Negative Consequences For Patients Research Articles

Comparison of Long Short-Term Memory and Convolutional Neural Network Models for Emergency Department Patients’ Arrival Daily Forecasting

Background: One of the most critical challenges in the emergency department (ED) is overcrowding, which creates negative consequences for patients and staff. Therefore, predicting the rate of patients entering the ED can help manage resources in this department effectively. Objectives: According to the time of data collection, we intended to predict the volume of patient admissions to the ED in epidemic conditions, such as COVID-19 and non-epidemic. In addition, we planned to compare the performance of the LSTM and CNN models. Methods: The collected data consists of three main categories. The first category pertains to air pollutants, provided by the Tehran air quality control organization. The second type relates to data from the Iran Meteorological Organization, and the third category includes the number of patients admitted to the ED of a hospital in Tehran. We also incorporated binary indicators for epidemic and non-epidemic conditions in the dataset. The data collection period spans from February 2018 to March 2022. We employed the Dickey-Fuller test to assess the stationarity of the data. After preprocessing, we independently developed long short-term memory (LSTM) neural network and convolutional neural network (CNN) models, considering various time windows of previous days. Keras and Tensorflow libraries in Python, along with the Google Colab environment, were utilized to execute the models. Results: The LSTM model exhibited the lowest root mean square error (RMSE) and mean absolute error (MAE) with a time window of the last seven days, while the CNN model outperformed the LSTM model with a time window of the previous 13 days. Additionally, the CNN model required less execution time than the LSTM model. Conclusions: In conclusion, deep learning algorithms prove suitable for analyzing multivariate time series data. The CNN model demonstrated the lowest prediction error.

Identification of Patients with Early HR+ HER2- Breast Cancer at High Risk of Recurrence.

Breast cancer incidence has increased in the last two decades and, simultaneously, survival has improved due to earlier detection and improved treatment options. Despite this improvement, locoregional recurrences and distant metastases occur in up to 10 and 30% of women diagnosed with early breast cancer, respectively. Around 70% of breast cancers are hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-), and associated with a persistent risk of relapse up to 20 years after diagnosis/initial treatment. We conducted a narrative review by combining PubMed searches with our clinical experience to describe patient characteristics, biomarkers, and genomic profiling tools available to clinicians for the identification of patients with HR+, HER2- early breast cancer at high risk of recurrence and to provide recommendations to classify patients into recurrence risk categories. National and international treatment guidelines are also summarised. Accurate assessment of the risk of recurrence in these patients is crucial as the predicted risk guides treatment decisions; imprecise estimations can result in over- or undertreatment, with either scenario having negative consequences for patients. Multiple prognostic tools and factors are recommended for early breast cancer, and no single test provides accurate prognosis in isolation. Since no single test can provide accurate prognosis in isolation, a combination of tools should be used. Risk thresholds are important to guide optimised and balanced therapeutic decisions in HR+, HER2- early breast cancer. However, prognostic assessment should be performed on a case-by-case basis, making patient-specific prognostic approaches essential to avoid over- or undertreatment.

Ambulance personnel use of coercion and use of safety belts in Norway

BackgroundProviding health care in a moving vehicle requires different considerations regarding safety than in other settings. Use of seatbelts are mandatory, and during ambulance transport patients are fastened to the stretcher with safety straps. However, patients who wriggle out of, or unfasten, their safety straps pose a threat to him/herself and escorting personnel in the ambulance compartment in case of an accident. To prevent harm, ambulance personnel sometimes restrain the patient or unfasten their own seatbelts to keep the patient safe on the stretcher. The prevalence of coercive measures, and the relationship between the use of mechanical restraints comparable to coercion and seatbelt use, are scarcely investigated. Use of coercion normally requires a specific statutory basis. However, coercive measures needed to ensure safety in a moving vehicle while providing healthcare is hardly discussed in the literature. The aim of this study is to explore the use of coercion in ambulance services, the use of safety belts among escorts in situations where they need to keep the patient calm during transportation, and to analyse the relationship between safety belt non-compliance and coercion in these situations.MethodsThis is a retrospective, cross-sectional study using a self-administered, online survey aiming to investigate the use of coercion and use of seatbelts during ambulance transport. Approximately 3,400 ambulance personnel from all 18 Health Trusts in Norway were invited to participate between Oct 2021 and Nov 2022. Descriptive analyses were used to describe the sample and the prevalence of findings, while multiple linear regressions were used to investigate associations.ResultsAltogether, 681 (20%) ambulance personnel completed the survey where 488 (72.4%) stated that they had used coercion during the last six months and 375 (55.7%) had experienced ambulance personnel or escorting personnel working with unfastened seatbelts during transport. The majority of respondents experienced coercion as being unpleasant and more negative feelings were associated with less use of seatbelts.ConclusionsCoercion seems to be used by ambulance personnel frequently. For the study participants, keeping the patient securely fastened was prioritized above escorting personnel’s traffic safety, despite feeling uncomfortable doing so. Because coercive measures have negative consequences for patients, is associated with negative feelings for health personnel, and is not discussed ethically and legally in relation to the prehospital context, there is an urgent need for more research on the topic, and for legal preparatory work to address the unique perspectives of the prehospital context in which traffic safety also is an important factor.

Variations in wait times for imaging services: a register-based study of self-reported wait times for specific examinations in Norway

BackgroundWhile the number of medical images has increased substantially, the demand has outpaced access, resulting in long wait times in many countries. Long wait times are a key problem for patient safety and quality of care as they can result in prolonged suffering, delayed diagnosis and treatment, as well as poorer prognosis and loss of lives. Surprisingly, little is known about wait times for imaging services.ObjectiveInvestigate wait times for specific imaging services in Norway and to compare wait times with the total number of examinations and their development over time.MethodsData from the wait time registry at the Norwegian Directorate of Health from 2018 to 2021 as well as data on outpatient imaging provided by the Norwegian Health Economics Administration (HELFO) and in-patient data afforded by fourteen hospital trusts and hospitals in Norway were analysed. Data include the total number of imaging examinations according to the Norwegian Classification of Radiological Procedures (NCRP). Analyses were performed with descriptive statistics.ResultsWait times vary through the months of the year. Conventional X-ray (XR) had the shortest wait times (3.0-4.4 weeks), and Magnetic Resonance Imaging (MRI) and ultrasound (US) had the lengthiest (8.7–12.0 and 7.9–11.4 weeks respectively). The wait times were lengthiest during the summer and winter holidays. Variations in wait times were also found for specific examination types between Norway’s four public health regions. In addition, there was variation over time within the health regions. The wait times with the private health providers were substantially lower than with the public health providers. From 2018 to 2021, the wait time for MRIs increased by 6.6%, while the number of examinations (per 10,000) increased by 8.6%. Those regions with the highest number of examinations per 1,000 inhabitants per year had the lowest wait times.ConclusionWait times for diagnostic imaging procedures varied with time, region, and modality in Norway from 2018 to 2021. Long wait times may entail many negative consequences for patients, professionals, and the healthcare system. Reducing long wait times is an obvious way to improve the quality, safety, and efficiency of care.

The ramifications of Missing Nursing Care on adverse patient outcomes are profound. Insights gleaned from data offer valuable perspectives on nursing practices and their direct repercussions on patient well-being

The study aims to explore the correlation between missed nursing care and adverse patient outcomes. It delves into the reasons behind missed nursing care leading to negative patient consequences. The research framework employs missed nursing care as an independent variable and adverse patient outcomes as a dependent variable. Utilizing convenient sampling, this cross-sectional quantitative deductive study gathered data from nurses. All factors under scrutiny were assessed via questionnaires utilizing an appropriate Likert scale. Out of a total population of 411 nurses, 202 were sampled. The study's findings indicate a direct relationship between missed nursing care and adverse patient outcomes, demonstrating that an increase in missed nursing care corresponds to a rise in negative patient consequences. These outcomes were statistically significant, with reliable scales and valid data. The research concludes that reducing missed nursing care is pivotal for improving adverse patient outcomes. It recommends offering advanced skill courses, implementing thorough monitoring of nurses' activities, and mandating the self-reporting of missed patient care and adverse events

Operational failures in general practice: a consensus-building study on the priorities for improvement.

System problems, known as operational failures, can greatly affect the work of GPs, with negative consequences for patient and professional experience, efficiency, and effectiveness. Many operational failures are tractable to improvement, but which ones should be prioritised is less clear. To build consensus among GPs and patients on the operational failures that should be prioritised to improve NHS general practice. Two modified Delphi exercises were conducted online among NHS GPs and patients in several regions across England. Between February and October 2021, two modified Delphi exercises were conducted online: one with NHS GPs, and a subsequent exercise with patients. Over two rounds, GPs rated the importance of a list of operational failures (n = 45) that had been compiled using existing evidence. The resulting shortlist was presented to patients for rating over two rounds. Data were analysed using median scores and interquartile ranges. Consensus was defined as 80% of responses falling within one value below and above the median. Sixty-two GPs responded to the first Delphi exercise, and 53.2% (n = 33) were retained through to round two. This exercise yielded consensus on 14 failures as a priority for improvement, which were presented to patients. Thirty-seven patients responded to the first patient Delphi exercise, and 89.2% (n = 33) were retained through to round two. Patients identified 13 failures as priorities. The highest scoring failures included inaccuracies in patients' medical notes, missing test results, and difficulties referring patients to other providers because of problems with referral forms. This study identified the highest-priority operational failures in general practice according to GPs and patients, and indicates where improvement efforts relating to operational failures in general practice should be focused.

Dentists' considerations concerning treating patients from the Deaf and Hard of Hearing community: A national survey.

Research shows that adults who were Deaf or Hard of Hearing (HoH) had poorer oral health than adults who did not belong to this community. The objectives were to assess dentists' education, knowledge, attitudes, and professional behavior related to treating patients from the Deaf or HoH community and the relationships between these constructs. A total of 207 members of the American Dental Association and the Michigan Dental Association responded to a mailed or web-based survey concerning their education, knowledge, attitudes, and professional behavior related to treating patients from the Deaf or HoH community. On average, the respondents disagreed that they were well educated in classroom-based, clinical, or community-based dental school settings (five-point answer scale with 1=disagree strongly; mean=2.29/2.27/2.35) or by their professional organization (mean=2.00) about treating Deaf or HoH patients. However, the more recently the respondents had graduated from dental school, the better they described their education about this topic (r=0.29; p<0.001). Additionally, 45.9% agreed/strongly agreed that they would like to attend a continuing education course about this topic; 68.9% agreed/agreed strongly that negative consequences for patients' general health can occur; and 61.1% that patients cannot be well educated about oral hygiene if Deaf or HoH patients do not have appropriate interpretive support in dental offices. The better dentists were educated about this topic, the more knowledge they had (r=0.50; p<0.001). On average, the respondents agreed more strongly that they were comfortable treating adult patients who communicated orally than patients using American Sign Language (4.02vs. 3.25; p<0.001). These findings show that efforts are needed to improve dental school and continuing education curricula about dental treatment for Deaf and HoH patients. The more recently the respondents had graduated, the more positively they described their education. Increased dental school and continuing education efforts are still urgently needed.

A protocol for the development and validation of a virtual reality-based clinical test of social cognition

BackgroundImpairments in social cognition are common after traumatic brain injury (TBI) and may have severe negative consequences for patients and their families. Most tests of social cognition have limited ecological validity due to simplistic and contrived social stimuli with limited relevance to everyday social functioning. There is a need for measures of social cognition that reflect the dynamic, multimodal and contextualized nature of social situations and that predict real-world functioning. Three hundred sixty–degree (360°) Virtual Reality (VR) video can increase ecological validity through enhanced social presence, or a sense of “being there”. This paper describes the development and protocol design for validation of a Norwegian VR-version of The Awareness of Social Inference Test (TASIT), which is a widely used video-based test of social cognition.MethodsDevelopment of VR TASIT included filming 61 short videos depicting social interactions in both VR and desktop format, using a 360° camera. Software for standardized test administration and collection of performance data was developed in Unity, for administration on both VR and desktop interface. The validation study will test the reliability and validity of VR TASIT in participants with TBI (n = 100) and healthy controls (n = 100). Half of the participants will perform the desktop version, and the other half the VR version. Analyses will include known groups validity, convergent and divergent validity, as well as test–retest reliability of VR TASIT. A comparison of the ability of TASIT VR and desktop versions to predict real-world functioning (ecological validity) will be explored using the Social Skills Questionnaire for TBI and La Trobe Communication Questionnaire. Finally, the levels of perceived social presence of the stimulus materials and prevalence of cybersickness after exposure to the virtual environment will be documented.DiscussionIt is expected that VR TASIT will have comparable or better psychometric properties than the desktop version, and that the hypothesized increased level of social presence experienced in a virtual environment will result in improved ecological validity. More broadly, benefits and limitations of using VR video as stimulus material in assessment of social cognition and considerations for future development and clinical validation are discussed.Trial registrationThe study protocol was pre-registered in ClinicalTrials (April 4th 2022, NCT05309005). The study was retrospectively registered in Open Science Framework (December 15th 2022, osf.io/2vem8).

Acupuncture out, dogma in: The U.K. National Institute for Health and Care Excellence guideline for osteoarthritis 2022

The recently published National Institute for Health and Care Excellence (NICE) guideline for osteoarthritis (NG226) does not recommend acupuncture. However, high-quality evidence exists that indicates acupuncture is effective for osteoarthritis and not simply a placebo. NICE clinical guidelines, such as NG226, provide recommendations for the National Health Service (NHS) in the U.K. In this opinion article the author examines the rationale and evidence set out in the Guideline NG226 and the supporting documentation. Two interrelated issues are identified: problems of interpretation and problems of definition. The problems of interpretation have been discussed in relation to previous NICE guidelines, these include: the evidence review erroneously analyses sham acupuncture as inert; the minimal important difference criterion for efficacy trials is not applied consistently; insufficient weight is given to pragmatic comparative effectiveness evidence. The problems of definition have not been discussed to the same degree. The evidence review employs no operational definitions of acupuncture or sham acupuncture. As a result, highly similar procedures are classified as sham in one trial but verum in another. This is illogical and unscientific. The guideline rationale fails to engage with the scientific debate regarding acupuncture research and repeats the mistakes of earlier guidelines. The interpretation of the evidence is erroneous as it is based on the dogma that sham acupuncture is inert. This is compounded by a failure to have clear definitions for acupuncture or sham acupuncture. The committee's interpretation of the acupuncture evidence will have negative consequences for patients in practice and for those enrolled in future clinical trials.

The rationing of nursing care phenomenon in the light of scientific reports – professional and personal satisfaction, life orientation of nursing staff – PART III

Rationing of nursing care is a widespread and growing phenomenon whose causes are multifaceted and whose consequences are serious. Nursing rationing is defined as withholding or failing to perform necessary nursing tasks due to insufficient time, staffing, and/or inadequate skills. Nursing rationing is also defined as omission, delay, failure to complete, which qualifies as an error of omission. Unfinished nursing care has many negative consequences for patients, nurses and organizations. The presented series of three papers aims to show many important aspects related to rationing of care. This third part of the series of rationing of nursing care phenomenon will address the important issues from the point of view of care rationing, such as nurses' job satisfaction, nursing staff life satisfaction, nursing staff burnout, and nursing staff life orientation.

Clinical outcomes of chronic heart failure patients with unsuppressed sleep apnea by positive airway pressure therapy.

Heart failure (HF) is an advanced stage of cardiac disease and is associated with a high rate of mortality. Previous studies have shown that sleep apnea (SA) is associated with a poor prognosis in HF patients. Beneficial effects of PAP therapy that is effective on reducing SA on cardiovascular events, were not yet established. However, a large-scale clinical trial reported that patients with central SA (CSA) which was not effectively suppressed by continuous positive airway pressure (CPAP) revealed poor prognosis. We hypothesize that unsuppressed SA by CPAP is associated with negative consequences in patients with HF and SA, including either obstructive SA (OSA) or CSA. This was a retrospective observational study. Patients with stable HF, defined as left ventricular ejection fraction of ≤50%; New York Heart Association class ≥ II; and SA [apnea-hypopnea index (AHI) of ≥15/h on overnight polysomnography], treated with CPAP therapy for 1 month and performed sleep study with CPAP were enrolled. The patients were classified into two groups according to AHI on CPAP (suppressed group: residual AHI ≥ 15/h; and unsuppressed group: residual AHI < 15/h). The primary endpoint was a composite of all-cause death and hospitalization for HF. Overall, data of 111 patients including 27 patients with unsuppressed SA, were analyzed. The cumulative event-free survival rates were lower in the unsuppressed group during a period of 36.6 months. A multivariate Cox proportional hazard model showed that the unsuppressed group was associated with an increased risk for clinical outcomes (hazard ratio 2.30, 95% confidence interval 1.21-4.38, p = 0.011). Our study suggested that in patients with HF and SA including either OSA or CSA, presence of unsuppressed SA even on CPAP was associated with worse prognosis as compared to those with suppressed SA by CPAP.

Identifying nonprescription antibiotic users with screening questions in a primary care setting

Background: Antibiotic use without a prescription (nonprescription use) leads to antibiotic overuse, with negative consequences for patient and public health. We studied whether screening patients for prior nonprescription antibiotic use in the past 12 months predicted their intentions to use them in the future. Methods: A survey asking respondents about prior and intended nonprescription antibiotic use was performed between January 2020 and June 2021 among patients in waiting rooms of 6 public clinics and 2 private emergency departments in economically and socially diverse urban and suburban areas. Respondents were classified as prior nonprescription users if they reported previously taking oral antibiotics without contacting a doctor, dentist, or nurse. Intended use was defined as answering “yes” or “maybe” to the question, “Would you use antibiotics without contacting a doctor, nurse, or dentist?” We calculated the sensitivity, specificity, and positive and negative predictive value (PPV and NPV) of prior nonprescription antibiotic use in the past 12 months for future intended nonprescription use. Bayes PPV and NPV were also calculated, considering the prevalence of nonprescription antibiotic use (24.8%) in our study. Results: Of the 564 patients surveyed, the median age was 51 years (SD, 19–92), with 72% of patients identifying as female. Most were from the public healthcare system (72.5%). Most respondents identified as Hispanic or Latino(a) (47%) or African American (33%), and 57% received Medicaid or the county financial assistance program. Prior nonprescription use was reported by 246 (43%) of 564 individuals, with 91 (16%) reporting nonprescription use within the previous 12 months. Intention to use nonprescription antibiotics was reported by 140 participants (25%). The sensitivity and specificity of prior nonprescription use in the past 12 months to predict the intention to use nonprescription antibiotics in the future were 75.9% (95% CI, 65.3–84.6) and 91.4% (95% CI, 87.8–94.2), respectively. After the Bayes’ adjustment, the PPV and NPV of prior use to predict future intention were 74.5% (95% CI, 66.7–80.9) and 92.0% (95% CI, 88.7–94.4) (Table 1). Conclusions: These results show that prior nonprescription antibiotic use in the past 12 months predicted the intention to use nonprescription antibiotics in the future (PPV of 75%). As a stewardship effort, we suggest clinicians use a simple question about prior nonprescription antibiotic use in primary-care settings as a screening question for patients at high risk for future nonprescription antibiotic use.Financial support: HSQR-R 5R01HS026901-04Disclosure: None

Real world data for venous thromboembolisms (VTEs) in patients with active cancer: Thromboprophylaxis pooled analysis from GMaT and ACT4CAT studies.

6637 Background: Venous Thromboembolisms (VTEs) lead to many negative consequences for patients with active cancer and are reported up to 20%. They affect anticancer treatment plan, increase morbidity, mortality, economic burden, and escalate psychological drain. Current guidelines recommend pharmacologic prophylaxis for thrombosis in ambulatory cancer patients with Khorana score ≥2. Methods: GMaT and ACT4CAT are prospective observational phase IV studies conducted by HeSMO in Greece. The aim was to record the clinical practice for ambulatory patients with active cancer who received thromboprophylaxis and enrolled after signing informed consent. Studies were approved by the bioethics committee. Results: 1157 patients from 26 oncology clinics enrolled who received thromboprophylaxis. Tumor types: gastrointestinal 38.5%, lung 24.8%, urological 12.2%, gynecological 6.9%, breast 6.1% and others 11.5%. Treatment lines: 1st 62.5%, 2nd 15.1%, 3rd 4%, adjuvant 9.7% and neoadjuvant 5.9%. Age ≥65 in 55.2%, BMI ≥30 in 17.8% and males 59.9%. High-Risk for Thrombosis Agents (HRTAs) received 82.3%: platinum agents (52.9%), antimetabolites (49.0%) and immunotherapy (10.2%). Notably, 52.7% of anticancer agents had potential drug-drug interactions (DDIs) with Direct Oral Anticoagulants (DOACs). High thrombotic risk factors presented in table. Thromboprophylaxis duration was 5.1±3.3 months with: tinzaparin 91.2%, fondaparinux 4.6%, bemiparin 2.3%, enoxaparin 1.2%, rivaroxaban 0.4% and apixaban 0.3%. Intermediate thromboprophylaxis doses of Low Molecular Weight Heparins (LMWHs) received 62% of patients; 50% in adjuvant setting &amp; 72.6% in metastatic. 32 thrombotic events reported (efficacy: 97.2%, 95%CI: 96.3-98.2%) and 26 grade 1 or minor bleedings (2.2%, 95%CI:1.4-3.1%). Patients receiving intermediate doses of LMWHs had less risk for thrombosis (p=0.0308). Conclusions: VTEs prophylaxis in ambulatory patients with active cancer was found safe and effective. Apart from Khorana score, metastasis, HRTAs and DDIs seem to affect clinical decision for thromboprophylaxis mainly with LMWHs and often using intermediate doses irrelevant of clinical setting. Cancer Associated Thrombosis (CAT) is not negligible risk for patients and oncologists appeared to be aware about this. Clinical trial information: NCT03292107 , NCT03909399 . [Table: see text]

Consequences and Perception of the COVID-19 Pandemic on Patients and Caregivers in an Austrian Memory Clinic Population One Year After Pandemic Onset.

The COVID-19 pandemic was associated with high mortality and negative consequences for patients with Alzheimer's disease or dementia and their caregivers. Memory clinics play an important role in enabling early dementia diagnosis and providing support for patients and their caregivers. This study investigates the impact of the COVID-19 pandemic and its restrictions on patients of a memory clinic and their caregivers between March 2020 and March 2021. We conducted a prospective, single-center, questionnaire-based, observational study to assess consequences and perception of the COVID-19 pandemic on emotion, cognitive function, social living, areas of care, and information retrieval. Results of 255 participants' (mean age 76.78, SD 8.9; 12% cognitively intact, 33% mild cognitive impairment, 55% dementia) and 203 caregivers' COVID-19 questionnaires (valid response rate 71%) could be included in the study. Participants reported a prevalence of psychological symptoms associated with the pandemic between 3-20%. Caregivers living outside compared to those living with the participant reported higher rates of new onset or worsening of neuropsychiatric symptoms in participants since pandemic onset. Patients with dementia showed the lowest use of digital communication before (15.7%) and after (17.1%) pandemic onset in the diagnostic groups. The COVID-19 pandemic frequently led to social isolation and reduced cognitive stimulation due to restrictions in elderly persons with cognitive deficits resulting in negative effects on emotional and social levels. We hypothesize that the implementation and sensitization with digital communication in clinical routine could provide a useful tool to counteract these negative effects.

The rationing of nursing care phenomenon in the light of scientific reports – personnel shortages, system requirements, consequences – PART II

Rationing of nursing care is a widespread and growing phenomenon whose causes are multifaceted and whose consequences are serious. Nursing rationing is defined as withholding or failing to perform necessary nursing tasks due to insufficient time, staffing, and/or inadequate skills. Nursing rationing is also defined as omission, delay, failure to complete, which qualifies as an error of omission. Unfinished nursing care has many negative consequences for patients, nurses and organizations. The presented series of three papers aims to show many important aspects related to rationing of care. This second part of the series of rationing of nursing care phenomenon will address the nursing shortages and demand for nursing care, nursing staffing rates and government policy, the effects of inadequate nursing care on patients and nursing staff, and the economic and social effects of inadequate nursing care.

Broad Patent Claims Come Before the Supreme Court in Amgen v Sanofi

This Viewpoint discusses a current Supreme Court lawsuit, Amgen v Sanofi, involving Amgen’s broad patents on PCSK9 that could effectively prevent other manufacturers from producing similar or even clinically superior antibodies, with important negative consequences for patients.

The use of copy number loads to designate mosaicism in blastocyst stage PGT-A cycles: fewer is better.

The use of copy number loads to designate mosaicism in blastocyst stage PGT-A cycles: fewer is better.

Psychometric Validity of the Anxiety Inventory for Respiratory Disease (AIR) Scale in an Indian Sample of Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study.

Introduction Researchers have found that chronic obstructive pulmonary disease (COPD)patients suffer from anxiety more than the general population.The Anxiety Inventory for Respiratory Disease (AIR) scale has been primarily used to assess non-somatic anxiety in COPD patients. The validity of AIR among COPD patients has not been evaluated in Indian settings. Therefore, this study was undertaken to determine the validity of AIR in these patients. The study aimed to evaluate concurrent criterion and discriminative validity of the AIR screening scale among patients with COPD using Mini International Neuropsychiatric Interview (MINI) 7.0.2 as the gold standard measure for diagnosing Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) anxiety disorders. Materials and methods A cross-sectional study was conducted in the Outpatients Department (OPD) of the Department of Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, from August 2018 to July 2019. A total of 100 patients diagnosed with COPD and aged 30 or above were recruited. All participants were further assessed in person by a psychiatry resident doctor using semi-structured proforma, MINI7.0.2, and AIRDisease (Hindi). Mann-Whitney U and receiver operating characteristic (ROC) curves were conducted. The two-sided p-value of less than 0.05 was considered to be statistically significant. Results To assess the concurrent criterion validity of the AIR scale for screening clinical anxiety disorders, the ROCcurve was constructed using MINI diagnoses of anxiety disorder as the gold standard measure. A cut-off score of 5.5 was found to maximize both the specificity and sensitivity of the AIR scale for screening anxiety disorders among COPD patients with COPD. The AIR scale showed a high sensitivity (95%) and specificity (89%) at this cut-point. Conclusion The findings of this studyrecommend a cut-off score of 5.5 on the AIR scale instead of 8 in previous studies, as maintaining the previously recommended cut-offs in Indian settings may lead to an increase in false negatives. This could have negative consequences for patients seeking treatment. Further studies may be planned to explore the psychometric properties of the current tool in a larger population.

The rationing of nursing care phenomenon in the light of scientific reports – definitions, system solutions, assessment methods – PART I

Rationing of nursing care is a widespread and growing phenomenon whose causes are multifaceted and whose consequences are serious. Nursing rationing is defined as withholding or failing to perform necessary nursing tasks due to insufficient time, staffing, and/or inadequate skills. Nursing rationing is also defined as omission, delay, or failure to complete, which qualifies as an error of omission. Unfinished nursing care has many negative consequences for patients, nurses, and organizations. The presented series of three papers aims to show many important aspects related to care rationing. This first part of the series of rationing of nursing care phenomenon will address definitions and concepts of rationing of nursing care, rationing of nursing care in the context of health care rationing, rationing of care versus omission of care or medical error, methods for assessing the rationing and the quality of nursing care, and main reasons for rationing of nursing care.

"Mãos de Conforto" (Hands of Comfort): A novel non-pharmacological intervention to ease agitation in elderly persons with dementia.

Behavioral symptoms associated with dementia, such as agitation, are frequent and associated with well-known negative consequences for patients, their carers, and their environment. Pharmacological treatments for agitation using sedatives and antipsychotics are known to have several undesirable side effects and modest efficacy. Non-pharmacological alternatives are recommended as first-line options for agitation in persons with dementia with few side effects, but there is limited evidence of efficacy. We developed a novel and simple non-pharmacological alternative for agitation in dementia residents based on a Brazilian intervention using warm water surgical gloves used in patients with COVID-19 in intensive care units during the pandemic. We coined it "Mãos de Conforto" - Hands of Comfort. We report a series of 7 cases in 3 residents with dementia who whore Hands of Comfort.