interventions were developed. After implementation of these interventions on the wards, a significant improvement in nighttime quietness and sleep opportunity was observed. These results demonstrate how human-centered design methods can generate practical and effective strategies for improving an important patient-related outcome and a core element of patient experience.

Evaluation of ceftazidime-avibactam resistance in clinical isolates of Enterobacterales from a large tertiary-care hospital, Italy, 2019-2023

Not available.