Care Outcomes Research Articles

Perceptions regarding attitude towards simulation-based learning among nursing students in Saudi Arabia: A cross-sectional study.

Simulation-based education is essential for preparing nursing students for their professional roles and enhancing their learning experiences and patient care skills. However, there is a gap in understanding how nursing students perceive and engage with simulation-based learning, particularly in the context of Saudi Arabia. This lack of insight limits the ability to develop effective educational strategies. This study aimed to evaluate nursing students' perceptions regarding attitudes toward simulation-based learning in Saudi Arabia. A cross-sectional study was conducted from December 2023 to February 2024, involving 173 nursing students from a single university. Participants completed a structured questionnaire assessing their attitudes toward simulation-based learning, focusing on its relevance, interprofessional education opportunities, communication, situation awareness, and roles and responsibilities. Descriptive statistics were used to analyze the data. Mann-Whitney and Kruskal-Wallis tests were used to examine correlations between variables, with a significance level of p <0.05. The study found that 91.3% of participants had a favorable attitude toward simulation-based learning (Median = 4.43, IQR = 4 - 5). Age and grade level significantly influenced attitudes; younger students (under 20 years) had lower scores (Z = -2.490, p = 0.013), while fourth-year students had higher scores than third-year students, showing a statistically significant difference (H = 8.573, p = 0.014). Additionally, grade point average (GPA) was a significant factor, as students with GPAs between 5.00 and 4.50 scored higher than those in the 3.74-2.75 range (H = 25.893, p <0.001). The study concluded that nursing students in Saudi Arabia have a generally positive attitude toward simulation-based learning, recognizing its importance in enhancing their educational journey and clinical preparedness. These findings highlight the need to integrate simulation-based pedagogical approaches in nursing education to foster critical thinking and improve communication skills, thereby enhancing patient care outcomes.

Exploring Physicians' Perceptions of Digital Health's Impact on the Patient-Physician Relationship in the Primary Health Care Setting: Qualitative Descriptive Study.

Digital health has become essential for effective clinical practice. However, the successful adoption of digital health is dependent on the strength of the patient-physician relationship. The patient-physician relationship shapes the quality of care and impacts health care outcomes, especially in primary care. However, the impact of the increasing use of digital health on the patient-physician relationship is uncertain. This study aims to explore the types of digital health primary care physicians use and understand their impact on the patient-physician relationship from their perspective. This exploratory qualitative descriptive study used individual in-depth interviews guided by a semistructured topic guide. We purposively sampled physicians from 6 general primary care clinics in Singapore and used thematic analysis to identify emergent themes. We conducted 12 interviews. We found that primary care physicians in Singapore had minimal exposure to digital health beyond the scope of institutional implementation. The three key themes that emerged were as follows: (1) evolving roles of both physicians and patients; (2) impact on trust, knowledge acquisition, and longitudinal care; and (3) adoption and use factors of digital health impacting patient-physician relationships. The adoption and use factors comprised "social and personal," "technical and material," and "organization and policy" factors. The study identified that, while primary care physicians held mostly positive views on adopting digital health in improving the patient-physician relationship, they were concerned that digital health might erode trust, hinder proper knowledge acquisition, and reduce humanistic interaction. These concerns called for a nuanced approach to ensure that digital health would not compromise the patient-physician relationship. This could be achieved by ensuring that physicians possess the necessary skills, knowledge, and positive attitude, while health care organizations would provide robust IT capabilities and support. We recommend that education be refined and government policies on digital health adoption and use be revised to align with the goal of strengthening the patient-physician relationship.

HIV Outcomes and Intervention Experiences of Enlaces Por La Salud: A Personal Health Navigation Intervention Informed by the Transnational Framework.

Latinos in the United States are disproportionately affected by HIV and experience sub-optimal levels of viral suppression. Enlaces Por La Salud is an individual-level intervention implemented by personal health navigators and guided by the transnational framework to improve HIV care outcomes among newly diagnosed and out-of-care Mexican and Mexican American men and transgender women in North Carolina. The purpose of this study was to assess: (1) changes in HIV care and treatment outcomes among Enlaces participants and (2) intervention engagement and experiences. Ninety-one participants were recruited between October 2014 and August 2017 for a single-arm, mixed-methods design including surveys at baseline, 6 and 12 months and qualitative in-depth interviews immediately following the intervention with an embedded cohort (n = 19). Mean participant age was 36.8 years and most identified as cisgender male (90%). Participants were significantly more likely to have an undetectable viral load at baseline (18%) compared to 6-months (78%) (p < .001). Outcomes were sustained but not significantly increased from 6 to 12 months. Intervention engagement was high with 81% completing all six intervention sessions. In qualitative interviews, participants emphasized the importance of their relationship with the personal health navigators, who provided information, instrumental, and emotional support. A person-centered intervention guided by the lived experience of migration could be an effective way to support Latinos with HIV from diverse countries of origin to achieve viral suppression and improve overall wellbeing.

Community Nurses' Experiences Assessing Early-Stage Pressure Injuries in People With Dark Skin Tones: A Qualitative Descriptive Analysis.

To examine community nurses' experiences of caring for people with dark skin tones at high risk of developing a pressure injury. Qualitative descriptive design. Focus groups and individual semi-structured interviews were conducted among registered nurses working in the community between November 2023 and March 2024. Thematic analysis was used. The findings reveal the lack of nurse education on diverse skin tones, how community nurses gain knowledge on skin tone diversity in the context of pressure injuries and the topics community nurses believe are crucial to improve the management of pressure injuries in patients with dark skin tones. The study highlights the gap in nurse education regarding diverse skin tones, revealing how community nurses acquire knowledge related to pressure injuries in patients with dark skin tones. This research could inform the development of targeted educational programmes and training initiatives, ultimately preventing patient harm and enhancing the quality of care and health outcomes for patients with dark skin tones. It provides valuable insights into key topics that community nurses consider essential for improving the early recognition and management of pressure injuries in people with darker skin tones. The research adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. A project steering group contributed to the concept of the study and checked the interview questions were relevant and suitable.

Is ABO blood type a risk factor for adjacent segment degeneration after lumbar spine fusion?

This study aimed to explore associations between ABO blood type and postoperative adjacent segment degeneration/disease (ASD) following lumbar spine fusion, as well as evaluate differences in spinopelvic alignment, perioperative care, postoperative complications, and patient-reported outcome measures (PROMs). An ambispective study was performed. Patients who underwent posterolateral or posterior lumbar interbody fusion were included. Demographic, perioperative and postoperative, clinical, and blood type information was recorded. Pre- and post-operative radiographic imaging was analyzed for alignment parameters and development of ASD. 445 patients were included, representing O+ (36.0%), O- (5.2%), A+ (36.2%), A- (6.3%), B+ (12.1%), B- (1.6%), and AB+ (2.7%) blood types. Most patients were female (59.1%), and had a mean age of 60.3 years and BMI of 31.1kg/m2. Postoperatively, groups did not differ in duration of the hospital (p = 0.732) or intensive care unit (p = 0.830) stay, discharge disposition (p = 0.504), reoperation rate (p = 0.192), or in-hospital complication rate (p = 0.377). Postoperative epidural hematoma was most common amongst A + patients (p = 0.024). Over a mean of 11.0 months of follow-up, all patients exhibited similar improvement in PROMs, with 132 (29.7%) patients developing radiographic evidence of ASD. B + patients were significantly more likely than A + and O + patients to develop spondylolisthesis and ASD (p < 0.05). No significant differences in sagittal alignment parameters and number of levels of fusion were found (p > 0.05). This is the first large-scale study to address and demonstrate proof-of-principle that ABO blood type, a non-modifiable risk factor, is associated with ASD following lumbar spine fusion.

Development of quality indicators for hypertension management at the primary health care level in South Africa.

Despite many quality initiatives at the primary health care (PHC) level, little is known about the actual quality of care of patients diagnosed with hypertension in South Africa. This study aimed to develop quality indicators for hypertension management at the PHC level to improve the quality of care and patient outcomes. The RAND/UCLA Appropriateness Method, comprising two rounds, was used to develop clear, appropriate, and feasible evidence-based quality indicators for hypertension. In Round 1, a 9-point scale was used by a panel of 11 members to rate clarity and appropriateness of 102 hypertension quality indicator statements, grouped under 9 dimensions of quality hypertension management, using an online MS Excel® spreadsheet. In Round 2, 9 of the same panellists discussed all indicators and rated their appropriateness and feasibility during a remote online, interactive face-to-face MS Teams® meeting. Statements rated ≥7-9 with agreement were defined as either appropriate or feasible. The panel rated 46 hypertension quality indicator statements ≥7-9 with agreement for the appropriate and feasible measurement of the management of hypertension: monitoring (n = 16), review (n = 5), lifestyle advice (n = 9), tests (n = 7), intermediate outcomes (n = 6), referrals (n = 2) and practice/facility structures (n = 1). No indicator statements were rated both appropriate and feasible for measuring blood pressure levels and treatment. If applied, these indicators would improve monitoring and management of patients with hypertension, patient outcomes, and data quality in South Africa and result in more efficient use of scarce resources. This study can be replicable for improving care of other non-communicable diseases across Africa.

The Measurement of Patients’ Satisfaction as a Key Indicator of Quality of Life for the Elderly: Two Services Compared

AbstractThe ageing population and increasing life expectancy in Italy, and in other developed countries, leads to an increasing number of elderly people suffering from loss of autonomy and dangers due to frailty. As a consequence, elderly patients usually suffer from chronic diseases which require long term care, with increasing healthcare needs and costs. Therefore, services provided by home care, day centers and residential services are necessary; their primary objective being to maximize patient well-being and satisfaction. Patient satisfaction is a key indicator of the quality of care and is an important outcome of care in its own right. This study aimed to develop two generic instruments to elicit patients’ satisfaction in residential care and in home care with a rigorous and systematic methodology. The two instruments were tested for psychometric performance with face-to-face interviews and applied to a Local Health District of the Marche Region. Furthermore, due to physical and mentally frailty, many elderly patients in residential homes or receiving home care, are unable to participate in studies on satisfaction with care services, while their carers/partners can often provide relevant information. Therefore, another aim of this study was to measure patients’ and carers’/partners’ agreement on patient satisfaction in the two services investigated. Finally, the principal factors influencing patient satisfaction in the two services investigated were investigated using logistic regression analysis.

Assessment of the Psychometric Properties of the Hospital's Culture of Nursing Research Scale Among Nurses.

Background and Purpose: The "Hospital's Culture of Nursing Research Scale" (HCNRS) is a critical assessment tool in health care research. It was created in response to the rising acknowledgment of nursing research's critical role in improving patient care outcomes. This study aimed to develop the HCNRS to assess the nurses' perceptions of the hospital's culture of nursing research. Methods: This study utilized the instrument development design in developing the HCNRS. The study was conducted in Astana, Kazakhstan, from May to September 2023. The study followed three major stages of scale development: "item development," "scale development," and "scale evaluation." "Principal component analysis" (PCA; n = 387) and "confirmatory factor analysis" (CFA; n = 362) were performed in this study. Cronbach's coefficient α was computed for reliability. Results: The PCA on the 32-item HCNRS revealed five factors with an eigenvalue of above 1, contributing 66.0% of the model's total variance. The CFA revealed the following findings supporting the five subscales of the HCNRS-R: χ 2 /df = 2.65, root mean square error of approximation = .068 (90% CI [0.063, 0.072]), comparative fit index = 0.92, Tucker-Lewis index = 0.91, and standardized root mean square residual = .04. Based on the items that loaded in each factor, the subscales were labeled "Research Ethics, Integrity, and Supportive Culture," "Nursing Research Institutionalization," "Hospital's Financial Support and Incentives for Research Initiatives," "Nursing Research Engagement and Innovation," and "Nursing Research Integration and Career Support." The computed Cronbach's coefficient α of the entire scale was .963. For its subscales, the Cronbach's coefficient α ranged from .833 to .953. Conclusions: The study developed a five-factor HCNRS to evaluate the multifaceted aspects of nursing research culture in hospital settings. Health care institutions can utilize this scale to identify areas for improvement in research culture and implement strategies to foster research ethics, integrity, and innovation. This tool can also be used by hospital leaders, policymakers, and nurse researchers seeking to evaluate the research culture within their health care organizations.

The Creation of a Free Outpatient Surgical Clinic: A Descriptive Report

Student run free clinics (SRFCs) are continuing to grow in scope and number given the significant benefits to both learners and disadvantaged patients. Despite recent growth, very few provide any form of surgical services. In order to address inequalities in patient access to care and clinical outcomes, it is imperative to include disadvantaged surgical patients, including in the settings of SRFCs. The Kansas City based chapter of Socially Responsible Surgery (SRS) opened a free, volunteer based, student and resident run outpatient surgical clinic. In this article we describe detailed steps to the establishment of the SRS Clinic to lay the framework for other SRFCs or chapters of SRS to continue to grow the number of free clinics able to provide surgical services.

Differential associations between experiences of contraceptive care and subsequent contraceptive access and preferences among family planning patients by racial and ethnic identity: Evidence from Arizona, Iowa, and Wisconsin.

While many frameworks exist for building person-centered and equitable systems of contraceptive care, evidence indicates that the reality of patients' experiences of care is often not in alignment with these ideals. Historical and current contexts of racism in the healthcare system contribute to negative perceptions and experiences of care, as well as reduced care-seeking behavior, for those who identify as Black, Indigenous, and people of color (BIPOC). Our objective in this analysis is to examine whether people's past experiences of contraceptive care are a driver of subsequent barriers to contraceptive access, and whether this relationship differs across racial and ethnic identity. We draw on panel data from five waves of surveys collected between 2018-2023 among patients ages fifteen and older seeking family planning care at sites that receive public funding for these services in Arizona, Iowa, and Wisconsin. Overall and stratified by race/ethnicity, we examine cross-sectional and longitudinal associations between patients' experiences of high-quality, person-centered contraceptive care and three contraceptive access outcomes: use of preferred contraception, satisfaction with contraceptive method, and experience of no barriers to accessing preferred contraception. We find longitudinal associations between patients experiencing higher-quality, more person-centered contraceptive care and subsequent satisfaction with contraceptive methods. Among non-Hispanic white-identifying patients, we find similar associations between shifting to higher-quality contraceptive care and use of preferred contraception, but we find no statistical relationship between experiencing higher-quality care and subsequent contraceptive outcomes for patients who identify as Black, Indigenous, or Person of Color (BIPOC). Highlighting the dissonance between clinical guidance for quality contraceptive care and patient experiences of care, and especially whether similar experiences across racial and ethnic identity lead to differential outcomes, is a crucial step toward bringing contraceptive care systems into alignment with principles of sexual and reproductive health equity.

Building the clinical workforce of pediatric infectious diseases in Bolivia for better care of children with cancer

Abstract Background Infections in children with cancer can be fatal if not appropriately managed. Access to trained and competent professionals in infection care and prevention (IC&amp;P) improve care outcomes. Bolivia expects about 1700 new pediatric cancer cases annually. In 2023, 2371 hematological neoplasms were reported in children, cared mainly at 4 public hospitals where, until 2016, 5 pediatric infectious disease (PID) specialists were working in 2 of these 4 hospitals. For better PID clinical workforce for critically ill children, we built a PID medical residency training. In 2017, the training accepted its first trainees at Hospital del Niño “Dr. Ovidio Aliaga Uría” (Hospital del Niño), a public hospital in La Paz. Here, we describe the program, how we built it, and its outcomes. Methods The PID training goal is to train leaders in PID for clinical observations, PID literature interpretation, and to transform them into concepts that can be applied to ID pathogenesis or treatment. At the end of the 2-year PID training program, we expect trainees will gain expertise in PID clinical practice and clinical or translational science research. Our PID program was based on other PID specialty training programs from Mexico, Spain, and the USA of which, we adapted standard topics and formats of training. The content has routine and prevalent PIDs of Bolivia and the region, including on immunocompromised patients. We expected that the trainee dedicate full time to the PID training program plus caring for assigned patients and those requested consultations in the wards and clinics of Hospital del Niño; review articles; participate in clinical discussions; attend the Infection Control Course of St. Jude Children’s Research Hospital; attend and / or present in the PID case-based learning international sessions; visit the virology, bacteriology, parasitology and immunology laboratories of the national reference laboratory; and attend international rotations at participating hospitals. Results Since 2017, 5 new PID pediatricians graduated from our program, 3 work in public hospitals that care for children with cancer and 2 work in government insurance hospitals. They are working in hospitals in La Paz (n=2), Cochabamba (n=1), Santa Cruz (n=1), and Tarija (n=1). These graduates are leaders in ICP, antimicrobial stewardships, and education of hospital staffs. As per December 2023, they produced 5 articles for local journals, 2 for international journals, 7 abstracts for scientific meetings. Currently, 2 pediatricians participate in the PID training program, and post-graduation, they plan to work in departments of Potosí and Sucre where there are no PID specialists. Challenges to establish PID specialists in Bolivia are lack of value attributed to PID and its role in care quality. Conclusion Creating local expertise in PID are essential to improve and sustain the optimum care for children with cancer in Bolivia especially in places where these personnel did not exist before. However, for best investment return of PID trained professionals, having PID job descriptions and paid positions in hospitals will absorb PID specialists to benefit the largest population of children with cancer in Bolivia.

The influence of age, gender and pharmacogenetic profiles on the perspective on medicines in the German EMPAR study.

Pharmacogenetic testing in routine care could provide benefits for patients, doctors and statutory health insurances. Therefore, the aim of the retrospective, observational study Einfluss metabolischer Profile auf die Arzneimitteltherapiesicherheit in der Routineversorgung (EMPAR) was to analyze the relationship between pharmacogenetic profiles, the risk of adverse drug reactions, and patients' perceptions of drug therapy in 10748 adult (≥18 years) participants in Germany. A questionnaire was used to assess views and beliefs about medicines and participants individual perception of sensitivity to drug therapies. The questionnaire consisted of the Beliefs about Medicines Questionnaire (BMQ)-General scales (Overuse, Harm, Benefit), the Perceived Sensitivity to Medicines (PSM), Natural Remedy, and Gene Testing scales. The influence of gender, age, study collective, genotype and phenotype of relevant pharmacogenes on participant's perception were evaluated. Overuse, PSM and Benefit scores were significantly higher among patients of the collective International Classification of Diseases and Health Related Disorders (ICD)-10 Y57.9! diagnosis, which indicates complications related to drugs, compared to the anticoagulant/antiplatelet and cholesterol-lowering drug collective. Age and gender also played a significant role in patients' perceptions, with younger patients and female participants more likely to believe in medication overuse according to the Overuse scale score compared to older and male participants. Female participants compared to male participants and the old age group compared to the young and/or middle-age subgroup, scored higher in PSM and/or Harm scales, respectively. Only a tendency of increased Harm, Overuse and PSM scores was observed in the participant group with five or more relevant actionable variants compared to subgroups with 0 up to 4 variants. In conclusion, patients' beliefs about medicines and their drug sensitivity perceptions are influenced by various factors including age, gender, previous complications with medicines, and with some tendency also pharmacogenetic profiles. The higher association with more negative views related to treatment indicates that there is a need to target the underlying issues in affected patient groups in order to improve compliance to treatment and outcomes in routine care. Trial registration: EMPAR was registered in the German Clinical Trials Register (DRKS) on 06 July 2018 (DRKS00013909).

Impact of pre-existing dementia on neurosurgical intervention and outcomes in older patients with head injury: an analysis of a nationwide trauma registry in Japan.

Dementia is a common comorbidity in older patients with traumatic brain injury (TBI), potentially affecting their care processes and outcomes. However, the impact of pre-existing dementia on TBI remains unclear as research on TBI often excludes older adults with comorbidities. This study aimed to investigate the association between pre-existing dementia and outcomes in older patients admitted to hospitals after TBI. This observational study included patients aged ≥ 65years with TBI who were identified from the Japan Trauma Data Bank between January 1, 2019, and December 31, 2021. Associations between pre-existing dementia and outcomes were assessed using multivariable logistic regression analysis. The primary outcome was survival at discharge. Secondary outcomes were neurosurgical interventions and discharge to home. In total, 16,270 patients from 175 hospitals were analyzed. Of these, 1,750 (10.8%) had pre-existing dementia, and 13,520 (83.1%) survived to discharge. No significant association was observed between pre-existing dementia and neurosurgical interventions and survival at discharge. In contrast, pre-existing dementia was associated with a significantly lower likelihood of being discharged to home. Subgroup analysis revealed interactions between pre-existing dementia and the subgroups, showing adverse impact in relatively younger patients and those without severe head injury. Patients with pre-existing dementia had similar chances for neurosurgical intervention and survival at discharge than their counterparts without dementia. However, pre-existing dementia was associated with a significantly lower likelihood of being discharged to home, especially in relatively younger patients and those without severe head injury. Therefore, recognizing the risks within this population and taking measures to facilitate social reintegration is necessary.

The Impact of Tocilizumab Coverage on Health Equity for Inpatients with COVID-19 in the USA: A Distributional Cost-Effectiveness Analysis.

We conducted a distributional cost-effectiveness analysis to evaluate how coverage of tocilizumab for inpatients with COVID-19 from 2021 to present impacted health equity in the USA. A published, payer-perspective, distributional cost-effectiveness analysis for inpatient COVID-19 treatments was adapted to include information on baseline health disparities across 25 equity-relevant subgroups based on race and ethnicity (5 census-based groups), and county-level social vulnerability (5 geographic quintiles). The underlying cost-effectiveness analysis was updated to reflect patient characteristics at admission, standard of care outcomes, tocilizumab efficacy, and contemporary unit costs. The distributional cost-effectiveness analysis inputs for COVID-19 hospitalization and subgroup risk adjustments based on social vulnerability were derived from published estimates. Opportunity costs were estimated by converting total tocilizumab spend into quality-adjusted life-years (QALYs), distributed equally across subgroups. Tocilizumab treatment was cost effective across all subgroups. Treatment resulted in larger relative QALY gains in more socially vulnerable subgroups than less socially vulnerable subgroups, given higher hospitalization rates and inpatient mortality. Using an opportunity cost threshold of US$150,000/QALY and an Atkinson index of 11, tocilizumab was estimated to have improved social welfare by increasing population health (53,252 QALYs gained) and reducing existing overall US health inequalities by 0.003% since 2021. Use of tocilizumab for COVID-19 since 2021 increased population health while improving health equity, as more patients with lower baseline health were eligible for treatment and received larger relative health gains. Future equitable access to tocilizumab for inpatients with COVID-19 is expected to lead to continued increases in population health and reductions in disparities.

Reducing Opioid Consumption and Length of Stay After Bariatric Surgery: A Nonpharmacologic ERAS Intervention Bundle

PurposeTo reduce opioid consumption and decrease length of stay (LOS) in bariatric surgical patients by implementing an evidence-based, nonpharmacologic enhanced recovery after surgery (ERAS) intervention bundle. DesignEvidence-based practice project. MethodsWe developed and implemented a nonpharmacologic ERAS bundle from existing American Society of PeriAnesthesia Nurses Standards and bariatric and subspecialty surgical ERAS protocols to standardize the postoperative nursing care of bariatric patients. The bundle consisted of early ambulation, immediate initiation and prolonged use of oxygenation, prevention of nausea and vomiting, frequent use of incentive spirometry, and application of ice packs to surgical sites. The two project outcomes were opioid consumption and patient LOS. We used descriptive statistics to summarize opioid consumption and LOS among surgical bariatric patients at baseline and post intervention and independent samples t tests to determine the statistical significance of pre- or post-LOS changes. FindingsAfter implementing the ERAS bundle in 31 bariatric surgical patients, we found that the percentage of patients given an opioid substantially decreased by 13.8%, with both fentanyl and hydromorphone (Dilaudid) consumption meaningfully decreasing by 11.0% and 25.6%, respectively. The average LOS significantly decreased (P = .015) by 23 minutes per patient following the intervention, from 1 hour and 58 minutes to 1 hour and 35 minutes, representing a 19.5% reduction in total patient time in the PACU. ConclusionsUse of a nonpharmacologic ERAS bundle and standardizing postoperative care decreased overall PACU bariatric surgical patient opioid consumption and significantly reduced PACU LOS. Optimizing pain management for bariatric patients in the PACU could lead to improved pain control and reduced reliance on opioids during their entire hospital stay, enhancing health care outcomes and improving patient safety. Perioperative leaders and educators can use our example to develop initiatives that decrease opioid use and LOS to improve care for the high-acuity bariatric patient population.

A comparative analysis of vacuum assisted closure therapy and conventional dressings: outcomes in chronic diabetic foot ulcers among Indian patients

Background: India faces a growing diabetes epidemic, with approximately 77 million individuals affected. Chronic non-healing diabetic foot ulcers (DFUs) are a common complication of diabetes and a major healthcare challenge in Conventional wound care methods often result in prolonged healing times, increasing the risk of infection, hospitalization, and amputations. Vacuum-assisted closure (VAC) therapy, a modern treatment modality, offers a potentially more effective approach to managing these ulcers. Methods: This prospective, observational study was conducted at a tertiary care hospital in India from March 2022 to March 2024. One hundred patients with chronic non-healing DFUs were randomized into VAC therapy or conventional dressing groups. The primary outcomes included wound size reduction and healing time, while secondary outcomes involved patient satisfaction and cost-effectiveness. Results: VAC therapy significantly reduced wound size (65.2% vs. 40.5%) and shortened healing time (6.2 vs. 10.9 weeks) compared to conventional dressings. Additionally, VAC therapy led to higher patient satisfaction and proved more cost-effective due to fewer dressing changes and shorter hospital stays. Conclusions: VAC therapy outperforms conventional dressings in managing DFUs, offering faster healing, better patient satisfaction, and cost-effectiveness. Expanding its use in India could greatly improve diabetic foot care outcomes.

Innovative and best models of palliative and end-of-life care - with focus on rural and remote communities.

The review aims to synthesize the most recent innovative models of palliative care being delivered in rural and remote locations. Worldwide, as the ageing population grows, more people will require palliative care. However, equal availability of high-quality palliative care services remains a significant challenge, particularly in rural and remote communities. Innovative models of palliative care have been developed to address the projected need of people in rural and remote areas. Models that leverage the use of digital healthcare (such as telecare and Artificial Intelligence), the non-specialized palliative care workforce (such as GPs, pharmacists, and family carers), and community driven approaches have demonstrated success in achieving positive palliative care outcomes, such as reduced physical and emotional distress, and family carers feeling more supported. There is a need to support people to remain within their rural and remote communities towards the end-of-life (EOL). While some models of care have been identified to help with this, there continues to be significant difficulties in access to health and social care in rural and remote areas. It is important we build on this research to understand more broadly the models of support for those living in remote and rural communities at the EOL.

Impacts of age and BMI on vancomycin model choice in a Bayesian software: Lessons from a very large multi-site retrospective study.

Model-informed precision dosing (MIPD) optimizes drug doses based on pharmacokinetic (PK) model predictions, necessitating careful selection of models tailored to patient characteristics. This study evaluates the predictive performance of various vancomycin PK models across diverse age and BMI categories, drawing insights from a large multi-site database. Adults receiving vancomycin intravenous therapy at United States health systems between January 1, 2022, and December 31, 2023, were included. Patient demographics, vancomycin administration records, and therapeutic drug monitoring levels (TDMs) were collected from the InsightRX database. Age and body mass index (BMI)-based subgroups were formed to assess model performance, with predictions made iteratively. The optimal model for each age-BMI subgroup was chosen based on predefined criteria: models were filtered for mean percentage error (MPE) ≤ 20% and normalized root mean squared error (RMSE) < 8 mg/L, and then the most accurate among them was selected. A total of 384,876 treatment courses across 155 US health systems were analyzed, contributing 841,604 TDMs. Eleven models were compared, showing varying accuracy across age-BMI categories (41%-73%), with higher accuracy observed once TDMs were available for Bayesian estimates of individual PK parameters. Models performed more poorly in younger adults compared to older adults, and the optimal model differed depending on age-BMI categories and prediction methods. Notably, in the a priori period, the Colin model performed best in adults aged 18-64 years across most BMI categories; the Goti/Tong model performed best in the older, non-obese adults; and the Hughes model performed best in many of the obese categories. Our study identifies specific vancomycin PK models that demonstrate superior predictions across age-BMI categories in MIPD applications. Our findings underscore the importance of tailored model selection for vancomycin management, especially highlighting the need for improved models in younger adult patients. Further research into the clinical implications of model performance is warranted to enhance patient care outcomes.

Forensic assessment of maternal deaths from the COVID-19 during the 2021 pandemic

BACKGROUND: According to the literature, the mortality rate from SARS-CoV-2 infection among pregnant women is up to 25%. The high-risk group for the development of severe forms of COVID-19 includes pregnant women with extragenital pathology. Obstetric tactics are determined by the severity of the condition of the mother and fetus, as well as the duration of pregnancy. The decision on early delivery is made as a result of an interdisciplinary medical consultation. Delivery in the midst of the disease is associated with an increase in maternal mortality. According to the literature, including our own research, it has been established that the basis for favorable perinatal outcomes in patients with severe and moderate forms of COVID-19 is: an adequate assessment of the condition of the pregnant woman and fetus (especially at the outpatient stage, where the pregnant woman goes first), early hospitalization, early initiation of intensive care and timely delivery before the onset of irreversible organ changes in pregnant women. AIM: The aim of this study was to analyze the tactics of pregnancy management, delivery and perinatal outcomes, assessing the quality of medical care at the outpatient and hospital stages provided to pregnant women who died in a specialized obstetric hospital from the extremely severe new coronavirus infection COVID-19 (based on the data of commission forensic examinations). MATERIALS AND METHODS: This retrospective study of pregnancy outcomes was performed in 11 patients who died from complications of extremely severe COVID-19 in a regional specialized obstetric hospital in Russia based on the data of commission forensic examinations performed in the Bureau of Forensic Medical Examination (Saint Petersburg, Russia) in 2021, at gestation periods of 28–34 weeks (n = 7) and 37–39 weeks (n = 4) in the context of assessing the quality of medical care in the field of obstetrics and gynecology. We confirmed the diagnosis of the new coronavirus infection COVID-19 in 10 (90.9%) patients by SARS-CoV-2 RNA identification using polymerase chain reaction in a nasopharyngeal smear on an average of 4.9 ± 3.6 days from the onset of the disease. In one patient, the clinical diagnosis was confirmed postmortem by the detection of SARS-Cov-2 RNA during autopsy (in the trachea, lungs, and spleen). All patients in the hospital underwent a comprehensive anamnestic, clinical and laboratory examination in the amount regulated by the administrative regulations of the Ministry of Health of the Russian Federation that were relevant at the time of providing medical care. Nine (81.8%) patients sought medical help from a local therapist on 3.1 ± 1.6 days from the onset of the disease and received outpatient treatment for 3.4 ± 1.8 days, two patients not seeing a doctor and receiving outpatient care. The average time before admission to the specialized obstetric hospital was 6.0 ± 2.2 days from the onset of the disease. RESULTS: During the forensic assessment of the medical records of deceased patients, significant defects in the quality of medical care were identified in the framework of this study at the stages of information collection, diagnosis, treatment, and succession. An indirect causal relationship was established between the most significant defects in the quality of medical care and adverse pregnancy outcomes, since the cause of death or critical conditions were individually determined severe complications, rather than defects in medical care, which, nevertheless, does not exclude their significance in the totality of causes of severe maternal outcomes. CONCLUSIONS: The data obtained indicate the need for earlier delivery in pregnant women with the new coronavirus infection COVID-19 before the appearance of irreversible changes in patients with progressive respiratory failure, multiple organ failure syndrome, systemic inflammatory response syndrome, and cytokine storm.

Precision emergency medicine in health care delivery and access: Framework development and research priorities.

The integration of precision emergency medicine (EM) into our conceptualization of the health care system affords the opportunity to improve health care access, delivery, and outcomes for patients. As part of the Society for Academic Emergency Medicine (SAEM) Consensus Conference, we conducted a rapid literature review to characterize the current state of knowledge pertaining to the intersection of precision EM (defined as the use of big data and technology to deliver acute care for individual patients and their communities) with health care delivery and access. We then used our findings to develop a proposed conceptual model and research agenda. We completed a rapid review of the existing literature on the utilization of big data and technology to ensure and enhance access to acute/unscheduled care for individual patients and their communities. Literature searches were conducted using Ovid MEDLINE, Embase.com, Cochrane CENTRAL via Ovid, and ClinicalTrials.gov in January 2023. Using the identified articles, we determined core domains, developed a framework to guide the conceptualization of precision EM in health care delivery and access, and used these to identify a research agenda. Of the 815 studies identified for initial screening, 60 underwent full-text review by our technical expert panel and 21 were included in the evaluation. Core domains identified included expedited/personalized prehospital care, delivery to the right level of care, personalized ED care, alternatives to ED care/post-ED care, prediction tools for system readiness, and creation of equitable systems of care. A research agenda with four priority research questions was defined following identification of the core domains. Precision EM includes consideration of the health care delivery system as a mechanism for improving access to emergency care using data-driven strategies. This provides a unique opportunity to use data and technology to advance systems of care while also centering patients, communities, and equity in these advances.