Hospital Wards Research Articles

Electronic Sepsis Screening Among Patients Admitted to Hospital Wards

Sepsis screening is recommended among hospitalized patients but is supported by limited evidence of effectiveness. To evaluate the effect of electronic sepsis screening, compared with no screening, on mortality among hospitalized ward patients. In a stepped-wedge, cluster randomized trial at 5 hospitals in Saudi Arabia, 45 wards (clusters) were randomized into 9 sequences, 5 wards each, to have sepsis screening implemented at 2-month periods. The study was conducted between October 1, 2019, and July 31, 2021, with follow-up through October 29, 2021. An electronic alert, based on the quick Sequential Organ Failure Assessment score, was implemented in the electronic medical record in a silent mode that was activated to a revealed mode for sepsis screening. The primary outcome was 90-day in-hospital mortality. There were 11 secondary outcomes, including code blue activation, vasopressor therapy, incident kidney replacement therapy, multidrug-resistant organisms, and Clostridioides difficile. Among 60 055 patients, 29 442 were in the screening group and 30 613 in the no screening group. They had a median age of 59 years (IQR, 39-68), and 30 596 were male (51.0%). Alerts occurred in 4299 of 29 442 patients (14.6%) in the screening group and 5394 of 30 613 (17.6%) in the no screening group. Within 12 hours of the alert, patients in the screening group were more likely to have serum lactate tested (adjusted relative risk [aRR], 1.30; 95% CI, 1.16-1.45) and intravenous fluid ordered (aRR, 2.17; 95% CI, 1.92-2.46) compared with those in the no screening group. In the primary outcome analysis, electronic screening resulted in lower 90-day in-hospital mortality (aRR, 0.85; 95% CI, 0.77-0.93; P < .001). Screening reduced vasopressor therapy and multidrug-resistant organisms but increased code blue activation, incident kidney replacement therapy, and C difficile. Among hospitalized ward patients, electronic sepsis screening compared with no screening resulted in significantly lower in-hospital 90-day mortality. ClinicalTrials.gov Identifier: NCT04078594.

Redesigning the Hospital Environment to Improve Restfulness

Hospital wards are often not conducive to patient sleep, negatively affecting patient health and experience. To assess determinants of in-hospital restfulness and to design and test rest-promoting interventions on the wards in partnership with clinicians, staff, and patients. This rapid-sequential mixed-methods quality improvement study was performed at a large urban academic hospital in St Louis, Missouri, from May 1, 2021, to December 31, 2022, with follow-up through hospitalization. Mixed-methods activities involved purposively selected hospitalized adults on the wards, nurses, hospitalists, and hospital staff. Interventions included all adult hospitalizations on the study wards. Sequential stacked bundles of multimodal rest-promoting interventions (general education, focused education on light or noise, safely reducing overnight monitoring or testing, and environmental personalization). Pre-post comparisons of perceived nighttime quietness (via surveys) and sleep opportunity (coprimary outcomes) as well as clinical interruptions overnight, environmental noise, and adoption and satisfaction. Nine patients (4 female) and 14 staff members (10 female; 3 nurse managers or administrators, 10 nurses, and 1 physician) were interviewed, 38 surveys were collected, and more than 100 hours of observation were performed. Interventions were evaluated for 671 patients (mean [SD] age, 60 [16] years; 336 [50%] female). Determinants of in-hospital rest included infrastructure, staff attitudes, priorities, culture, and patient experiences of anxiety, uncertainty, and loss of control. Informed by these determinants, codesign workshops yielded 39 potential interventions, from which 9 were selected for testing. Related interventions were organized into bundles, which were tested in sequential 2-week sprints. Perceived nighttime quietness improved nonsignificantly during the project (wards "always" quiet at night: 51% preintervention vs 86% postintervention; P = .09), with excessive noise events decreasing from 0.65 (95% CI, 0.53-0.77) to 0 per 100 patient-nights before the intervention (P = .02). Sleep opportunity improved significantly (mean, 4.94 [95% CI, 4.82-5.06] hours per patient-night before the intervention vs 5.10 [95% CI, 5.00-5.20] hours per patient-night after the intervention; P = .01). In this quality improvement study, a set of feasible, acceptable, and beneficial rest-promoting interventions were developed. After implementation of these interventions on the wards, a significant improvement in nighttime quietness and sleep opportunity was observed. These results demonstrate how human-centered design methods can generate practical and effective strategies for improving an important patient-related outcome and a core element of patient experience.

Technology-enabled anticipatory guidance and peer support in empowering parents to prevent early childhood caries: a randomized controlled trial

IntroductionDental caries is one of the most prevalent chronic diseases of childhood. Early childhood caries (ECC), defined as onset of dental caries before 6 years of age, is preventable and reversible in the early stages with proper interventions. The purpose of the study is to assess the clinical effectiveness and cost-effectiveness of technology-enabled anticipatory guidance and peer support in empowering parents to establish good diets, feeding and oral hygiene practices to prevent ECC.Methods and analysisMother-child dyads will be recruited from pre-natal clinics and post-natal wards of a tertiary care hospital in Singapore. The control group will receive conventional oral health education materials while the intervention group will join four rounds of online parent empowerment sessions focusing on anticipatory guidance and peer-support. Mothers will complete a questionnaire and food frequency checklist when their child turns 12, 24 and 36 months; each child will undergo an oral examination at the age of 24 and 36 months. Chi-square tests and two-sample t-tests, or their non-parametric equivalents will be used to compare proportions of children with caries by decayed, missing and filled teeth (dmft) and decayed, missing and filled surfaces (dmfs) scores between groups. Effect sizes and their confidence intervals will be calculated along with number needed to treat. Multivariable analyses will be carried out to assess the effect of the intervention on primary outcomes (caries incidence at 24 and 36 months) and secondary outcomes (including parental efficacy, child’s oral health behaviours and oral hygiene status, quality of life). Cost-effectiveness analyses will also be carried out.Ethics and disseminationThe study was approved by Domain Specific Review Board (DSRB 2024/00244). Results will be published in international peer-reviewed journals.Trial registration numberThe trial was retrospectively registered on ClinicialTrials.gov (NCT06558955) around the time of the commencement of patient recruitment, but prior to the commencement of any intervention.

Välkky's voyage on to a hospital ward: Expectations, explorations and emergent robocentric nursing care.

Drawing on ethnographic fieldwork in Finland, we report on the trial of a teleoperated care robot named Välkky introduced onto a fully operational hospital neurological ward. Our data revealed a narrative arc where participants' early expectations of the hospital-based trial altered as the project unfolded. Greeted with techno-excitement and experimental enthusiasm about the place of robotics in reshaping roles within clinical care, Välkky became the focus for collaborative in situ learning, adaptation and redesign amongst the roboticists, designers, nurses, patients, and managers. Välkky acted as an 'attractor' provoking thinking about, and a reimagining of, future arrangements of care. Our empirically informed insights seek to pave the way for real-world nuanced thinking that pushes beyond human/non-human and success/failure binaries. Building on debates in STS and feminist posthumanism, we propose a robocentric approach, which encourages us to 'queer' health care robots, and to understand them as fluid, hybrid, distributed and relational figures, rather than purely as inert, mechanical, non-human objects that might replace humans. Nursing care practices by and with robots will generate new meanings and practices of care that will emerge iteratively, as caring relations, relationships and practices develop within the context of operational ward environments. Robots may or may not be able support care, but they will invariably challenge what care is.

Nutritional risk screening by the emergency medical services: Agreement with in-hospital assessment

IntroductionEarly recognition of nutritional risk is important to prevent the adverse consequences of malnutrition. However, nutritional risk screening is often disregarded in hospitals. PurposeTo evaluate the agreement of nutritional risk screening results between screening performed by emergency medical services (EMS) and at the hospital ward. MethodsThe EMS used the Nutritional Risk Screening 2002 (NRS-2002) to screen the nutritional risk of community-dwelling patients aged ≥ 70 years transported to the emergency department of a large Finnish hospital. The NRS-2002 results from the EMS were compared to results obtained during hospitalization. ResultsThe EMS screened 472 patients and recognized nutritional risk in 81 (17 %). NRS-2002 was repeated at hospital ward in 97 of the screened. In about two-thirds of the cases (69 %), the EMS and ward personnel agreed on whether the patient had nutritional risk or not, and one-third of patients (31/97, 32 %) had the exact same score. The EMS tended to give lower scores (mean difference 0.70 ± 1.29, p < 0.001). Twenty-four patients considered not to be at nutritional risk according to the EMS were recognized as risk patients at the ward. ConclusionNutritional risk screening by the EMS could help in identifying persons requiring more detailed assessment of nutritional status.

Searching for a Serial Killer on a Hospital Ward

The recent case of Lucy Letby in the UK shows that exposing a serial killer in healthcare is challenging. Statistical evidence has been used in the courts, but the overturning of the life sentence of a Dutch nurse in 2008 due to inadequate data analysis suggests the need for objective statistical approaches. In our case, a nurse was convicted after injecting an infant with insulin following a dispute at a family party and killing a patient with insulin in an institute for disabled persons. The nurse had previously worked in a geriatric unit for seven months, during which 29 deaths occurred, some with suspicious features.We applied statistical methods developed for the evaluation of diagnostic tests to analyze the nurse’s possible involvement in these deaths. We searched for discrepancies in the death certificates and performed medico-legal autopsies on exhumed deceased patients.During the 7 months, 69 nurses and practical nurses at the geriatric ward completed 27,324 shifts. Of the deaths, 16/29 (55%) occurred during night shifts. The convicted nurse had worked a clearly higher number of night shifts, in particular, than others. She was among the highest 10% whose work shifts coincided with the deaths in terms of sensitivity, specificity, and likelihood ratios. Of the deaths, 11/29 (38%) occurred during or immediately after her shift. Unexplained suspicious blood glucose fluctuations or hypoglycemia-mimicking comas unrelated to known illnesses were reported in 6 (55%) of the 11 deaths, and in one of these cases, the incident was supported by autopsy findings.Statistical methods for diagnostic accuracy may allow the targeting of the investigation when searching for a possible serial killer in a hospital. However, a statistical approach does not allow an unambiguous determination of a perpetrator nor does it replace a thorough examination of the circumstances and cause of death when investigating a small number of suspicious deaths among patients with serious illnesses and high mortality.

The impact of the COVID-19 pandemic on hospital admissions in a psychiatric ward in a general hospital in Greece.

The negative consequences of the COVID-19 pandemic and the subsequent restrictive measures on the mental health and well-being of the population and psychiatric patients have been widely recognized. Patients' treatment attendance and engagement with mental health services had been negatively affected by the pandemic, whereas patients were less likely to receive timely outpatient care. The pandemic also impacted the use of inpatient services. The aim of the present study was to explore the variability of attendance and admissions to a general hospital psychiatric ward over a 12-month interval after the onset of the pandemic (March 2020), compared to the respective 12-month pre-pandemic interval. A retrospective, observational pre/post study was performed, involving a general hospital psychiatric ward in Corfu, Northwest Greece, which serves an insular catchment area of approximately 100,000 inhabitants. For data analysis, c- and u-charts of statistical process control charts were employed, using monthly data (March 2019 to February 2021). Overall, a significant decline in attendance rates was observed, mostly accounted for by a 26.5% reduction in voluntary attendance rates (1516 patients prior vs. 1114 patients after the onset of the pandemic). The involuntary commitment of patients did not differ between the two periods (106 prior vs. 100 after the onset of the pandemic). Admission rates did not change significantly between the two periods. Diagnoses that exhibited significant variance in examinations between the two study periods were mood disorders and personality disorders, whereas there was no significant variation in the number of admissions across different diagnoses. Length of hospital stay increased significantly by 13.2% over the first year of the pandemic, from 25.57 days (Md= 13, IQR= 22) during the pre-COVID-19 period to 28.95 days (Md= 22, IQR= 28) during the COVID-19 period. Patients with schizophrenia and related disorders (Mean= 34.25 days, SD= 43.19) and mood disorders (Mean= 26.26, SD= 33.48) had prolonged hospital stays compared to other diagnoses. These findings highlight significant shifts in psychiatric care delivery during the pandemic and underscore the need for targeted interventions to address the evolving demands on mental health services during public health crises.

The Effects of a Digital Multimedia Foot Ulcer Care Program on Health Beliefs and Self-Care Behaviors in People With Diabetic Foot Ulcer

Foot complications, common among diabetic patients, often lead to amputation and increased dependence on daily living assistance. Effective and sustained intervention programs are important challenges that nursing staff must address. This study was designed to explore the effectiveness of a digital multimedia foot ulcer care program on the foot health beliefs and self-care behaviors of diabetic patients. An experimental research design was adopted, with a total of 62 patients with type 2 diabetes in the plastic surgery ward of a regional hospital in southern Taiwan enrolled as participants. The participants were randomly assigned to either the experimental group (n = 31), which received a digital multimedia foot ulcer care program via mobile phones or tablets for eight weeks, or the control group (n = 31), which received conventional diabetic foot care education leaflets. The research instruments included a demographic questionnaire, the Diabetic Foot Ulcer Health Belief Scale, and the Diabetic Foot Care Behavior Scale. Data were collected at baseline, four weeks, and eight weeks, and were analyzed using SPSS 22.0. The study was completed with 30 participants in both groups. The experimental group showed significantly greater improvements in health beliefs at the fourth and eighth weeks post-assessment than the control group, with increases of 3.77 and 5.13, respectively (p = .03, p = .02). These improvements were statistically significant and exceeded baseline values significantly (p < .05). In terms of self-care behaviors, improvements in the experimental group exceeded those in the control group by 2.27 and 1.83, respectively, at four and eight weeks (p = .03, p = .05). Furthermore, the experimental group exhibited superior changes in scores compared to the control group. The digital multimedia foot ulcer care program implemented in this study significantly enhanced health beliefs and self-care behaviors in patients with diabetic foot ulcers. This program may be employed during hospitalization and post-discharge to improve foot ulcer care techniques and reduce diabetic foot ulcer deterioration.

149 Receptive music therapy session improves psychological functioning and is followed by changes in skin parameters of hospital ward patients

149 Receptive music therapy session improves psychological functioning and is followed by changes in skin parameters of hospital ward patients

Experimental study of ventilation performance of three ventilation strategies using aerosols and tracer gas

Effective ventilation plays a crucial role in reducing the risk of infection by airborne contaminants. This study was conducted in a hospital ward of specific dimensions (41.58 m3) equipped with two respiratory thermal manikins: a healthcare worker and an infected patient. Three ventilation strategies were employed in the ventilation system: supply and exhaust air through upper grilles, upper and lower grilles, and swirl diffusers with lower grilles. The air flow rate of the ventilation system was maintained constant at 200 m3/h. The airflow was distributed 50-50% by a combination of a personalised ventilation system and personalised exhaust system. The effectiveness of a ventilation system and its combination with a personalised exhaust system was investigated using aerosol and tracer gas techniques. The efficacy of contaminant removal was evaluated in both the patient and healthcare inhaled volume. Determination of the clean air flow rate of the three ventilation system strategies at inhaled volume was carried out. Also, the exposure of healthcare worker to the contaminants exhaled by infected patient in the microenvironment formed by both was analysed. Experimental findings revealed that CO2 showed a higher ventilation efficiency compared to particles, independently of the ventilation strategy used. The highest clean air flow rate values were detected in the inhaled volume of patient infected. On the other hand, the highest particle removal efficiency was observed in swirl diffusers with lower grilles, which combined the ventilation system with the PES. This strategy also showed the lowest exposure values in the microenvironment.

The Experience of turnover to long-term care hospital nurse: A phenomenological qualitative research

Purpose: The purpose of this study was to explore the experience of turnover to a long-term care hospital nurse. Methods: Data were collected using in-depth interviews and analyzed using a Giorgi’s phenomenological approach. The participants were ten nurses who worked on the wards of a long-term care hospital in Busan metropolitan. Results: The results were summarized into five themes and seventeen core meanings. The five themes were ‘A choice based on one's convenience’, ‘Feeling overwhelmed by tasks beyond the scope of nursing duties’, ‘Thinking about turnover from time to time’, ‘An environment where personal growth as a nurse cannot be expected’ and ‘Becoming a nurse for long-term care’. Conclusion: To ensure patient safety and prevent nurse turnover in long-term care hospitals, it is necessary to improve the nursing environment, establish clear job manuals, and create a reasonable salary system.

Lessons Learnt from Testing Three Spatial Observation Tools in a Hospital Ward.

Observation tools are increasingly important in healthcare building design research. They enable us to understand how the design of healthcare buildings affects users' health and organisational outcomes. Observations are used in case studies and pre- and post-occupancy evaluations. However, these case studies often struggle to pinpoint the specific design features responsible for observed outcomes. Additionally, harnessing collective knowledge from multiple cases can be challenging. This underscores the need for structured observations. The paper describes the lessons learnt from using three spatial observation tools as part of a study to assess a hospital ward design. Its goal is to reflect on the purpose, usability, advantages, disadvantages, and future improvements of these tools and to offer insights into their potential to support research on hospital ward design. The first tool, by the Centre for Health Design, utilizes a checklist-style matrix to evaluate the design of patient rooms, assessing 17 Evidence Based Design goals, including patient safety, worker safety and effectiveness, quality of care, patient experience, and organizational performance. The second tool is a one-time observation tool, a structured spatial inventory aimed at documenting design features throughout the entire hospital ward, covering elements such as room size, access to daylight, natural elements, furniture, safety measures, and more. It can be combined with the third tool; the recurring observation tool, which focuses on monitoring usage, users, their activities, and behaviour across various types of environments, including patient, staff, care, and supportive spaces. The last two observation tools were developed for the research project, adapting the Smart Sustainable Offices method for healthcare environments. This paper emphasizes the importance of selecting suitable observation tools for specific research objectives, providing guidance for working with observations and conducting pre-and post-studies. While not aimed at validating observation tools, it offers reflections to aid in development and use of observation tools. Finally, documenting spatial contexts enhances understanding of study findings, and reusing observation tools enables cross-study comparisons, with future potential for leveraging artificial intelligence.

Comparative evaluation of BacT/ALERT VIRTUO and BACTEC FX400 blood culture systems for the detection of bloodstream infections.

Bloodstream infections (BSI) pose significant threats to patient health, necessitating timely and accurate diagnostics to reduce mortality and morbidity. This study aimed to evaluate the clinical performance of the BacT/ALERT VIRTUO blood culture system with FANPlus bottles compared to the BACTEC FX400 system in detecting bloodstream pathogens. A total of 1,772 blood specimens were collected from various hospital wards. Specimen selection criteria were based on clinical suspicion of bloodstream infections, ensuring the inclusion of relevant and representative patient samples. These blood samples, collected from the same suspected sepsis patients, were cultured in parallel using both the BacT/ALERT VIRTUO and BACTEC FX400 systems. The diagnostic efficiency of both systems, including detection rates, time to detection (TTD), and sensitivity across different bacterial species, was assessed. In various application scenarios, the VIRTUO system demonstrates a higher positive detection rate, whether in the intensive care unit (ICU) (8.5% vs 6.4%, P = 0.028) or in general wards. Additionally, for different types of bacteria, the TVIRTUO system exhibits superior detection rates for anaerobic bacteria (5.9% vs 3.2%, P < 0.001) and aerobic bacteria (9.1% vs 7.2%, P = 0.043). Furthermore, it boasts a shorter median TTD of 14 hours compared to 16 hours, and a higher sensitivity for Gram-positive bacteria (2.8% vs 1.6%, P < 0.001). These findings emphasize VIRTUO's effectiveness in enhancing diagnostic accuracy, achieving faster time to detection, and expanding the spectrum of detected organisms, thereby facilitating the quicker initiation of appropriate therapies, supporting precise clinical decision-making, and ultimately improving patient outcomes.IMPORTANCEOur study conducted a critical evaluation of advanced blood culture technologies for managing bloodstream infections (BSI). A distinctive strength of our research is the large sample size and the concurrent testing of the same patients with two systems, a methodology rarely achieved in other studies. BSIs present severe health threats, necessitating prompt and accurate diagnostics to mitigate morbidity and mortality. The BacT/ALERT VIRTUO system, in comparison to the BACTEC FX400 system, demonstrated superior detection capabilities, emphasizing the critical role of advanced diagnostics in clinical settings.

Improving medication safety for intensive care patients transitioning to a hospital ward: development of a theory-informed intervention package.

Care of critically ill patients is complex, requiring effective collaboration co-ordination and communication across care teams and professions. Medicines are a fundamental component of the acute interventions intensive care unit (ICU) patients receive, requiring frequent review and optimisation according to patient needs. ICU patients recovering to transfer to a hospital ward are at risk of medication transition errors, contributing to poorer patient and health-system outcomes. We aimed to develop of a theory-informed intervention package to improve medication safety for ICU patients transferring to a hospital ward. We conducted a qualitative study comprising two UK face-to-face focus group meetings in April and May 2022. There were ten participants in each meeting (7-8 healthcare professionals and 2-3 patient and public representatives). Each meeting had four foci: (i) What needs to change (intervention targets)? (ii) What are the core intervention components? (iii) What will the intervention components change and how (mechanisms of action), and what key outcomes will the changes impact on? (iv) What are the barriers and facilitators to intervention delivery? A background to the problem and previous intervention development work was provided. Meetings were digitally recorded and transcribed verbatim. Iterative analyses, informed by the Behaviour Change Wheel framework, were conducted to provide a behavioural diagnosis, identify key behaviour change techniques and outline the mechanisms of action through which the intervention might impact on key outcome. We identified what needs to change to improve medication safety for UK ICU patients on this care transition. A theory-informed intervention package was developed, based on seven core intervention components (e.g., medication review (targeted), task organisation and prioritisation). For each intervention component the mechanism of action, targeted change, and key outcomes were identified (e.g., medication review (targeted); action planning; decreases problematic polypharmacy; decreased preventable adverse drug events). Barriers and facilitators to intervention component delivery were described. We developed a theory-informed core intervention package to address the limitations in medication safety for ICU patients transferring to a hospital ward. Understanding what needs to change, and the accompanying facilitators provides a basis for intervention feasibility testing and refinement prior to future evaluation of effectiveness.

Conformational Flexibility in Capsids Encoded by the Caliciviridae

Caliciviruses are a diverse group of non-enveloped, positive-sense RNA viruses with a wide range of hosts and transmission routes. Norovirus is the most well-known member of the Caliciviridae; the acute gastroenteritis caused by human norovirus (HuNoV), for example, frequently results in closures of hospital wards and schools during the winter months. One area of calicivirus biology that has gained increasing attention over the past decade is the conformational flexibility exhibited by the protruding (P) domains of the major capsid protein VP1. This was observed in structure analyses of capsids encoded by many species and is often a consequence of environmental cues such as metal ions, changes to pH, or receptor/co-factor engagement. This review summarises the current understanding of P-domain flexibility, discussing the role this region plays in caliciviral infection and immune evasion, and highlighting potential avenues for further investigation.

Diagnostic Accuracy of Transthoracic Echocardiography in Detecting the Cardiac Source of Emboli in Ischemic Stroke Patients in a Tertiary Hospital

Background: Transesophageal Echocardiography (TEE) is superior in identifying potential cardiac sources of emboli in stroke workup. But it is more costly and difficult to perform than Transthoracic Echocardiography (TTE). Moreover, facilities for TEE are not evenly distributed in Bangladesh. The study aimed to assess the diagnostic accuracy of TTE in detecting the cardiac source of emboli in admitted ischemic stroke patients in a Neurology ward of a tertiary hospital in Bangladesh. Materials and methods: Ninety-two consecutively admitted patients admitted with a diagnosis of ischemic stroke without any preexisting indication of anticoagulation and known heart disease were enrolled in this study from the Neurology ward of Chittagong Medical College Hospital (CMCH) Chattogram, Bangladesh. All patients were underwent TTE and TEE. Results: Mean age was 48.36±12.64 years with male predominance (Male to Female ratio was 1.88: 1). Eleven cardioembolic sources were detected by TEE (8 Left atrial appendage thrombus, 2 patent foramen ovale and 1 mild mitral stenosis) in 10 patients. Among these TTE could identify only one case (mild mitral stenosis). The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of TTE to detect cardioembolic sources were 10%, 100%, 100%, 90.11% and 90.22% respectively. Conclusion: Diagnostic yield of TTE was very low in detecting the cardiac source of embolism in selected patients with ischaemic stroke. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 68-71

An Easy-to-Use Tool to Predict SARS-CoV-2 Risk of Infection in Closed Settings: Validation with the Use of an Individual-Based Monte Carlo Simulation

The dynamics of the SARS-CoV-2 pandemic showed that closed environments, such as hospitals and schools, are more likely to host infection clusters due to environmental variables like humidity, ventilation, and overcrowding. This study aimed to validate our local transmission model by reproducing the data on SARS-CoV-2 diffusion in a hospital ward. We implemented our model in a Monte Carlo procedure that simulates the contacts between patients and healthcare workers in Trieste’s geriatric ward and calculates the number of infected individuals. We found the median number of infected workers to be 38.98 (IQR = 7.75), while all patients were infected in most of the simulation runs. More infections occurred in rooms with lower volumes. Higher ventilation and mask-wearing contribute to reduced infections; in particular, we obtained a median value of 35.06 (IQR = 9.21) for the simulation in which we doubled room ventilation and 26.12 (IQR = 10.33) in the simulation run in which workers wore surgical masks. We managed to reproduce the data on infections in the ward; using a sensitivity analysis, we identified the parameters that had the greatest impact on the probability of transmission and the size of the outbreak.

Post-earthquake spiritual well-being and depression levels of postpartum women in Turkey

ABSTRACT This study was carried out to examine the spiritual well-being and depression levels of postpartum women following the two major earthquakes that occurred in 2023 with the epicenter Kahramanmaraş in Turkey. This cross-sectional analytical study was conducted with the participation of 345 postpartum women admitted to the maternity ward of a medical faculty hospital in the provincial center of Kahramanmaraş in Turkey between June and September 2023. Data were collected using the Spiritual Well-Being Scale (SWBS) and the Edinburgh Postnatal Depression Scale (EPDS). Independent-samples t-tests, Pearson’s correlation tests, and simple linear regression analysis were used in the analyses. It was determined that 48.7% of the participants were at risk of postpartum depression. The participants whose relatives were lost/injured in the earthquakes and those who experienced financial losses had significantly lower total SWBS scores and significantly higher total EPDS scores (p < 0.05). A negative and statistically significant relationship was found between the total SWBS and total EPDS scores of the participants (p < 0.001). In this study, it was determined that after the Kahramanmaraş earthquakes in 2023, almost one in every two postpartum women was at risk of depression, and their earthquake experience affected their mental health and spiritual well-being negatively. Moreover, as the spiritual well-being of the postpartum women increased, their risk of postpartum depression decreased.

Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections.

Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain. In a multicenter, noninferiority trial, we randomly assigned hospitalized patients (including patients in the intensive care unit [ICU]) who had bloodstream infection to receive antibiotic treatment for 7 days or 14 days. Antibiotic selection, dosing, and route were at the discretion of the treating team. We excluded patients with severe immunosuppression, foci requiring prolonged treatment, single cultures with possible contaminants, or cultures yielding Staphylococcus aureus. The primary outcome was death from any cause by 90 days after diagnosis of the bloodstream infection, with a noninferiority margin of 4 percentage points. Across 74 hospitals in seven countries, 3608 patients underwent randomization and were included in the intention-to-treat analysis; 1814 patients were assigned to 7 days of antibiotic treatment, and 1794 to 14 days. At enrollment, 55.0% of patients were in the ICU and 45.0% were on hospital wards. Infections were acquired in the community (75.4%), hospital wards (13.4%) and ICUs (11.2%). Bacteremia most commonly originated from the urinary tract (42.2%), abdomen (18.8%), lung (13.0%), vascular catheters (6.3%), and skin or soft tissue (5.2%). By 90 days, 261 patients (14.5%) receiving antibiotics for 7 days had died and 286 patients (16.1%) receiving antibiotics for 14 days had died (difference, -1.6 percentage points [95.7% confidence interval {CI}, -4.0 to 0.8]), which showed the noninferiority of the shorter treatment duration. Patients were treated for longer than the assigned duration in 23.1% of the patients in the 7-day group and in 10.7% of the patients in the 14-day group. A per-protocol analysis also showed noninferiority (difference, -2.0 percentage points [95% CI, -4.5 to 0.6]). These findings were generally consistent across secondary clinical outcomes and across prespecified subgroups defined according to patient, pathogen, and syndrome characteristics. Among hospitalized patients with bloodstream infection, antibiotic treatment for 7 days was noninferior to treatment for 14 days. (Funded by the Canadian Institutes of Health Research and others; BALANCE ClinicalTrials.gov number, NCT03005145.).

Planning hospital-focused training in internal medicine at the CHUV

Switzerland already suffers from the long-predicted shortage of physicians. Moreover, the latter often face long and meandering postgraduate training. At the beginning of their career, most doctors work on internal medicine hospital wards, even though their future may just as well lie in an outpatient or inpatient setting, in general internal medicine or in other disciplines. To help these physicians identify and clarify their hospital trajectory at an early stage, thus optimizing training pathways, the Medicine Department of the CHUV set up its Housestaff. Using a mentorship system and clearly defining a training track (outpatient practice, hospital, academic, or transition), it supports candidates, in close partnership with other departments, regional hospitals and networks, in particular ambulatory ones.