Hospital Protocol Research Articles

VIVÊNCIA DAS ESTUDANTES DE ODONTOLOGIA DA FACULDADE DO AMAZONAS – IAES NO PROJETO DE EXTENSÃO REFERENTE ÀS PRÁTICAS MULTIDISCIPLINARES EM ODONTOLOGIA HOSPITALAR – UM RELATO DE EXPERIÊNCIA

Introduction: The role of the university is to train critical, reflective and ethical professionals. In this context, as an educational strategy, aligning theoretical teaching with practice, this experience took place at the Hospital and Emergency Room 28 de Agosto. The study was carried out by undergraduate students of the Dentistry course, in their sixth semester, with the practice taking place on two days a week, monthly, with a total duration of eight hours. The activities included lectures to patients, such as oral hygiene care and intraoral examinations, under the supervision of Prof. MSc. Guilherme Ferreira. Hospital Dentistry is a consolidated specialty in the care of hospitalized patients, encompassing a multidisciplinary approach and dental interventions. The care structure at the hospital was organized, ensuring safety and comfort for patients. In the Intensive Care Unit, there was one intubated patient, receiving continuous monitoring, and the other patients demonstrated good health. This experience report aims to share the experience acquired in the practice of Hospital Dentistry, highlighting the multidisciplinary work, the application of the relevant legislation and the challenges faced. Methodology: Descriptive in nature, providing an insight into the dental practices applied in the hospital environment – ​​description of the care provided, the clinical conditions of the patients, the multidisciplinary approaches and the difficulties faced by the professionals. Results and Discussion: Dental care provided to patients with various clinical conditions was observed, allowing an immersion in hospital dentistry. There was an opportunity to learn about hospital protocols and how they align with the hospital's standards and procedures, in relation to infection control and patient safety. The experience highlighted the complexity of dental care and highlighted the importance of multidisciplinary collaboration. Conclusion: The experience was an essential act for future professional practice, providing theoretical and practical learning, the opportunity to observe in a real clinical environment, to verify the complexity of hospital dental care and to adapt to the challenges of the environment.

Serum Albumin Assessment in Neonatal Jaundice: Impact on Phototherapy Decision-Making.

The objective of this study was to investigate the impact of serum albumin assessment on early neonatal jaundice treatment decisions. A retrospective review of medical records was conducted for infants of 35 weeks' gestation or more, evaluated for early neonatal jaundice in 3 hospitals in Thailand from January 1 to December 31, 2023. Per hospital protocol, serum albumin levels were routinely measured during the jaundice evaluation. Infant demographics; serum albumin; total serum bilirubin (TSB); laboratory work-up for jaundice; hyperbilirubinemia neurotoxicity risk factors; hour-specific, risk-based phototherapy threshold; and rates of phototherapy treatment were evaluated. Out of 935 infants evaluated for hyperbilirubinemia, 250 infants (26.7%) had serum albumin levels less than 3.0g/dL. Among 121 infants who received phototherapy at TSB levels meeting the guideline threshold, 49 infants had serum albumin less than 3.0g/dL as one of the neurotoxicity risk factors. However, the decision for phototherapy would not have changed when other neurotoxicity risk factors were present, when TSB at the time of initiation of phototherapy was higher than the threshold without neurotoxicity risk factors, or when TSB at the time of cessation of phototherapy was lower than the threshold with neurotoxicity risk factors. As a result, the identification of serum albumin less than 3.0g/dL affected phototherapy treatment decision in 16 infants (affected initiation in 13, cessation in 1, and both the initiation and cessation in 2) or 1.7% of all infants evaluated for jaundice. Serum albumin levels less than 3.0g/dL are common, affecting 1 in 4 infants assessed for jaundice. However, this has minimal impact on phototherapy decisions.

‘We tried our best... it wasn’t great’: a qualitative study of clinician experiences on child psychiatry wards at the height of COVID-19

Changing public health and hospital protocols during the height of the COVID-19 pandemic shaped the provision of inpatient mental health care. While a growing body of research explores the challenges of restrictions on adult psychiatric wards, the impact on clinical teams and epidemiological trends in youth mental health, no research has explored inpatient psychiatric hospital services for child and adolescent psychiatry during the pandemic. This study seeks to understand how clinicians in Canada working in child and adolescent mental health wards experienced caring for their patients while navigating pandemic hospital restrictions. Following a qualitative descriptive methodology and also drawing on institutional ethnography we generated data using two methods: 1) an online survey of clinicians across the country asking about experiences providing care and COVID restrictions and 2) in-depth, semi-structured interviews with clinicians. Data from 54 surveys and 14 interviews were analyzed using thematic analysis yielding two major themes. First, clinicians felt that clinical care was compromised with likely impact on patient outcomes. Second, respondents reported that the context of the pandemic provoked tensions and resistance within the clinical teams and the institution. Our findings have important implications not only for future public health crises, but also for rethinking how psychiatric care is provided and prioritized. This study points to the need for 1) mechanisms which support collaborative decision making at the institutional level, to ensure regulations are more flexible and can adapt to the needs of child mental health patients; and 2) that child psychiatry prioritize generating spaces of ethical reflection for clinical teams and institutional decision-makers so that paternalism does not trump principles of primum non-nocere (first, do no harm), autonomy and reciprocity.

Perinatal death, collective action and legislation against obstetric violence in Argentina

This article explores the interconnections between perinatal death, collective action, and legislation against obstetric violence in Argentina. It employs a comprehensive methodological approach, including in-depth interviews, document reviews, a survey, and intensive ethnographic fieldwork to provide a multidimensional understanding of how collective actions influence legislative outcomes. Johanna Piferrer’s case, a poignant example detailed in this study, illustrates how personal tragedy catalyzed public and legislative acknowledgement of obstetric violence. This article argues that her advocacy, coupled with the broader feminist movement’s support, was crucial in transforming personal grief into a public issue that led to significant legislative changes. These changes include the creation of “Johanna’s Law,” which mandates improved hospital protocols and health professional training to handle perinatal deaths more sensitively and effectively. The study concludes that collective action is a powerful catalyst for creating transformative legislation that addresses the systemic issues of obstetric violence in Argentina.

Point-of-care lung ultrasound in the diagnosis of childhood pneumonia.

Lung ultrasound is emerging as a rapid, simple and safe alternative for diagnosing pneumonia since it has a higher sensitivity than X-rays and lower radiation exposure than computerized tomography. This is a prospective observational study done at a tertiary care centre in Chennai to study the diagnostic utility of lung ultrasound in pneumonia. Children aged 1 month to 12 years who were admitted to the hospital with complaints of cough, fever and/or breathing difficulty and on examination had tachypnea and/or chest indrawing were included in the study. All children underwent chest X-rays which was a standard hospital protocol. At admission, an independent investigator who was blinded to the clinical and radiological features of the child performed lung ultrasound. In all children, the final diagnosis of pneumonia was made by another independent expert paediatrician on the basis of the clinical features and chest X-ray. The test characteristics of ultrasound and chest X-ray were compared against this gold standard of physician-diagnosed pneumonia. Out of the 252 children studied, 225 (89.3%) had pneumonia while the rest 27 (10.7%) had other diagnoses. Among the 225 children with pneumonia, 223 (99.1%) were detected by ultrasound while 157 (69.8%) were detected by chest X-ray. All the test characteristics such as sensitivity, specificity, positive and negative predictive values of ultrasound were higher than those of chest X-ray. The sensitivity and specificity of ultrasound to diagnose pneumonia were 99.11% and 81.48%, respectively, while the sensitivity and specificity of X-ray for the same were 69.77% and 74.07%, respectively. Overall diagnostic accuracy for chest ultrasonography was 97.22% (94.36% to 98.88%), whereas for chest radiography, it was found to be 70.24% (64.18% to 75.81%).While both modalities were able to diagnose pneumonia significantly, ultrasound had better strength of association (Cramer's V value = 0.849) than X-ray to the final diagnosis. Lung ultrasound can be employed as a point-of-care investigation to diagnose pneumonia in suspected cases and can even replace chest X-ray in such circumstances.

Antimicrobial surface coating in the emergency department as protective technology for infection control (ASEPTIC): a pilot randomized controlled trial

Study objectiveWe examined the effectiveness of an antimicrobial surface coating for continual disinfection of high touch-frequency surfaces in the emergency department (ED).MethodsFollowing a preliminary observation identifying stretcher rails as the surface with highest touch-frequency in the ED, we conducted a pilot randomized controlled trial involving 96 stretcher rails. The stretchers were randomized to receive an antimicrobial surface coating or placebo coating. Routine cleaning of stretchers subsequently continued as per hospital protocol in both arms. Sampling for total aerobic, gram-positive halophilic, gram-negative and methicillin-resistant Staphylococcus aureus bacteria was performed pre- and post-treatment at 24 h, 7 days and 180 days. Individuals who applied the coating and outcome assessors were blinded to the allocated arms. The primary outcome is contamination of antimicrobial versus placebo rails measured as colony forming units per cm2(CFU/cm2).ResultsBaseline total aerobic bacteria was comparable between placebo and intervention arms (0.84 versus 1.32 CFU/cm2, P = 0.235). Total aerobic bacteria contamination was significantly lower on antimicrobial versus placebo rails at 24 h (0.61 versus 1.01 CFU/cm2, median difference 0.40 CFU/cm2, 95% confidence interval [CI] 0.01 to 1.01 CFU/cm2). There was a non-statistically significant tendency for contamination to be lower on antimicrobial versus placebo rails at 7 days (1.15 versus 1.50 CFU/cm2, median difference 0.35 CFU/cm2, 95% CI -0.64 to 1.28 CFU/cm2), but higher at 180 days (2.06 versus 1.84 CFU/cm2, median difference − 0.22 CFU/cm2, 95% CI -1.19 to 0.78 CFU/cm2).ConclusionThis is the first double-blinded, placebo-controlled, randomized trial to evaluate an antimicrobial surface coating on high touch-frequency surfaces in the emergency department. Total aerobic bacteria found on antimicrobial-coated patient transport stretcher rails was significantly lower than placebo rails at 24 h.

Community Healthcare-Associated Infections: Enhancing Control with Software and Tailored Protocols

Abstract Issue/Problem Healthcare-associated infections are major global public health challenges. In Portugal, the prevalence of resistant Enterobacteriaceae is particularly alarming. Studies typically focus on hospitals and long-term care facilities, neglecting community settings where patients, particularly the elderly with multiple comorbidities, often transition between hospital and home. Description of the problem Effective control measures are vital across all healthcare environments. In home care, sporadic implementation of Contact Precautions, due to the lack of specific guidelines and challenges in accessing colonization information, has been a major gap. This project aimed to close this gap by integrating a software, previously used only in hospitals, to enhance infection control in domiciliary care. The intervention adapted contact transmission-based precautions for home settings and used data from the previous year’s infections and colonization to tailor recommendations for each patient, preventing transmission between homes and enhancing caregiver education. Results Preliminary data from a two-month monitoring period involved 40 patients under the care of three domiciliary teams. Eleven had records of infections involving 19 microorganisms, including 7 Enterobacteriaceae, five of which were carbapenemase producers. This led to five customized recommendations for improved precautions. The intervention also heightened nurses’ awareness of patients’ microbiological histories, evidenced by increased inquiries to the infection control team. Lessons Adapting measures to the unique dynamics of home care, distinct from hospital settings, is critical. Involvement of care teams in decision-making ensures practical adherence and enhances measure effectiveness. Regular monitoring is crucial for compliance, making this approach a model for other settings. Key messages • Adapting hospital protocols to community settings and offering close support to caregiving teams increases compliance. • Implementing software that facilitates communication about infection and colonization enhances infection control effectiveness in community settings.

The effect of using a local skin cooling device on arteriovenous fistula cannulation pain and comfort level of patients on hemodialysis: A single-blind randomized controlled study.

The study aimed to investigate the impact of the using local skin cooling on arteriovenous fistula cannulation pain and the comfort levels of hemodialysis patients. The single-blind randomized controlled trial was formed with 50 patients between June 20, 2023, and July 31, 2023, in the hemodialysis units of two state hospitals in Turkey. Patients were randomly assigned to either the experimental group (n = 25) or the control group (n = 25) using the block randomization method. This data were collected through the use of the CoolSense device, the "Patient Information Form," the "Verbal Category Scale," and the "General Comfort Scale." Patients in the experimental group received the local skin cooling for five seconds during arteriovenous fistula cannulation, while the control group followed the standard hospital protocol. The study was registered on Clinical Trials (NCT06144801). The study revealed that the application of the local skin cooling during arteriovenous fistula cannulation significantly reduced pain and increased patients' comfort levels, demonstrating an anesthetic effect (p < 0.001). Furthermore, it was observed that as pain levels decreased, patient comfort levels increased (p < 0.001). It is concluded that the using lokal skin cooling is an effective tool for reducing pain and enhancing comfort during arteriovenous fistula cannulation in hemodialysis patients.

The effect of depression on the outcome of infertile females underwent the first In Vitro Fertilization procedure

Background: Infertility affects married adults, and In Vitro Fertilization (IVF) is an Assisted Reproductive Technology (ART) that can treat it. Women undergoing IVF are more likely to experience depression. There is a need to reduce depression by supporting and advising sufferers. The aim of this study is to evaluate the effect of depression on pregnancy rates among infertile females underwent IVF treatment. Materials and Methods: This observational study analyzed 149 patients attending the infertility center at Kamal Al-Samaraie hospital seeking a chance of a conception. The participants received a traditional hospital protocol. The study assessed depression status using the CES-D (Center for Epidemiologic Studies Depression) scale at the beginning of the IVF cycle. Results: Conclusion: Our findings show that the pregnancy rate was not related to baseline depression of women underwent the first IVF procedure. .

Assessment of the adherence to perioperative nutritional care protocols in Brazilian hospitals: The PreopWeek study

ObjectivesThe study (PreopWeek) aimed to assess the perioperative nutritional care for major surgical patients in Brazilian hospitals, focusing on adherence to emerging multimodal protocols like Enhanced Recovery After Surgery and Acceleration of Total Postoperative Recovery. MethodsAn observational cross-sectional study was conducted in Brazilian hospitals enrolled voluntarily from June 19 to June 23, 2023 (convenience sample). Data were collected through patient interviews and medical records review. ResultsData from 219 patients up to the fifth postoperative day or postoperative discharge across 24 hospitals were analyzed. Only three hospitals (12.5%) had established institutional perioperative protocols. Most of the patients were female (60.3%) and over 60 y old (81.7%) and underwent gastrointestinal (34.7%) or orthopedic (33.3%) surgeries. General and nutritional preoperative counseling was provided to a respective 82.2% and 62.6% of the patients. Only 25.7% of the patients had preoperative fasting for up to 3 h, and 28.8% received carbohydrate-rich supplements. Immunonutrition was not received by 43.8% at any point. Although most started postoperative refeeding within 24 h (81.7%), 39.4% started with a liquid diet and 70.6% reported postoperative immobilization in the first 24 h. Notable differences were observed between hospitals with and without protocols. Hospitals with institutional protocols reported significantly more preoperative exercises and nutritional counseling and higher adherence rates for all the perioperative protocols. ConclusionsOur study demonstrates a lack of adherence to the multimodal protocols, even in hospitals with institutional protocols. Future educational programs are necessary to improve this result.

Colonization of Bone Flaps by Cutibacterium acnes During Decompressive Craniectomies for Traumatic and Non-traumatic Indications: A Retrospective Observational Study.

Background Cutibacterium acnes (C. acnes) is one of the most common bacteria in the human skin microbiota. Due to it generally requiring special culturing techniques, it was generally not routinely included in culture. However, recent laboratory automation advancements have allowed C. acnes to be a routinely tested pathogen. Though this could improve outcomes by detecting a virulent pathogen early, it has raised concerns about potential false positives leading to increased costs and medical risks. This study aims to analyze the C. acnes colonization rates in traumatic craniectomies and compare it to non-traumatic craniectomies, the former including risk factors due to penetrations and the latter being conceptually similar to a craniotomy with a lack thereof. This would help establish a baseline rate to understand the pathogen's implications better. Methodology We analyzed the electronic health records of 124 patients who underwent a craniectomy followed by a cranioplasty at Inova Health System from January 1, 2018, to January 1, 2023. The following categories of data were recorded for each patient: patient descriptors, comprehensive surgical timelines and outcomes, and bone flap viability and microbial colonization assessment. The chi-squared tests of independence and Wilcoxon signed-rank tests were used to assess statistical significance between groups in the indications underlying surgery (traumatic vs. non-traumatic) with C. acnes colonization, flap status (reimplanted vs. discarded), hospital length of stay (LOS), and unexpected 30-day readmission. Results Traumatic (67%) and non-traumatic (33%) craniectomies were compared. There was no significant association between the two craniectomy etiologies in terms of C. acnes colonization (40% vs. 26.5%, p=0.19), flap discardment (40% vs. 24%, p=0.12), or readmission rates (20% vs. 9.6%, p=0.18). However, a significant association was found between C. acnes colonization and LOS during the index craniectomy procedure (24.8 vs. 25.9 days, p=0.049), indicating that colonization may influence LOS. No significant association was found between the type of cranial surgery and LOS (p=0.83), suggesting other factors may play a more crucial role in determining LOS. The findings highlight the need to consider the impact of C. acnes colonization on surgical outcomes and hospital protocols. Conclusion Our findings illustrate that there is no significant difference between C. acnes colonization in traumatic and non-traumatic craniectomies; therefore, C. acnes can be expected to be cultured at a baseline level regardless of the etiology. Furthermore, there was no association with surgical indication and flap status, LOS, and readmission rates. However, a significant association was found between C. acnes status and LOS, indicating the increased complexity of care associated with the pathogen's detection. These findings support the protocol of deferring C. acnes culturing unless specific concerns are found.

Variation among venous thromboembolism risk assessment tools for postcesarean patients: a retrospective cohort study.

Venous thromboembolism (VTE) risk in pregnant women is four to five-fold higher than in nonpregnant women, and the risk of VTE is an additional four-fold higher after Cesarean section compared to normal vaginal delivery. Recommendations regarding anticoagulant prophylaxis are inconsistent across international guidelines, and VTE remains one of the leading causes of maternal morbidity and mortality. This study aimed to compare the need for postcesarean anticoagulation for VTE prophylaxis based on three major guidelines and our own institutional protocol. It was a retrospective cohort study that reviewed the medical records of patients who underwent a cesarean section at a tertiary-level care hospital in the United Arab Emirates (UAE). The need for anticoagulation was assessed using clinical tools from the American College of Obstetricians and Gynecologists (ACOG), Royal College Obstetricians and Gynecologists (RCOG), American College of Chest Physicians (ACCP), and the study site hospital protocol. A total of 1134 postcesarean women, aged 18-55 years, were included in the study. Most patients (87%) were at moderate risk for VTE. According to the study site hospital tool, 90.7% qualified for anticoagulant prophylaxis, while the ACOG, RCOG, and ACCP tools indicated that 0.5, 90.9, and 36.7% qualified, respectively. Enoxaparin was the primary anticoagulant used in 95% of cases. Only one patient developed VTE during the follow-up period. Anticoagulation needs assessment tools vary extensively in their estimations, highlighting the need for a uniform tool across multiple societies to establish a consistent standard of care and guide the development of evidence-based, site-specific protocols.

Knowledge and Practices Regarding Prevention of Central Venous Catheter Removal-Associated Air Embolism: A Survey of Nonintensive Care Unit Medical and Nursing Staff.

Air embolism is a potentially serious complication of central venous catheter (CVC) use. While CVC insertion is usually performed by a trained specialist, extraction is frequently the responsibility of junior staff members. This complication can be easily prevented by following several simple measures described in common guidelines. We conducted a single-center survey to assess knowledge and practices concerning the prevention of air embolism associated with CVC removal among healthcare workers from nonintensive care units. The correct answers to the questionnaire were determined according to best-practice recommendations for CVC removal. Based on a comparison of the total sum of correct answers between the categories of groups, factors that predicted the level of knowledge were identified using an independent sample t test. Of the 156 respondents, one-third were unfamiliar with air embolism as a complication of CVC extraction. Almost 80% were unaware of the existence of a CVC removal protocol. Almost half of respondents did not follow guidelines regarding patient position when removing a CVC, 72% did not ask the patient to perform the Valsalva maneuver during the procedure, and 54% did not ask the patient to remain supine after the procedure. Adherence to the protocol was correlated with professional experience, with a lower level among those with experience of less than 1 year and, particularly, among interns. Our survey revealed inappropriately low awareness of CVC removal-associated air embolism risk and low familiarity with CVC removal best-practice recommendations among nonintensive care unit healthcare workers. Staff members with experience of less than 1 year, including interns, were found to have a lower level of knowledge. These findings emphasize the importance of development and distribution an internal hospital protocol and the integration of educational intervention into a preliminary internship program.

From Thesis to Scientific Articles: Publication of Neonatal Research in Ecuador

Objective: To determine the proportion of scientific articles published by health professionals in Neonatology services in Ecuador in the last 20 years. Theoretical framework: Perinatal research is a priority in public health. Writing a thesis allows students to acquire research skills. Publishing these findings in indexed journals ensures their validity and relevance, becoming references for future studies, systematic reviews, hospital protocols and clinical guidelines. Method: Bibliometric study that examined the temporal evolution, research design, language, affiliations, keywords, journals and academic degrees of thesis writers. The search was carried out in databases and repositories from the last 20 years, using Zotero, Mendeley, Rayyan and R for the analysis. Results and Discussion: It was identified that 13% of the theses were published in indexed journals in Ecuador. (79%) corresponded to postgraduate studies in pediatrics and neonatology. Almost half (48.97%) were published in local journals and the majority (63.69%) in Spanish. The low rate of scientific publication is a common problem in Spanish-speaking countries. Ecuador contributes only 0.11% of world publications. Research implications: Strengthen research training for students and encourage other professionals involved in newborn care to publish their theses. Originality/Value: The publication of theses as scientific articles contributes to the advancement of knowledge. This process broadens the scope of research, enhancing its impact and application in clinical practice and evidence-based decision-making.

Implementing an obstetric simulation training protocol in a critical access hospital

BackgroundA high-fidelity (HF) simulation training protocol was implemented to improve nurses' knowledge, skills, and self-confidence to improve patient quality of care and safety, thus ultimately having an impact on decreasing maternal mortality rates. SampleThe sample consisted of 16 participants including nurses, a physician, emergency medical technicians (EMTs), and paramedics. MethodsThis project used a self-confidence and competence assessment prior to and following participation to determine statistical significance. In addition, review of the National League for Nursing Student Satisfaction and Self-Confidence in Learning tool data was done to determine the overall success of implementing a HF simulation training protocol. ResultsSuccess of the simulation and content was determined by a reported increase in self-confidence and competence post-simulation. The summative evaluation revealed that participants felt that implementing a HF simulation training protocol, in general, was useful for training. ConclusionWhile this project focused on obstetrics, the premise of the project can be applied to many subject areas to advance practice in rural health. Findings suggest that use of a high-fidelity simulation training protocol is beneficial.

12620 Developing Hospital Protocols For Managing Patients With Hypertriglyceridemia-induced Acute Pancreatitis In Diabetic Ketoacidosis Hospitalizations

Abstract Disclosure: U. Agbedia-ejughemre: None. Methods: We queried the combined 2017-2020 nationwide inpatient sample database for all adult hospitalizations for DKA with and without HTG-AP using the ICD-10 revision codes. Baseline characteristics were compared between DKA hospitalizations with and without HTG-AP using Pearson’s χ2 tests and Student’s t-test for categorical and continuous variables. Study endpoints were the incidence, predictors, and outcomes of HTG-AP, including mortality, hospitalization duration, mean hospital costs, and acute in-hospital complications (sepsis, ARDS, and acute renal failure). Predictors of HTG-AP were assessed using stepwise multivariable logistic regression analysis. Illness severity, baseline risk of mortality, and comorbidity burden were adjusted using APR-DRG metrics and CCI. Prolonged hospitalization was defined as the length of hospital stay in the top decile of hospital stay for all hospitalizations in the study. Results: We analyzed 630,435 hospitalizations for DKA. The study cohort was 51.4% male, 57.6% white Americans and 26.1% Blacks, with a mean age of 40 (SD, 16.2) years. Incidence of HTG-AP was 2.1% (13,445). Hospitalizations with HTG-AP were older (mean age: 44 vs. 40 years; P&amp;lt;0.001) and had greater comorbidity (CCI score of 2: 38.7 vs. 33.8; P&amp;lt;0.001) compared with DKA hospitalizations without HTG-AP. While DKA hospitalizations showed an uptrend, increasing from 105,769 to 199,429 hospitalizations (Average annual percent change [AAPC]: 27.04%; P=0.029), the incidence of HTG-AP showed a downtrend from 2650 (2.5%) to 4085 (2.0%) (P=0.006). Predictors of HTG-AP included Hispanic (aOR: 2.45; 95% CI: 1.95-3.07; P&amp;lt;0.001) or Asian race (aOR: 2.48; 95% CI: 1.37-4.48; P=0.003), private insurance (aOR: 1.57; 95% CI: 1.10-2.25; P=0.013), self-pay (aOR: 2.2; 95% CI: 1.49-3.27; P&amp;lt;0.001), APR-DRG moderate risk of mortality (aOR: 1.52; 1.21-1.92; P&amp;lt;0.001), APR-DRG major loss of function (aOR: 1.46; 95% CI: 1.31-1.69; P&amp;lt;0.001), dyslipidemia (aOR: 1.87; 95% CI: 1.47-2.38; P&amp;lt;0.001), hypertension (aOR: 1.39; 95% CI: 1.13-1.72; P=0.002), obesity (aOR: 3.09; 95% CI: 2.42-3.96; P&amp;lt;0.001), obstructive sleep apnea (aOR: 2.05; 95% CI: 1.35-3.10; P=0.001), chronic liver disease (aOR: 9.44; 95% CI: 6.61-13.48; P&amp;lt;0.001), old MI (aOR: 2.11; 95% CI: 1.02-4.38; P=0.045), and COPD (aOR: 2.31; 95% CI: 1.47-3.64; P&amp;lt;0.001). DKA hospitalizations with HTG-AP were correlated with higher risk of septicemia (aOR: 1.20; 95% CI: 1.05-1.69; P=0.029), ARDS (aOR: 1.24; 95% CI; 1.04-2.07; P=0.004), and resource use, including prolonged hospitalization (26.3% vs. 11.1%; P&amp;lt;0.001), and higher mean hospital costs ($57,773 vs. $32,692; P&amp;lt;0.001). Conclusion: HTG-AP was linked to worse outcomes, excluding mortality, in hospital admissions for DKA. There is a need for enhanced diagnostic guidelines and protocols targeting this subgroup of patients could improve outcomes. Presentation: 6/2/2024

Comparing Guidelines to Daily Practice When Screening Older Patients for the Risk of Functional Decline in Hospitals: Outcomes of a Functional Resonance Analysis Method (FRAM) Study.

Dutch hospitals are required to screen older patients for functional decline using 4 indicators: malnutrition, delirium, physical impairment, and falls, to recognize frail older patients promptly. The Functional Resonance Analysis Method was employed to deepen the understanding of work according to the protocols (work-as-imagined [WAI]) in contrast to the realities of daily practice (work-as-done [WAD]). Data have been collected from 3 hospitals (2 tertiary and 1 general) and 4 different wards: an internal medicine ward, surgical ward, neurology ward, and a trauma geriatric ward. WAI models were based on national guidelines and hospital protocols. Data on WAD were collected through semistructured interviews with involved nurses (n = 30). Hospital protocols were more extensive than national guidelines for all screening indicators. Additional activities mainly comprised specific preventive interventions or follow-up assessments after adequate measurements. Key barriers identified to work according to protocols included time constraints, ambiguity regarding task ownership, nurses' perceived limitations in applying their clinical expertise due to time constraints, insufficient understanding of freedom-restricted interventions, and the inadequacy of the Delirium Observation Scale Score in patients with neurological and cognitive problems. Performance variability stemmed from timing issues, frequently attributable to time constraints. The most common reasons for deviating from the protocol are related to time constraints, lack of knowledge, and/or patient-related factors. Also, collaboration among relevant disciplines appears important to ensure good health outcomes. Future research endeavors could shed a light on the follow-up procedures of the screening process and roles of other disciplines, such as physiotherapists.

Barriers to Offering Organ Preservation for Rectal Cancer in a Predominantly Hispanic Safety Net Hospital.

Total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC) has shown promise in achieving pathologic complete response (pCR) and enabling organ preservation through watch-and-wait (WW) strategies. However, implementation of WW protocols in diverse patient populations and safety-net hospitals faces unique challenges. The objective of this study is to evaluate TNT outcomes and identify barriers to WW implementation in a predominantly Hispanic safety-net hospital in South Texas. A retrospective review was conducted of 40 LARC patients treated with TNT at an academic tertiary referral center in South Texas between 2018 and 2023. Patient demographics, disease characteristics, and pCR rates were analyzed. A survey of multidisciplinary providers assessed perceived institutional and patient-related barriers to WW implementation. The cohort was 70% Hispanic, with a median age of 54 years. Most patients had advanced disease at diagnosis (57.5% T4, 65% N2). The pCR rate was 18.5% (5/27) among patients undergoing surgery. Re-review of MRIs for pCR patients revealed that 2/5 had minimal residual disease. The provider survey identified MRI quality variability, lack of dedicated treatment coordinators, and concerns about patient compliance and financial barriers as key obstacles to WW implementation. Despite advanced disease presentation in a predominantly Hispanic population, TNT achieved pCR rates comparable to international trials. Institutional and patient-level barriers to WW were identified, informing the development of a tailored WW protocol for this unique patient population.

Stakeholders' Perceptions of Hospital-Based Early Childhood Parenting Education Services: A Thematic Analysis

BACKGROUND: Postnatal parental education is deficient yet necessary to enhance the implementation of evidence-based newborn care practices among families. Educating both mother and father is crucial for optimal childhood development, and interventions targeting families can improve childcare practices. Implementing these interventions through systematic policies and protocols in LMIC hospitals is essential. This study explores the perceptions of pregnant women, parents, and healthcare workers regarding parenting education in a tertiary care hospital in Karachi, Pakistan. METHODS: In a qualitative study conducted in a tertiary care hospital in Karachi, Pakistan, participants included pregnant women, parents, and healthcare workers. The study used in-depth interviews with purposively selected participants, consisting of two individuals from each category. Interviews were conducted using a prepared guide, and data collection was performed by trained staff. Interviews were conducted until data saturation was achieved. The interviews were conducted in Urdu, transcribed, and translated into English. Thematic analysis was carried out manually. RESULTS: The analysis of pregnant women's experiences identified themes of personal pregnancy experiences, support systems, and hospital facilities. Women discussed physical, emotional, and financial challenges during pregnancy. They valued support from family and physicians but expressed a need for better educational resources in hospitals. For parents with children under one-year-old, themes included personal experiences, hospital experiences, and educational resources. Parents faced emotional changes, financial challenges, and desired improved work-life balance. They appreciated outpatient care but found lacking in inpatient experiences, particularly in the NICU. Healthcare workers emphasized the role of parents, families, and hospitals, highlighting the importance of teaching and understanding family dynamics. Also suggested improvement in holistic approaches, mandatory educational programs, and integrating parenting readiness into primary care. CONCLUSION: Hospital-based postpartum parenting education enhance overall baby care. Expanding literature emphasizes the importance of high-quality parenting for lifelong development. Identifying efficient programs and resources to enhance parental abilities and foster positive child growth is increasingly important.

Role of Newborn Hearing Screening Done Over One Year in a Tertiary Care Hospital: A Cross-Sectional Study.

Newborn hearing screening (NHS) is universally acknowledged as a critical early intervention to prevent adverse developmental outcomes caused by undetected hearing loss. Despite its proven benefits, the implementation of NHS varies, especially in tertiary care hospitals that manage high-risk neonates. This study investigates the effectiveness and implementation of NHS protocols in these settings. This cross-sectional study was conducted in the Department of Neonatology at Saveetha Medical College, Chennai. All newborns delivered between January 2023 and December 2023 were included. Screening involved initial otoacoustic emissions (OAEs) tests, automated auditory brainstem response (AABR) followed by brainstem evoked response audiometry (BERA) for those who failed.Data on demographic characteristics, screening results, and follow-up compliance were collected and analyzed. A total of 1,398 neonates were screened. Initial screeningresulted in 416 (29.7%) referrals. Follow-up screenings showed high compliance rates, with significant detections of hearing impairments through BERA. The screening was completed for 1,341 babies. Fifty-five babies were lost to follow-up. Of these, 2 babies (0.1%) with a high risk for hearing loss were diagnosed with bilateral severe hearing loss. The study also noted demographic factors such as kinship and obstetric history that might influence hearing loss risks. NHS plays a vital role in the early detection and management of hearing impairments, which is crucial for preventing negative impacts on a child's development. This study advocates for the systematic implementation of NHS protocols in all tertiary care hospitals, especially those serving high-risk neonates, to ensure optimal developmental outcomes.