Patients In Hospital Wards Research Articles

Prevalence of Drug Resistance and Pathogenic Factors of Pseudomonas aeruginosa Isolates Recovered from Hospitalized Patients

Background: Humans can develop both acute and chronic infections from Pseudomonas aeruginosa, a bacterium that is a prominent cause of nosocomial infections, as well as respiratory, urinary tract, burn, wound, ear, eye, and bloodstream infections. Objectives: This study aimed to identify antibiotic resistance in P. aeruginosa strains obtained from hospitalized patients and assess the frequency of virulence genes. Methods: In this cross-sectional study, 86 strains of P. aeruginosa were isolated from patients in various hospital wards in Shiraz and Yasuj in 2021. Antibiotic susceptibility was tested using the disk diffusion method, while the frequency of virulence genes (aprA, phzM, phzS) and antibiotic resistance genes (blaGES, blaSPM, blaVIM) was evaluated using PCR and specific primers. Results: The P. aeruginosa isolates showed the highest antibiotic resistance to imipenem and the lowest resistance to piperacillin-tazobactam. PCR amplification of aprA, phzM, and phzS genes indicated that aprA had the highest frequency among the isolates, with a prevalence of 98.8%. The frequencies of phzM and phzS were 96.5% and 91.9%, respectively. Conclusions: This study revealed a high prevalence of the virulence genes aprA, phzM, and phzS in P. aeruginosa isolates. Given the bacterium’s resistance to many antibiotics, clinicians should exercise caution when prescribing antibiotics, particularly for infections caused by P.aeruginosa.

Characteristics of Rapid Response Team Calls in a Tertiary Hospital in Egypt

Abstract Background Rapid Response Teams (RRTs) help in the early recognition of deteriorating patients in hospital wards, and provide the needed management at the bedside by a qualified team. Aim of the Work To describe the characteristics of the RRT calls in a tertiary hospital in Egypt. Patients and Methods A prospective cohort study for a one-year duration from January 2021 till December, 2021was conducted, during this period a total of 2338 patients were reviewed, and 34 RRT calls were recorded. Results Our results showed that 10 calls (63%) of Rapid Response Team calls were in the daytime, and Nurses were the main activators with 27 activations (90%). Modified Early Warning scoring system (MEWS) and Pediatric Early Warning Score (PEWS) used were the main cause of RRT activation with a total of (66.7%), the majority of cases didn’t refer to the Intensive Care Unit (ICU), 19 patients stay in the ward (76%) and 22 cases (100%) were recovered. Conclusion More than half of RRT calls were in the daytime, and nurses were the main activators. Most rapid response team activations involve relatively few interventions, patient-activated RRT should consider as a patient right in the future, and further studies showed be conducted to evaluate the best effective methods for applying RRT among different health care facilities.

Effectiveness of Rapid Response Team implementation in a tertiary hospital in Egypt: an interventional study

BackgroundRapid response teams (RRTs) help in the early recognition of deteriorating patients in hospital wards and provide the needed management at the bedside by a qualified team. RRT implementation is...

Oral health education strategies for patients living with cardiovascular disease within hospital settings: a scoping review.

To identify and describe the impact of current oral health education programmes provided to patients in cardiology hospital wards and outpatient clinics. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Scoping Reviews statement. Searches were conducted using electronic databases: Cochrane, Medline, and Scopus, as well as grey literature searching. Three eligible studies were identified. All included studies reported generalised poor oral health in their participants at baseline, with significant improvement at follow-up. They all reported significant reductions in plaque deposits and gingival bleeding. One study reported significantly less bacteria on participant tongues, as well as fewer days with post-operative atrial fibrillation in the intervention group. Furthermore, in this study, one patient in the intervention group developed pneumonia, whilst four patients in the control group did. Oral health education for patients with cardiovascular disease is limited and many have poor oral health. Educational programmes to improve oral health behaviours in patients with cardiovascular disease can improve both oral and general health outcomes. Oral disease is a modifiable risk factor for cardiovascular disease. Integrating oral health education into cardiology hospital settings is a simple strategy to improve access to oral health information and improve both oral and cardiovascular outcomes.

Capability to identify and manage critical conditions: effects of an interprofessional training intervention

BackgroundThe burden of critical illness is a global issue. Healthcare systems often fail to provide essential emergency and critical care for deteriorating patients, and the optimal strategy for ensuring safe care is not fully known. This study aimed to explore the capability to identify and manage critical conditions and to evaluate how an interprofessional training intervention that included theory as well as high-fidelity simulation (proACT) in the short and long term affected the capability.MethodsA questionnaire study was performed. A cross-sectional survey of all in-hospital nurses and physicians in a Swedish region (n538) and a longitudinal cohort of participants entering the proACT course during a six-month period (n99) were included. Descriptive and comparative statistics were generated. Additionally, qualitative content analysis was performed for free text answers.ResultsThe findings demonstrated that the intervention improved the individual healthcare professionals’ competence with a sustained effect over time. The coverage of proACT trained staff increased from 13.2% to 26.5%, but no correlation was observed with workplace conditions that support safe care. Collaboration and workplace climate were perceived to be mainly positive, but for safer care, an overall need for improved competence and staffing was emphasized.ConclusionsThe present study confirms previously identified issues and the need for improvements in the care of critically ill patients in general hospital wards. It supports the notion that a training intervention, such as proACT, can increase the capability to identify and manage patients with critical conditions. All healthcare professions increased the competence. Hence, more effort is needed to enable staff of all professions to participate in such training. Studies of interventions cover higher number of trained staff in the setting are warranted to clarify whether the training can also improve workplace conditions that support safe care of deteriorating and critically ill patients.

Patient aggression experienced by professional nurses in acute psychiatric ward: South Africa.

Aggression of patients in hospital wards has become an endemic problem and professional nurses are particularly at high risk. This article presents the types of patient aggression experienced by professional nurses working in an acute psychiatric ward in Vhembe District, South Africa. Vhembe District, South Africa. A qualitative approach using exploratory, descriptive and contextual research design was used. Four hospitals were purposively selected and 10 professional nurses were conveniently sampled to participate in the study. Individual interviews were used to collect data, which were then analysed through Tesch Open Coding Method. Measures to ensure trustworthiness and ethical considerations were adhered to throughout the study. This study shed some light on the professional nurses' lived experiences regarding the types of aggression from patients in an acute psychiatric ward in Vhembe District. The types of aggression are physical aggression, destructive behaviour and verbal aggression. The findings show that the types of aggression to which professional nurses are exposed are overwhelming and the consequences are shocking. As a result, the health of professional nurses is compromised. Therefore, this study recommends further studies to determine the kind of support needed by professional nurses working in an acute psychiatric ward and to investigate the impact of aggression from patients in acute psychiatric ward with regard to the quality of care. This article contributes to the body of knowledge regarding patients' aggression in acute wards in Vhembe District, South Africa.

Their children.

A poem describing the author's emotional response to seeing the children of elderly patients in hospital wards. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Respecting the Patient's Right to Information in Hospital Wards in Poland - Socio-Economic Determinants of Patients' Opinions.

Implementation of the patient's statutory right to information is one of determinants the quality and safety of medical services. The patients' opinions survey is an element of patient-centric care, which is now one of the most important things in modern healthcare. The main aim of the work is to examine patients' opinions on the observance of patients' right to information in the hospital and quality of healthcare in the hospital. A secondary objective was to examine the impact of socioeconomic variables on patients' opinions. The study was based on the Computer-Assisted Web Interview (CAWI) questionnaire, carried out in March 2022. The sample included 801 persons. Respondents were patients hospitalized within a maximum of 12 months. The questionnaire contained closed questions about the quality of medical care, observance of the patient's right to information. Probability of referral was measured using the Net Promoter Score (NPS). Respondents answered the question about the recommendation on a scale from 0 to 10. People who rated the hospital ward at 10 and 9 are promoters, people who rated the hospital ward at 8 and 7 are neutral people. In turn, people who rated the hospital ward at 6, 5, 4, 3, 2, 1 or 0 are critics, ie people who will not recommend the hospital to their relatives. Most patients in hospital wards were the detractors (37%). The percentage of promoters was only 1% lower (36%) than that of the detractors. Patients was rated medical and nursing staff at a similar level with regard to the observance of the patient's right to information. Most statistically significant differences in the assessment of medical care in the hospital ward were associated with such sociodemographic variables as age and income. People aged 55-64 and 65+ rated most of the analyzed aspects better.

Students' Attitudes Toward the Clinical Learning Environment and Clinical Supervision in Nursing College at the University of Mosul

Background: Clinical training is a part of nursing education and it is the way to prepare nursing students to become responsible for providing high quality of care as nursing care professionals. Objectives: Assessing students' attitudes toward the clinical learning environment and clinical supervision. Also, identifying if student class and the patient’s number in the wards had an effect on attitudes. Methodology: A descriptive study design and choose a random sample consisted of (200) students from Nursing College at Mosul University. The present study was conducted from the 1st March of 2022 to the 1st of March 2023. The questionnaire comprises first section which contains demographic characteristics. The second section include (12) questions for a clinical environment, In addition, the third section was (12) questions for clinical supervision. Results: Students had negative attitudes toward clinical supervision and the clinical learning environment (42%, 36.5%) respectively. The current study found a significant relationship between students' attitudes and the role of the clinical supervisor at a P-value equal to or less than 0.05. Conclusion:Nursing students had mixed attitudes, with negative attitudes about clinical supervision and positive attitudes about the clinical learning environment. In addition, determining the class of students and the number of patients in hospital wards had an impact on students' attitudes

Do We Need more Volunteer Work in Medicine? Project Examples from Trauma Surgery

The nursing shortage, legal requirements, and funding deficits have led to increasingly poor patient care in German hospitals.Volunteer patient companions offer support by conversing with and caring for patients. This can work to relieve hospital staff while diminishing patients' fears/worries.Volunteer companions visited selected lonely and thus, delirium-prone patients in hospital wards and spent approximately one hour with patients conversing, playing, reading aloud, or mostly listening. A surgical escort service was also offered. Patients met the escort one day in advance. The escort then accompanied the patient to the operating room and later from recovery back to the ward. Transition companions were assigned to provide support after discharge. They contacted patients prior to discharge and assisted patients in organizing their home environment as well as continued social and medical care.From 1 July 2017 until 1 April 2023, 12000 patient companions were provided in 14 wards of 4 hospitals. Using a German school grading system (1 to 6, with 1 as the optimum), the volunteers' evaluation of their success averaged 1.3, and the patients' assessments averaged 1.2. Since November 2020, 120 surgery escorts were carried out by volunteers in trauma surgery. These were so successful that we now also make a comparable offer with a family member for all older patients. Since 2022, 30 transition companions have successfully supported patients at home in a pilot project.Volunteering in and around the hospital offers important support to older and single patients while relieving the hospital medical staff. It is a "win-win-win-win situation" for patients, volunteers, staff, and management.

Intra- and Extra-Hospitalization Monitoring of Vital Signs—Two Sides of the Same Coin: Perspectives from LIMS and Greenline-HT Study Operators

Background: In recent years, due to the epidemiological transition, the burden of very complex patients in hospital wards has increased. Telemedicine usage appears to be a potential high-impact factor in helping with patient management, allowing hospital personnel to assess conditions in out-of-hospital scenarios. Methods: To investigate the management of chronic patients during both hospitalization for disease and discharge, randomized studies (LIMS and Greenline-HT) are ongoing in the Internal Medicine Unit at ASL Roma 6 Castelli Hospital. The study endpoints are clinical outcomes (from a patient’s perspective). In this perspective paper, the main findings of these studies, from the operators’ point of view, are reported. Operator opinions were collected from structured and unstructured surveys conducted among the staff involved, and their main themes are reported in a narrative manner. Results: Telemonitoring appears to be linked to a reduction in side-events and side-effects, which represent some of most commons risk factors for re-hospitalization and for delayed discharge during hospitalization. The main perceived advantages are increased patient safety and the quick response in case of emergency. The main disadvantages are believed to be related to low patient compliance and an infrastructural lack of optimization. Conclusions: The evidence of wireless monitoring studies, combined with the analysis of activity data, suggests the need for a model of patient management that envisages an increase in the territory of structures capable of offering patients subacute care (the possibility of antibiotic treatments, blood transfusions, infusion support, and pain therapy) for the timely management of chronic patients in the terminal phase, for which treatment in acute wards must be guaranteed only for a limited time for the management of the acute phase of their diseases.

Safety And Efficacy Evaluation Of The Oxyjet Cpap Device Compared To High-flow Nasal Oxygen For Treating Hypoxemic Covid-19 Patients In General Hospital Wards: A Randomized Controlled Trial

Background: During the COVID-19 pandemic, general wards generally were capable of providing up to 15L/ min of oxygen. Shortage of Intensive Care Unit (ICU) beds, High-Flow Nasal Oxygen (HFNO), and other intermediary devices have caused many premature deaths during the pandemic. During this period, we have developed OxyJet CPAP, a locally-made 3D printed continuous positive airway pressure (CPAP) device that can provide up to 60 liters/min of oxygen without electric power. This study assessed whether the OxyJet CPAP could be a non-inferior alternative to an HFNO device in COVID-19 wards. Methods: We performed an open-label, parallel-assignment, randomized controlled trial in 45 patients admitted to the general COVID- 19/suspected wards of Dhaka Medical College Hospital (DMCH), Bangladesh, between April 17, 2021, and July 9, 2021. Eligible patients were confirmed/suspected COVID-19 aged between 18—65 with oxygen saturation (SpO2) between 85—90% while being treated with a non-rebreather mask at 15L/min of 100% oxygen. We used a computerized pseudorandom sequence generator for randomization. The sample size was calculated based on a non-inferiority margin of 1.5 days. Analysis was intention-to-treat. Results: The primary outcome of the trial was ventilator-free days (VFDs) within a 10-day period assessed after study completion. A total of 180 patients were screened, and 45 eligible patients were enrolled. We randomly assigned 23 (51.11%) patients to receive CPAP and 22 (48.89%) patients to receive HFNO. For the CPAP and HFNO arms, the mean value of the primary outcome was found to be 7.41 (STD 3.68) and 6.6 (STD 3.69) days, respectively. The mean difference in the primary outcome was 0.81 (95% CI -1.41—3.03), with the lower bound above the non-inferiority margin, thus, establishing the non-inferiority hypothesis (p = 0.021). Adverse events (AE) were recorded according to the Common Terminology Criteria for Adverse Events (CTCAE) scale (1—5). In the CPAP and HFNO arms, the mean CTCAE scale was found to be 1.39 (STD 0.499) and 1.59 (STD 0.503), respectively, showing no significant difference (p = 0.189). In Post Hoc analysis, we found that, on average, the OxyJet CPAP requires significantly less oxygen per patient compared to HFNO with a median difference of -16.11 L/min (95% CI -24.63—-6.67, p=0.001). Conclusion: The results show that the OxyJet CPAP treatment was non-inferior compared to the HFNO treatment. In the context of many hospitals in Bangladesh, especially in rural areas, using the locally made OxyJet CPAP could provide significant benefits due to its lower cost and usability. This device can be used as an effective bridging therapy reducing ICU admissions in the general ward settings or preserving life while awaiting resource availability. In addition, the device can also be used in emergencies and ambulances. The Directorate General of Drug Administration (DGDA) has provided limited approval of the device for hospital use. Currently, we are using the device in different hospitals for hypoxemic patients. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 206-207

Deviations in continuously monitored electrodermal activity before severe clinical complications: a clinical prospective observational explorative cohort study

Monitoring of high-risk patients in hospital wards is crucial in identifying and preventing clinical deterioration. Sympathetic nervous system activity measured continuously and non-invasively by Electrodermal activity (EDA) may relate to complications, but the clinical use remains untested. The aim of this study was to explore associations between deviations of EDA and subsequent serious adverse events (SAE). Patients admitted to general wards after major abdominal cancer surgery or with acute exacerbation of chronic obstructive pulmonary disease were continuously EDA-monitored for up to 5 days. We used time-perspectives consisting of 1, 3, 6, and 12 h of data prior to first SAE or from start of monitoring. We constructed 648 different EDA-derived features to assess EDA. The primary outcome was any SAE and secondary outcomes were respiratory, infectious, and cardiovascular SAEs. Associations were evaluated using logistic regressions with adjustment for relevant confounders. We included 714 patients and found a total of 192 statistically significant associations between EDA-derived features and clinical outcomes. 79% of these associations were EDA-derived features of absolute and relative increases in EDA and 14% were EDA-derived features with normalized EDA above a threshold. The highest F1-scores for primary outcome with the four time-perspectives were 20.7–32.8%, with precision ranging 34.9–38.6%, recall 14.7–29.4%, and specificity 83.1–91.4%. We identified statistically significant associations between specific deviations of EDA and subsequent SAE, and patterns of EDA may be developed to be considered indicators of upcoming clinical deterioration in high-risk patients.

Carbapenem resistance among Gram-negative isolates collected from patients in ICU and non-ICU hospital wards in Hong Kong: SMART 2017–2020

To estimate carbapenem resistance in Pseudomonas aeruginosa and Enterobacterales isolated from infected patients in intensive-care unit (ICU) and non-ICU hospital wards in Hong Kong. Isolates of P. aeruginosa (ICU, n=35; non-ICU, n=264) and Enterobacterales (ICU, n=129; non-ICU, n=1390) were collected in four Hong Kong hospitals in 2017-2020. CLSI broth microdilution MICs were interpreted by CLSI 2021 M100 breakpoints. β-lactamase genes were identified in imipenem-, imipenem/relebactam-, and ceftolozane/tazobactam-non-susceptible isolates. Ceftolozane/tazobactam demonstrated potent in vitro activity against both P. aeruginosa (ICU, 88.6%; non-ICU, 98.5%) and Enterobacterales (96.1% susceptible; 97.1%). Percent susceptible values for P. aeruginosa isolates from ICU and non-ICU patients were: meropenem (ICU, 74.3%; non-ICU, 84.1%) and imipenem (68.6%; 73.1%). Only one of 77 isolates tested for β-lactamase genes carried a carbapenemase (VIM-2). Percent susceptible values for Enterobacterales isolates from ICU and non-ICU patients were: meropenem (100%; 99.4%), ertapenem (100%; 98.0%), and imipenem (88.4%; 88.6%). 62 Enterobacterales isolates were tested for β-lactamase genes. Only three isolates carried a carbapenemase gene; two (both Escherichia coli) were metallo-β-lactamase-positive (both NDM-5) and one (Klebsiella pneumoniae) was OXA-48-like-positive. Carbapenem-nonsusceptible isolates of P. aeruginosa were common (>15% of isolates). P. aeruginosa percent susceptible values to ceftolozane/tazobactam (97.3% susceptible overall) were ≥14% higher than carbapenems for both ICU and non-ICU isolates. Carbapenemases were rare among both P. aeruginosa (one isolate) and Enterobacterales (three isolates). Most Enterobacterales isolates tested from ICU and non-ICU patients in Hong Kong hospitals in 2017-2020 were susceptible to meropenem and ertapenem (≥98%); imipenem was less active (89% susceptible).

Improving VTE prophylaxis in ward and ICU surgical urology patients: a Six-Sigma DMAIC methodology improvement project

PurposeThis study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.Design/methodology/approachThe authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.FindingsDMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.Research limitations/implicationsThe project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.Practical implicationsSeveral recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.Originality/valueDMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

Phenotypic Detection of AmpC \(\beta\)-lactamase Producing Escherichia coli among Patients in Hospital Wards

Background and Objectives: AmpC β-lactamase producing Escherichia coli has emerged in hospital environments as an important health issue that is of a global health concern as drug-resistant pathogenic bacteria that has evolved into strains that are resistant to many classes of antibiotics. However, awareness of the prevalence of AmpC β-lactamase producing microorganisms such as E. coli could be very valuable for achieving more accurate epidemiological results, as well as controlling their spread in the different hospital wards.
 Methodology: A total of four hundred (400) clinical samples comprising of two hundred and seventy-nine (279) urine samples and one hundred and Twenty-one (121) wound samples were collected from patients in different ward at AE-FUTHA. The clinical samples were analyze using standard microbiological culture and identification of Escherichia coli. Detection of phenotypic AmpC β-lactamases production was performed using Cefoxitin-Cloxacillin Double-Disk Synergy Test (CC-DDST). Antibiotic susceptibility studies of AmpC β-lactamases producing Escherichia coli was determined using the Kirby–Bauer disk diffusion method and the results were construed using the Clinical Laboratory Standard Institute (CLSI) zone diameter breakpoints.
 Results: Phenotypic AmpC β-lactamases producing E. coli accounted overall prevalence rate of 94.1%. The frequency of AmpC β-lactamases producing E. coli in urine samples were 57(93.4%) comprising of high occurrence rate in Surgical ward 15(100%) followed by medical ward 24(88.9%) but also accounted for overall prevalence rate of 38(95.0%) in wound samples consisting of 9(100 %) from children ward and medical ward 10(100%) followed by Orthopedic ward 13(86.7%) with the least prevalence rate. The AmpC β-lactamases producing E. coli exhibited high percentage of resistance within the range of 50-100% against ceftriaxone, ceftazidime, cefepime, azetronam, Trimethoprim-Sulfamethoxazole Ticarcillin-clavulanic acid but were susceptible to ofloxacin 70.0%, Imipenem 83.3% and amikacin 100%.
 Conclusion: The findings of this study is a proof of the occurrence of AmpC β-lactamase producing Escherichia coli among patients admitted to hospital wards and there’s an urgent need for controlling and managing the development of MDR genotype strain. Moreover, to prevent the spread of resistance among AmpC β-lactamase producing Escherichia coli to other strains and improve the effectiveness of antibiotics, it is suggested to establish a precise schedule for antibiotic use in each region based on their antibiotic resistance pattern.

Investigating nurses’ knowledge and attitudes about delirium in older persons: a cross-sectional study

IntroductionDelirium is the most common emergency for older hospitalized patients that demands urgent treatment, otherwise it can lead to more severe health conditions. Nurses play a crucial part in diagnosing delirium and their competencies facilitate the appropriate treatment and management of the condition.AimThis study aims to enhance the understanding of delirium care by exploring both knowledge and attitudes of nurses toward patients in acute care hospital wards and the possible association between these two variables.MethodThe Nurses Knowledge of Delirium Questionnaire (NKD) and the Attitude Tool of Delirium (ATOD) that were created for the said inquiry, were disseminated to 835 nurses in the four largest Public Hospitals of the Republic. These tools focused particularly on departments with increased frequency of delirium (response rate = 67%).ResultsOverall nurses have limited knowledge of acute confusion/delirium. The average of correct answers was 42.2%. Only 38% of the participants reported a correct definition of delirium, 41.6 correctly reported the tools to identify delirium and 42.5 answered correctly on the factors leading to delirium development. The results of the attitudes’ questionnaire confirmed that attitudes towards patients with delirium may not be supportive enough. A correlation between the level of nurses’ knowledge and their attitude was also found. The main factors influencing the level of knowledge and attitudes were gender, education, and workplace.ConclusionThe findings of this study are useful for the international audience since they can be used to develop and modify educational programmes in order to rectify the knowledge deficits and uninformed attitudes towards patients with delirium. The development of a valid and reliable instrument for the evaluation of attitudes will help to further assess nurses’ attitudes. Furthermore, the results are even more important and useful on a national level since there is no prior data on the subject area, making this study the first of its kind.

Impact of isolation on the biopsychosocial functioning of older people with COVID-19.

COVID-19 is a highly contagious coronavirus disease that has had a significant impact on the functioning of society. On 11 March 2020, due to the rapid spread of the virus, the WHO declared a global pandemic. By the end of 2021, 5 variants of SARS-CoV-2 had been identified since the beginning of the pandemic. The course of the disease varied depending on the age of the patients and the presence of possible comorbidities. Most patients were asymptomatic or sparsely symptomatic of the infection; however, in about 6% of cases, the course of the disease was critical. Typical symptoms of COVID-19 include: fever, muscle pain and headache, lack of smell and taste, cough, dyspnea, diarrhoea and nausea. According to epidemic guidelines, infected patients were subjected to isolation, which harmed their mental state, especially the elderly. The aim of the study was to assess the impact of isolation on the biopsychosocial functioning of elderly patients with COVID-19. The study was conducted among 360 elderly patients in hospital wards operating as a unit in a hospital complex dedicated to patients infected with the SARS-CoV-2 virus. Data were collected using standardized questionnaires: ADL Scale, IADL, GDS, SF-36 Quality of Life Scale, Multidimensional Scale of Perceived Social Support, and supplementary questions about, among others, the oxygen therapy provided, length of stay in the unit, and the support received from relatives. Almost half (48%) of the subjects received oxygen therapy, and 36% had a length of disease of 7-14 days. A correlation was observed between the quality of life and the above-mentioned factors. Correlations of quality of life indicators with the length of illness were moderate (except for the level of pain) and positive, meaning that the longer the patients were ill, the lower their quality of life. Correlations of disease severity were moderate for pain, vitality, and emotional limitations, while vital for physical functioning and limitations and general and mental health. The intensity of oxygen therapy was moderately correlated with physical and emotional limitations and general health and strongly correlated with physical functioning, vitality and mental health. Correlations between functional status and mental status of elderly patients were also studied. Analysis of variance showed that the constructed model was an excellent fit to the data, F = 37.14; p < 0.001, explaining 42% of the variance in the dependent variable (R2= 0.42). As many as 80% of the respondents felt that isolation harmed their well-being. Examining the impact of quality of life on their well-being showed that most of the associations tested were statistically significant, and all were positive. Associations of moderate strength were shown for physical functioning, physical limitations and general health, while strong associations were shown for vitality, emotional limitations and mental health. Pain complaints were associated with changes in well-being at the level of statistical trend (p = 0.055). This means that the lower the patients' quality of life, especially in terms of vitality and mental health, the more significant the impact of isolation on their well-being. The study also investigated the effect of social support on mental state. The model proved to be an excellent fit to the data, F = 5.91, p = 0.002, and explained 23% of the variance in the dependent variable (Adjusted R² = 0.23). At the same time, support from friends turned out to be the only significant predictor (Beta = 0.53), and this means that the more support the subjects received from them, the lower the level of depression they manifested. 1) The better the functional state of a senior and the support received from relatives, the lower the severity of depression. 2) The lower the quality of a senior's life, especially in terms of mental state, the greater the negative impact on his/her well-being in isolation. 3) The low quality of life of a senior increased the likelihood of depression. 4) The quality of life of older Covid-19 patients was higher in those without chronic disease. 5) The quality-of-life level was lower in patients with a more severe course of COVID-19, and longer duration of disease and oxygen therapy.

Optimizing the response to mental health deterioration: Nurses experiences of using a Mental Health Observation Response Chart.

Recognizing mental health deterioration remains a challenge for health systems globally, with evidence of suboptimal care for patients with increasing co-morbid psychiatric illness. Mechanisms exist to detect and respond to physical deterioration with the use of Observation Response Charts, monitoring of vital signs and medical emergency teams but registered nurses lack psychiatric nursing skills to care for this patient population. Currently, there are no validated processes in place to recognize and respond to mental health deterioration in general hospital wards. This qualitative descriptive study explores nurses' experiences of using a Mental Health Observation Response Chartthat uses signs of distress to track and trigger tiered responses to mental health deterioration on general hospital wards. Thirty-five surgical and rehabilitation nurses participated in focus groups from January to March 2020. All qualitative data were thematically analysed using an inductive approach. Analysis resulted in four themes: clinical relevance, a useful chart, identifying distress, and working with doctors. The clinical relevance of the chart was influenced by the level of nursing experience; patient distress; existing escalation pathways and ward culture. The study findings will inform the establishment of a process for nurses to recognize mental health deterioration that could improve patient outcomes and promote staff safety. Further research is needed to validate specific signs of distress with patients in general hospital wards and to develop findings for the clinical relevance of this approach to detect mental health deterioration and improve patient outcomes.

When Social Work Client Self-Determination Principle Meets Confucius Culture: A Living Will Decision-Making Case Study in China.

Background. In western countries like the United States of America, living will is seen as a vehicle for achieving greater wisdom and skill in a fundamental aspect of health care and a civilized approach to mortality. However, the inception of living will in China emerged only a decade ago. Although, nowadays, Chinese medical social workers can provide living will service in health settings, their services are in a preliminary status. Objective. This exploratory case study aims to present an ethical dilemma and analyzes the reasons the social work client self-determination principle failed in living will decision-making in the oncology ward that has Confucius as a cultural context. Results. This case illustrates that the patient's family has the final say in living will decision-making. The social work principle of client self-determination exemplifies the difficulties of applying medical social work practices with living will to Chinese patients in hospital wards. Conclusions. Chinese patients and their families are still bound to Confucianism's long tradition. In China, individuals are still being defined by relationships, and the "self" exists only in a hierarchical interpersonal network known as the differential pattern. The Chinese people do not like to talk about death. Even in modern society, it will take time for the Chinese people to come to terms with the end-of-life planning with living will, mainly for cancer patients after diagnosis. Practice Implications. Future social work practices that implied living will similar to this case that has Confucius culture in the background should consider the cultural context where the social worker-client are situated and the types of social work values the profession hold.