Patients In Medical Wards Research Articles

PAIN MANAGEMENT KNOWLEDGE AMONG MEDICAL WARD NURSES IN MALAYSIA

Pain, a common symptom for patients in medical wards, can be relieved by effective pain management, with nurses playing a vital role in this regard. A study was undertaken to determine the knowledge of nurses on pain management and to examine the factors that influence their acquisition of such knowledge. A total of 143 medical ward nurses (representing 60% response) in a government referral hospital in Malaysia participated in the study. Data from this study derived from a set of questionnaires were analysed using 2 x 2 contingency tables and the chi squared test with Yate’s correction. Approximately two thirds of the nurses were deficit in knowledge regarding pain management, registering a mean knowledge score of 40.5 out of a possible 100 points. There was no significant association between the level of knowledge on pain management and demographic characteristics such as age and work experience. There was also no significant relationship between the level of knowledge on pain management and the pain courses attended. A better understanding of the factors that affect the acquisition of such knowledge could provide useful information that can be incorporated in an improved educational program on pain management for nurses.

Evaluation of Antibiotic Use in Medical Ward of Fitche District Hospital, North Showa Zone, Oromia Region, Ethiopia

Background: Antibiotic are among the most prescribed drug in medical ward. Because of the rise in health care cost lack of uniformity in drug prescribing and the emergency of antibiotic resistance monitoring and control of antibiotic use are growing concern and strict antibiotic policies should be warranted. Inappropriate use of antibiotic can increase morbidity, mortality, patient cost and bacterial antibiotic resistance. Objective: To evaluate antibiotic use practice in medical ward of Fitche hospital, North Showa Zone, Oromia region, Ethiopia. Methodology: Institution based cross sectional study was conducted by collecting data retrospectively from 200 patient cards drawn by Simple random sampling using balloting from Medical ward of Fitche hospital from March 10- May 30, 2016. After checking for completeness and consistency, data was entered in SPSS (IBM 20) and descriptive statistics was carried. Result: Out of the total 200 patient cards, 110 (55%) were of male and 90 (45%) were of female. Most antibiotics were prescribed for empirical treatment 163 (81.5%) and least for prophylactic treatment 5 (2.5%). In this study, of the total 340 drugs prescribed in Medical ward, the prevalence of antibiotics use was 220 (64.7%). In this study, 65% received more than one antibiotic. And the most commonly prescribed groups of antibiotic were Cephalosporin 32.5% and the most commonly prescribed antibiotic was ceftriaxone 27.5%. Conclusion: This study revealed that of the total of 340 drugs prescribed for 200 patients in Medical Ward of Fitche District Hospital, 64.7% were antibiotics and the most commonly prescribed groups of antibiotic were Cephalosporin and the most commonly prescribed antibiotic was ceftriaxone. And majority of patients in Medical ward 65% received more than one antibiotic.

A Study on Predictive Value of Thrombocytopaenia in Cases of Malaria

Malaria is a major health problem in India. In cases of fever with thrombocytopenia , malaria should be on top of the differential diagnosis. This was a study of admitted patients in Medical wards of Bhaskara Medical Colleges, Hyderabad which were diagnosed with malaria and they were assessed for Thrombocytopenia using automated quantitative D3 Analyzer .The data was analyzed using SPSS version 16.0 .Viral hemorrhagic fevers can also present as fever with high hematocrit and leucopenia along with thrombocytopenia. In Our study the commonest cause of thrombocytopenia in malaria was vivax malaria.

Spectrum of Diseases, Disease Related Mortality and Overall Financial Burden of Hospitalized Patients in Medical Wards of Tertiary Care Public Hospital

Background: Detailed assessment of pattern of diseases and trend of mortalities tends to aid in formulating pivotal aspects of in-hospital policies, standards of care and so consequently promoting efficient work system. This also reserves limited resources keeping within the limit of financial grasp. The study aims to reimburse the colossal paucity of data covering epidemiological burden of diseases, impact on mortality as well as financial burden in socioeconomically challenged public health system. Methods: This was a retrospective cross-sectional hospital based study conducted in department of Medicine, Civil Hospital Karachi, from February 2016 to July 2016 using questionnaire based data collection system. Results: Eight thousand and fifty three (8053) cases with almost equal gender proportion were analyzed. Chronic liver disease (CLD) was the most rampant disease, followed by cerebrovascular accident (CVA), tuberculosis and diabetes. Overall 51% cases were attributed to infectious diseases. Overall the average percentage mortality was found to be 20% of all cases. Mean duration of stay was 7.56 ± 7 days. Estimated average total in-hospital expenditure per patient on each visit or stay was 159.15 ± 41.2 $USD (16670.96 ± 4315.7 PKR). Average total diagnostic and medications costs per visit or stay were 89.74 ± 31.2 $USD (9400.26 ± 3268.2 PKR) and 48.68 ± 18.0 $USD (5099.23 ± 1885.5 PKR) respectively. Conclusion: Chronic liver disease, cerebrovascular accident and diabetes were most frequent reasons of hospital admission and mortality. Recognition of most common and fatal diseases with their expenditure is going to lead to formulation of targeted policies both of which would be effective and efficient.

The effect of delirium and dementia on length of stay (LOS) and functional recovery of patients in elderly medical wards

The effect of delirium and dementia on length of stay (LOS) and functional recovery of patients in elderly medical wards

Evaluation of the Treatment of Candiduria at an Academic Medical Center.

To evaluate the epidemiology, management, and outcomes associated with candiduria in intensive care unit (ICU) and medical ward (MW) patients. This was a retrospective cohort study conducted in a tertiary care academic medical center. Adult patients aged between 18 and 75 years who were admitted for at least 5 days with a urinary culture that grew a Candida species between July 2010 and June 2011 were included. Medical records were retrospectively reviewed. Laboratory data, urinary symptoms, risk factors for urinary and invasive candidiasis, treatment, and patient outcomes were collected and evaluated. Sixty-seven ICU and 65 MW patients met the inclusion criteria. ICU patients were more likely to have risk factors for invasive candidiasis and candiduria. Candida albicans and Candida glabrata were the most frequently identified urinary isolates. Antifungal therapy was commonly initiated despite rapid replacement or removal of urinary drainage devices and a lack of patient reported symptoms. Fluconazole was the most commonly used antifungal agent, followed by micafungin. Hospital length of stay did not vary significantly between the ICU and MW groups (P = 0.0628). All-cause mortality was higher in the ICU patients compared with that of the MW patients (22.4% vs. 3.1%, P = 0.0012). Differences exist between ICU and MW patients that develop candiduria with respect to risk factors, and outcomes. Antifungals, including fluconazole and micafungin, were often used inappropriately (ie, asymptomatic patients) in this patient cohort. Efforts to improve healthcare provider awareness of the contemporary recommendations to manage candiduria are necessary to improve patient care and antifungal use.

EPICO 3.0. Management of non-neutropenic patients in medical wards

BackgroundAlthough the management of invasive fungal infection (IFI) has improved, a number of controversies persist regarding the approach to invasive fungal infection in non-neutropenic medical ward patients. AimsTo identify the essential clinical knowledge to elaborate a set of recommendations with a high level of consensus necessary for the management of IFI in non-neutropenic medical ward patients. MethodsA prospective, Spanish questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists (intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases) in IFI and belonging to six scientific national societies. They responded to five questions prepared by the coordination group after a thorough review of the literature published in the last few years. For a category to be selected, the level of agreement among the experts in each category had to be equal to or greater than 70%. In a second round, 73 specialists attended a face-to-face meeting held after extracting the recommendations from the chosen topics, and validated the pre-selected recommendations and derived algorithm. ResultsThe following recommendations were validated and included in the algorithm: 1. several elements were identified as risk factors for invasive candidiasis (IC) in non-hematologic medical patients; 2. no agreement on the use of the colonization index to decide whether prescribing an early antifungal treatment to stable patients (no shock), with sepsis and no other evident focus and IC risk factors; 3. agreement on the use of the Candida Score to decide whether prescribing early antifungal treatment to stable patients (no shock) with sepsis and no other evident focus and IC risk factors; 4. agreement on initiating early antifungal treatment in stable patients (no shock) with a colonization index>0.4, sepsis with no other evident focus and IC risk factors; 5. agreement on the performance of additional procedures in stable patients (no shock) with sepsis and no other evident focus, IC risk factors, without colonization index>0.4, but with a high degree of suspicion. ConclusionsBased on the expert's recommendations, an algorithm for the management of non-neutropenic medical patients was constructed and validated. This algorithm may be useful to support bedside prescription.

Glycemic Control of Hospitalized Patients at a Medical Center in Taiwan

Achieving the glycemic target is essential to reduce morbidity and mortality in hospitalized patients; however, the status of glycemic control in Taiwan has not yet been evaluated. We conducted a retrospective study to evaluate the status of glycemic control in our hospital. We collected all the point-of-care blood glucose (POC-BG) data generated in general wards and intensive care units (ICUs) between April 2012 and June 2012. Parameters including mean of total POC-BG values, proportion of any POC-BG value less than 70 mg/dL, more than 250 mg/dL and 70 ~ 250 mg/dL, patient-day weighted mean glucose (PDWMG) value and percentage of PDW-MG value more than 180 mg/dL were compared between patients in medical and surgical wards, patients in medical and surgical ICUs, and among patients in each of the medical wards and surgical wards. The mean glucose and PDW-MG values were 192.4 mg/dL and 183.1 mg/dL in the general wards and 196.3 mg/dL and 187.7 mg/dL in the ICUs, respectively. The quality of inpatient glycemic control was poorer for patients in medical wards than in surgical wards, but the difference was smaller between patients in medical and surgical ICUs. The quality of glycemic control among patients in the different medical wards was inconsistent. In summary, the quality of inpatient glycemic control in our hospital was found to be suboptimal as compared with the current guidelines. The development of a strategy for improvement is critical, and the subsequent clinical effectiveness needs further investigation.

Evaluation of Drug Dosing in Renal Failure

Introduction: Rapid accumulation and toxicity can be developed if drugs dosages are not adjusted in patients with chronic kidney diseases (CKD). Objectives: To evaluate the prevalence of correct dosing in chronic kidney diseases depending on renal function estimation. Study Design: A cross-sectional observational study involving patients in medical ward from January to July 2014 at Aseer Central Hospital in Abha, Kingdom of Saudi Arabia Methods: Demographic data were collected from patients, patients' files and healthcare providers. Dosage adjustment depends on the patients’ kidney function, most often estimated by the patient's glomerular filtration rate (eGFR) calculated by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) and a computerized system was used to determine the adjusted renal dose. Results: From total 2470 prescribed drugs for 500 inpatients, 420 (17%) drugs need a dosing adjustment in chronic renal failure and 2050 (83%) drugs do not need. From the 420 drugs that need a dosing adjustment, the dose of 202 (48.1%) drugs were adjusted, and of 218 (51.9%) drugs were not. Drugs that need a readjustment are allopurinol, ampicillin, cefepime, cefixime, ceftazidime, ceftriaxone, gentamycin, levofloxacin, meropenem, metoclopramide, metronidazole, ranitidine, rosuvastatin, tazocin, tienam and vancomycin. Conclusions: The dosing of more than half of the medications that need dosing adjustment in CKD were not adjusted which can increase the side effects and toxicity of these drugs for CKD patients. It is the pharmacist duty by co-operation with the medical team to ensure the prescribing of optimal dose. Keywords: Aseer Central Hospital, Chronic kidney disease, chronic renal failure, glomerular filtration rate, dialysis, dosing adjustment, Renal dysfunction, Renal impairment.

Vancomycin-ResistantStaphylococcus aureusisolates among hospitalized patients; a tertiary medical care center experience from Southern Iran

AbstractBackground and Objective: Bacterial resistance to different types of antibiotics has been globally emerging over recent years. The present study was carried out to investigate the rate of vancomycin-resistant Staphylococcus aureus (VRSA) at a tertiary medical care center in Kerman, Iran. Materials and Methods: In this cross-sectional study, 250 samples with positive culture for coagulase-positive S. aureus, taken from the suspected infectious sites of patients admitted to different medical and surgical wards at Bahonar hospital from 2009 to 2011, were studied. Results: 9.2% of S. aureus isolates were found to be vancomycin-resistant. There was no significant difference in the rate of resistance between males and females (8 vs. 12.9%, respectively). Though the rate of resistance was shown to be marginally higher in post-surgical compared to medical ward patients, the difference was statistically insignificant (p = 0.8). Across the wards, general surgery housed the largest number of patients with VR...

Modified Early Warning Score (MEWS) Identifies Critical Illness among Ward Patients in a Resource Restricted Setting in Kampala, Uganda: A Prospective Observational Study.

IntroductionProviding optimal critical care in developing countries is limited by lack of recognition of critical illness and lack of essential resources. The Modified Early Warning Score (MEWS), based on physiological parameters, is validated in adult medical and surgical patients as a predictor of mortality. The objective of this study performed in Uganda was to determine the prevalence of critical illness on the wards as defined by the MEWS, to evaluate the MEWS as a predictor of death, and to describe additional risk factors for mortality.MethodsWe conducted a prospective observational study at Mulago National Referral Teaching Hospital in Uganda. We included medical and surgical ward patients over 18 years old, excluding patients discharged the day of enrolment, obstetrical patients, and patients who self-discharged prior to study completion. Over a 72-hour study period, we collected demographic and vital signs, and calculated MEWS; at 7-days we measured outcomes. Patients discharged prior to 7 days were assumed to be alive at study completion. Descriptive and inferential statistical analyses were performed.ResultsOf 452 patients, the median age was 40.5 (IQR 29–54) years, 53.3% were male, 24.3% were HIV positive, and 45.1% had medical diagnoses. MEWS ranged from 0 to 9, with higher scores representing hemodynamic instability. The median MEWS was 2 [IQR 1–3] and the median length of hospital stay was 9 days [IQR 4–24]. In-hospital mortality at 7-days was 5.5%; 41.4% of patients were discharged and 53.1% remained on the ward. Mortality was independently associated with medical admission (OR: 7.17; 95% CI: 2.064–24.930; p = 0.002) and the MEWS ≥ 5 (OR: 5.82; 95% CI: 2.420–13.987; p<0.0001) in the multivariable analysis.ConclusionThere is a significant burden of critical illness at Mulago Hospital, Uganda. Implementation of the MEWS could provide a useful triage tool to identify patients at greatest risk of death. Future research should include refinement of MEWS for low-resource settings, and development of appropriate interventions for patients identified to be at high risk of death based on early warning scores.

Frequent Prescription of Antibiotics and High Burden of Antibiotic Resistance among Deceased Patients in General Medical Wards of Acute Care Hospitals in Korea.

BackgroundAntibiotics are often administered to terminally ill patients until death, and antibiotic use contributes to the emergence of multidrug-resistant organisms (MDROs). We investigated antibiotic use and the isolation of MDROs among patients who died in general medical wards.MethodsAll adult patients who died in the general internal medicine wards at four acute care hospitals between January and June 2013 were enrolled. For comparison with these deceased patients, the same number of surviving, discharged patients was selected from the same divisions of internal medicine subspecialties during the same period.ResultsDuring the study period, 303 deceased patients were enrolled; among them, 265 (87.5%) had do-not-resuscitate (DNR) orders in their medical records. Antibiotic use was more common in patients who died than in those who survived (87.5% vs. 65.7%, P<0.001). Among deceased patients with DNR orders, antibiotic use was continued in 59.6% of patients after obtaining their DNR orders. Deceased patients received more antibiotic therapy courses (two [interquartile range (IQR) 1–3] vs. one [IQR 0–2], P<0.001). Antibiotics were used for longer durations in deceased patients than in surviving patients (13 [IQR 5–23] vs. seven days [IQR 0–18], P<0.001). MDROs were also more common in deceased patients than in surviving patients (25.7% vs. 10.6%, P<0.001).ConclusionsPatients who died in the general medical wards of acute care hospitals were exposed to more antibiotics than patients who survived. In particular, antibiotic prescription was common even after obtaining DNR orders in patients who died. The isolation of MDROs during the hospital stay was more common in these patients who died. Strategies for judicious antibiotic use and appropriate infection control should be applied to these patient populations.

Determinants of Hypertension Complications Among Adult Hypertensive Patients in Medical Wards at Kenyatta National Hospital, Nairobi

Hypertension is a silent killer disease owing to the late recognition of symptoms. Uncontrolled hypertension is the primary risk factor for stroke, heart failure and kidney failure in sub Saharan Africa. Control of hypertension is associated with a larger reduction in morbidity and mortality. Efforts to address the complications associated with hypertension are still a global concern. In sub Saharan Africa the epidemiological transition of non communicable diseases poses a great threat to most of the population. The main aim of this study was to identify the determinants of hypertension complications among hypertensive patients in Kenyatta National Hospital. A cross sectional descriptive design among eighty hypertensive patients in medical wards in Kenyatta National Hospital was conducted. Data was collected using structured questionnaires, key informants interviews and focused group discussions. 34 (42.5%) participants were already suffering hypertension complications at the time of the study. The mean age of participants was 49.7 years (SD 15.1). There was a significant association between current systolic blood pressure (p = 0.033), adding salt to food (p = 0.01), level of education (p=0.001) and hypertension complication. Finances and lack of adequate knowledge were main factors cited to be contributing to development of hypertension complications among in the key informants interviews and Focused Group Discussion.

Clinical profile of geriatric patients in medical wards at a rural tertiary care hospital in South India

Background: Health problems associated with ageing are multiple and sparse data are available on this topic from India. Methods: We carried out an observational study in 200 of geriatric patients (age 60 years) at our medical college teaching hospital at Kuppam, Andhra Pradesh during the period November 2012 and October 2013. Results: Most patients (31%) were in age group 65-69 years. The most common disease conditions noted were hypertension (49%), diabetes mellitus (47%), and chronic obstructive pulmonary disease (37%). Majority of the patients (82.5%) had more than one co-morbid condition. Conclusions: Cardiovascular and respiratory diseases are important causes for hospital admission in geriatric patients. The majority of cases had three or more diagnoses necessitating admission contributing to higher disease burden in the elderly.

Prevalence of Hypoalbuminemia in Hospitalized Patients

Introduction: Hypoalbuminemia is a common and vexing problem in hospitalized individuals. Serum albumin levels fall, often dramatically from early in the course of critical illness and will not increase again until the recovery phase of the illness. Increased risk of morbidity and mortality are correlated with lower serum albumin levels. Objective: This study was done to find out the prevalence of hypoalbuminemia in hospitalized patients. Materials and Methods: The study was a retrospective observational study which was carried out on 1071 patients. Serum total protein and serum albumin were measured. Results: 165 patients had hypoalbuminemia which accounts for a prevalence of 15%. Patients from burns ward accounted for 44.8%, those from medical wards accounted for 34.5% and from surgical wards for 20.1%. Mean±S.D of serum albumin was 2.5±0.42 g/dl in both burn and medical wards patients and 2.4±0.38 g/dl for those admitted in surgical wards. Conclusion: Hypoalbuminemia results from decreased production, defective synthesis, deficient intake or increased losses of albumin. Measuring serum albumin concentration can serve as a prognostic marker for predicting morbidity and mortality. The prevalence of hypoalbuminemia was high in patients admitted in burns ward in our study. Key Words: Albumin, Total Proteins, Hypoalbuminemia, Morbidity, Mortality

Can a Computerized Sepsis Screening and Alert System Accurately Diagnose Sepsis in Hospitalized Floor Patients and Potentially Provide Opportunities for Early Intervention? A Pilot Study

Title: Can a Computerized Sepsis Screening and Alert System Accurately Diagnose Sepsis in Hospitalized Floor Patients and Potentially Provide Opportunities for Early Intervention? A Pilot Study. Background: Sepsis Syndromes are major causes of morbidity and mortality for hospitalized patients. Several evidence-based interventions have been shown to improve outcomes but they must be instituted early to achieve better outcomes. However, early recognition of sepsis syndromes in hospitalized patients is challenging. Regrettably, SIRS is overly sensitive and not specific in the patient populations at greatest risk for developing sepsis. In addition, many hospitalized patients have baseline end-organ dysfunction, wherein subtle trends in laboratory abnormalities may escape detection. Electronic detection and alert systems offer a more focused and efficient methodology. This strategy has been deployed successfully in other aspects of critical care, e.g. in the early recognition of acute respiratory distress syndrome. We developed an electronic recognition and alert system to identify floor patients with sepsis syndromes. The objective of this study was to test the feasibility, accuracy, and potential value of a computerized sepsis screening and alert system in a large university hospital. Methods and findings: The sepsis alert used an abnormal white blood cell count coupled with a blood culture order to define sepsis. Cases were categorized as severe sepsis by meeting specified changes in laboratory tests for organ dysfunction in accordance with consensus conference criteria. Using a retrospective cohort study design, we evaluated 97 consecutive, non-intensive care unit patients who triggered a sepsis alert at a large, urban, academic medical center. The charts of the patients were reviewed and abstracted manually to determine whether sepsis was present. For confirmed sepsis cases, we determined adherence with sepsis care bundle measures, including the recognition of sepsis (using physician documentation as a proxy measure), measurement of serum lactate, administration of antibiotics, and intravenous fluid resuscitation for severe sepsis cases. Within the 97 patient cohort, 72 were confirmed to have sepsis or severe sepsis (positive predictive value of 74%). Sepsis or severe sepsis was not documented in 79%, serum lactate was not measured in 57%, antibiotics were not administered in 14% of patients with severe sepsis, and fluid boluses were not administered in 17% of patients with severe sepsis who had lactic acidosis, hypotension, and/or acute kidney injury. In patients with sepsis or severe sepsis, adherence to the complete sepsis bundle did not occur in 65%. Opportunities to improve sepsis care were more common when sepsis was not documented. Conclusion: A computerized sepsis screening and alert system designed to identify sepsis in hospitalized medical ward patients without the use of vital signs was feasible to implement and predictive for sepsis. This suggests that implementation of this system may improve the quality of sepsis care in hospitalized ward patients.

Beneficial Effects of Implementing Stroke Protocols Require Establishment of a Geographically Distinct Unit.

Usefulness of multidisciplinary stroke units in acute stroke patients is well established. There is extensive western literature on usefulness of stroke units in outcome, but limited evidence from the rest of the world. We aim to evaluate the impact of establishing a stroke unit on outcome in patients presenting to a tertiary care facility. This is a retrospective study of 1003 patients with acute stroke admitted to Hamad General Hospital, Qatar, between January 2014 and February 2015. Patients directly admitted to intensive care unit (132) were excluded. We compared outcomes of pre- and poststroke ward (SW) establishment and in SW patients versus those of general medical wards. Before the establishment of the SW, 175 patients were admitted to the hospital. From April 2014 to February 2015, 696 patients were admitted (SW, 545; medical ward, 151). There was a significant reduction in length of stay from 14.7±27.7 to 6.2±20.2 days (P=0.0001) and incidence of complications (23.6% versus 6.4%, P=0.0001) after implementation of stroke-specific protocols. Prognosis at discharge (modified Rankin Scale 0-2 in 56.0% versus 70.4%, P=0.001) and at 90 days (modified Rankin Scale 0-2 in 70.6% versus 95.0%, P=0.001) also significantly improved. Compared with medical ward patients, outcome was significantly better in SW patients with fewer complications (10.9% versus 5.0%, P=0.013) and shorter length of stay (8.9±30.7 versus 5.4±16.1 days, P=0.05). Establishing a distinct SW is essential for achieving full benefits of stroke protocols implementation. SW patients have significantly fewer complications and better prognosis when compared with patients in medical wards.

Exogenous Melatonin for Delirium Prevention: a Meta-analysis of Randomized Controlled Trials.

Recently, two high-quality clinical randomized controlled trials (RCTs) regarding the preventive effect of exogenous melatonin on delirium drew inconsistent conclusions. We therefore performed a systemic review to explore whether melatonin had a benefit on delirium prevention. MEDLINE, EMBASE, and Cochrane Library were searched from January 1980 to April 2015 for English language studies. After strict selection and evaluation, the data were extracted from the included four RCTs. The primary outcome of this meta-analysis was the incidence of delirium. The secondary outcome was the improvement of sleep-wake rhythm. A total of four RCTs with 669 elderly patients were included in the present study. Melatonin group showed a tendency to decrease the incidence of delirium (relative risk [RR] 0.41, 95% confidence interval [CI] 0.15 to 1.13; P = 0.08) compared with control group. In subgroup analysis of the elderly patients in medical wards, melatonin supplementation decreased theincidence of delirium by 75% (RR 0.25, 95% CI 0.07 to 0.88; P = 0.03), but not in sleep-wake disturbance (RR 1.24, 95% CI 0.51 to 3.00; P = 0.64). No differences were found in the incidence of delirium between the two groups in the elderly patients that were presented to surgical wards. In conclusion, melatonin supplementation had a significant preventive effect in decreasing the incidence of delirium in elderly patients that were presented to medical wards. Further studies should provide sufficient evidence about the effect of melatonin on delirium in a large sample size.

Expanding the scope of Critical Care Rapid Response Teams: a feasible approach to identify adverse events. A prospective observational cohort

IntroductionAdverse events (AEs) affect 3–12% of hospitalised patients. These are estimates from a labour-intensive chart review process,which is not feasible outside research. Clinical deterioration on the wards triggers a rapid...

Association between exposure to nonactionable physiologic monitor alarms and response time in a children's hospital.

Alarm fatigue is reported to be a major threat to patient safety, yet little empirical data support its existence in the hospital. To determine if nurses exposed to high rates of nonactionable physiologic monitor alarms respond more slowly to subsequent alarms that could represent life-threatening conditions. Observational study using video. Freestanding children's hospital. Pediatric intensive care unit (PICU) patients requiring inotropic support and/or mechanical ventilation, and medical ward patients. None. Actionable alarms were defined as correctly identifying physiologic status and warranting clinical intervention or consultation. We measured response time to alarms occurring while there were no clinicians in the patient's room. We evaluated the association between the number of nonactionable alarms the patient had in the preceding 120 minutes (categorized as 0-29, 30-79, or 80+ alarms) and response time to subsequent alarms in the same patient using a log-rank test that accounts for within-nurse clustering. We observed 36 nurses for 210 hours with 5070 alarms; 87.1% of PICU and 99.0% of ward clinical alarms were nonactionable. Kaplan-Meier plots showed incremental increases in response time as the number of nonactionable alarms in the preceding 120 minutes increased (log-rank test stratified by nurse P < 0.001 in PICU, P = 0.009 in the ward). Most alarms were nonactionable, and response time increased as nonactionable alarm exposure increased. Alarm fatigue could explain these findings. Future studies should evaluate the simultaneous influence of workload and other factors that can impact response time.