Quality Standards Of Care Research Articles

Towards Establishing Quality Standards on Human Rights for Services in Dementia Care.

People with dementia often experience violations of fundamental human rights and impeded access to healthcare. This study aims to investigate the views of experts regarding the use of the United Nations Convention on the Rights of People with Disabilities (CRPD) principles as quality standards for human rights-based care. A single-round Delphi e-consultation with 15 dementia experts was designed to evaluate each CRPD principle and collect feedback on their views about the application of the CRPD principles in dementia care. The CRPD principles were fully endorsed as quality standards; however, several experts commented on the complexities of the use of CRPD principles in relation to information disclosure, capacity assessment, stakeholders' involvement in decision-making, respecting needs and preferences, holistic approaches in care practice, and protection against abuse, neglect and discrimination. These findings indicate the CRPD quality standards were fully applicable for people with dementia although some clarification around interpretation could assist in their use. Future research should elaborate on further points of support and guidance for dementia care providing examples of good practice from across the globe, and develop a concordant, human rights-based scheme for the implementation and evaluation of dementia services. This study suggests that the CRPD can serve as a benchmark for human rights-based practices in dementia services globally that could enhance nursing care practice. Nursing staff are encouraged to consider human rights in relation to the complexities associated with people with dementia, their caregivers, and other services involved in their care.

Impact of the Early COVID-19 Pandemic on the Quality of Obstetric Care in a Tertiary Care Center in Karachi, Pakistan.

Objective This study aimed to assess the indirect impactof the COVID-19 pandemic on obstetric quality measures. Materials and methods This cross-sectional study was conducted at a private-sector tertiary care hospital in Karachi, Pakistan. Data were collected for specific antenatal, intrapartum, and postpartum care indicators during the initial six months of the COVID-19 phase (March to August 2020) and compared with baseline measures from the preceding six months before the COVID-19 phase (September 2019 to February 2020) using frequencies and percentages. Results During COVID-19, there was a 10% reduction (pre-COVID: 1041 and during COVID: 946)in outpatient obstetric volumes and a 65% increase(pre-COVID: 240 and during COVID: 396) in clinic cancellations, indicating a decreased influx of antenatal patients. Teleclinics served 8.3% (1429/18279) of the total obstetric patients during this period. Marginal decreases were observed in spontaneous vaginal deliveries 1358 (44%)vs 1049 (42.4%) and labor inductionrates 818 (26.6%)vs 606 (24.2%). Additionally, there was a slight increase in instrumental deliveries, 121 (3.9%) vs 114 (4.6%) during the COVID phase. However, these changes were not statistically significant. Similarly, no substantial impact was observed on elective and emergency C-sections. Notably, there were more cases of primary postpartum hemorrhage (PPH) during the COVID-19 phase 36 (1.17%) vs46 (1.86%), and these changes were statistically significant (p= 0.035). Similar trends were observed for eclampsia (p =0.05) and preeclampsia cases (p-value 0.074). However, other maternal morbidity indicators and intrauterine fetal deaths remained relatively unchanged. NICU admissions increased significantly (p=0.001), while early neonatal deaths remained unaffected. Patient satisfaction rates remained steady for inpatients and improved for outpatients during COVID-19. Conclusion The COVID-19 pandemic primarily affected antenatal volumes, neonatal admissions, and maternal morbidity indicators such as PPH, preeclampsia, and eclampsia. Despite the challenges, patient satisfaction and quality care standards were maintained during COVID-19 through new strategies and revised patient care processes.

Nursing assessment of mental health issues in the general clinical environment: A descriptive study.

To evaluate the effectiveness of a mental health screening form for early identification and care escalation of mental health issues in general settings. A secondary aim was to explore general nurses' use of the form and their confidence to discuss mental health issues with patients. A cross-sectional design comprising a review of clinical records to determine use of the form, instances of missed care and escalation to the mental health team. The survey focused on nurses' confidence in general settings to engage in discussions with patients about mental health. Data were collected from April to December 2022. The Strengthening the Reporting of Observational Studies in Epidemiology Statement guided this study. Of 400 patient records, 397 were analysed; 293 (73.8%) of those had mental health screening by nurses. Age was a significant factor, with younger patients more likely to be screened although concerns were typically recognized in older patients. Of the 20 patients identified with mental health concerns, 9 (45%) were referred for further evaluation by the Clinical Liaison Team. While nurses were proactive in assessing physical risks, assessing risk factors that required deeper conversations with patients, including psychiatric history, was lacking. The survey highlighted fewer than half of the respondents (46%, n = 10) felt competent to engage in discussions about mental health; however, most (59%, n = 13) knew when to seek a mental health referral. General nurses have a role in the early identification and referral of patients with mental health challenges. However, training is imperative to facilitate deeper patient interactions concerning mental health. Integrating mental health checks within general settings is crucial for early detection and intervention, aligning with global quality care standards. STROBE guidelines. We received feedback that shaped the research protocol from a consumer representative.

Machine Translation for Multilingual Cancer Patient Education: Bridging Languages, Navigating Challenges.

This commentary evaluates the use of machine translation for multilingual patienteducation in oncology. It critically examines the balance between technologicalbenefits in language accessibility and the potential for increasing healthcare disparities.The analysis emphasizes the need for a multidisciplinary approach to translation thatincorporates linguistic accuracy, medical clarity, and cultural relevance. Additionally, ithighlights the ethical considerations of digital literacy and access, underscoring theimportance of equitable patient education. This contribution seeks to advance thediscussion on the thoughtful integration of technology in healthcare communication,focusing on maintaining high standards of equity, quality, and patient care.

Retrospective analysis of the construction of the national system of hospice and palliative care in Great Britain

Today, Great Britain has one of the best hospice care systems for palliative patients in the world, which leads to interest in the path of building a Hospice and Palliative Care (НPC) system in this country. The hospice care system is mainly financed by the volunteer sector, which indicates a significant development of the state-society partnership in the organization of НPC. The national НPC system consists of inpatient care, day palliative care, care in the community and emergency hospitals. 2004–2008 is considered the key moment in the formation of the country's НPC system, which will be the focus of this study. For specialist palliative care, the National Health Service of Great Britain allocated almost £50 million a year in those days until 2004. At the same time, volunteer support was about 4 times greater. More than 220 volunteer support groups for palliative patients operated in the country. The success of building a national НPC system is described in the Palliative Care White Paper. A number of interrelated national programs may be used as a standard of palliative care in 20 years by many other countries. The development of the НPC system has influenced the British homes for the elderly, the system of primary care, the attitude to the НPC problem of doctors, local communities and society as a whole, increased the quality and availability of palliative care. Palliative care since those years has been provided 24/7, managed by coordination centers located outside medical facilities and hospices. High national НPC standards and mechanisms for monitoring their compliance have been created. Narcotic analgesia for palliative patients with chronic pain, the necessary medical, psychological, social and spiritual care is mostly available. The public debates the question of a dignified death without restrictions. The value for money of НPC is recognized by British society as acceptable. Therefore, studying the British experience of НPC organization as one of the "best practices" is useful for other countries with less developed НPC systems. Keywords: "best practices", place of death, palliative care quality standards.

Blended Tele-mentoring Support for Strengthening Antenatal Care by Private Health care Facilities: FOGSI VISTRIT INITIATIVE.

The objective of the present initiative was to build capacity of health care providers in private sector along with standardisation of care during antenatal period for common antenatal problems of GDM and iron deficiency anaemia in private sector. A pilot project for all levels of health care providers including doctors, nurses, counsellors and laboratory technicians of 34 private facilities in six districts of Jharkhand was planned. Training modules for GDM and anaemia based on government of India guidelines were developed. End line evaluation included data collection and descriptive analysis of quantitative data quality scores from assessment standards on GDM and anaemia in pregnancy. Knowledge assessment of health care providers and doctors through baseline and end line knowledge assessment survey questionnaire showed that 100% health care providers who were trained scored 85% or more in knowledge assessment questionnaires as seen by baseline and end line questionnaire results. All project hospitals (n = 34) in Jharkhand achieved quality standards of care in intervention period for gestational diabetes mellitus and anaemia in pregnancy. They achieved total score more than 80% and exceeded target of 80% of the quality standards. A systematic strengthening of private health care facilities through a blended tele-mentoring and onsite support is possible. The online version contains supplementary material available at 10.1007/s13224-023-01866-5.

Quality Care in Residential Care and Treatment Settings in North America: From Complex Research to Four Everyday Principles for Practice

Quality is a central topic in contemporary discussions about residential care, and specifically about group or congregate care. Such care settings have been contested in recent years specifically resulting from anecdotal evidence that quality is lacking. To this end, the response has focused on the development of quality indicators and standards. In this essay, the author argues that, although such approaches are necessary and have helped to embed evidence-based practices in residential care settings, they are not easily translated into everyday practice. Quality care must mean more than frameworks for care that are governed by professional system designs. Quality care also must include the experiences of young people living life in these settings. To this end, to help with the translation of quality care standards for residential care, the essay presents four core principles that, on the one hand, are familiar and easily translatable for youth workers and social workers in these settings, and on the other hand, honour and are congruent with core elements of almost all evidence-based practice approaches.

DOP03 Gaps between ECCO quality standards of care and the real world: the E-QUALITY survey on processes and outcomes

Abstract Background The European Crohn’s and Colitis Organisation (ECCO) Position Paper on Quality-of-Care (QoC) proposed essential standards on process and outcomes for units that manage patients with inflammatory bowel disease (IBD). The E-QUALITY taskforce investigated whether gaps between these standards and real-world practice exist. Methods A 74-question web survey accessible to all institutions affiliated with ECCO was developed. One delegate per institution was requested to respond. A descriptive analysis was done. Results From March to October 2023, 166 centres from 28 different countries replied to the survey (Fig.1). At diagnosis, disease extent is assessed by colonoscopy in 96% and completed by small bowel (SB) evaluation in 43%. At least 2 biopsies from each segment are obtained in 55%. SB investigation for Crohn’s disease (CD) takes place in 60%. 54% of centres provide access to endoscopy with deep sedation for the majority of patients. To assess treatment response, faecal calprotectin is used in 65%, endoscopy in 54%, cross-sectional imaging for CD in 36%. In the case of primary failure of any drug, therapeutic decisions are based on objective measures of inflammation in 98%. A scheduled monitoring protocol for asymptomatic patients is followed in 42%. Patients with prolonged use of corticosteroids are being switched to a steroid-sparing treatment in 84%, but there is no protocol to track or act upon high steroid exposure in 43% of centres. 72% centres monitor metabolic bone health. Only 51% of units screen IBD patients for colorectal cancer, but screening is done with high-definition endoscopy in 92%. Chromoendoscopy with targeted biopsies is performed in only 47% units. Patients with perianal fistula are managed by combined medical and surgical approach in 67%, and reassessment by clinical and endoscopy and/or pelvic MRI is done in 62%. Laparoscopic approach for intra-abdominal surgery is used in 76%, and preoperative nutritional assessment in 62%. Patients receive therapies to prevent post-operative recurrence based on risk factors in 70%, standard endoscopy within 6-12 months after surgery is done only in 52% of centres. Although only 8% of centres lack a defined protocol to manage acute severe ulcerative colitis flares, 13% lack a standard algorithm, and 36% do not involve the surgeon in this setting from day 1. 38% of centres have a paediatric to adult transition clinic. The main reason for not adhering to ECCO standards are difficulty of providing tests in a timely fashion in up to 83% of centres. Conclusion Our survey has revealed significant gaps between ECCO standards and real-world practice. These results will help ECCO improve initiatives to help institutions to provide standard QoC. 1) Fiorino et al. JCC 2020;14:1037-48

Analysis of problems associated with the quality standards of primary care in the Federal District

RESUMO Este artigo analisa os problemas prioritários estabelecidos nos planos de ação da gestão local no âmbito do Programa de Qualificação da Atenção Primária à Saúde do Distrito Federal – QualisAPS. Trata-se de um estudo descritivo, com abordagem qualitativa, conforme autoavaliações descritas nos Planos de Ação para a Qualidade, elaborados por 100 gestores das Gerências de Serviços de Atenção Primária em 2022. Os resultados demonstraram que, das cinco dimensões do instrumento de autoavaliação da qualidade, a atenção ao usuário e a organização do trabalho são as centrais para a melhoria da Atenção Primária à Saúde. Na análise temática dos problemas, foram identificados nós críticos que sinalizam prioridades de intervenção dos gestores: territorialização; planejamento e monitoramento; comunicação com o usuário; organização do trabalho; estrutura; qualificação dos profissionais; e pandemia. Os resultados demonstram que o processo contínuo de identificação de prioridades é essencial para subsidiar o planejamento em saúde pelos gestores e equipes e que o QualisAPS constitui um acertado passo para fomentar experiências com enfoque de planejamento estratégico em outros sistemas locais.

Person-centered maternity care during childbirth and associated factors among mothers who gave birth at public health institutions of Debre Markos town, Northwest Ethiopia, 2022: A cross-sectional study.

Person-centered maternity care is a crucial scheme for a positive childbirth experience. It enhances facility-based delivery, improves patient-provider communication, and increases women's satisfaction. However, there is limited evidence on the magnitude of person-centered care and certain variables were missed in Ethiopia. Therefore, this study assessed the magnitude of person-centered maternity care during childbirth and associated factors at health institutions of Debre Markos town, Ethiopia. Institution-based cross-sectional study was conducted at public health institutions of Debre Markos town. Participants were enrolled using systematic random sampling technique. Data were collected through face-to-face exit interviews, cleaned, coded, and entered into Epi-Data version 3.1 then exported to SPSS version 25 for analysis. After generating simple linear regression analysis, variables with p-value ⩽ 0.25 were fitted into multivariable linear regression model and p-value < 0.05 was declared statistically significant with 95% CI for β. Finally, study findings were presented using texts, tables, and figures. In this study, 380 women participated, with a response rate of 98.19%. The respondent's mean person-centered maternity care score was 56.83 with 95% CI: (55.83, 57.83). Mean score for sub-scale was 15.08 for dignity and respect, 14.42 for communication and autonomy, and 27.33 for supportive care. Commencing antenatal care during third trimester (β = -4.86, 95% CI: -8.22, -1.49), caesarean delivery (β = -5.78, 95% CI: -7.68, -3.87), college and above educational level of women (β = 3.75, 95% CI: 1.11, 6.39), being multiparous (β = 3.69, 95% CI: 1.85, 5.55), and health center delivery (β = 6.59, 95% CI: 4.17, 9.02) were factors significantly associated with person-centered maternity care. This study showed person-centered maternity care was low compared with World Health Organization standards. This informs local policymakers, district health offices, institutional healthcare administrators, and healthcare professionals of the discrepancies in achieving international standards of quality care.

Effect and causes of burnout on mental health among healthcare professionals

Burnout, which refers to workplace stress, poses a threat to the well-being of healthcare practitioners, affecting both their individual mental health and the overall functioning of the healthcare system. The demanding nature of the profession, cultural expectations, and organizational challenges all contribute significantly to the signs of burnout, such as exhaustion, depersonalization, and reduced personal achievement. Research conducted in Saudi Arabia and GCC countries sheds light on the factors that contribute to burnout among healthcare professionals, emphasizing the need for a different approach to clinical management. The study explores the relationship between burnout and mental health, uncovering an interplay that undermines both individuals' well-being and patient care quality. It delves into how burnout extends beyond boundaries to impact lives and the broader healthcare system. The review highlights the importance of tailored interventions, stress management techniques, and organizational support in clinical management strategies that address the challenges faced by healthcare professionals in these regions. Furthermore, it emphasizes individualized support systems, team-based approaches to care provision, and policies promoting work-life balance as measures for mitigating burnout. To effectively address burnout, it is crucial to implement monitoring and evaluation systems while advocating for policy changes at both governmental levels. By taking an approach, we can ensure the prevention and management of burnout. As healthcare systems continue to evolve, prioritizing the well-being of healthcare professionals becomes increasingly important. This ensures healthcare delivery and maintains a high standard of quality care.

Providing Hemodialysis in Unstable Areas: An Assessment and Framework for Effective Care

Providing hemodialysis to patients with kidney failure (KF) in conflict-affected areas poses a significant challenge. Achieving and sustaining reasonable quality hemodialysis operations in such regions necessitates a comprehensive approach. In the conflict area of Northwest (NW) Syria, a 3-phase project was initiated to address the quality of hemodialysis operations. The assessment phase involved the examination of infection prevention and control (IPC) protocols, staff training, medical protocols, individualized hemodialysis prescriptions, and laboratory testing capabilities. The second phase involved activities toward capacity building and implementing an action plan based on feasibility and sustainability. The assessment phase revealed that only 7 of 14 centers had IPC protocols, and 8 centers provided IPC training for their staff. Furthermore, only 7 centers had medical protocols, and 5 used individualized hemodialysis prescriptions. Difficulties in testing for potassium was reported in 7 centers and the inability to perform hepatitis B and C serologies was reported in 3 centers. Only 2 centers adhered to machine and water treatment system maintenance guidelines, and 4 conducted daily water quality checks. Recommendations were formulated, and an action plan was developed for implementation in the second phase. The plan encompassed enhancements in IPC practices, medical protocols, record-keeping, laboratory testing, and equipment maintenance. This project underscores that hemodialysis services in conflict-affected areas do not meet the standards for quality care. It emphasizes the necessity of implementing a comprehensive framework that engages relevant stakeholders in defining and upholding quality care, a model that should be extended to other protracted conflict-affected regions.

P136: Human Rights and Quality Standards for Services in Dementia Care

People with dementia can experience violations of fundamental human rights and impeded access to healthcare. This work builds on the World Health Organization’s good practice guidance on community mental health services by investigating the range of dementia services around the world and national/international clinical guidelines, and the views of experts regarding the use of the United Nations Convention on the Rights of People with Disabilities (CRPD) principles as quality standards for human rights-based care. Two scoping reviews of database and grey literature resources summarized the range of services, and clinical guidelines using content analysis. A single-round Delphi e-consultation with dementia experts was designed to evaluate each CRPD principle and collect feedback on their views about the applicability of the CRD principles.Services in 31 countries were clustered in 7 categories: Supports and Services for families, Community centres, Community health and social outreach support, Crisis Services, Community health services, Networks of Services, Palliative/End-of-Life Care Services, and Supported living. National and international guidelines for quality practice were summarized for each service type. The CRPD principles were highly endorsed as quality standards, however as expected, given dominant practices in the field, several experts challenged the applicability of CRPD principles in relation to information disclosure, capacity assessment, stakeholders’ involvement in decision making, respecting needs and preferences, holistic approaches in care practice, and protection of human rights against abuse, neglect and discrimination. These findings provide an overview of different services and clinical recommendations for dementia care and lay the foundation for an international evaluation framework of quality practice. Future work will develop a concordant, human-rights based scheme for the evaluation of dementia services and use this to establish good practice guidance for dementia care using examples from across the globe.

Proposed correlation between effectively addressing quality issues and improving provider well-being

Abstract: Introduction: Quality assurance and performance improvement (QAPI) and performance improvement projects (PIP) are tools to ensure quality care, safety, and problem-solving standards are met and exceeded. This paper examines possible correlations between data gained from implemented QAPI programs at Robert C. Byrd Clinic (RCBC) and provider burnout. Methods: Two surveys were evaluated for this paper. The first survey, Quality Report, identified each respondent's department, the monthly quality reports’ satisfaction rating, and the reports’ perceived accuracy. 28 providers completed the first survey. The second survey was the Well Being Index (WBI), which assesses provider burnout. 38 providers completed the second survey. Results: More than half (53.57 %) of individuals were dissatisfied with using the monthly reports to calculate quality reimbursement for insurance companies, and (65.79%) of participants in the WBI indicated that they felt burned out from their work in the past month. Conclusion: The findings of these two surveys warrant future research to evaluate the possibility of a correlation between the perceived accuracy of quality reports and provider burnout.

A day in the life of a home care worker in England: A human factors systems perspective

The delivery of home care in England is explored with respect to (a) the work system (b) the barriers that challenge worker performance, and most importantly (c) whether these barriers impact the quality and safety of the care received by older adults. Data were collected using surveys and interviews with home care workers (n = 11). The analysis used two validated Human Factors and Ergonomics (HFE) models to map the data which identified three key performance barriers; (1) time factors, (2) organisational practices, and (3) job design. Adaptive behaviour was identified as being routine to manage time barriers, which resulted in trade-offs between care outcomes (delivery), quality and safety standards and work-related quality of life. The findings make an important contribution to the limited research literature on home care work by highlighting the opportunity for an HFE systems perspective to provide a novel approach for both understanding home care and building better home care systems.

Monitoring of ECFS quality standards for the clinical management of adults with cystic fibrosis

BackgroundAlthough cystic fibrosis (CF) standards of care have been produced and regularly updated, they are not specifically targeting at the adult population. The ECFS Standards of Care Project established an international task force of experts to identify quality standards for adults with CF and assess their adherence. MethodsThis study was composed of two phases. In the first one, a task force of international experts derived from published guidelines and graded ten quality standards for adult CF care using a modified Delphi methodology. In the second phase, an international audit was conducted among adult CF centers to retrospectively validate the quality statements and monitor adherence. ResultsThe task force identified 10 quality standards specific to the care of adults with CF, mainly based on the 2018 ECFS standards of care. 14 adult CF centers participated in the audit, which showed that most quality standards for the management of CF in adults are met across Europe. Heterogeneity in adherence to standards was found across centers according to geographical setting and centers’ characteristics. ConclusionsThe identification of quality standards is a valuable resource for the standardization and monitoring of care delivery across centers taking care of adults with CF.

The Updated Global Malnutrition Composite Score Clinical Quality Measure: Its Relevance to Improving Inpatient Clinical Outcomes and Health Equity

Quality improvement has existed in health care for centuries with a dramatic transformation over time, largely motivated by the academic health quality movement. Throughout this evolution, the Centers for Medicare and Medicaid Services have been at the forefront of the development and provision of quality measures for health care in a variety of settings, including acute care. Quality initiatives aid in the evaluation of patient care to encourage quality improvement efforts, determine pay-for-performance rates, and help patients and consumers evaluate their care providers. The addition of the Global Malnutrition Composite Score as an electronic Clinical Quality Measure in 2022 highlights the key role nutrition plays in outcomes and quality of hospitalized patients. With this, credentialed nutrition and dietetics practitioners lie front and center for the development of quality improvement processes to help promote high quality standards of nutrition care, improve length of stay, and reduce health care costs and readmissions while addressing malnutrition, health equity, and nutrition care as a human right. As the Global Malnutrition Composite Score steward, it is the obligation of the Academy of Nutrition and Dietetics and the Commission on Dietetic Registration to promote the measure and support credentialed nutrition and dietetics practitioners in advocating for the implementation of this measure. Therefore, the purpose of this practice update is to provide necessary information to credentialed nutrition and dietetics practitioners and other health care leaders related to the history and implementation of the Global Malnutrition Composite Score, along with relevant updates to the measure and practice implications.

Compliance with Health Care Quality Standards in Government Accredited Hospitals in the Province of Albay

Global health systems operate within ever-evolving local and global environments, influenced by various factors, including economic shifts, demographic dynamics, and technological advancements, among other variables. A study was conducted to determine the Health Care Quality Standards among the government-accredited hospitals in the province of Albay. Specifically, it identified the status of Health Care Quality Standards in the Province of Albay along with Policies and Procedures, Services, Human Resources, Budget, and Logistical Resources. It determines the Health Care Quality Standards among the government-accredited hospitals in the province of Albay regarding Patient Care Management, Human Resource Management, Information Management, and Safe Practice and Environment. The quantitative method was used to gather responses from respondents. The respondents of the study are personnel from the top and middle management and selected patients in the three hospitals. Hence, the study revealed that the Health Care Quality Standards among the government-accredited hospitals in the province of Albay are complied with based on the requirements set forth by the hospitals among the four components. Thus, it ensures that health services are responsive to the needs of targeted individuals and communities and encourages the role of communities as co-producers of health. The study recommends a sustainable healthcare management framework to strengthen and sustain comprehensive healthcare services, thus improving the community's quality of life.

Long-term anticoagulation treatment in proximal femoral fractures as obstacle to surgery in the 24h time window? : Results of an analysis of Quality Assurance data on 32,252 treatment courses with osteosynthesis

Both in Germany and internationally there is avehement controversy about the appropriate time for care of proximal femoral fractures in older patients. The effort to achieve high quality and uniform standards of care culminated in the German healthcare system in the strict requirement of delay-free surgery within 24 h. Until now, in view of their high vulnerability patients who were severely injured were too often operated on late with the reference to ageneral medical condition that could be improved preoperatively. In particular, the fear of complications due to apre-existing long-term anticoagulation treatment was repeatedly emphasized. The present study is dedicated to the question of whether adelay in surgery of anticoagulated patients with proximal femoral fractures already during the inpatient course has adetrimental effect on the complication statistics and the mortality of the patients. The extent to which external quality assurance data are suitable for rebutting any objections to an operation as soon as possible are examined. The study is based on treatment data from the external inpatient quality assurance procedure of the federal state of North Rhine-Westphalia from the years 2018-2020. Patients with aproximal femoral fracture were considered. This includes femoral neck fractures and fractures in the area of the pertrochanteric to subtrochanteric region. Only cases with joint-preserving fracture care were selected. The data sets were analyzed using suitable statistical software. More general complications and deaths have been observed in anticoagulated patients. The trend of delayed fracture treatment under anticoagulant medication continues to be clearly visible. Apositive association between longer preoperative waiting time and undesirable courses can be confirmed. With respect to fracture care when taking anticoagulants, it must be critically examined to what extent arapid normalization of the coagulation situation is necessary and this actually improves the chances of low complication courses. Should the elimination of the anticoagulant effect by substitution or antidote appear necessary, this should not prevent early care.

Novel Memories of Motherhood: Childbirth Lived Experiences of Mothers with Coronavirus Disease 2019 (COVID-19).

The critical coronavirus pandemic presents a global challenge with dimensions yet unknown, underscoring the essential need to comprehend the lived experiences, especially for vulnerable groups. This study delves into the childbirth experiences of mothers dealing with coronavirus disease 2019 (COVID-19). Employing hermeneutic phenomenology, this qualitative research was conducted at Mashhad University of Medical Sciences (Iran). Purposeful sampling involved 16 mothers with maximum variation. Unstructured telephone interviews collected data, analyzed using the Diekelman approach. Unveiling the theme "Novel Memories of Motherhood," four central themes emerged: "The Missing Link in Quality Care," "Coronavirus Stigma," "A lonely mother in quarantine," and "Cascade of Psychological Trauma." COVID-19 acts as an intervening factor, distorting routine care and delivery programs. The focus for service providers attending to mothers in labor should extend beyond physical care, encompassing the elimination of coronavirus-related stigma and prioritizing psychological attention. This holistic approach is crucial for maintaining quality care standards.