Hospital Setting Research Articles

Fidelity, acceptability, and feasibility of the revised functional autonomy measurement system for hospitalised people: An implementation study.

The revised functional autonomy measurement system (SMAF-R) is an outcome measure of activity performance and resource needs. This study aimed to measure the implementability of the SMAF-R as a routine outcome measure in acute and subacute inpatients. This was a mixed-methods implementation study. Occupational therapists were asked to complete the SMAF-R in hospitalised people with an anticipated length of stay greater than 48 hours over a 12-month period (n= 13,348). A baseline audit of SMAF-R completion rates was conducted, and behaviour change interventions were delivered over 12 months. The Implementability of Healthcare Interventions conceptual framework was used to evaluate fidelity (completion rates), acceptability (staff survey with quantitative and qualitative responses), and feasibility (change in SMAF-R scores from admission to discharge). Quantitative and qualitative (analysed thematically) data were integrated. Occupational therapists and other staff working to improve outcome measure completion within the electronic medical record and other allied health teams were consulted when developing and delivering behaviour change interventions. Peak completion of the SMAF-R did not meet an 80% fidelity success rate (admission: 32% in acute and 66% in subacute; discharge: 12% in acute and 48% in subacute). Two thirds of occupational therapists reported the SMAF-R was an acceptable measure to use, but only 38% liked using it. Thematic analysis revealed three themes: (1) A greater understanding of the relevance of the SMAF-R influenced acceptability; (2) using the SMAF-R within an electronic medical record may facilitate completion; and (3) it takes more time to complete SMAF. Patients made clinically significant improvements in SMAF-R scores during their hospital stay (median difference 16.5 [6.5-27.0], p< 0.001, n= 764). Although most occupational therapists reported the SMAF-R was acceptable, there were mixed opinions regarding the relevance of the SMAF-R in this setting, which may have impacted fidelity. Additional prompting and training (especially regarding understanding SMAF-R relevance to practice) may assist with improving SMAF-R completion. Further research is required to assess the psychometric properties of the SMAF-R in the hospital environment. The revised functional autonomy measurement system (SMAF-R) is an assessment tool used to measure performance in everyday activities (such as showering) and the resources needed to complete these tasks (e.g., a shower chair or someone's help). Occupational therapists can use it at the start of a patient admission and again at the end in different hospital settings to assess patients' needs and see if they improve. This study aimed to measure (1) how often occupational therapists use the SMAF-R with patients in hospital, (2) how acceptable occupational therapists find the SMAF-R, and (3) whether the SMAF-R shows changes in patients' abilities during their hospital stay. Before the study, usual completion of the SMAF-R was measured, and it was found to be completed in less than 1% of patients. Strategies were introduced to improve SMAF-R completion over 12 months. After this, completion of the SMAF-R improved to between 9% and 38% in different hospital settings. Changes in SMAF-R scores showed that patients improved during their time in hospital. Most occupational therapists reported the SMAF-R was an acceptable measure, but less than half liked using it. The low completion rates suggested that either the SMAF-R was not fit for purpose in this setting or that more support is needed to increase completion.

Implementation of bedside handover that includes patients or carers in hospital settings: A systematic review.

Increasing complexity in healthcare systems necessitates effective handover. While a universal structure is often recommended, many frameworks do not include the patient. A systematic review was completed examining outcomes following handover that included patients or carers using a realist-orientated paradigm. The research group used Covidence™ software and followed PRISMA guidelines. A librarian-led search of Embase, Medline, PsycINFO and SCOPUS yielded 5,790 relevant studies for screening. Included studies reported on peer-reviewed studies that assessed qualitative or quantitative outcomes resulting from patient-centred handover. To assess quality, we used the McMaster Mixed Methods Appraisal Tool (MMAT). Patient-orientated and quantitative outcomes are reported descriptively. For qualitative outcomes, we employed a deductive analytical approach. Braun and Clarke's steps were followed to develop themes with group work used to clarify and discuss the various codes. Heterogenous reporting precluded meta-analysis. Thirty studies were eligible (10 mixed methods; 11 quantitative; 9 qualitative) with variable quality and scope. Most studies related to nursing-led bedside handover and originated in Anglophone countries. Positive effects were reported for patient satisfaction, engagement, autonomy and effective information exchange. Providers reported a positive experience but also barriers to implementation, cognitive load and reducing compliance over time. There were contradicting findings for patient-orientated outcomes including falls risk. Publication bias may have led to under reporting of negative trials. There was limited reporting on physician-led handovers that included patients. Patient-centred handover was associated with self-reported benefits for patients and providers but potential advantages over conventional handover could be undermined by barriers such as time, implementation challenges and a perceived increase in staff workload.

A study to assess the level of stress, domestic violence and coping strategies among spouse of patients with alcohol dependence admitted at DIMHANS, Dharwad

Background of the study: Alcoholism is one of the major health and social problems all over the world. Alcoholism is a significant problem in India. There is a vast body of literature in India and in the West devoted to understanding the marital dynamics involved in alcoholism and ascertaining the deleterious impact that alcoholism could have on the personality and function of spouse. Aim : Assess the levels of Stress, Domestic violence and coping strategies among the wives of patients with alcoholic dependence.. Methodology: A descriptive survey design is used to assess level of stress, domestic violence and coping strategies among wives of patients with alcohol dependence admitted at DIMHANS, DHARWAD. Non-probability purposive sampling technique was adopted for data collection from 100 wives of alcoholics admitted in wards of the DIMHANS. Results : Data was analyzed by using descriptive and inferential statistics, majority of the participants had moderate level of stress(61%).Assessment of the overall level of domestic violence revealed that 54% wives of alcoholics had average domestic violence. Assessment of the overall level of coping strategies revealed that 63% wives of alcoholics had average coping. There was a partial association between the level of stress, domestic violence and coping strategies of the wives of patients with alcohol dependence with demographic variable only religion (χ2=6.9170, p=02), had significant relationship with level of stress. The result found non-significant negative correlation(r= -0.1810 p= 0.0720) was observed between stress and domestic violence scores and non significant positive correlation(r=0.0793 p=0.4330) was observed between stress and coping strategies scores. But significant and negative correlation (r= -0.2407 p=0.0160*) (*p&lt;0.05) was observed between domestic violence and coping strategies scores. It means that domestic violence and coping strategies scores are dependent on each other. Conclusion: Research needs to focus on the impact of stress, domestic violence and coping on health, a nurse plays a pivotal role both in hospital and community setting in improving the health of the Individual. Innovative approaches in this field have to be initiated in nursing.

Management and monitoring of anesthesia during the perioperative period in a Tertiary Hospital in Bangladesh

Background: Anesthesia management is crucial for ensuring patient safety and optimal surgical outcomes during the perioperative period. In Bangladesh, the challenges faced in managing and monitoring anesthesia in tertiary care hospitals necessitate a comprehensive evaluation of current practices. This study aims to assess the anesthetic management protocols and monitoring strategies employed in a tertiary hospital in Bangladesh. Methods: This observational study was conducted in Islami Bank Medical College Hospital, Rajshahi, Bangladesh from July to December 2023. Data were collected from patients undergoing various surgical procedures requiring anesthesia. The anesthetic techniques used, intraoperative monitoring parameters, and any complications encountered were recorded. The study included a review of anesthesia charts, patient records, and interviews with anesthesia providers. Statistical analysis was performed to identify trends and correlations. Results: A total of 200 patients were included in the study. The most commonly used anesthetic technique was general anesthesia (65%), followed by regional anesthesia (30%) and local anesthesia (5%). Intraoperative monitoring parameters included heart rate, blood pressure, oxygen saturation, and end-tidal carbon dioxide levels, which were consistently documented in 95% of cases. Complications occurred in 10% of patients, primarily involving respiratory issues and cardiovascular instability. Proper adherence to monitoring protocols significantly reduced the incidence of complications. Conclusion: Effective management and monitoring of anesthesia during the perioperative period are vital for patient safety in a tertiary hospital setting. The study highlights the importance of standardized protocols and continuous monitoring to minimize complications. Recommendations for improving anesthetic practices include regular training for anesthesia providers and enhancing monitoring infrastructure to ensure optimal patient care.

Surgical Treatment of Pediatric Foot and Ankle Fractures in a Freestanding Ambulatory Surgery Center is a Safe, Cost-effective Alternative to a Hospital.

In the United States, the number of pediatric fractures treated in ambulatory surgery centers (ASCs) continues to increase. Few studies have compared the outcomes and complications of treating these injuries in a freestanding ASC versus in a hospital setting. The purpose of this study was to compare clinical and radiographic outcomes, treatment times, and costs for treatment of pediatric foot and ankle fractures in the ASC and hospital. A retrospective review identified pediatric patients with isolated, closed, and acute (below 3wk) distal tibia, ankle, or foot fractures who underwent closed reduction in an operating room or operative fixation between January 2015 and December 2019. The patients were divided into 2 groups: ASC and hospital. Medical records were reviewed for patient demographics, mechanism of injury, surgical time, facility time, costs for treatment, and complications. Preoperative and postoperative alignment was assessed on radiographs. Clinical outcomes included pain, weight-bearing, or deformity at final follow-up. Multivariable generalized linear models and logistic regression were used to determine the association between surgical setting and treatment outcomes, times, and costs. Two hundred and twenty-three patients were identified; 115 treated in the ASC and 108 treated in the hospital. Adjusted for age at treatment, injury type, procedure performed, and preoperative alignment, there were no differences in surgical time, clinical or radiographic outcomes, or complications between groups. The mean total operating room time, total facility time, and total charges were significantly lower in patients treated in the ASC than in the hospital. Pediatric distal tibia, ankle, and foot fractures can be safely treated in an ASC with equivalent outcomes and complications compared with those in a hospital setting. Benefits include shorter total surgical and facility times as well as decreased cost of care. These findings could allow for patients to receive more timely and efficient treatment with less financial burden. Level III-therapeutic.

Caregivers’ Mastery in Handling Gastrostomy at Home after Educational Intervention: Qualitative Descriptive Study

Background: Effective hospital discharge planning is crucial, particularly in educating caregivers on handling medical devices. This education helps manage the patient’s signs and symptoms, prevents post-discharge complications, and reduces early readmissions. This study aimed to understand aspects involved in the acquisition of mastery by home caregivers, in handling care of a patient who just underwent gastrostomy, after educational intervention during hospitalization and telemonitoring upon return home. Methods: Qualitative descriptive study. It followed 15 caregivers of people with percutaneous endoscopic gastrostomy. The intervention took place between November 2022 and July 2023 in the neuromusculoskeletal unit of a Brazilian university hospital. Results: The educational intervention had four stages. In stage 1, caregivers felt confused and uncertain about managing PEG. By stage 2, they expressed a desire to be capable of handling care, especially in the event of potential complications, and showed increased awareness and engagement. Stage 3 highlighted the effectiveness of hands-on training with feedback from professionals. In stage 4, during monitoring, several complications were noted, including granuloma formation in the stoma, tube obstruction, and accidental tube loss. However, caregivers demonstrated the ability to handle these situations, indicating the effectiveness of the training and telemonitoring interventions. Conclusions: Nursing professionals should consider various factors when training caregivers in a hospital setting, including providing adequate space, allocating sufficient time for educational interventions, offering both theoretical and practical demonstrations, ensuring effective communication, and taking into account the caregivers’ context, as they play a direct role in acquiring a safe and effective skill set.

Health care utilization at the end of life in Parkinson’s disease: a population-based register study

BackgroundKnowledge of health care utilization at the end of life in Parkinson’s disease (PD) is sparse. This study aims to investigate end of life health care utilization, characterized by emergency room (ER) visits, receipt of specialized palliative care (SPC), and acute hospital deaths in a Swedish population-based PD cohort.MethodsWe conducted a retrospective cohort study on deceased patients (≥ 18 years) with a PD diagnosis during their last year of life (n = 922), based on health care-provider data from Region Stockholm´s data warehouse, for the study period 2015–2021. Univariable and multivariable logistic regression analyses tested associations and adjusted Odds ratios (aORs) were calculated.ResultsDuring the last month of life, approx. half of the cohort had emergency room (ER) visits and risk of frailty (measured by Hospital Frailty Risk Score) significantly predicted these visits (aOR, 3.90 (2.75–5.55)). In total, 120 people (13%) received SPC during their last three months of life, which positively associated with risk for frailty, (aOR, 2.65 (1.43–4.94, p = 0.002). In total, 284 people (31%) died in acute hospital settings. Among community-dwellers, male gender and frailty were strongly associated with acute hospital deaths (aOR, 1.90 (1.15–3.13, p = 0.01) and 3.70 (1.96–6.98, p < 0.0001)).ConclusionsRates of ER visits at end of life and hospital deaths were relatively high in this population-based cohort. Considering a high disease burden, referral to SPC at end of life was relatively low. Sex-specific disparities in health care utilization are apparent. Identifying people with high risk for frailty could assist the planning of optimal end-of-life care for people with PD.

Deciphering consumer behaviours in the innovative hospitality settings

Purpose This study aims to analyse the antecedents and consequences of consumer participation behaviour in the hotel industry. It investigates how citizenship behaviour influences the link between participation and switching intention. It also investigates hotel innovativeness, brand identification and consumer value co-creation using the frameworks of innovation diffusion theory, social identity theory and social exchange theory. By combining different academic perspectives, the study provides a thorough grasp of the elements that influence consumer behaviour and loyalty to hospitality brands. Design/methodology/approach This study used a descriptive-analytical approach to survey 526 guests who stayed at five-star hotels affiliated with chains in Egypt. The hotels were chosen using stratified random sampling, which ensured representation across multiple segments. For practical reasons, convenience sampling techniques were used to pick research participants. To test the study hypotheses, structural equation modelling was used, which provided a strong statistical analysis to assess the correlations between variables and validate the suggested theoretical framework. Findings The research indicates that hotel innovativeness has a substantial impact on consumers’ brand identification and involvement behaviour, but not their propensity to move brands. The relationship between participation behaviours and intention to switch is mediated by consumer citizenship behaviour. Research limitations/implications The cross-sectional study methodology may not address causal linkages or developmental difficulties because it only collected data at one point in time. A longer study period is required, and the sample group’s breadth is restricted to five-star hotel guests from Egypt’s chain-affiliated hotels. Originality/value This study offers a thorough methodology for assessing how hotel innovation influences consumer brand identification. It also looks at how consumer brand identification affects involvement and switching intentions. The study also investigates the moderating influence of consumer citizenship behaviour in the link between involvement and switching intentions.

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.

Leveraging digital platforms to improve Public Health in hospital smart buildings

Abstract The integration of digital platforms into hospital infrastructure represents a significant leap forward in public health management. This session explores how smart hospital buildings, equipped with advanced digital technologies, can enhance public health outcomes through more effective disease surveillance, improved environmental controls and enhanced patient care management. Smart hospital buildings utilize a range of new technologies such as IoT sensors, AI-driven analytics and big data solutions to monitor and optimize various aspects of hospital operations and care. These technologies enable real-time data collection on environmental conditions, patient health metrics and resource utilization, creating an ecosystem that not only supports the immediate health needs of patients but also contributes to broader public health goals. The session will address four key areas where digital platforms can make an impact: -Disease Surveillance and Management: Digital tools can track health data trends and patterns within hospital settings, enabling early detection of infectious outbreaks and more precise tracking of patient outcomes. -Environmental Monitoring: IoT sensors can continuously assess conditions such as air quality, temperature and humidity, which are critical for preventing hospital-acquired infections and ensuring a safe environment for patients and staff. -Resource Optimization: AI algorithms can analyse data to optimize resource allocation, ensuring that medical supplies and human resources are used efficiently, which is crucial in health emergencies. -Patient-Centred Care: Digital platforms can facilitate personalized patient care through real-time health monitoring and data analysis, ensuring timely medical interventions and better health management. This session will highlight case studies demonstrating successful implementation of digital technologies in smart hospital buildings and discuss the challenges and lessons learned from these initiatives.

Distribution and Molecular Characterization of Antibiotic-Resistant Pseudomonas aeruginosa in Hospital Settings of Sulaymaniyah, Iraq.

Pseudomonas aeruginosa is a significant pathogen in hospital settings, notorious for its role in hospital-acquired infections and its ability to develop resistance to multiple antibiotics. This study investigates the prevalence, distribution, and antibiotic resistance gene profiles of P. aeruginosa in seven hospitals in Sulaymaniyah City. A total of 300 samples were collected from various hospital surfaces including mops, sinks, medical equipment, beds, desks, and floors. Using bacteriological, biochemical, and molecular methods, 66 isolates were confirmed as Pseudomonas species, with 26 identified as P. aeruginosa. Antibiotic susceptibility testing revealed resistance rates of 23.3% to streptomycin, 13.6% to tobramycin, 22.7% to moxifloxacin, 21.2% to levofloxacin, and 22.7% to norfloxacin. Furthermore, the antibiotic resistance gene detection showed the presence of the bla CTX-M, bla SHV, qnrB, and bla ACC-1 genes among the isolates. The study highlights a 22% contamination rate of hospital surfaces with Pseudomonas species, emphasizing the urgent need for enhanced infection control measures and targeted antimicrobial stewardship to manage and reduce the spread of multidrug-resistant P. aeruginosa.

Adverse Drug Reactions to β-Lactam Antibiotics: A Portuguese Pharmacovigilance Database Analysis

Abstract Background The β-lactam antibiotics are one of the most relevant drug classes globally. They accounted for the largest share of systemic antibiotics consumption in Portugal across both community and hospital settings. Due to their significance, continuous monitoring of adverse drug reactions (ADR) associated with β-lactams is fundamental. Aim To analyse and characterise cases related to β-lactam antibiotics received by the Portuguese National Pharmacovigilance System. Methods Retrospective analysis of cases containing at least one medicinal product classified as suspect under the Anatomical Therapeutic Chemical (ATC) code J01C or J01D, reported to the Portuguese Pharmacovigilance System between 2014 and 2023. Characterisation of cases considered patient demographics, reported suspected medicines, MedDRA Preferred Term (PT), seriousness and type of reporter. Results A total of 3557 cases were identified (54.0% females; median age = 42.0 years; interquartile range = 52.2), with 95.9% originating from spontaneous reporting and 93.5% being reported by healthcare professionals. The most frequently reported medicines were those belonging to ATC J01CR. Around 70% of cases were classified as serious, with 38.7% being related to situations of disability or other criteria of greater seriousness. Most frequently reported PTs were related to skin disorders. Anaphylactic reaction was the most reported Designated Medical Event term. The PTs “Drug ineffective” and “Off label use” were reported in 5.2% and 2.4% of the cases, respectively. Conclusions Despite the majority of cases are serious, most of the ADR identified are related to already known hypersensitivity reactions. To improve the knowledge regarding these medicines and to generate evidence to address emerging public health issues it is of paramount importance to strength the Portuguese Pharmacovigilance System. This can be achieved through enhancing spontaneous reporting and implementing active pharmacovigilance programs. Key messages • Monitoring the efficacy and safety profile of β-lactams in a real-world context is crucial to mitigate the impact in public health and associated economic burden. • Enhancing the surveillance systems improves data collection and evidence generation, supporting tailoring treatment approaches and implementation of public health policies.

Electronic Health Record Adoption and Its Effects on Healthcare Staff: A Qualitative Study of Well-Being and Workplace Stress

Adopting electronic health records (EHRs) offers improved communication and information sharing and reduces medical staff errors. Despite these potential benefits, EHR adoption often introduces new challenges for healthcare staff, including increased administrative burdens and workplace stress. This study examines the impact of EHR systems on the well-being and workplace stress of healthcare staff in a hospital setting. Using a qualitative multi-perspective research approach, 16 guideline-based interviews were conducted to explore experiences, insight, and perceptions surrounding the anticipated introduction of EHRs. Data analysis reveals a complex interplay between the perceived advantages of EHRs, such as improved data accessibility and patient safety, and the challenges related to increased workload. Based on interviewers’ perceptions, emerging themes were categorized as technostress creators or inhibitors. The findings highlight a dual impact of EHRs: while participants acknowledged improvements in patient safety and information access, they also expressed concerns about increased workload, technostress, and potential disruptions to team dynamics. This study identified two major themes: “EHR Adoption as a Double-Edged Sword” and “EHRs’ Influence on Professional Dynamics”. These findings underscore the need for organizational readiness and staff support to mitigate the negative impacts of EHRs on healthcare workers’ well-being and job satisfaction.

Incident heart failure: comparing management and outcome in primary care and hospital settings in Western Sweden 2008-2017

Abstract Background Heart failure (HF) is a major problem in primary care (PC) and hospital care (HC). HF patients managed in these two settings may differ in their demography, comorbidities, treatment and outcomes. Aim We aimed to compare the patient management in PC and HC in the Västra Götaland Region (VGR) in Sweden. Methods The VEGA database is an administrative database includes all patients living in VGR. Patients with a first principal or contributory diagnosis of HF (I50) ≥18 years old between 2008 and 2017 were included. One-year mortality was used as the outcome. Results In total, 62,229 new-onset HF cases were included, with 18,722 identified only in PC and 16,651 in HC. HF patients in PC were older (80.7±10.9 vs 76.1±13.6), more women (57.1% vs 44.9%), with more hypertension, musculoskeletal and mental disorders, but less myocardial infarction. Guideline directed medical therapy was more frequently used in HC despite similar medication before HF diagnosis. Patients in HC had almost 4 times higher all-cause 1-year mortality [3.92 (3.77 - 4.08), p&amp;lt;0.0001] compared with PC after adjustment for age and sex. Over 10-year period, despite decreasing mortality in both settings, hazard ratios for HC vs. PC were significantly increased for all patients (p for interaction 0.0004), which was more marked in female and for 70-80 years old patients. Conclusion Over a 10-year period, not withstanding decreasing mortality in HF patients in both PC and HC settings, differences remain between these two HF populations not only demographic profile and medications but also outcomes.

Point Prevalence Survey of HAIs as a key component of Infection Prevention and Control programs

Abstract Healthcare-Associated Infections (HAIs) are a global concern, requiring surveillance strategies as Point Prevalence Surveys (PPS) to estimate their burden and investigate associated risk factors for targeted interventions in high-risk areas. This study aims to assess the prevalence of HAIs, identify determinants and evaluate antimicrobial use in a teaching hospital in Rome. A PPS was carried out from June 19th to 23rd, 2023, in accordance with the European Centre for Disease Prevention and Control (ECDC) protocol for HAIs and antimicrobial use in European acute care hospitals (version 6.1). Pearson’s chi-squared test was employed to investigate correlations between potential risk factors and HAIs. The survey included 829 patients with an average age of 56.3 years (SD: ±24.6). Of these, 48.4% were female and over half had visited the hospital’s Emergency Department (53.7%). The prevalence of active HAIs was 8.7%, with 72 patients diagnosed. Furthermore, 51.0% of all patients received at least one systemic antimicrobial agent, and 16.7% of those treated had an HAI. Penicillins (39.7%) and third-generation cephalosporins (37.8%) were the most frequently prescribed antimicrobials. The primary HAIs were bloodstream infections (34.1%), followed by urinary tract (27.3%), surgical site (23.9%), lower respiratory tract (6.8%), and gastrointestinal infections (7.9%). Escherichia coli (13.2%), Staphylococcus aureus (9.2%), and Clostridium difficile (6.6%) were the most frequently isolated pathogens. Intensive Care Unit admission, use of medical device, recent antibiotic therapy and prior hospitalization or surgery significantly correlated (p &amp;lt; 0.05) with increased HAIs risk. The detected prevalence of HAIs is lower than the national rates observed in 2022 (10.2%), which have increased since 2016. HAIs surveillance is essential for developing effective infection prevention and control programs and for optimizing resource allocation in hospital settings. Key messages • Surveillance of Healthcare-Associated Infections is crucial for developing targeted Infection Prevention and Control programs and optimizing hospital resource allocation. • Point Prevalence Surveys offer essential information for assessing the burden of Healthcare-Associated Infections and directing intervention strategies in hospitals.

National early warning systems for emerging AMR in high-income countries: a systematic review

Abstract Background An urgent need of implementing national surveillance systems for timely detection and reporting of emerging antimicrobial resistance (AMR) was recently advocated by the World Health Organization (WHO). However, public information on existing national early warning systems (EWSs) is often incomplete. Furthermore, when findings are available, understanding these systems is challenging due to different approaches used for data collection, reporting and definitions, with a comprehensive overview on this topic currently lacking. The aim of this study was to map existing EWSs for emerging AMR, focusing on high-income countries, and describe their main characteristics. Methods A systematic review was performed on bibliographic databases, and a targeted search was conducted on national websites. Any article, report or webpage describing national EWSs in high-income countries was eligible for inclusion. EWSs were identified considering the emerging AMR reporting WHO framework. Results We identified seven national EWSs in 72 high-income countries: two (Australia, Japan) in the East Asia and Pacific Region, three (France, Sweden, United Kingdom) in Europe and Central Asia, and two (United States, Canada) in North America. The systems were established quite recently; in most cases they covered both community and hospital settings, but their main characteristics varied widely across countries in terms of organization and microorganisms under surveillance, with also different definitions of emerging AMR and alert functioning. A formal system assessment was available only in Australia. Conclusions A broader implementation and investment of national surveillance systems that allow early detection of emerging AMR is still needed to establish EWSs in countries and regions lacking such capabilities. A more standardized data collection and reporting is also advisable to improve cooperation on a global scale. Key messages • This study provides a synthesis of publicly available information on national EWSs for emerging AMR in high-income countries, highlighting the urgent need for a broader implementation of such systems. • Main characteristics of EWSs have been outlined, varying widely across countries. Findings could help stakeholders in strengthening current standard national AMR surveillance systems.

Valacyclovir induced neurotoxicity, with therapeutic drug monitoring, in a hospital-based setting in the Netherlands

Background: Valacyclovir-induced neurotoxicity is a rare side effect. The aim of this study was to perform a retrospective analysis of patients with valacyclovir-induced neurotoxicity and establish valacyclovir plasma concentrations in a tertiary hospital between January 2018 and November 2022. Case descriptions: In total 208 patients were identified with measured acyclovir concentrations, and the electronic health records of these patients were analysed. Based on the in- and exclusion criteria, 4 patents were identified in whom high plasma concentrations were linked to neurotoxicity. The first patient experienced balance and coordination problems, visual hallucinations, speaking difficulties and headaches. The second patient experienced a progressive decline of consciousness, resulting in coma. The third patient also experienced reduced consciousness and was found unconscious on the floor during the night. The fourth patient experienced vertigo after administration of acyclovir. Conclusion: Based on this study, neurotoxicity appears to be an underreported adverse effect of valacyclovir therapy in a hospital setting. This side effect may have a high impact on individuals as well as on the duration of hospitalization. In order to exclude valacyclovir as the cause, clinicians should consider requesting an acyclovir plasma concentration as standard hospital-based intervention whenever a patient experiences neurotoxic symptoms. Moreover, pharmacists and clinicians should be made better aware of the interaction between valacyclovir and cyclosporine and/or mycophenolic acid, in particular in elderly patients with impaired kidney function.

Life-Threatening Spontaneous Hematoma in Unusual Sites in Patients with COVID-19 on Anticoagulant Therapy: A Case Series

Thromboembolic manifestations are a common phenomenon in patients affected by corona virus (SARS CoV-2). Recent studies have shown that patients with acute renal failure are also at a greater risk of venous and arterial thromboembolism, 15-30% in ICU, and 7% inpatient care. However, frequently unjudicial use of anticoagulants may develop severe life-threatening hematoma. In our hospital settings we had a dedicated COVID Unit with a Hemodialysis facility. Our Nephrology department had managed 381 patients being COVID positive along with renal impairment from March 2020 to January 2022. Among these patients, four patients developed spontaneous non traumatic hematoma in unusual sites. On admission all the patients received treatment according to our national guidelines for COVID-19. Cases: It is a retrospective analysis in a single-centered hospital. Four cases with confirmed COVID-19 with acute kidney injury and on anticoagulant therapy had developed sudden concealed bleeding. These patients had no previous history of anticoagulant therapy before admission. Case 1 developed hemorrhage in Right lower anterior paramedian deep parietal wall of abdomen, Case 2 had hematoma in retroperitoneal space and in lower third of Iliopsoas, Case 3 developed hemorrhage in left cerebral hemisphere, Case 4 had Intramuscular Hematoma in left rectus abdominis. Out of these four patients two of them required Hemodialysis and one of them went into shock. All patients included were male. The mean age was 57±19.64years. All the four patients were initially managed conservatively with keen monitoring and with proper volume resuscitation, blood transfusion and discontinuation of the anticoagulants. Three of the patients survived with conservative management and one patient died due to sudden massive cardiac arrest. The use of therapeutic anticoagulant can increase the risk of bleeding in atypical sites and may exhibit higher patient death with COVID-19 if not identified at early stage. So a risk-benefit ratio of usage of anticoagulants should be kept in mind and further clinical trials needed to justify its random use in COVID-19. J Bangladesh Coll Phys Surg 2024; 42: 393-400

BE-SAFE: Intervention to reduce benzodiazepine and sedative hypnotics in elderly with sleep problems

Abstract Introduction Benzodiazepine and sedative hypnotics (BSH) may have significant adverse effects and associated costs, especially in older adults: increased risk of falls, fractures, hospitalisations, impaired functioning, delirium, cognitive impairment and mortality. Addressing BSH overuse is therefore an urgent priority to improve patient safety in Europe. Objectives To present the 5-year research project BE-SAFE, funded by the European Commission (HORIZON Europe) and by the Swiss State Secretariat for Education, Research, and Innovation. BE-SAFE aims to improve patient safety by addressing knowledge and practice gaps related to the reduction of BSH used by older adults for sleep problems. Methods BE-SAFE involves seven inter-related work packages and six European countries (Belgium, Greece, Norway, Poland, Spain and Switzerland) as well as experts from Canada; it proposes an interdisciplinary and inter-sectorial approach with experts in guidelines, implementation, dissemination, case studies, geriatrics and sleep. BE-SAFE will develop an intervention comprising trustworthy clinical guidelines, implementation recommendations and patient-centred material. This intervention will be tested in a cluster randomized controlled trial; 470 patients (65 years old and above) and 62 prescribing physicians in hospital and outpatient settings. Results BE-SAFE is expected to result in reduction of BSH use. Its toolkit, encompassing setting-specific implementation recommendations, will enable healthcare professionals (HCPs) to identify, evaluate and prevent risks of BSH use. The BE-SAFE approach could also be expanded to cover reduction of use of other medications. Conclusions Through BE-SAFE, patient safety is expected to improve; BE-SAFE project will reach a wide-ranging audience, including general population, informal carers, older adults, HCPs, healthcare system leaders and decision makers. Authors acknowledge the significant input of J. Grimshaw and W. Levinson, Canada. Key messages • Deprescription of benzodiazepine and sedative hypnotics, especially in older adults, is a priority due to their side effects, particularly in this age group. • The European project BE-SAFE aspires to create easy-to-use guidelines to this aim, improving thus patient safety and healthcare.

The identification, referral and management of patients with cardiac-related distress: a new model to support psychological recovery after a cardiac event

Abstract Background Identification, referral and management of patients with psychological distress is an important component of cardiac rehabilitation (CR). We developed a protocol to identify patients in hospital, CR and primary care settings, and refer them to a specialist psychocardiology clinic. Using the newly developed Cardiac Distress Inventory (CDI), we demonstrated that counselling resulted in reduced rates of cardiac-related distress. This study demonstrates the importance of having a clear pathway from screening to referral to intervention to support cardiac patients in their recovery. Purpose The team identified a dearth of high-quality research on distress in cardiac patients, including a lack of data on the resolution of cardiac-related distress after psychotherapeutic intervention. This was due to the lack of appropriate measurement of cardiac distress, and the absence of clear pathways for identification, referral and management of cardiac distress. Methods The Cardiac Emotions Study is a multi-site, multi-component study of cardiac-related distress. The team first developed the 55-item Cardiac Distress Inventory (CDI), a comprehensive clinical assessment tool. A brief screening version, the 12-item Cardiac Distress Inventory Short Form (CDI-SF), was then developed. Patients referred to the specialist psychocardiology clinic over a 6-month period (N=113) were administered the CDI-SF, together with the Generalised Anxiety Disorder 7 (GAD7) and the Patient Health Questionnaire (PHQ9), with all measures re-administered at discharge. Results More than half the clients presented to the Clinic within the first 3 months post-event (58%), while 84% presented within the first year. At presentation, over half the clients were anxious (GAD7&amp;gt;10; 53%), depressed (PHQ9&amp;gt;10; 57%), or distressed (CDI-SF&amp;gt;13; 56.4%). Levels of particular aspects of cardiac distress are shown in the Figure. On completion of counselling, distress had resolved for the majority of clients, with the distress rate of 18.6% at discharge equivalent to that seen in a normative sample of cardiac patients. Rates of anxiety and depression also significantly decreased after counselling. Conclusion This study demonstrated that distressed cardiac patients could be appropriately identified in settings such as hospital, CR and primary care and referred for counselling, and that counselling resulted in significant reductions in rates of cardiac distress, anxiety and depression. Undergoing counselling through a specialist psychocardiology clinic assisted clients in obtaining normative rates of post-cardiac event distress. The analysis showed the necessity of having a clear clinical pathway from screening to psychological treatment, and the utility of having a validated measure of cardiac distress that is sensitive to change after intervention.