Stages Of Patient Care Research Articles

Perioperative risk management by the circulating Ibode

An essential link in the smooth running of the operation, the role of circulator is another facet of the operating room nurse's (ORN) activities. As the orchestra conductor of the operation, the circulating role gives the nurse the ability to coordinate the entire team, ensure continuity at every stage of patient care in the OR, and manage all risks that may arise during the operation.

Predictors and Outcome of Surgical Repair of Obstetric Fistula at a Private Hospital of Dhaka City

Background: Obstetric fistula remains a significant public health issue in low-resource settings, with high prevalence in countries like Bangladesh. The condition often results from prolonged, obstructed labor, compounded by socio-cultural factors such as early marriage, financial constraints, and lack of access to skilled birth attendants. This study aimed to explore the socio-demographic characteristics and surgical outcomes of women undergoing fistula repair at a private hospital in Dhaka, Bangladesh. Methods: This observational descriptive study included 62 women who underwent obstetric fistula repair between September 2010 and September 2012. Data were collected on socio-demographic characteristics, fistula details, and surgical outcomes through a structured booklet completed at various stages of patient care. Surgical success, complications, and post-operative outcomes were analyzed to identify factors influencing recovery and success rates. Result: The study found that 100% of participants were married at an early age, with significant financial barriers reported by all. A majority (87.10%) had home deliveries attended by unskilled birth attendants. Surgical repair was successful in 88.71% of cases, with a small proportion (11.29%) of unsuccessful repairs. Residual stress incontinence was noted in 4.84% of participants. The mean hospital stay was 17.52 days, with 95.16% of participants requiring continuous catheterization for 7 to 10 days. Conclusion: The high success rate of surgical repairs is promising, but the persistence of socio-cultural barriers and residual complications highlights the need for improved access to maternal healthcare and enhanced post-operative care. Addressing these issues is critical for reducing the burden of obstetric fistula and improving outcomes for affected women.

Mindful Care: Nursing Strategies in Traumatic Brain Injuries: A Brief

A literature review was conducted to further analyze nursing care for patients with traumatic brain injuries (TBIs), the purpose of this literature review is to emphasize the important role of the nurse throughout the various stages of patient care and management.

Modern information technology in cardiac rehabilitation. Applications for mobile devices (review)

Using information technologies at all stages of patient care is necessary at the current state of medical development. It is particularly important to implement innovative information technologies in the management of patients with cardiovascular diseases in the outpatient setting, in secondary prevention and rehabilitation that continues throughout life. Various wearable devices for hemodynamic monitoring, electrocardiographic and physical activity assessment, that help the patient`s condition during rehabilitation, have been widely used in clinical practice all over the world. However, considering the outpatient setting, a cardiologist or rehabilitologist should to be able to monitor the data obtained using a single source, and to communicate with the patient in order to adjust treatment. Applications for mobile devices providing feedback can be a convenient tool in this regard. To date, many applications have been developed for smartphones, including those that synchronize with wearable devices, to record patient parameters, including the level of physical activity. Most of them are limited by self-control. Both in Russia and in other countries, a number of problems and limitations associated with the use of these technologies are related to the patient, the imperfection of the health care system, and problems with the devices themselves. The present article is devoted to an overview of existing remote rehabilitation technologies focusing on the applications for mobile devices. The authors present a short summary on domestic and international development in information technologies, identify the problems and future development of this area in health care.

Identifying and Prioritising the Causes of Medication Errors in the Pharmacy

Abstract Introduction Medication errors can negatively impact the health of numerous individuals worldwide and even lead to fatalities, from incorrect timing, dosages, or methods of administration of drugs to mismanagement of drug interactions. Such errors can arise from patients and healthcare professionals in all stages of patient care. Therefore, all healthcare workers must pay attention to preventing medication errors, correctly managing encountered errors, and reporting them appropriately to ensure patient safety. Parallel to these, one of the FIP's development goals for pharmacists was also determined as Patient Safety. Despite various studies that have analysed medication errors from different perspectives, no study has thoroughly evaluated the causes of medication errors specific to community pharmacists. Aim This project aimed to identify and prioritise the causes of medication errors encountered in community pharmacies. Methods According to the aim of the study, semi-structured qualitative interviews were conducted with 16 community pharmacists in Van. Thematic analysis was conducted on the qualitative interview findings. Additionally, at the end of the qualitative interviews, a questionnaire was applied due to the Analytical Hierarchy Process (AHP), to prioritize the causes of the medication errors. This study was conducted after Van Yüzüncü Yıl University Non-interventional Research Ethics Committee approved the study ethically (Date:18/11/2022, Decision No: 2022/11-25). This study is supported by The Scientific and Technological Research Council of Türkiye (TUBITAK)’s 2209/2022 2nd term projects (Project No: 1919B012217783). Results Three main themes and 13 sub-themes were obtained. The study's results emphasise that communication gaps and manual prescriptions are the most significant causes of medication errors reported by pharmacists. As a result of the AHP, prescription errors (31.5%) were found to be the most encountered reason for medication errors, followed by medication knowledge gaps (25.7%). Discussion/Conclusion Pharmacists, aware of their responsibilities for patient and drug safety, also have an essential role in solving problems that cause medication errors. With this study, it is also seen that pharmacists show the necessary self-sacrifice and take precautions to minimize medication errors originating from the pharmacy. So, the findings obtained from this study are thought to have guiding implications for preventing medication errors.

517 A retrospective audit into the implementation of CT as the recommended first-line imaging in the investigation of suspected Acute Bowel Obstruction in a Tertiary General Surgical Unit

Abstract Introduction The NCEPOD ‘delay in transit’ report 2020 explored the management of patients presenting with Acute Bowel Obstruction (ABO), highlighting delays at all stages of patient care from presentation to management. CT scan as the first definitive imaging was a key recommendation to prevent delay in decision making. The Aim of this audit was to investigate compliance with this key recommendation and consequential delay in decision making and treatment. Methods Data from imaging requests for patients above the age of 16, with a provisional diagnosis of ABO from March-September 2022 was included in the study and analysed. Data analysed included: times of admission, X-ray of abdomen, CT, and time of decision to treat (TDT). The hypothetical time to decision to treat (TDT) was calculated if CT was the first investigation instead of X-Ray; the time of X-ray being performed as the potential time of performance of CT. Delays at each stage of care were calculated. Results Between March 2022 and September 2022, 37 patients were admitted under surgery and diagnosed with ABO. The median TDT when X-ray was done prior to CT was 7 hours 3 minutes (IQR 4 hours 32 minutes to 16 hours 42 minutes). 82% of patients required a CT after X-Ray for definitive decision making. Conclusion Our surgical service is yet to achieve compliance to this NCEPOD recommendation, with consequential delay in decision making. Further education and change of practice are necessary to implement this key recommendation for raising physician awareness and improve care.

Artificial intelligence is revolutionizing everyday medical practice

Introduction This article discusses the impact of artificial intelligence (AI) on the medical field and its daily use in the practice of medicine. AI has applications in many stages of patient care, i.e.: prevention, diagnosis, personalising treatment plans, predicting disease progression and therapeutic outcomes or analysing medical images. GPs play a key role in patient care, but due to the complexity of medicine and the variety of symptoms, care and diagnosis can be time-consuming and difficult. Methods and materials The aim of this study is to explore and evaluate the potential of artificial intelligence in the process of diagnosing diseases by physicians and to provide practical suggestions and insights for its use in medical practice to improve the quality of healthcare. The methodology was based on material from PubMed and a review of the scientific literature on previous research and developments in AI in medicine. State of knowledge Investment in artificial intelligence (AI) in medicine is growing rapidly. The role of GPs in patient care is highlighted and examples of the use of AI in everyday medical practice are given, including the role of Chatbots and the use of AI in specialised treatment. Conclusions The conclusions of the article highlight the potential of AI in the area of physician-diagnosed diseases to reduce diagnosis time, increase accuracy of diagnoses and improve healthcare efficiency. Final diagnosis and therapy should still be determined by a qualified physician. There are areas where the doctor cannot be replaced by AI. AI cannot replace a doctor's diagnostic intelligence, empathy and rapport therefore doctors need to find a balance between these combinations to achieve better health outcomes with the highest possible care for patients.

Pengalaman Manajemen Nyeri pada Pasien dengan PPOK: Studi Kualitatif

<p><strong><em>Background</em></strong><em>:</em> <em>Chronic obstructive pulmonary disease (COPD) is a common health problem in the community. One of the conditions that will appear in this phase of the disease is chronic pain. This study aims to describe the experiences of patients with COPD about their pain experiences and how they manage their pain. </em><strong><em>Methods</em></strong><em>: This study used descriptive qualitative research conducted through an interview process in one of the Jambi Provincial Hospitals, Indonesia. Sampling continued until saturation was reached, resulting in five participants who met the inclusion criteria. Data were collected by interview and analyzed through collaizi analysis. </em><strong><em>Results:</em></strong><em> The participants were all male and aged between 60-70 years old. The duration of COPD disease is between 5-20 years. The results of this study found 6 (six) main themes that describe the experience of pain in COPD patients, including experiences regarding the factors that cause pain, pain quality, pain location, pain scale, pain time and pain management. </em><strong><em>Conclusion</em></strong><em>: Chronic pain is common in patients with COPD and adversely affects quality of life and participation in daily physical activities. However, several ways of managing pain symptoms can be practiced by patients. The impact of effective pain management is that it will improve the quality of life in people with COPD. There is a need to develop pain management that can be recommended at any stage of patient care. Healthcare providers are advised to provide information to patients on how to manage pain so that they can improve their healthcare.</em></p><p><strong>Keywords: </strong><em>pain, COPD patients, qualitative</em></p><p><em><br /></em></p>

Patient’s experience in nursing care and related factors

Introduction: Improving the quality of care and treatment is a central task of all hospitals and is conducted regularly to meet the patient’s health care needs. Surveying the patient’s experience of care to provide information on patient satisfaction and indicate necessary changes in a process or stage of patient care. Objectives: Determine the average score of the patient’s experience of care and determine the related factors of the patient’s experience of care. Methodology: A descriptive cross-sectional study was conducted with 218 patients treated from Feb 2021 to Nov 2021. Interviewees completed the PEC questionnaire (Patient’s Experience of Care) with scores ranging from 26 - 130 points. Results: The overall score of patient experience of care is 97.37 ± 11.9. The study found a statistically significant relationship between the patient’s experience of care and the patient qualification (p = 0.029) and treatment department (p < 0.001). Conclusion: The average score of patient’s experience of care is high (97.37) but managers need to pay attention and contribute interventions to increase the patient’s experience score thereby increasing the level of satisfaction of care inpatient based on specific contents: nurses publicize drugs with patients (2.94); cleanliness, the convenience of use of toilets and bathrooms (3.38); nurses greet and introduce themselves when interacting with patients (3.40). Key words: experience, nursing care, PEC (Patient’s Experience of Care).

The Understanding of Medical Informatics among Dental and Medical Students.

Background Current medical care deeply relies on informatics during all stages of patient care, which is significantly enhanced due to its use. The healthcare professional's formation in medical informatics results crucial for their everyday practice. However, healthcare study programs not always provide education about the use of this wide variety of systems, and young professionals find that they need to learn about it over the experience. The aim of this study was to assess the understanding of medical and dental students regarding medical informatics and ICTs. Materials and Methods A questionnaire was produced with 3 sections and a total of 24 questions. Students replied to the survey before and after taking the medical informatics course. Results A total of 719 students from second year of medical and dental school were recruited for the study between the period of September of 2017-May 2018, September 2018-May 2019, September 2019-May 2020, and September 2020-May 2021. Medical and dental students showed a good level of understanding regarding medical informatics, as well as a good perception of the relevance of ICT learning for the professional practice. Course attendance increased the percentage of students that felt confident of their knowledge about medical informatics. However, most students felt that little or no medical informatics education was lectured at their schools and that the University should adapt the academic program to include it. After taking the course, the student's perception on this matter was improved. Conclusion Medical and dental students find medical informatics learning useful for their future professional practice and feel inclined to use it. However, they feel that Universities need to adapt their programs in order to include medical education courses and trainings; partly because they are not completely aware of the use of ICTs that already are established in their courses.

Trustworthy AI: Closing the gap between development and integration of AI systems in ophthalmic practice.

An increasing number of artificial intelligence (AI) systems are being proposed in ophthalmology, motivated by the variety and amount of clinical and imaging data, as well as their potential benefits at the different stages of patient care. Despite achieving close or even superior performance to that of experts, there is a critical gap between development and integration of AI systems in ophthalmic practice. This work focuses on the importance of trustworthy AI to close that gap. We identify the main aspects or challenges that need to be considered along the AI design pipeline so as to generate systems that meet the requirements to be deemed trustworthy, including those concerning accuracy, resiliency, reliability, safety, and accountability. We elaborate on mechanisms and considerations to address those aspects or challenges, and define the roles and responsibilities of the different stakeholders involved in AI for ophthalmic care, i.e., AI developers, reading centers, healthcare providers, healthcare institutions, ophthalmological societies and working groups or committees, patients, regulatory bodies, and payers. Generating trustworthy AI is not a responsibility of a sole stakeholder. There is an impending necessity for a collaborative approach where the different stakeholders are represented along the AI design pipeline, from the definition of the intended use to post-market surveillance after regulatory approval. This work contributes to establish such multi-stakeholder interaction and the main action points to be taken so that the potential benefits of AI reach real-world ophthalmic settings.

Medication Administration Errors and Contributing Factors at Nurses Workplace: Literature Review

Abstract. Medication errors are a serious problem that can be a threat to health and patient safety and can lead to mistrust of the health system and the work of professionals. Medication administration errors occur at any stage of patient care and can be related to a variety of influencing factors [1].
 This literature review identifies the main medication administration errors, which are grouped into medication administration and incorrect documentation of administered medication groups. Along with medication administration errors, the main reasons why nurses make errors in medication administration are identified.
 The study focuses on medication administration errors and their determinants in nurses' work.
 The aim of the literature review was to analyze medication errors and their determinants in nurses' work.
 Methods: an exploratory review was conducted to analyze medication administration errors and their determinants in nurses' work. The methodology considered five main stages that contributed to a focused analysis of the selected studies.
 Results of the literature review. It was found that medication errors are influenced by the work environment, which is full of extraneous sounds, other members of the medical team, and conversations unrelated to the administration of medicines. The human factor is also a factor in medication administration errors related to the medication, its dose, or the wrong administration time. Medication administration errors are inevitable, no matter how advanced the patient's care and nursing techniques.

Association of socioeconomic deprivation with asthma care, outcomes, and deaths in Wales: A 5-year national linked primary and secondary care cohort study.

Socioeconomic deprivation is known to be associated with worse outcomes in asthma, but there is a lack of population-based evidence of its impact across all stages of patient care. We investigated the association of socioeconomic deprivation with asthma-related care and outcomes across primary and secondary care and with asthma-related death in Wales. We constructed a national cohort, identified from 76% (2.4 million) of the Welsh population, of continuously treated asthma patients between 2013 and 2017 using anonymised, person-level, linked, routinely collected primary and secondary care data in the Secure Anonymised Information Linkage (SAIL) Databank. We investigated the association between asthma-related health service utilisation, prescribing, and deaths with the 2011 Welsh Index of Multiple Deprivation (WIMD) and its domains. We studied 106,926 patients (534,630 person-years), 56.3% were female, with mean age of 47.5 years (SD = 20.3). Compared to the least deprived patients, the most deprived patients had slightly fewer total asthma-related primary care consultations per patient (incidence rate ratio [IRR] = 0.98, 95% CI 0.97-0.99, p-value < 0.001), slightly fewer routine asthma reviews (IRR = 0.98, 0.97-0.99, p-value < 0.001), lower controller-to-total asthma medication ratios (AMRs; 0.50 versus 0.56, p-value < 0.001), more asthma-related accident and emergency (A&E) attendances (IRR = 1.27, 1.10-1.46, p-value = 0.001), more asthma emergency admissions (IRR = 1.56, 1.39-1.76, p-value < 0.001), longer asthma-related hospital stay (IRR = 1.64, 1.39-1.94, p-value < 0.001), and were at higher risk of asthma-related death (risk ratio of deaths with any mention of asthma 1.56, 1.18-2.07, p-value = 0.002). Study limitations include the deprivation index being area based and the potential for residual confounders and mediators. In this study, we observed that the most deprived asthma patients in Wales had different prescribing patterns, more A&E attendances, more emergency hospital admissions, and substantially higher risk of death. Interventions specifically designed to improve treatment and outcomes for these disadvantaged groups are urgently needed.

Interventional imaging – a modern Telemacheia

Interventional imaging is maturing into a complex field, which addresses an extremely diverse pathology and integrates the findings of multimodality imaging. The interventional imager is an essential member of a multidisciplinary team focused on the transcatheter treatment of structural heart disease. Advanced echocardiography and cardiac computed tomography techniques and interpretation skills are required in order to provide instrumental information in all stages of patient care, from diagnosis through intraprocedural guidance and follow-up.

Applications of Machine Learning in Cardiac Electrophysiology.

Artificial intelligence through machine learning (ML) methods is becoming prevalent throughout the world, with increasing adoption in healthcare. Improvements in technology have allowed early applications of machine learning to assist physician efficiency and diagnostic accuracy. In electrophysiology, ML has applications for use in every stage of patient care. However, its use is still in infancy. This article will introduce the potential of ML, before discussing the concept of big data and its pitfalls. The authors review some common ML methods including supervised and unsupervised learning, then examine applications in cardiac electrophysiology. This will focus on surface electrocardiography, intracardiac mapping and cardiac implantable electronic devices. Finally, the article concludes with an overview of how ML may impact on electrophysiology in the future.

Caroli syndrome: a clinical case

This article covers a case of the rare, hereditarily caused disease, "Caroli Syndrome". The publication of this case is important because it shows that rare diseases occur, should be diagnosed and treated at all stages of patient care. It is important to know that this pathology is diagnosed and treated according to the state program — "Rare diseases".

Positron-emission tomography-guided radiation therapy: Ongoing projects and future hopes

Radiation therapy has undergone significant advances these last decades, particularly thanks to technical improvements, computer science and a better ability to define the target volumes via morphological and functional imaging breakthroughs. Imaging contributes to all three stages of patient care in radiation oncology: before, during and after treatment. Before the treatment, the choice of optimal imaging type and, if necessary, the adequate functional tracer will allow a better definition of the volume target. During radiation therapy, image-guidance aims at locating the tumour target and tailoring the volume target to anatomical and tumoral variations. Imaging systems are now integrated with conventional accelerators, and newer accelerators have techniques allowing tumour tracking during the irradiation. More recently, MRI-guided systems have been developed, and are already active in a few French centres. Finally, after radiotherapy, imaging plays a major role in most patients’ monitoring, and must take into account post-radiation tissue modification specificities. In this review, we will focus on the ongoing projects of nuclear imaging in oncology, and how they can help the radiation oncologist to better treat patients. To this end, a literature review including the terms “Radiotherapy”, “Radiation Oncology” and “PET-CT” was performed in August 2019 on Medline and ClinicalTrials.gov. We chose to review successively these novelties organ-by-organ, focusing on the most promising advances. As a conclusion, the help of modern functional imaging thanks to a better definition and new specific radiopharmaceuticals tracers could allow even more precise treatments and enhanced surveillance. Finally, it could provide determinant information to artificial intelligence algorithms in “-omics” models.

Programmatic Specialization and Pathway Development Improves Outcomes in Mechanical Circulatory Support

Cardiac surgery continues to transform into areas of sub-specialization and expertise. With increasing complexity of cases and scrutiny of outcome-based reimbursement, it is imperative that these cases are performed with reduced variability and superior outcomes. This can be achieved by introducing sub-specialization in mechanical circulatory support (MCS) therapies, implementing clinical care pathways and using standardized protocols during various stages of patient care. We analyzed the impact of protocol and clinical pathway-driven sub-specialization on MCS outcomes. A single center retrospective analysis was conducted of patients undergoing long term MCS device placement between 2002-2018. The analysis was conducted comparing management of patients before (Era 1: 2003-2011) vs. after (Era 2: 2012-2018) introduction of MCS sub-specialization. Since 2012, multiple initiatives were introduced in our program, namely recruitment of specialized MCS/transplant surgeons, multidisciplinary team rounds, establishment of a shock team, development of clinical care pathways, electronic medical record order sets and clinical practice guidelines. Quality metrics were analyzed every month, and process improvement projects were initiated during this era. During Era 1, five cardiac surgeons implanted LVADs in 181 patients, while in Era 2, three MCS/transplant trained surgeons implanted LVADs in 326 patients. Era 2 included higher number of INTERMACS 1 and 2 profile patients (66% vs. 85%) reflecting higher-acuity patient population. With implementation of the sub-specialization services, 1-year survival improved from 58% to 96%. Median ICU stay decreased from 13 to 8 days and percent of patients discharged to home increased from 62% to 95%. Standardized protocols for management of high LDH, GI bleeding, and blood pressure management resulted in significant reduction in overall hospital length of stay. With introduction of clinical care pathways, the average time for workup from admission to LVAD implant decreased from 27.6 days to 8.5 days. With improved outcomes in Era 2, the program grew 200%. Introduction of sub-specialization services, with use of clinical pathways and protocols in managing patients with LVADs can help improve survival, reduce variability in medical care, and reduce ICU length of stay.

The value of in vitro diagnostic testing in the provision of medical care to patients with cardiovascular diseases.

In vitro diagnostics are used at all stages of patient care. The aim of this study was to assess the impact of laboratory examination on clinical decision-making in providing medical care to patients with a cardiovascular profile. We also took into account the level of financing for the laboratory industry in the Russian Federation. We divided our study on three sequential steps: literature review, survey of clinicians and test-survey of clinicians. The share of costs for the laboratory tests in 2017 amounted to about 8% of the total funding for Russian health care. About 80% (70; 90) of the visits of the attending physicians are associated with the appointment of laboratory tests. Among patients who were prescribed any laboratory test - in 62.1% (95% CI 16.9-24.9) cases, the results of these tests influenced clinical decision making related to the initiation, modification or termination of any treatment. All visits of clinicians were divided by purpose: tests were prescribed in almost 100% (90; 100) cases during the initial examination, in 40% (20; 60) cases during repeated visits, and in 40% (15; 40) cases when patients were examined before discharge. In more than half of cases (57,4%; n=31), doctors correctly assumed about the about the share of financing of the laboratory industry. The majority of respondents considered the amount of expenses adequate and recommended to maintain the current level in the future. According to attending physicians, new laboratory markers should demonstrate additional information about clinical relevance to improve patient outcomes. Thus, in current economic realities, future laboratory tests should be financially maximally available and at the same time be clinically highly effective auxiliary instruments. It creates new challenges in finding laboratory biomarkers and putting them into clinical practice.

RAS mutation: site of disease and recurrence pattern in colorectal cancer.

Somatic mutation status in metastatic colorectal cancer (CRC), and namely mutational activation of the Kirsten rat sarcoma viral oncogene homolog (KRAS) oncogene, is becoming more and more relevant in clinical practice. In this review, we describe the current data about the importance of associations between the mutational activation status of the KRAS oncogene and clinical outcomes, prognosis and metastatic patterns of CRC. The presence of a KRAS mutation is detected in approximately 30-50% of CRC and represents a powerful predictor of oncologic outcomes. It is associated with low response to systemic chemotherapy and for insensitivity to the anti-EGFR antibodies in the preoperative setting. It is more frequently associated with right colon cancer. In non-metastatic patients, KRAS mutation leads to more aggressive disease with shorter recurrence free survival (RFS) and more lung recurrences. After resection of CRC liver metastases (LiM), KRAS mutation is directly associated with increased risk of recurrence, worse overall survival (OS), and a distinct metastatic pattern with more invasive intrahepatic recurrence and increased recurrence outside of the liver, particularly in the lung, the peritoneum, and even in uncommon metastatic sites such as the brain and bones. As metastasectomy with curative intent is increasingly considered, a comprehensive approach of tumor biology is required to face the specific challenge of patients with metastatic CRCs. Thus, as it represents one of the strongest predictors of oncologic outcomes, integrating the KRAS mutational status at all the different stages of patient care appears crucial in order to adapt both medical and surgical strategies.