Patient Care Process Research Articles

Collecting Patient Feedback as a Means of Monitoring Patient Experience and Hospital Service Quality - Learning from a Government-led Initiative.

Patient feedback plays a significant role in hospital service improvement. However, how to encourage patient feedback that can guide hospital service improvement is still being explored. By examining patient feedback data related to a tertiary hospital in China that was collected from the "12345" Government Service Convenience Hotline (GSCH), the paper discusses the learnings from GSCH in encouraging patient feedback and how quality improvement initiatives have effected the number and types of complaints made by patients and their families via GSCH. The study retrospectively collected and analyzed complaints on a Tertiary General University-affiliated hospital made via GSCH between 2016 and 2020. Patient care process-related complaints were coded using the health care complaint analysis tool (HCAT) and other complaint data were categorized based on the nature of the complaints. The autoregressive integrated moving average (ARIMA) models and mosaic plots were used to observe complaints trends and different complaint variables, respectively. The relationship between various quality improvement initiatives introduced since 2018 and patient complaints was also tested. Close to 67% (n=2688) of calls made to the GSCH hotlines about the hospital were classified as a complaint including 60.6% vs 39.4% related to patient care process and nonpatient care process, respectively. For patient care process-related complaints, specifically against departments and personnel, 57.72% (n=961) were on clinical departments and 55.87% (n=471) were on doctors. Comparing the proportion of the complaint data in different categories in the two-year period of 2017-2018 and 2019-2020, an increase in management problems (47.73% vs 58.50%, P<0.001) and decrease in relationship problems (33.65% vs 25.69%, P=0.002) were recorded. A unified, transparent, and impartial GSCH platform greatly encourages feedback from patients and families. Feedbacks provide evidence to guide health care organizations in improving the overall experience of patients and the quality of services that they provide.

Training Nigerian pharmacy interns for leadership and clinical pharmacy advancement using the ADDIE method of instructional design

Background: Leadership skills are required to promote and advance clinical pharmacy practice in Nigeria. The Nigerian pharmacy curriculum does not include any modules or training in leadership. Objective: A twelve-month online training on leadership and clinical pharmacy improvement was designed and delivered to intern pharmacists in Nigeria using the ADDIE (Analysis, Design, Development, Implementation, and Evaluation) method of instructional design. The goal was to train interns to demonstrate leadership skills by identifying gaps in patient care or medication use processes at their practice sites and developing projects to solve them. Method: The Kirkpatrick's four-level method of training evaluation was used to assess the training. Result: About 42% of participants completed the training with the required capstone project. Conclusion: This paper describes the implementation and evaluation of a yearlong training designed to provide pharmacy interns in Nigeria with the necessary leadership skills to advance the field of clinical pharmacy.

Generic Patient-Centered Blockchain-Based EHR Management System

Accessing healthcare services by several stakeholders for diagnosis and treatment has become quite prevalent owing to the improvement in the industry and high levels of patient mobility. Due to the confidentiality and high sensitivity of electronic healthcare records (EHR), the majority of EHR data sharing is still conducted via fax or mail because of the lack of systematic infrastructure support for secure and reliable health data transfer, delaying the process of patient care. As a result, it is critically essential to provide a framework that allows for the efficient exchange and storage of large amounts of medical data in a secure setting. The objective of this research is to develop a Patient-Centered Blockchain-Based EHR Management (PCEHRM) system that allows patients to manage their healthcare records across multiple stakeholders and to facilitate patient privacy and control without the need for a centralized infrastructure by means of granting or revoking access or viewing one’s records. We used an Ethereum blockchain and IPFS (inter-planetary file system) to store records because of its advantage of being distributed and ensuring the immutability of records and allowing for the decentralized storage of medical metadata, such as medical reports. To achieve secure a distributed, and trustworthy access control policy, we proposed an Ethereum smart contract termed the patient-centric access control protocol. We demonstrate how the PCEHRM system design enables stakeholders such as patients, labs, researchers, etc., to obtain patient-centric data in a distributed and secure manner and integrate utilizing a web-based interface for the patient and all users to initiate the EHR sharing transactions. Finally, we tested the proposed framework in the Windows environment by compiling a smart contract prototype using Truffle and deploy on Ethereum using Web3. The proposed system was evaluated in terms of the projected medical data storage costs for the IPFS on blockchain, and the execution time for a different number of peers and document sizes. The findings of the study indicate that the proposed strategy is both efficient and practicable.

Febrile Neutropenia: Improving Care Through an Oncology Acute Care Clinic.

Patients with cancer are at risk for oncologic emergencies, including febrile neutropenia (FN). Timely treatment of FN can prevent complications. Providing this care in the outpatient setting has been shown to be safe and effective. This project implemented and evaluated a new process using an outpatient acute care clinic (ACC) to manage FN in patients with hematologic cancer. The aims were to reduce the time from fever identification to antibiotic administration, decrease emergency department (ED) visit rates, and evaluate patient satisfaction. Using a pre-/postimplementation design, an interprofessional team was educated about a new process of caring for patients with hematologic cancer and FN at an outpatient ACC using a comprehensive algorithm. 31 patients participated in the project (15 pre- and 16 postimplementation). Time to antibiotic administration decreased from 144.88 minutes to 63.69 minutes. Participant visits to the ED decreased by 2.33 times per month on average. Overall, patients were satisfied with the ACC. These findings support using a dedicated outpatient ACC for patients with FN receiving hematology care.

AAPM task group report 273: Recommendations on best practices for ai and machine learning for computer-aided diagnosis in medical imaging.

Rapid advances in artificial intelligence (AI) and machine learning, and specifically in deep learning (DL) techniques, have enabled broad application of these methods in health care. The promise of the DL approach has spurred further interest in computer-aided diagnosis (CAD) development and applications using both 'traditional' machine learning methods and newer DL-based methods. We use the term CAD-AI to refer to this expanded clinical decision support environment that uses traditional and DL-based AI methods. Numerous studies have been published to date on the development of machine learning tools for computer-aided, or AI-assisted, clinical tasks. However, most of these machine learning models are not ready for clinical deployment. It is of paramount importance to ensure that a clinical decision support tool undergoes proper training and rigorous validation of its generalizability and robustness before adoption for patient care in the clinic. To address these important issues, the American Association of Physicists in Medicine (AAPM) Computer-Aided Image Analysis Subcommittee (CADSC) is charged, in part, to develop recommendations on practices and standards for the development and performance assessment of computer-aided decision support systems. The committee has previously published two opinion papers on the evaluation of CAD systems and issues associated with user training and quality assurance of these systems in the clinic. With machine learning techniques continuing to evolve and CAD applications expanding to new stages of the patient care process, the current task group report considers the broader issues common to the development of most, if not all, CAD-AI applications and their translation from the bench to the clinic. The goal is to bring attention to the proper training and validation of machine learning algorithms that may improve their generalizability and reliability and accelerate the adoption of CAD-AI systems for clinical decision support. This article is protected by copyright. All rights reserved.

Industry Update, October 2022.

Industry Update, October 2022.

Scope of technology in health care, special focus on nursing

ABSTRACT Integrating artificial intelligence (AI) into health care reshapes nursing practices and education, enhancing patient care and clinical processes. This article discusses the transformative potential of AI in nursing, from streamlining documentation and diagnosis using AI applications to the evolution of nursing. The utilization of AI in primary care through automated communication strategies and the emergence of humanistic AI solutions are explored. As nurses adapt to AI-driven health-care technologies, balancing present needs with future demands becomes imperative. AI provides substantial advantages, but it’s crucial to address challenges to ensure the successful integration of technology in healthcare and maintain the delivery of high-quality patient care in our tech-driven healthcare environment.

Automatic patient bed comfort structure analysis based on the RULA method

To improve patient care, reduce medical staff injuries, and increase the efficiency of the patient care process, automated patient beds are a very important innovation in the world of healthcare. However, there needs to be a study to find an ergonomic automatic bed design so that it is safe and comfortable when used by patients. This research concerns the study of the ergonomics of patient bed design using the Rapid Upper Limb Analysis (RULA) method. The patient bed that has been designed is then analyzed using RULA to obtain initial ergonomic data from a designed patient bed. There are 3 observations made, namely the patient’s condition when sitting, the patient’s condition when lying down, and the patient’s condition when the bed can be adjusted low. When in the sitting position, the average RULA result is obtained at 3, when lying down, the average RULA result is obtained at 3, and when the bed is set low, the average RULA result is obtained at 3. This ergonomic value is an accumulation of the assessment of the structure of the upper arms and forearms, lower body, muscles, neck, torso, legs, wrists, and arms.

Development and implementation of an intraoperative documentation protocol for enhancing patient safety in the operating room: A mixed methods protocol study.

Documentation is an important part of the patient care process; however, there is no regular program for documenting intraoperative care in Iran. This study was conducted to design an intraoperative documentation for enhancing patient safety in the operating room (OR). This exploratory, mixed-methods, qualitative-quantitative study (in 2021) consists of four phases. The first phase involves a conventional content analysis of healthcare providers in the OR to identify the needs, strategies, and content of a pertinent documentation. In this phase, purposeful sampling will be used to collect data through semi-structured interviews. In the second phase, a literature review will be carried out to extract the documentation procedures in the intraoperative period in many other countries. In the third phase, a panel of experts is recruited and the classic Delphi (RAND) technique is run to validate the initial draft of the designed program and, the protocol is then finalized. In the last phase, the designed protocol will be implemented through a quasi-experimental study in one group (before and after intervention), and the effectiveness of the intervention will be evaluated. To design a protocol for intraoperative documentation, healthcare providers' experiences during surgery in the Iranian healthcare setting, where the lack of documentation might forensically harm both the healthcare providers and the patients, will be explored. This information alongside some universal standards developed in other countries should help improve patients' safety in ORs.

Technologies in Anaesthesia for the Paediatric Patient.

Spine surgery is an increasingly frequent surgery and includes a wide range of procedures, from minor surgeries (removal of herniated discs, simple laminectomies) to major surgeries (arthrodesis, removal of spinal meningiomas, etc.).These surgeries commonly involve complex patients (elderly population, ASA II-III) and are sometimes performed in emergency settings (polytrauma, cauda syndrome, pathological fractures), which require specific positions (pronation or lateral decubitus), whereby there can be difficulty in airway management, especially in surgeries that concern the cervical tract.One of the main peculiarities of spine surgery involves the prone position.Patient positioning on the operating bed is an action that must be carried out under medical supervision, in particular by the anaesthetist who is supposed to supervise the regular positioning of the patient at the very moment in which it is performed. The correct positioning of the patient is one of the most important moments of the patient care process in the operating room, given that an error in this field may cause serious damage to the patient by giving rise to permanent and significant nerve damage.The prone position is associated with a variety of complications (Kwee et al., Int Surg 100(2): 292-303, 2015). The points of greatest compression during pronation are eyes, nose, breasts, genitals and neck veins.Therefore, the main risks that can derive from an incorrect position are visual disturbances from inappropriate orbital compression, brachial plexus stretching, ulnar nerve compression and lateral femur-cutaneous nerve stretching. In addition, an inappropriate compression of the abdominal organs in this position, may cause ischemia and consequent organ failure resulting in hospitalization prolongation, permanent disability and sometimes even death (Edgcombe et al., Br J Anaesth 100: 165-183, 2008).In addition to the mechanical effects on anatomical structures, there are also the physiological effects of the prone position, which can be divided into circulatory and respiratory effects.These effects are even more pronounced in elderly patients, cardiopaths or patients with respiratory diseases.

The Role of Interactive Technologies in Optimizing the Process of Patient Treatment: Prospects and Challenges for Health Care

The introduction of medical digital technologies can provide better access and flexibility of healthcare for the population. It includes the availability of open information about health, treatment, complications, and recent progress in biomedical research. Nowadays, even in low-income countries, diagnostic and medical services are becoming more accessible. However, many issues related to digital health technologies remain unresolved, including reliability, security, testing, and ethical issues.The penetration of AI currently affects almost all areas of work of medical organizations and government and supervision bodies in the field of healthcare, as well as all major nosological groups. The leading areas of AI application are: medical diagnostics and image analysis, predictive clinical and managerial analytics, medical decision support systems, data analysis of wearable devices, telemedicine, monitoring of patients with chronic non-communicable diseases, virtual assistants, including robot-assisted surgery, decision assistance mental health problems, etc.This article explores the role of interactive technologies in optimizing the patient care process and discusses the prospects and challenges they present for healthcare. In recent years, interactive technologies such as mobile applications, virtual reality, remote medical consultations and electronic health monitoring systems have become increasingly common in medical practice. Digital platforms can help optimize patient diagnosis, counselling and treatment. However, due to the lack of official regulations and recommendations, stakeholders, including private and public organizations, face the problem of adequate verification and testing of new digital health technologies. In this regard, proper scientific research is needed before a digital product is deployed for the health sector.The authors emphasize that interactive technologies have a significant potential for optimizing the process of treating patients in healthcare. They can improve the availability and quality of medical care, as well as increase patient satisfaction.

Penerapan SDKI, SLKI, dan SIKI dalam Pendokumentasian Asuhan Keperawatan di Ruangan Interne Pria RSUP Dr. M. Djamil Padang

Nursing services are often used as a benchmark for the image and quality of a hospital in the eyes of the public. One indicator of service quality is nursing documentation. Nursing documentation is a nursing care process for patients that must be carried out by nurses. The results of interviews conducted with nurses in the Men's Internal Room at RSUP Dr. M. Djamil Padang found that nursing documentation through IDHS, SLKI, and SIKI had not run optimally. Therefore, it is necessary to provide education on the application of the SDKI, SLKI, and SIKI in carrying out nursing documentation. The purpose of this activity is that nurses can apply nursing documentation with SDKI, SLKI, SIKI to patients. The implementation of the activity was carried out directly to the nurses with a total of 30 respondents starting with the pretest, giving material, and ending with the post test. The results of the pre test were the level of knowledge of nurses in the Men's Internal Room of Dr. M. Djamil Hospital Padang regarding the application of SDKI, SLKI, and SIKI in nursing documentation before being given education, namely 7 nurses had good knowledge (23%), 10 nurses had sufficient knowledge (33%), 13 nurses have less knowledge (44%). The results of the post test were the level of knowledge of nurses in the Men's Internal Room Dr. M. Djamil Hospital Padang regarding the application of SDKI, SLKI, and SIKI in nursing documentation after being given education, namely 25 nurses had good knowledge (83%), 5 nurses had sufficient knowledge (17%). Based on these results it can be concluded that this educational activity is very useful and can increase nurses' knowledge about documentation and can be applied directly to patients. The suggestion is that nursing managers can control the nursing documentation process so that the quality of nursing services can be optimal.

The voice of stoma care nurses: an exploration of stoma care in England

This article is part two of a series presenting the findings of stakeholder surveys with ostomates and stoma care nurses (SCNs) for stoma services in England. Part one explored the experiences of ostomates. This article focuses on the views and experiences of 108 SCNs in England. To understand the experience of SCNs in England in relation to current services provided. This includes the scope of the SCN role, the service they provide, and SCN experience and views on areas for improvement. SCNs were invited to share their experiences and views in a national online survey. Questions considered the experience of the nurse, where the care they provide is delivered, how their post is funded and their views on current issues such as responsibility for managing waste of stoma product. Two free-text questions asked what areas of stoma care services worked well and what areas could be improved, results of which were coded and thematically analysed. Themes included patient care, industry involvement and prescribing process. Overall, survey respondents felt that they provided a good standard of care. Nurses reported complex industry relationships. Awareness of the Nursing and Midwifery Council Code, Bribery Act 2010 and NHS England guidance on managing conflicts of interest is advocated, as is promoting transparency in funding arrangements. It was noted that there appears to be variation in the care provided to ostomates.

Association of an Acute Kidney Injury Follow-up Clinic With Patient Outcomes and Care Processes: A Cohort Study

To determine whether attendance at an acute kidney injury (AKI) follow-up clinic is associated with reduced major adverse kidney events. Propensity-matched cohort study. Patients hospitalized with AKI in Ontario, Canada, from February 1, 2013, through September 30, 2017, at a single clinical center, who were not receiving dialysis when discharged. Standardized assessment by a nephrologist. Time to a major adverse kidney event, defined as death, initiation of maintenance dialysis, or incident/progressive chronic kidney disease. Propensity scores were used to match each patient who attended an AKI follow-up clinic to 4 patients who received standard care. Cox proportional hazards models were fit to assess the association between the care within an AKI follow-up clinic and outcomes. To avoid immortal time bias, we randomly assigned index dates to the comparator group. We matched 164 patients from the AKI follow-up clinic to 656 patients who received standard care. During a mean follow-up of 2.2±1.3 (SD) years, care in the AKI follow-up clinic was not associated with a reduction in major adverse kidney events relative to standard care (22.1 vs 24.7 events per 100 patient-years; HR, 0.91 [95% CI, 0.75-1.11]). The AKI follow-up clinic was associated with a lower risk of all-cause mortality (HR, 0.71 [95% CI, 0.55-0.91]). Patients aged at least 66 years who attended the AKI follow-up clinic were more likely to receive β-blockers (HR, 1.34 [95% CI, 1.02-1.77]) and statins (HR, 1.35 [95% CI, 1.05-1.74]), but not angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (HR, 1.21 [95% CI, 0.94-1.56]). Single-center study and residual confounding. Specialized postdischarge follow-up for AKI survivors was not associated with a lower risk of major adverse kidney events but was associated with a lower risk of death and increased prescriptions for some cardioprotective medications.

Quality and team care response to the pandemic stresses in high performing primary care practices: A qualitative study.

To learn how high performing primary care practices organized care for patients with diabetes during the initial months of the COVID-19 pandemic. Semi-structured interviews were conducted between August 10 and December 10, 2020 with 16 leaders from 11 practices that had top quartile performance measures for diabetes outcomes pre-COVID. Each clinic had completed a similar interview and a survey about the existence of care management systems associated with quality outcomes before the pandemic. Transcript analysis utilized a theoretical thematic analysis at the semantic level. The pandemic disrupted the primary care practices' operations and processes considered important for quality prior to the pandemic, particularly clinic reliance on proactive patient care. Safety concerns resulted from the shift to virtual visits, which produced documentation gaps and led practices to reorder their use of proactive patient care processes. Informal interactions with patients also declined. These practices' challenges were mitigated by technical, informational and operational help from the larger organizations of which they were a part. Care management processes had to accommodate both in-person and virtual visits. These high performing practices demonstrated an ability to adapt their use of proactive patient care processes in pursuing quality outcomes for patients with diabetes during the pandemic. Continued clinic transformation and improvements in quality within primary care depend on the ability to restructure the responsibilities of care team members and their interactions with patients.

ASUHAN GIZI KANKER PAYUDARA PASKA OPERASI

Background : Cancer is the second leading cause of death globally. The type of cancer with the highest prevalence in women is dominated by breast cancer. Decreased appetite is a nutritional problem that occurs in cancer patients. Therefore, the intake of energy, protein, fat, and carbohydrates needs to be specifically considered. Energy, protein, fat, and carbohydrates have an important role in maintaining the nutritional status of patients to remain in the normal range, considering that there will be changes in metabolism in cancer patients which have an impact on decreasing nutritional status.Objectives : To describe the implementation of nutritional care process in breast cancer patients.Method : The study design used was a Case StudyResults : The abstract should be typed as concise as possible and should be composed of: problem statement, method, scientific finding results, and short conclusion. The abstract should only be typed in one paragraph and one-column format. (Times New Roman 12pt)Nutrition care process for cancer patients begins with nutrition screening, nutritional assessment, nutritional diagnosis, intervention, monitoring and evaluation of nutrition. Provision of a high-energy, high-protein diet for three days in the form of soft foods. Nutrition education and counseling were provided to patients and their families. Overall there was an increase in the amount of food intake every day.Conclusion : Implementation of the nutrition care process for three days increased food intake. Clinical physical data showed fluctuating results.

Lost to follow up from chronic care services during COVID-19 from health facilities, in Northwest Ethiopia.

The COVID-19 pandemic and the responses to it have greatly altered individual lives, particularly those with chronic illnesses. The pandemic affected the processes of routine comprehensive care for patients. Because chronic illnesses depress the immune system, they make individuals more susceptible to infection as well as more sickly and less likely to recover from the COVID-19 pandemic. Because of this, the rate of loss to follow-up (LTFU) from chronic illness care is accelerated by the COVID-19 pandemic, and the number of patients receiving new treatments is decreased. Therefore this study aimed to assess the mean difference of loss to follow-up among HIV/AIDS, diabetes mellitus (DM), and hypertension patients during the COVID-19 period as compared to pre-COVID-19 at health facilities in Northwest Ethiopia. An institution-based secondary data analysis of the Gondar city health report from October 2019 to Jun 2021 was done. Excel data were transformed to STATA 14 for analysis. An independent t-test was used to compare the mean difference of loss to follow-up and new initiation of treatment among HIV/AIDS, DM, and hypertension patients during the pre-COVID-19 and COVID-19 periods at facilities in Northwest Ethiopia. Variables with a mean difference of p < 0.005 with a 95% confidence interval were used to declare the significant level. There was a significantly higher mean difference in the number of patients with LTFU from Anti-Retroviral Therapy (ART) and antihypertensive treatment during COVID-19 as compared to the pre-COVID-19 period [μd =17.85, 95%CI: 3.25, 32.95] and [μd =17.31, 95%CI: 8.35, 26.97] respectively. The mean number of patients who were newly started anti-hypertensive treatment during the COVID-19 season was significantly decreased as compared to those who were before the COVID-19 period [μd = -32.94, 95%CI: -63.76, -2.12]. There was a significantly higher mean difference in the number of patients with LTFU from Anti-Retroviral Therapy (ART) and antihypertensive treatment during COVID-19 as compared to the pre-COVID-19 period. The mean number of patients who were newly started anti-hypertensive treatment during the COVID-19 season was significantly decreased as compared to the pre-COVID-19 period. Therefore the Ministry of Health Ethiopia (MOH) should update and prepare convenient care and follow-up such as remote chronic illness management methods during the ongoing COVID-19 pandemic in Ethiopia.

Defining the Practice of Dietitians in Malaysia Using the Nutrition Care Process in Patients with Type 2 Diabetes Mellitus

(1) Background: The quality of dietetic care is crucial to improve patient outcomes. The aim of this study was to measure the current practices regarding the provision of nutrition care in type 2 diabetes mellitus (T2DM) among dietitians in Malaysia. (2) Methods: A 49-item online survey was distributed via Malaysian Dietitians’ Association and Ministry of Health Malaysia social media platforms. Self-reported dietetic practices in the management of T2DM were evaluated against practice guidelines. (3) Results: A total of 173 dietitians completed the survey, with a response rate of 62%. Three-quarters of dietitians in the public sector consulted patients within two to three weeks or more than four weeks versus less than two weeks (86.3%) among private dietitians (p-value &lt; 0.001). More than 95% of private dietitians spent 31–60 min or more than 60 min on new cases versus 71% among public dietitians (p-value &lt; 0.001). Group counseling was only practiced among public dietitians (36.0%). Different practice settings led to the current findings. A limited use of behavioral counseling theories and strategies was observed among dietitians from both sectors. Limited adherence to nutrition-related recommendations (62.8%) and lack of readiness for diet/lifestyle changes (45.5%) were the key challenges faced by dietitians when managing T2DM. (4) Conclusions: The survey indicates that there is a need for the development of comprehensive training to increase the utilization of behavioral counselling. Practice setting is an element to consider when designing training.

Abstract 13692: Gender, Process of Care and Mortality in Heart Failure Patients in India: Findings From the National Heart Failure Registry India

Introduction: HF mortality rate vary by gender in high income countries. Process of care is often associated with differences in HF mortality. Hypothesis: We hypothesized that, HF process of care is associated with differential mortality in men and women. Methods: National Heart Failure Registry is a nationwide registry . Data from 10851 consecutive acute decompensated heart failure patients (ESC2016) criteria was analysed. At baseline we examined sociodemographic characteristics, clinical features , disease etiology and co-morbid conditions of patients. We assessed both in-hospital and 90-day mortality. Results: The mean age of study population was 59.9 (SD=13.5). More than two third (69%) participants were men. Sixty-five percent (Women = 58.6%, Men =68.2%, p value = p&lt;0.001) and 13%( Women = 19.5%, Men =9.6%, p value = p&lt;0.001) of patients had HF with reduced ejection fraction and HF with preserved ejection fraction, respectively. In this study, 71.2%(Women =74.2 %, Men = 69.8%, p value = p&lt;0.001) of patients had New York Heart Association (NYHA) Class III or Class IV. In-hospital and 90-day mortality rate were 6.7%(Women = 7.6%, Men = 6.3%, p value = 0.010) and 14.2%(Women = 14.9%, Men = 13.9%, p value =0.160), respectively(Fig:1). Beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), and mineralocorticoid receptor antagonists (MRA) were prescribed in 75.7% (Women=74.2%, Men=76.4%, p value = 0.015), 61.2% (Women=60.6%, Men=61.4%, p value = 0.405) and 64.7% (Women=66.4%, Men=64.0%, p value = 0.016), respectively. The study population had very low usage of devices like the automatic implantable cardioverter-defibrillator 0.9% (Women=0.4%, Men=1.1%, p value =p&lt;0.001), cardiac resynchronization therapy defibrillator 1.0% (Women=1.1%, Men=1.0%, p value =0.75). Conclusion: The HF process of care differences may partially explains the differences in mortality in men and women.

Nursing role in the process of care in patients with pneumonia

The general objective of the research was to determine the role of nursing in the care process in patients with pneumonia. The approach formulated by the researcher for the methodological development of this work was the quantitative approach with a descriptive methodology with non-experimental design, which was supported by documentary-bibliographic analysis. Documents were used for this type of study. A research process was organized in which the study population relied primarily on written documents such as theses, statistics and scientific articles to examine the writings in order to study them and draw conclusions. It is concluded that the role of the nursing professional in the process of care in patients with pneumonia is oriented to the promotion of health, reaching the conformation of work teams, innate leadership, relationships with patients and interaction with their relatives, medical specialists focused on care.