Quality Of Care Research Articles

Procedural sedation in the emergency department by Italian emergency physicians: results of the SEED SIMEU registry

Background and importance Effective and safe procedural sedation is pivotal for the quality of care in the emergency department (ED). Objectives The aim of this work is to evaluate the feasibility, effectiveness, and safety procedural sedation performed by emergency physicians in the ED setting in Italy. Design/setting and participants/intervention Following a specific training of the staff and with the adoption of a standardized protocol, a registry of procedural sedations performed on adult patients in 10 Italian EDs was compiled from 2019 to 2022; the following basic data were recorded: demographic and clinical information, procedure’s indication, administered drugs, predefined, and actual sedation level. Outcome measures and analysis Effectiveness was evaluated considering three parameters: successful completion of the procedure, absence of procedural pain, and no memory of the procedure; adverse events were classified according to the World Society of Intravenous Anaesthesia criteria and evaluated taking into account clinical and procedural variables. Main results The study included 1349 patients (median age 68 years, male 64%). Sedation was performed for electrical cardioversion (66.3%), orthopedic procedures (23.2%), or other procedures (10.5%). Propofol (67%) and midazolam (24.2%) were the two most frequently used sedatives and 70.6% of the patients achieved a deep level of sedation. Procedural failure occurred in 4.6% of cases, with no significant differences between procedure types or drugs used. Recall of the procedure and procedural related pain were reported by 2.9% and 2.6% of patients, respectively, and were more frequently related to orthopedic procedures, midazolam use – if compared with propofol, and lower levels of sedation. A total of 135 adverse events were observed, with an overall incidence of 10%: 38 minimal adverse events (2.8%), 38 minor adverse events (2.8%), and 59 moderate adverse events (4.4%). There were no adverse events requiring unplanned hospital admission or escalation of care, and no sentinel adverse events were observed. All adverse events were resolved with simple and noninvasive treatments. The incidence of adverse events was greater with higher American Society of Anesthesiologists class, intermediate/difficult airway, and deeper sedation levels. Conclusion Procedural sedation performed in Italian EDs by emergency physicians, with propofol as main sedative, was effective and safe, and has comparable adverse event rates with previous international studies.

“If we work as a team, there are success stories.” Unpacking team members’ perceptions and experiences of what impacts team performance in a maternal and neonatal quality improvement programme in South Africa, before, and during COVID-19

Many maternal and neonatal deaths and stillbirths can be avoided if quality of care is improved. The South African National Department of Health implemented a multi-partner quality improvement (QI) programme between 2018 and 2022, in 21 facilities, with the aim to reduce maternal and perinatal mortality. We conducted a qualitative evaluation to explore QI team members’ perceptions of the factors shaping variation in team performance. The evaluation was conducted in 15 purposively selected facilities. We interviewed 47 team members from the 14 facilities consenting to participate in the evaluation, over three time points. We conducted 21 individual interviews and 18 group interviews. Data were thematically analysed using ATLAS.ti 8. Based on a preliminary assessment, six teams were rated as well-performing and eight, less well-performing. Patterns of divergence between well-performing and less well-performing teams were then examined through in-depth analysis of the full data set. Well-performing teams had a core team of members with a good understanding of the programme aims and QI methodology; a second in-charge member to ensure leader continuity; and leader stability throughout the implementation period. Well-performing teams were recruited from existing facility service teams who had a positive prevailing work culture. Team leaders’ enthusiasm for QI and their ability to mobilise member buy-in, and how well teams worked together, further affected teams’ performance. Existing facility contexts, how teams are set up, leadership—and member buy-in into the methodology, affect QI teams’ performance. Focusing on these as well as supporting leaders to foster a shared vision and culture of excellence; mitigating contextual and implementation barriers; and strengthening team members’ technical QI skills, has the potential to improve QI teams’ performance.

A cluster randomized trial assessing the effect of a digital health algorithm on quality of care in Tanzania (DYNAMIC study)

Digital clinical decision support tools have contributed to improved quality of care at primary care level health facilities. However, data from real-world randomized trials are lacking. We conducted a cluster randomized, open-label trial in Tanzania evaluating the use of a digital clinical decision support algorithm (CDSA), enhanced by point-of-care tests, training and mentorship, compared with usual care, among sick children 2 to 59 months old presenting to primary care facilities for an acute illness in Tanzania (ClinicalTrials.gov NCT05144763). The primary outcome was the mean proportion of 14 major Integrated Management of Childhood Illness (IMCI) symptoms and signs assessed by clinicians. Secondary outcomes included antibiotic prescription, counseling provided, and the appropriateness of antimalarial and antibiotic prescriptions. A total of 450 consultations were observed in 9 intervention and 9 control health facilities. The mean proportion of major symptoms and signs assessed in intervention health facilities was 46.4% (range 7.7% to 91.7%) compared to 26.3% (range 0% to 66.7%) in control health facilities, an adjusted difference of 15.1% (95% confidence interval [CI] 4.8% to 25.4%). Only weight, height, and pallor were assessed statistically more often when using the digital CDSA compared to controls. Observed antibiotic prescription was 37.3% in intervention facilities, and 76.4% in control facilities (adjusted risk ratio 0.5; 95% CI 0.4 to 0.7; p<0.001). Appropriate antibiotic prescription was 81.9% in intervention facilities and 51.4% in control facilities (adjusted risk ratio 1.5; 95% CI 1.2 to 1.8; p = 0.003). The implementation of a digital CDSA improved the mean proportion of IMCI symptoms and signs assessed in consultations with sick children, however most symptoms and signs were assessed infrequently. Nonetheless, antibiotics were prescribed less often, and more appropriately. Innovative approaches to overcome barriers related to clinicians’ motivation and work environment are needed.

Improving Data-Informed Care in New Brunswick Long-Term Care Homes: A Qualitative Study on an Educational Intervention for interRAI Coordinators

Background/Objectives: InterRAI is a globally validated platform aimed at improving care for individuals with disabilities and complex medical needs, particularly in long-term care settings. This study explores the experiences of interRAI coordinators in New Brunswick, Canada, and their perceptions of an educational intervention designed to enhance their ability to effectively use interRAI data for quality care. Methods: The study recruited interRAI coordinators from 73 New Brunswick long-term care homes for an educational intervention. Nine coordinators participated in interviews about their experiences. A qualitative descriptive approach was used to analyze field notes and interview transcripts with thematic analysis. Results: Nine interviews and six sets of field notes were collected over one year, focusing on the roles of interRAI coordinators. Participants (all female, averaging 54 years old) expressed positive perceptions of the intervention, noting increased knowledge and collaboration. Key themes included the context of the interRAI coordinator role, the use of interRAI data for quality indicators, and recommendations for future educational initiatives. Conclusions: The findings emphasize the critical role of interRAI coordinators in improving quality care in long-term care settings through effective data use and collaboration. Participants reported that the educational intervention significantly improved their understanding and application of interRAI data. Recommendations for ongoing training and broader engagement stress the importance of continuous support to advance care quality in long-term care homes.

Exploring Rapport Formation Between Nurses and End-of-Life Patients: A Meta-ethnographic Synthesis.

This study aims to deepen the understanding of rapport formation between nurses and end-of-life patients by synthesizing existing qualitative research. Using meta-ethnography, this research integrates findings from various studies to explore the essence and process of rapport formation from nurses' perspectives. A comprehensive search across MEDLINE, EMBASE, CINAHL, and Web of Science databases in August 2024 identified 13 relevant studies. The quality of these studies was assessed using the Critical Appraisal Skills Programme checklist. The analysis identified 5 key themes in rapport building: "secure acceptance and safety," "genuine and transparent interaction," "insight into the patient's world," "bonding enhanced by professional support," and "advancing connections within boundaries." These themes underscore the role of rapport in enhancing the quality of palliative care, providing emotional stability, and improving the nurse-patient relationship. This study offers valuable insights for health care professionals to strengthen nurse-patient interactions, emphasizing the importance of rapport in end-of-life care.

Artificial intelligence in respiratory care

The evolution of artificial intelligence (AI) has revolutionised numerous aspects of our daily lives, with profound implications across various sectors, including healthcare. Although the concept of AI in healthcare was introduced in the early 1970s, the integration of this technology in healthcare is still in the evolution phase. Despite barriers, the current decade is witnessing an increased utility of AI into diverse specialities of the medical field to enhance precision medicine, predict diagnosis, therapeutic results, and prognosis; this includes respiratory medicine, critical care, and in their allied specialties. AI algorithms are widely studied in areas like mechanical ventilation, sleep medicine, lung ultrasound, and pulmonary function diagnostics and the results are found to be promising. The quality of patient care and safety can be greatly enhanced if respiratory care professionals fully understand the concept and importance of AI, as they are already incorporating various aspects of this technology into their clinical practice. Awareness of AI in the clinical field is essential during this phase; hence, it is desirable to establish widely accepted standards presented in a clear and accessible language. This article aims to describe the existing and prospective role of AI in the field of respiratory care and allied areas.

Prevalence of meconium-stained amniotic fluid and factors associated with emergency cesarean section: multicenter cross-sectional study in south central Ethiopia

BackgroundMeconium is thick black-green fetal intestinal content starting from the early first trimester of gestation. Unfortunately, if it is released into the amniotic cavity due to any cause, it can be associated with neonatal mortality and morbidity.ObjectiveTo identify the factors associated with meconium-stained amniotic fluid among mothers undergoing emergency cesarean section in specialized hospitals cross-sectional study in south central Ethiopia from August 1, 2022, to 30, October 2022MethodInstitution based multicenter cross-sectional study was done prospectively through meticulous chart review and interview on 875 mothers who gave birth with emergency cesarean section. Data were entered using Epi data 7 and analyzed with SPSS 26. The association between independent variables and meconium-stained amniotic fluid was estimated using an odds ratio with 95% confidence intervals. The statistical significance of the association was declared at P-value < 0.05ResultThe prevalence of meconium-stained amniotic fluid is 31.4%. Gravidity (AOR 3.643; 95% CI:1.215,10.921), time interval between decision to delivery (AOR 1.361; 95% CI: 0.424,4.365),eclampsia(AOR 8.022; 95% CI: 1.634,39.372), time taken from referring institution to managing institution (AOR 15.258; 95% CI: 1.591,146.328), obstructed labor (AOR 24.614; 95% CI: 6.073,99.766), cephalopelvic disproportion (AOR 2.640; 95% CI:1.002,6.950), fetal heart beat abnormality (fetal bradycardia AOR 2.068; 95%CI 0.997,4.292) (fetal tachycardia AOR 3.513; 95% CI:1.633,7.556) duration of labor(AOR 5.44; 95% CI: 1.355,9.782) and referral from health center(AOR 5.41; 95% CI: 2.053,14.272) are associated with MSAF whereas obstetric complications(AOR 6.820; 95% CI: 2.870,16.202), cesarean section scar (AOR 3.010; 95% CI: 1.344,6.740) are negatively associated.ConclusionPrevalence of meconium-stained amniotic fluid is relatively high for which intrapartum, obstetric and institution related factors are incriminated. Therefore, an improvement in the quality of antenatal and intrapartum care is strongly recommended; professional development at the health center, building the infrastructure, and strengthening the referral system is also suggested.

Moral injury and mental health in healthcare workers are linked to organizational culture and modifiable workplace conditions: Results of a national, mixed-methods study conducted at Veterans Affairs (VA) medical centers during the COVID-19 pandemic

Using mixed methods, we examined drivers of risk for moral injury, mental health symptoms, and burnout among frontline healthcare workers in high-risk Veterans Affairs (VA) clinical settings during the COVID-19 pandemic. Across 21 VA medical centers, 2,004 healthcare workers completed an online survey assessing potential risk factors for moral injury, posttraumatic stress, depression, and burnout. Assessed risk factors included: pandemic exposures; individual worker characteristics; aspects of workplace/organizational culture; and facility performance on standardized measures of care quality, patient satisfaction, and employee satisfaction (extracted from VA administrative data). Among surveyed workers, 39% were at risk for moral injury, 41% for posttraumatic stress, 27% for depression, and 25% for persistent burnout. In generalized linear mixed models, significant predictors of moral injury risk included perceived lack of management support for worker health/safety, supervisor support, coworker support, and empowerment to make job-related decisions—all modifiable workplace factors. Pandemic-related risk factors for moral injury included prolonged short-staffing, denying patient-family visits, and high work-family conflict. Predictors of posttraumatic stress, depression, and burnout were similar. Forty-six surveyed workers completed a follow-up qualitative interview about experiences of moral distress in the workplace, and interview themes aligned closely with survey findings. Rapid qualitative analysis identified protective factors that may reduce moral injury risk, including a collaborative workplace community, engaged leadership, empowerment to make changes in the workplace, and opportunity to process distressing events. We conclude with recommendations to mitigate moral injury risk in healthcare organizations. These include involving workers in discussions of high-stakes decisions that will affect them, creating consistent and clear channels of communication between the frontlines and leaders of the organization, practicing leadership rounding to improve leaders’ understanding of the daily work of frontline teams, and collaborating to understand how existing processes and policies may contribute to safety risks and moral conflict.

The Behavioral Health Service Corps: An Innovative Model for Workforce Development.

The increased prevalence of behavioral health problems in the US is intensified by the critical shortage of providers in the field. The historical failure of behavioral health specialties to attract BIPOC students and workers limits leadership, access to quality care, and the generalizability of research findings. Most workforce development programs serve only those with earned graduate degrees. This report describes a service-learning program that is successfully attracting new graduates with bachelor's degrees and culturally diverse professionals into the behavioral health workforce.

Key Aspects of Recovery-Oriented Practice in Caring for People With Mental Ill-Health in General Emergency Departments: A Modified Delphi Study.

To identify key aspects of recovery-oriented practice in caring for people with mental ill-health in general emergency departments. A modified Delphi study with three rounds. A 24-member expert panel was recruited consisting of people with lived experience of mental ill-health, registered nurses working in emergency care, registered nurses specialised in psychiatric and mental health nursing and mental health recovery researchers. In the initial round, important aspects of recovery-oriented practice were identified through focus group interviews. Thematic analysis generated statements that were then reformulated as a questionnaire for subsequent rounds. The experts rated each statement's perceived importance on a 5-point Likert scale. The consensus level was set at ≥ 80%. Descriptive statistics were used to analyse the data. Consensus was reached on the importance of 39 of 73 statements, with ≥ 80% deemed 'very important' in recovery-oriented practice in general emergency departments. The study emphasises the delicate balance between the essential elements of recovery-oriented practice, their practical feasibility and the predominant biomedical perspective in general emergency department care. It proposes strategies to empower nursing staff and managers to adopt recovery-oriented practices that enhance the quality of care for people with mental ill-health. Enabling staff by providing the necessary prerequisites and a care environment that supports reflective practices is crucial. The responsibility for facilitating these changes needs to be a shared commitment between nursing staff and managers. The identified issues can serve as a framework for interventions, education and training to support the integration of recovery-oriented practice in general emergency care. They can also be used to develop tools for evaluating emergency care environments and promoting alignment with recovery-oriented principles. Problem addressed: People with mental ill-health are at risk of being neglected, judged and dismissed in general emergency department care, creating obstacles to their mental health recovery. The Delphi study identified 39 key aspects of recovery-oriented practice in general emergency departments, emphasising person-centred, strength-based, collaborative and reflective care. The research seeks to establish a foundation for developing training programmes, education and interventions and for the integration of recovery-oriented practices in general emergency care. It thus has the potential to enhance the quality and equality of care for patients with mental ill-health in emergency care. The impact extends to nursing staff and managers as it seeks to empower them to systematically reflect on and reevaluate established emergency department practices to ensure that every person, irrespective of their health condition, is treated with dignity and respect in emergency department settings. The CREDES guidance on conducting and reporting Delphi studies. The authors have nothing to report.

A NECESSIDADE DE ESTERILIZAÇÃO DE PRODUTOS PARA SAÚDE IMPORTADOS NO BRASIL: UMA QUESTÃO DE SEGURANÇA

Globalization facilitates access to innovative Health Products (HPPs), but it also brings significant challenges, such as contamination during transport in containers, compromising initial sterilization. In Brazil, these products are distributed to hospitals and clinics, and the lack of re-sterilization can expose patients to serious infections. According to RDC 15/2012, it is recommended to re-sterilize materials transported between hospitals, which makes it even more essential that imported PPS be re-sterilized when they arrive in Brazil. Studies reinforce the importance of this process, highlighting the need to ensure the safety and efficacy of health care. This article defends the re-sterilization of imported PPS, aiming to align with international standards and ensure the quality of care provided to the population.

Mixed study on barriers of access to prevention, diagnosis and treatment of gestational malaria in pregnant women at risk from an endemic region of Colombia

BackgroundGestational malaria (GM) is a serious public health problem, control of GM requires guarantee universal access to prevention, diagnosis and treatment. In Colombia, no studies have been conducted on barriers to healthcare access for pregnant women exposed to GM. The objective of this study was to analyse the barriers to healthcare access for women at risk of GM in an endemic region of Colombia.MethodsA mixed QUAN-QUAL study with 400 pregnant women; from this group, 28 were selected for the QUAL component, to which an interview with eight health workers was added. The barriers investigated were sociocultural, economic, institutional response capacity, knowledge of the actors, previous experiences and health financing. In the QUAN component, the frequency of the barriers and their associated factors were identified. In the QUAL component, a hermeneutic analysis was conducted to enhance the explanatory depth of the barriers, through open (description), axial (conceptual ordering) and selective (theorization) categorization.ResultsThe most frequent barriers included delays in care from a physician (93%) or specialist (89%), and procedures with a Health-Promoting Entity (HPE) (84%); the least frequent barriers were the delivery of drugs (23%) and quality of care (23%). All pregnant women reported at least one barrier, 50% reported between 7 and 11 barriers, with the highest number of barriers among housewives, multigravida and poor pregnant women. The QUAL component included the intersection of GM with sociocultural and economic barriers, financial limitations of public health programmes, failure to fulfill responsibilities by health professionals, and a lack of knowledge regarding health rights among pregnant women.ConclusionMultiple access barriers were identified; the most affected subgroups were identified, and some sociocultural and economic explanations for this problem were explored in depth. It is important to expand the health action of GM control, and to improve the care of pregnant women and their quality of life.

Interhospital variations in diagnostic work-up following recall at biennial screening mammography-a population-based study.

Quality control in breast cancer screening programmes has been subject of several studies. However, less is known about the clinical diagnostic work-up in recalled women with a suspicious finding at screening mammography. The current study focuses on interhospital differences in diagnostic work-up strategies. In this retrospective analysis, using a prospectively obtained database, we included 17,809 women who participated in the Dutch national screening programme between 2009 and 2019 and were recalled to a hospital for analysis of a suspicious mammographic abnormality. The diagnostic work-up (e.g., type and frequency of additional imaging and biopsy) in the different hospitals were compared and analysed by multivariable analysis to correct for confounders. Use of biopsy varied from 36.7% to 48.7% (p < 0.001) between hospitals, and the use of problem-solving magnetic resonance imaging (MRI) from 2.1% to 6.9% (p < 0.001). These interhospital differences remained after correction for patients and tumour characteristics. The percentage of women with a delayed breast cancer diagnosis, defined as histopathological confirmation of breast cancer more than three months after recall or first analysis in the hospital, varied from 2.7% to 6.1% between hospitals (p = 0.07). In our screening region interhospital differences were observed in diagnostic work-up following recall at biennial screening mammography. Though statistically significant, absolute differences were small, and therefore, their clinical impact appears to be limited. Question It is unclear how diagnostic work-up strategies vary between hospitals for women recalled after suspicious findings in breast cancer screening. Findings Significant differences in biopsy techniques and the use of problem-solving MRI were observed, though the clinical impact of these variations is likely to be marginal. Clinical relevance Evaluation of interhospital variation in the diagnostic work-up strategies after recall may aid in optimising the quality of breast cancer care and, indirectly, the effectiveness of the screening programme.

Long-Term Follow-Up After Bariatric Surgery: Key to Successful Outcomes in Obesity Management

Background/Objectives: Bariatric surgery (BS) is considered one of the most effective interventions for the treatment of obesity. To achieve optimal long-term results, continuous follow-up (FU) within a multidisciplinary treatment team is essential to ensure patient compliance and maximize the benefits of BS. However, many patients find it difficult to maintain regular FU, which can affect the quality of care and lead to postoperative complications. This review aims to highlight factors that may hinder compliance with FU after BS, examine potential causes and consequences of inadequate FU, and identify strategies to improve patient participation in long-term FU. Methods: The literature search was conducted between October 2023 and June 2024 in Medline (PubMed) and the Cochrane Library datasets. Studies were selected for their relevance to adherence to FU, multidisciplinary approaches, and long-term bariatric outcomes. Results: The pre- and postoperative period is critical for educating patients and healthcare team members about the importance of FU, addressing potential barriers (e.g., logistical, psychological, and social challenges), and highlighting the risk of relapse to obesity after surgery. The lack of a standardized FU protocol leads to differences between medical centers, further impacting patient adherence. Conclusions: Tailored and regularly updated strategies are essential to address individual patient needs and improve adherence to FU. Further research is needed to identify the specific factors that influence variability in long-term BS outcomes, highlighting the need for a patient-centered approach to obesity treatment.

Multidimensional perspectives on nurse burnout in China: a cross-sectional study of subgroups and predictors

BackgroundBurnout is a state of physical and mental exhaustion triggered by long-term work stress, which is manifested mainly as emotional exhaustion, depersonalization, and a decreased sense of accomplishment. Among them, emotional exhaustion is its core feature, which often leads to a significant decrease in an individual’s enthusiasm for work. Owing to the high intensity of the work environment and the special requirements of emotional labor, the nursing community is more vulnerable to burnout. This burnout not only affects the quality of care but also significantly increases nurses’ willingness to leave their jobs.ObjectivesThis study aimed to identify burnout subgroups among Chinese nurses and explore the predictors of each subgroup.DesignA cross-sectional study.MethodsA total of 500 nurses were recruited for this study via convenience sampling, of whom 470 completed the survey. Nurses’ burnout subgroups were identified through latent profile analysis of 15 items on the Burnout Scale. Relationships between subgroups and sociodemographic variables were subsequently explored via one-way ANOVA, chi-square tests, and multivariate logistic regression analyses.ResultsThree burnout subgroups were identified: low depersonalization with low achievement burnout (26.2%, n = 123), overall moderate burnout (52.1%, n = 245), and high emotional exhaustion with low achievement burnout (21.7%, n = 102). The results of multiple logistic regression analysis revealed that age, years of working experience, marital status, education level, and number of night shifts per month were significant predictors of different burnout subgroups among nurses.ConclusionThis study applied latent profile analysis to explore the subgroups of burnout among Chinese nurses, and the results revealed the diversity of burnout and provided a new perspective for future nursing research. Continued attention to the multifaceted factors affecting burnout and its dynamic changes is recommended to better understand and address the challenges facing the nursing profession.

Clinical study on visual outcomes with four different intraocular lens following cataract surgery

Objectives: The aim of this study was to evaluate and compare the visual acuity and refractive outcomes of four commonly used posterior chamber intraocular lens (IOL) brands implanted during routine cataract surgery. All the lenses were monofocal, hydrophobic acrylic but belonged to a variable price range. Material and Methods: This was a retrospective study of cataract surgery patients who underwent phacoemulsification with four different types of IOL. The IOLs studied were Tecnis Eyhance ICB00 (Group A), AcrySof IQ SN60WF (Group B), Hoya iSert 150 (Group C), and S lens (Group D); 35 eyes in each group. The parameters studied were uncorrected distance visual acuity (UCVA), best-corrected visual acuity (BCVA), and manifest refraction on post-operative days (POD) 1, 7, and 30. Results: On average, 97.14% of patients attained BCVA of 6/12 or better at the final follow-up; 83.57% of patients attained UCVA of 6/6–6/12 at the final follow-up. The highest percentage of patients achieving good UCVA (6/6– 6/12) was seen with AcrySof IQ (94.28%), followed by S-Lens (88.57%), Hoya iSert 150 (82.85%), and Eyhance (68.57%). In POD 1, log MAR UCVA in the four groups did not show any difference (P = 0.42). In POD 7, Group B (AcrySof IQ) had statistically significantly better UCVA as compared to the other three groups (P = 0.04). In POD 30, the UCVA in Groups B, C, and D were comparable, which was better than Group A (Eyhance) (P = 0.01). The spherical equivalent required to achieve BCVA was lowest in Group B (0.15 ± 0.24) and highest in Group A (0.30 ± 0.28) (P = 0.13). Conclusion: All four IOLs produced comparable post-operative visual acuity and refractive outcomes. Surgeons can confidently select more affordable monofocal IOLs without compromising the quality of care, considering both the percentage of patients achieving the optimal vision and the consistency of the outcomes across different lens types.

Evaluating the Knowledge, Attitudes and Practices of Early Career Pharmacists Concerning Opioid Use Disorder (OUD) and Co-morbid Mental Health Conditions: Predicting Patients Health Outcomes in Nigeria

Background: This study aims to evaluate the understanding, perceptions and practices of early career pharmacists concerning opioid use disorder and its associated mental health outcomes for patients in Nigeria. The research seeks to identify the level of knowledge that these pharmacists possess about opioid-related issues and the mental health challenges that often accompany them. By examining their attitudes and practices, the study intends to uncover potential gaps in education and training that may affect the quality of care provided to patients suffering from these interconnected health conditions. Methodology: This was a cross-sectional survey conducted across the six geopolitical zones in Nigeria. We used evidence of licensure and not more than 5 years in practice to identify eligible participants. Information sheets were sent to all potential participants through email. If interested, they signed the consent form and sent the survey online to be completed and returned within 24 hours. Results: Descriptive statistics were used to summarize the data. Out of 514 participants, the majority had accurate knowledge of basic questions as well as a negative attitude regarding how comfortable in providing patient care as well as in monitoring and assessment. 342 (66.5%) respondents and 357 (69.5%) respondents were neutral on the information regarding the percentage of patients that achieve treatment adherence and average patient satisfaction respectively, while (166, 32.3%) (128, 24.9%) reported low/negative treatment adherence and patient satisfaction respectively. Conclusion: By fostering improved knowledge and attitudes among pharmacists, it is possible to mitigate the stigma associated with mental health issues, thereby enhancing treatment adherence and ultimately leading to better health outcomes. The findings show that in as much as the knowledge of these medical conditions is substantial, the negative outcomes persist.

Advancing District Nursing Care Through a Learning Healthcare System: A Viewpoint on Key Requirements

The increasing complexity of healthcare needs driven by an ageing population places pressure on district nursing care. Many vulnerable older adults prefer to remain at home, requiring care coordinated with general practitioners and other professionals. This demand for integrated care is further challenged by a shortage of nursing professionals and the lack of standardised approaches to measure care quality. This article identifies the key requirements for implementing a learning healthcare system in district nursing care, using patient outcome data to foster continuous improvement and create a more adaptive, evidence-based, and patient-centred approach. This paper synthesises findings from multiple studies conducted as part of a PhD thesis, utilising a multi-method approach. These methods include examining patient outcomes in district nursing care and evaluating necessary cultural, organisational, and financial changes. Four key requirements were identified: (1) standardising patient outcome measures; (2) fostering a data-driven culture and strengthening professional autonomy; (3) enhancing organisational support and integrated care; and (4) adopting financing models that incentivise continuous learning and quality improvement. Implementing a learning healthcare system with patient outcome data in district nursing care requires a transformative shift. Standardising outcome measures, investing in information systems, and promoting continuous learning are crucial. Aligning financial incentives with patient outcomes, strengthening professional autonomy, and enhancing organisational support can make district nursing more responsive and capable of meeting complex needs. The described requirements are essential for advancing district nursing care through a more adaptive, evidence-based, and patient-centred approach.

The effect of time to neurosurgical or neuroradiological intervention therapy on outcomes and quality of care after traumatic brain injury, a registry-based observational study

BackgroundEvidence regarding the effect of time to neurosurgical and neuroradiological intervention on outcomes in traumatic brain injury (TBI) across Asia-Pacific region is limited. This study evaluates the quality of care and outcomes for TBI patients undergoing neurosurgical and neuroradiological procedures at different timings.MethodsAdult TBI patients who received any neurosurgical or neuroradiological interventions during the year 2015–2022 in the Pan-Asian Trauma Outcome Study database were analyzed. The time to intervention, as the main exposure, was classified into three groups (Early, Intermediate, and Delayed) using Restricted Cubic Spline (RCS) analysis. The outcomes were in-hospital mortality and unfavorable neurological outcomes. W score was utilized to compare the quality of care among exposure groups. Multivariable logistic regression analysis and interaction analysis were performed to identify the association between the exposure groups and outcomes, reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI).ResultsA total of 1,780 patients were included. From the RCS analysis, patients were classified into three groups according to time to intervention: Early (< 1.9 h), Intermediate (1.9–4.1 h), and Delayed (> 4.1 h). According to the time to intervention, W score was − 8.6 in the early group, -1.1 in the intermediate group, and + 0.4 in the delayed group. Patients receiving intermediate and delayed intervention showed significantly lower mortality (AOR 0.64, 95% CI 0.47–0.86 and AOR 0.66, 95%CI 0.48–0.90, respectively).ConclusionEarly neurosurgical and neuroradiological interventions in TBI patients in the Asia-Pacific region were associated with lower quality of care and higher mortality. The quality of care should be focused and improved during the early hours of TBI.

Artificial Intelligence as an Innovation Tool in Hospital Management: a Study Based on the SDGs

Objective: To analyze recent advances in the implementation of artificial intelligence (AI) in hospital management, highlighting its benefits, challenges, and future prospects. Theoretical Framework: Artificial intelligence (AI) has revolutionized hospital management, driven by machine learning, robotics, and intelligent decision-making systems. These advances have enabled tools that optimize administrative and clinical processes, improving the use of hospital resources and the quality of patient care. Method: The methodology used was an exhaustive bibliographic review, using academic sources and relevant studies published between 2020 and 2024. The databases consulted include PubMed, Scopus, and ScienceDirect. Results and Discussion: The findings show that artificial intelligence has transformed hospital management by improving operational efficiency and the quality of patient care. Applications such as electronic medical record management, predictive algorithms to optimize resource allocation, and AI-assisted telemedicine have enabled a more efficient distribution of resources and a reduction in waiting times. Research Implications: It is highlighted that, although AI offers great potential to improve hospital management and contribute to sustainability, its implementation must be carefully planned to address technical and ethical challenges. It is crucial to promote staff training and establish clear regulatory frameworks that ensure equitable and responsible use of AI. Originality/Value: The study offers a comprehensive view of recent advances in artificial intelligence in hospital management. Its originality lies in the exploration of how AI optimizes both administrative and clinical processes, ensuring and promoting healthy lives for all (SDG:3).