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Mitchell M, Newall F, Bernie C, Brignell A, Williams K. Simulation-based education for teaching aggression management skills to healthcare providers in acute healthcare settings: A systematic review. Int J Nurs Stud 2024; 158:104842. [PMID: 38964221 DOI: 10.1016/j.ijnurstu.2024.104842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/31/2024] [Accepted: 06/10/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Behavioural emergencies involving aggression in acute care hospitals are increasing globally. Acute care staff are often not trained or confident in their prevention or management. Of available training options simulation-based education is superior for clinical medical education and is gaining acceptance for teaching clinical aggression management skills. OBJECTIVE The aim of this study was to conduct a systematic review of the effectiveness of simulation-based education for teaching aggression management skills for health professionals working in acute healthcare settings. METHODS The study protocol was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement, registered (27/02/2020) and published. We included randomised controlled trials, non-randomised controlled trials, quasi-experimental studies, and observational studies involving healthcare professionals in acute hospital settings or trainee health professionals who received simulation-based training on managing patient aggression. Comprehensive searches were conducted in PubMed, Ovid MEDLINE, PsycINFO, CINAHL and The Cochrane Library. Two reviewers independently screened all records, extracted data and assessed risk of bias. The primary outcomes included patient outcomes, quality of care, and adverse effects. Secondary outcomes included workplace resource use, healthcare provider related outcomes, knowledge (de-escalation techniques), performance, attitudes, and satisfaction. A narrative synthesis of included studies was performed because substantial variation of interventions and outcome measures precluded meta-analyses. RESULTS Twenty-five studies were included with 2790 participants, 2585 (93 %) acute care hospital staff and 205 (7 %) undergraduate university students. Twenty-two studies combined simulation-based education with at least one other training modality. Three studies were randomised controlled trials, one was a pilot and feasibility cluster randomised controlled trial, one was a three-group post-test design and twenty were pre-/post-test design. Twenty-four studies were deemed to be high/critical or serious risk of bias. Four studies collected primary outcome data, all using different methods and with inconsistent findings. Twenty-one studies assessed performance in the test situation, seven studies provided objective ratings of performance and eighteen provided self-report data. Twenty-three studies reported objective or subjective improvements in secondary outcomes. CONCLUSIONS Acute healthcare staff who completed simulation-based education on managing clinical aggression showed statistically significant improvements in knowledge and self-reported confidence. However, there is a lack of evidence about the magnitude of these improvements and impact on patient outcomes. REGISTRATION PROSPERO Registration Number CRD42020151002. TWEETABLE ABSTRACT Simulation-based education improved acute healthcare clinician knowledge and confidence in managing aggression.
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Affiliation(s)
- Marijke Mitchell
- Department of Paediatrics, Monash University, Clayton, Melbourne, Australia; Royal Children's Hospital, Parkville, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Australia; Monash Children's Hospital, Clayton, Melbourne, Australia.
| | - Fiona Newall
- Royal Children's Hospital, Parkville, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Australia; Murdoch Children's Research Institute, Parkville, Melbourne, Australia
| | - Charmaine Bernie
- Department of Paediatrics, Monash University, Clayton, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Australia; Murdoch Children's Research Institute, Parkville, Melbourne, Australia; Southern Cross University, Bilinga, Queensland, Australia
| | - Amanda Brignell
- Department of Paediatrics, Monash University, Clayton, Melbourne, Australia; Murdoch Children's Research Institute, Parkville, Melbourne, Australia; Monash Children's Hospital, Clayton, Melbourne, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Clayton, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Melbourne, Australia; Murdoch Children's Research Institute, Parkville, Melbourne, Australia; Monash Children's Hospital, Clayton, Melbourne, Australia
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Butt JH, Yafasova A, Thein D, Begun X, Havers-Borgersen E, Bække PS, Smerup MH, De Backer O, Køber L, Fosbøl EL. Burden of hospitalization during the first year following transcatheter and surgical aortic valve replacement. Am Heart J 2024; 276:12-21. [PMID: 39084484 DOI: 10.1016/j.ahj.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/25/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Hospitalizations are a major burden for both patients and society but are potentially preventable. We examined the one-year hospitalization burden in patients undergoing transcatheter aortic valve replacement (TAVR) and compared hospitalization rates and patterns with those undergoing isolated surgical aortic valve replacement (SAVR). METHODS Using Danish nationwide registries, we identified patients who underwent first-time TAVR and isolated SAVR (2008-2019), respectively. Subsequent hospitalizations were classified as cardiovascular or noncardiovascular according to discharge diagnosis codes. RESULTS Patients undergoing TAVR (N = 4,921) were older and had more comorbidities than those undergoing SAVR (N = 5,220). There were 5,725 and 4,426 hospitalizations within the first year after discharge in the TAVR and SAVR group, respectively. During the one-year follow-up period post-TAVR, 46.6% were not admitted, 25.4% were admitted once, 12.6% twice, and 15.4% 3 times or more. The corresponding proportions in patients undergoing SAVR were 55.3%, 25.1%, 10.0%, and 9.5%, respectively. Among patients with ≥1 hospitalization following TAVR, 50.3% had a total length of all hospital stays between 1 and 7days, 19.0% 8-14days, 18.0% 15-30days, 9.9% 31-60days, and 2.8% ≥61days. The corresponding proportions for patients undergoing SAVR were 58.6%, 17.2%, 13.1%, 7.4%, and 3.7%, respectively. Compared with patients undergoing SAVR, those undergoing TAVR had a lower early (day0-30: HR 0.89 [95% CI, 0.80-0.98]), but a higher late hospitalization rate (day 31-365: 1.46 [1.32-1.60]). CONCLUSIONS The 1-year hospitalization burden following TAVR is substantial. Compared with patients undergoing isolated SAVR, those undergoing TAVR had a lower early, but a higher late hospitalization rate - a difference that likely reflects unmeasured differences in the patient cohorts.
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Affiliation(s)
- Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
| | - Adelina Yafasova
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David Thein
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Xenia Begun
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Havers-Borgersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Pernille S Bække
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten H Smerup
- Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Cohen C, Bélanger L, Turcotte M, Pereira F. Stressors and coping strategies in older people hospitalised for hip surgery following a fall: a multiple case study. BMC Nurs 2024; 23:653. [PMID: 39272183 PMCID: PMC11401280 DOI: 10.1186/s12912-024-02316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 09/02/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND More than half of older persons admitted to an emergency department after a fall have a hip fracture and require surgery for a total hip replacement. This procedure has a high risk of postoperative complications and consequences for older persons, their informal caregivers, and the healthcare system. This study aimed to explore the perceptions of older persons, their informal caregivers and health professionals about intra-personal, inter-personal and extra-personal stressors arising from hip surgery following the fall of an older person hospitalised in orthopaedics, as well as the coping strategies used and the results obtained. METHODS A qualitative multiple case study. The sample consisted of eight cases. Each case consisted of one older person, their informal caregiver and the professionals involved in their care: a nurse, an orthopaedic surgeon and a physiotherapist. A total of 32 participants were recruited. Data were collected between August 2018 and February 2019 in a public hospital in French-speaking Switzerland. Intra- and inter-case analyses were performed. RESULTS Five topics emerged: two concerning stressors for older persons (the physical and psychological consequences of the fall and hospitalisation; the loss of relational and environmental markers and habits); two relating to the coping strategies used to face the stressors (being resilient and involved in their own care; partially meeting the older person's needs); and one regarding the results of the strategies used (reassurance through consideration of some of their needs). CONCLUSIONS Older persons hospitalised for hip surgery after a fall are confronted with various intra-, inter- and extra-personal stressors and have to explore, together with their informal caregivers, strategies to cope with the consequences of these stressors. Healthcare professionals should possess efficient intervention strategies to help identify and support older persons who experience various types of stressors during hospitalisation for hip surgery following a fall.
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Affiliation(s)
- Christine Cohen
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue Vinet 30, Lausanne, 1004, Switzerland.
| | - Louise Bélanger
- Département des sciences infirmières, Université du Québec en Outaouais, Saint-Jérôme, QC, Canada
| | - Mathieu Turcotte
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue Vinet 30, Lausanne, 1004, Switzerland
| | - Filipa Pereira
- School of Health Sciences, HES-SO Valais/Wallis, University of Applied Sciences and Arts, Western Switzerland, Sion, Switzerland
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Dayan-Schwartz A, Abd Elgani S, Abdul-Ghani T, Kogan L, Reiss A, Tal A. Pharmacological treatment of ectopic pregnancy: Accuracy, safety and cost-effectiveness of day 1-7 β-hCG measurements. Int J Gynaecol Obstet 2024; 166:1330-1336. [PMID: 38619463 DOI: 10.1002/ijgo.15511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/09/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE The aim of the present study was to compare accuracy, safety and cost-effectiveness of three β-hCG measurements protocols, applied in managing ectopic pregnancies (EP) with methotrexate (MTX): (1) day 1 to 7 β-hCG levels, (2) day 1 to 4 β-hCG levels and (3) day 4 to 7 β-hCG levels. METHODS Cost-minimization analysis (CMA) based on a retrospective study of patients treated with single-dose MTX for EP, was evaluated at a single institution between January 2001 to May 2021. Successful MTX treatment was defined as no surgical intervention. We evaluated safety by analyzing cases of day 4 interventions and cases of inconsistency between the different protocols. Predicting accuracy was assessed by the area under the receiver operating characteristic (AUC) curve. RESULTS A total of 229 patients with single dose MTX treatment were included. Overall, 184 (80.3%) patients were treated successfully with a single dose of MTX. For days 1 and 7 the optimal cutoff point was 7% reduction in β-hCG levels with sensitivity, specificity and PPV of 76.6% (69.9-82.5, 95% CI), 75.5% (60.5-87.1, 95% CI) and 92.8% (88.4-95.6, 95% CI), respectively. There was no significant difference between the protocols' AUC. None of the patients had any change of management during their day 4 visit in our 20 years of records. The cost for each visit day (day 4 and 7) was calculated with a total cost of 251 USD per patient. CONCLUSION Patients treated with MTX for EP, measurement of day 1 and day 7 β-hCG serum levels has a cost minimization advantage and is not inferior to the traditional protocol for predictive accuracy and safety.
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Affiliation(s)
- Adi Dayan-Schwartz
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Suzan Abd Elgani
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | | | - Liron Kogan
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
| | - Ari Reiss
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Alon Tal
- Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Brown AE, Press VG, Meltzer DO. Association of health confidence with hospital length of stay and readmission. J Hosp Med 2024; 19:794-801. [PMID: 38751348 DOI: 10.1002/jhm.13405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 04/26/2024] [Accepted: 05/03/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Length of stay (LOS) is an important measure of hospital quality and may be impacted by patient participation. However, concepts of patient participation, like health confidence, have received little examination in hospitalized patients' LOS, especially in diverse populations. OBJECTIVE To determine if the Health Confidence Score (HCS) is associated with hospital LOS and readmission in a socioeconomically diverse population. DESIGNS, SETTINGS, AND PARTICIPANTS We conducted a prospective cohort study in 2022 of adult general medicine patients at an academic hospital in Chicago, Illinois. INTERVENTION None. MAIN OUTCOME AND MEASURES Patient-reported responses to the HCS (scored 0 [lowest health confidence] to ‒12 [highest health confidence]), as well as demographic, socioeconomic, and clinical questions, were collected. Primary outcome was LOS and secondary outcomes were 30- and 90-day readmission. RESULTS Among 2797 socioeconomically diverse patients who completed the survey (response rate 28.5%), there was an average HCS of 9.19 (SD 2.68, range 0-12). Using linear regression, patients with high HCS (HCS ≥ 9) had a 1.53-day lower LOS (p < .01, 95% confidence interval [CI] [-2.11, -0.95]) than patients with a low HCS (HCS < 9). This association remained when examining individual HCS questions and controlling for covariates. In logistic regression, HCS was not significantly associated with readmission, but the question "I am involved in decisions about me" (adjusted model: odds ratio 0.83; 95% CI [0.71, 0.96]; p = .01) was associated with 90-day readmission.
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Affiliation(s)
- Ashley E Brown
- Primary Care Investigators Training in Chronic Disease & Health Disparities (PITCH) Fellowship, University of Chicago, Chicago, Illinois, USA
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Valerie G Press
- Section of General Internal Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - David O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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Cavdar VC, Ballica B, Aric M, Karaca ZB, Altunoglu EG, Akbas F. Exploring depression, comorbidities and quality of life in geriatric patients: a study utilizing the geriatric depression scale and WHOQOL-OLD questionnaire. BMC Geriatr 2024; 24:687. [PMID: 39143531 PMCID: PMC11325729 DOI: 10.1186/s12877-024-05264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The increasing prevalence of depression among older adults is a growing concern. Chronic health conditions, cognitive impairments, and hospitalizations amplify emotional distress and depression levels in this population. Assessing the quality of life is crucial for the well-being of older adults. AIMS Our study aimed to examine how comorbidities affect depression and quality of life in geriatric patients in both outpatient and hospital settings. METHODS 100 patients (50 from internal medicine outpatient clinic and 50 from internal medicine ward) were included in the study according to inclusion and exclusion criteria. Patients were classified into different age groups (65-74 years, 75-84 years and ≥ 85 years). Data on patients' location of application, age, sex, living alone or with family status, number of comorbid diseases, types of accompanying diseases were recorded and WHOQOL-OLD and Geriatric Depression Scale (GDS) questionnaires were administered. Results were evaluated using SPSS. RESULTS The WHOQOL-OLD questionnaire score was higher in the 65-74 age group compared to other groups, but there was no significant difference between outpatient group and hospitalized group. Patients with comorbid diseases had lower WHOQOL-OLD questionnaire scores compared to those without comorbid diseases. In the 75-84 and ≥ 85 age groups, the GDS scores were higher compared to the 65-74 age group. In hospitalized group, GDS scores were higher than outpatient clinic group. In patients with comorbid diseases, GDS scores were higher than the ones without comorbid diseases. DISCUSSION Our findings indicate that quality of life is higher among those aged 65-74, with lower incidence of depression compared to other age groups. Hospitalization correlates with higher depression rates but not quality of life. As number of comorbid diseases increases in older adults, the frequency of depression rises and the quality of life declines. CONCLUSIONS Early detection and intervention for depression are crucial for enhancing older adults' well-being.
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Affiliation(s)
- Vahit Can Cavdar
- University of Health Sciences, Department of Internal Medicine, Istanbul Training and Research Hospital, Abdurrahman Nafiz Gürman Cad. Etyemez, Samatya, Istanbul, 34098, Turkey
| | - Basak Ballica
- Faculty of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Mert Aric
- University of Health Sciences, Department of Internal Medicine, Istanbul Training and Research Hospital, Abdurrahman Nafiz Gürman Cad. Etyemez, Samatya, Istanbul, 34098, Turkey
| | - Zekiye Busra Karaca
- Department of Internal Medicine, Beylikduzu State Hospital, Istanbul, Turkey
| | | | - Feray Akbas
- University of Health Sciences, Department of Internal Medicine, Istanbul Training and Research Hospital, Abdurrahman Nafiz Gürman Cad. Etyemez, Samatya, Istanbul, 34098, Turkey.
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Alotaibi JS. Hospital Patient Satisfaction With Nursing Care in Saudi Arabia. Cureus 2024; 16:e67840. [PMID: 39323706 PMCID: PMC11424041 DOI: 10.7759/cureus.67840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/27/2024] Open
Abstract
Introduction Patient satisfaction is a critical indicator of health care quality, yet research exploring patient satisfaction with nursing care in Saudi Arabia (SA) remains limited. This study investigated patients' satisfaction with nursing care quality during their hospitalization in SA. Material and methods A cross-sectional study was conducted using a convenience sample of 746 patients from five hospitals in five different regions of SA. Data were collected using the Newcastle Satisfaction With Nursing Scale (NSMS), which has been shown to be valid and reliable. Results The average overall patient satisfaction with nursing care was 71.16 ± 13.51 out of 95 (75.96%), indicating a high level of satisfaction with the nursing care the patients received. The highest-scoring items of patient satisfaction were the nurses' manners when carrying out their duties, the amount of privacy the nurses provided and their capability to perform their jobs. However, the level of satisfaction regarding the frequency of nurse check-ins, time spent with patients, and support provided to patients' relatives indicated areas for potential improvement. Also, patients with primary education who were divorced or married and those admitted to the gynecology ward were more satisfied with nursing care. Conclusion This study's findings indicate that the patients were highly satisfied with the care their nurses provided, although opportunities for improvement in some areas of nursing care were identified. These findings may encourage nurses to be more attentive in meeting their patients' needs according to best nursing practices. It is recommended that hospital administrators prioritize initiatives to enhance the quality of nursing care, thereby improving overall patient satisfaction.
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Kaur N, Konrad M, Hajek A, Smith L, Kostev K. Hospital Length of Stay and Associated Factors in Adult Patients with Depression in Germany: A Cross-Sectional Study. J Clin Med 2024; 13:4331. [PMID: 39124598 PMCID: PMC11313675 DOI: 10.3390/jcm13154331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
Objective: The aim of the present study was to evaluate the hospital length of stay (LoS) and its associated factors among adult patients hospitalized with depression in Germany. Methods: This cross-sectional study included all adults (≥18 years) hospitalized with depression from January 2019 to December 2023 treated in 36 hospitals across Germany. The primary outcome was patients' hospital LoS in days. The associations between age, sex, depression severity, co-diagnoses, hospital, and hospital LoS were analyzed using hierarchical multivariable linear regression models. Results: A total of 6579 patients (mean age 46.6 ± 17.7 years) with 8965 hospitalizations for depression were available. The mean hospital LoS was 35.2 days. Severe depression (+4.9 days) was associated with a longer hospital LoS, with moderate depression as the reference. Older age was positively associated with a longer hospital LoS. Vitamin D deficiency (+9 days), lipid metabolism disorders (+8 days), obesity (+8 days), sleep disorders (+7 days), and reaction to severe stress and adjustment disorders (+5 days) were also significantly associated with hospital LoS. Conclusions: In patients with depression, higher depression severity, advanced age, vitamin D deficiency, lipid metabolism disorders, obesity, sleep disorders, reactions to severe stress, and adjustment disorders were associated with a longer hospital LoS. Addressing these factors through comprehensive and integrated care strategies could help optimize hospitalization duration and improve overall patient outcomes.
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Affiliation(s)
- Nimran Kaur
- Epidemiology, IQVIA, Bangalore 560 103, India
| | - Marcel Konrad
- Department of Health and Social, FOM University of Applied Sciences for Economics and Management, 60486 Frankfurt am Main, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, 20246 Hamburg, Germany
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Karel Kostev
- Epidemiology, IQVIA, Unterschweinstiege 2-14, 60549 Frankfurt am Main, Germany
- University Clinic, Philipps-University, 35043 Marburg, Germany
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Lusk JB, O'Brien EC. Days Alive and Out of Hospital: Reframing Stroke Outcomes for Better Patient-Centered Care. J Am Heart Assoc 2024; 13:e035849. [PMID: 38958144 PMCID: PMC11292753 DOI: 10.1161/jaha.124.035849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Jay B. Lusk
- Department of NeurologyDuke University School of MedicineDurhamNC
| | - Emily C. O'Brien
- Department of NeurologyDuke University School of MedicineDurhamNC
- Duke Clinical Research InstituteDurhamNC
- Department of Population Health SciencesDuke University School of MedicineDurhamNC
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Storman D, Jemioło P, Sawiec Z, Swierz MJ, Antonowicz E, Bala MM, Prokop-Dorner A. Needs Expressed in Peer-to-Peer Web-Based Interactions Among People With Depression and Anxiety Disorders Hospitalized in a Mental Health Facility: Mixed Methods Study. J Med Internet Res 2024; 26:e51506. [PMID: 38996331 DOI: 10.2196/51506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 04/03/2024] [Accepted: 05/06/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Hospitalization in psychiatric wards is a necessary step for many individuals experiencing severe mental health issues. However, being hospitalized can also be a stressful and unsettling experience. It is crucial to understand and address the various needs of hospitalized individuals with psychiatric disorders to promote their overall well-being and support their recovery. OBJECTIVE Our objectives were to identify and describe individual needs related to mental hospitals through peer-to-peer interactions on Polish web-based forums among individuals with depression and anxiety disorders and to assess whether these needs were addressed by peers. METHODS We conducted a search of web-based forums focused on depression and anxiety and selected samples of 160 and 176 posts, respectively, until we reached saturation. A mixed methods analysis that included an in-depth content analysis, the Pearson χ2 test, and φ coefficient was used to evaluate the posts. RESULTS The most frequently identified needs were the same for depression and anxiety forums and involved informational (105/160, 65.6% and 169/393, 43%, respectively), social life (17/160, 10.6% and 90/393, 22.9%, respectively), and emotional (9/160, 5.6% and 66/393, 16.8%, respectively) needs. The results show that there is no difference in the expression of needs between the analyzed forums. The needs were directly (42/47, 89% vs 98/110, 89.1% of times for depression and anxiety, respectively) and not fully (27/47, 57% vs 86/110, 78.2% of times for depression and anxiety, respectively) addressed by forum users. In quantitative analysis, we found that depression-related forums had more posts about the need for informational support and rectification, the expression of anger, and seeking professional support. By contrast, anxiety-related forums had more posts about the need for emotional support; social life; and information concerning medications, hope, and motivation. The most common co-occurrence of expressed needs was between sharing own experience and the need for professional support, with a strong positive association. The qualitative analysis showed that users join web-based communities to discuss their fears and questions about psychiatric hospitals. The posts revealed 4 mental and emotional representations of psychiatric hospitals: the hospital as an unknown place, the ambivalence of presumptions and needs, the negative representation of psychiatric hospitals, and the people associated with psychiatric hospitals. The tone of the posts was mostly negative, with discussions revolving around negative stereotypes; traumatic experiences; and beliefs that increased anxiety, shock, and fright and deterred users from hospitalization. CONCLUSIONS Our study demonstrates that web-based forums can provide a platform for individuals with depression and anxiety disorders to express a wide range of needs. Most needs were addressed by peers but not sufficiently. Mental health professionals can benefit from these findings by gaining insights into the unique needs and concerns of their patients, thus allowing for more effective treatment and support.
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Affiliation(s)
- Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | | | - Zuzanna Sawiec
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Jan Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - Ewa Antonowicz
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Kraków, Poland
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Prokop-Dorner
- Chair of Epidemiology and Preventive Medicine, Department of Medical Sociology, Jagiellonian University Medical College, Kraków, Poland
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Cazeta BBR, de Queiroz RS, Nacimento TS, Ferreira BR, Saquetto MB, Martinez BP, Carvalho VO, Gomes-Neto M. Effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness: A systematic review and meta-analysis of randomized trials. Clin Rehabil 2024; 38:898-909. [PMID: 38556253 DOI: 10.1177/02692155241241665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to analyze the published randomized controlled trials (RCTs) that investigated the effects of exercise interventions on functioning and health-related quality of life following hospital discharge for recovery from critical illness. DESIGN Systematic review and meta-analysis of RCTs. DATA SOURCES We searched PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, PEDro data base, and SciELO (from the earliest date available to January 2023) for RCTs that evaluated the effects of physical rehabilitation interventions following hospital discharge for recovery from critical illness. REVIEW METHODS Study quality was evaluated using the PEDro Scale. Mean differences (MDs), standard MDs (SMD), and 95% confidence intervals (CIs) were calculated. RESULTS Fourteen studies met the study criteria, including 1259 patients. Exercise interventions improved aerobic capacity SMD 0.2 (95% CI: 0.03-0.3, I2 = 0% N = 880, nine studies, high-quality evidence), and physical component score of health-related quality of life MD 3.3 (95% CI: 1.0-5.6, I2 = 57%, six studies N = 669, moderate-quality evidence). In addition, a significant reduction in depression was observed MD -1.4 (95% CI: -2.7 to -0.1, I2 = 0% N = 148, three studies, moderate-quality evidence). No serious adverse events were reported. CONCLUSION Exercise intervention was associated with improvement of aerobic capacity, depression, and physical component score of health-related quality of life after hospital discharge for survivors of critical illness.
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Affiliation(s)
- Bianca Bigogno Reis Cazeta
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - Rodrigo Santos de Queiroz
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - Tais Silva Nacimento
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | | | - Micheli Bernardone Saquetto
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
| | - Bruno Prata Martinez
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
| | | | - Mansueto Gomes-Neto
- Physical Therapy Department, Federal University of Bahia - UFBA, Salvador, Brazil
- Programa de Pós-Graduação em Medicina e Saúde, UFBA, Salvador, Brazil
- Physiotherapy Research Group, UFBA, Salvador, Brazil
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12
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Kweon YR, Jang KS, Back M, Lee M. Development and Psychometric Test of the Inpatients Experiences Measurement Scale (IEMS). Patient Prefer Adherence 2024; 18:1359-1372. [PMID: 38953018 PMCID: PMC11216549 DOI: 10.2147/ppa.s457746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024] Open
Abstract
Purpose In South Korea, hospitalized patients' experiences significantly impact satisfaction and treatment outcomes. This study developed and evaluated the Inpatients Experience Measurement Scale (IEMS) for its psychometric properties. Patients and Methods Participants from three hospitals were recruited using convenience sampling. Scale item generation involved patient interviews and a Delphi survey with experts. Psychometric testing used Exploratory Factor Analysis (EFA) with 150 participants and Confirmatory Factor Analysis (CFA) with 151 participants. Results A total of 301 patients participated, resulting in a 20-item scale across four factors: "Care Quality and Information Provision", "Patient Safety and Dietary Services", "Facility and Comfort Infrastructure", and "Comprehensive Patient Support Services". Rated on a 5-point Likert scale, the scale showed a high Content Validity Index (CVI) over 0.80. EFA explained 61.43% of the variance. The four-factor model was validated using CFA with favorable fit indices. The IEMS demonstrated strong convergent validity, supported by high composite reliability (CR) and average variance extracted (AVE) values. Significant correlations with the Patient Satisfaction Scale reinforced its convergent validity. Discriminant validity was confirmed, and all reliability measures exceeded the minimum threshold of 0.80. Conclusion The IEMS effectively captures inpatients' experiences, demonstrating robust reliability and validity. This scale is a valuable tool for assessing patient experiences, facilitating enhancements in patient care and satisfaction within hospital settings.
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Affiliation(s)
- Young-Ran Kweon
- Department of Nursing, Chonnam National University, Gwangju, South Korea
| | - Keum-Seong Jang
- Department of Nursing, Chonnam National University, Gwangju, South Korea
| | | | - Mikyoung Lee
- Department of Nursing, Kwangju Women’s University, Gwangju, South Korea
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13
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Malshy K, Balen A, Golijanin B, Jentzsch M, Greenberg R, Kazal F, Glebocki R, Danaher K, Spence R, Hyams E, Golijanin D, Pareek G, Eaton S. Optimising postoperative care: Same-day discharge after transurethral resection of the prostate. J Perioper Pract 2024:17504589241251697. [PMID: 38785312 DOI: 10.1177/17504589241251697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
INTRODUCTION This study aims to assess the feasibility and safety of same-day discharge after transurethral resection of the prostate. MATERIALS AND METHODS Five years of records were retrospectively analysed. Length of stay categorised patients into Groups 1 (same-day discharge) and 2 (standard-length discharge). Logistic regression analysis was performed, controlling for clinicodemographic factors. Student's t-test compared continuous bladder irrigation and catheter dwell times. RESULTS A total of 459 patients were identified between 2016 and 2021, 280 in Group 1 and 179 in Group 2, with median ages of 71.0 (interquartile range 36-92) and 72.0 (interquartile range 47-101) years (p = 0.067), respectively. Same-day discharge rates notably increased post-2018 (p = 0.025). Median prostate tissue resected in Group 2 was 7.1g (3.4-12.4g) and in Group 1 was 4.9g (2.4-10.2g; p = 0.034). While continuous bladder irrigation >1 hour was significantly lower in Group 1 than Group 2 (96.8% versus 27.4%; p = 0.0001), catheter dwell times were comparable (70.1 and 70.8 hours, respectively). Control-adjusted results showed a 40% reduction in emergency department representation odds for Group 1 compared with Group 2 (odds ratio = 0.60; 95% confidence interval = 0.37-0.99; p = 0.04). Length of stay was not significantly associated with hospital readmissions (p = 0.11). Continuous bladder irrigation for <1 hour in Group 1 was associated with a reduced emergency department representation (odds ratio = 0.43; 95% confidence interval = 0.197-0.980) but not readmission (odds ratio = 0.413; 95% confidence interval = 0.166-1.104). CONCLUSIONS Same-day discharge post-transurethral resection of the prostate may be a viable and safe option for carefully selected patients.
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Affiliation(s)
- Kamil Malshy
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Alejandra Balen
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Borivoj Golijanin
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Rachel Greenberg
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Frances Kazal
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | - Katherine Danaher
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Ryland Spence
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Elias Hyams
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Dragan Golijanin
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Gyan Pareek
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Samuel Eaton
- Brown Urology, Providence, RI, USA
- The Warren Alpert Medical School, Brown University, Providence, RI, USA
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Aimo A, Tono I, Benelli E, Morfino P, Panichella G, Damone AL, Speltri MF, Airò E, Monti S, Passino C, Lazzarini M, De Rosis S, Nuti S, Morelli MS, Evangelista C, Poletti R, Emdin M, Bergamasco M. The Fondazione Toscana Gabriele Monasterio app: a digital health system to improve wellbeing of inpatients with heart or lung disease. J Cardiovasc Med (Hagerstown) 2024; 25:294-302. [PMID: 38305137 DOI: 10.2459/jcm.0000000000001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND An app providing material for education and entertaining is a possible way to support patients and healthcare providers in achieving person-centered care. METHODS An app tailored on the Fondazione Toscana Gabriele Monasterio (FTGM), a research hospital treating cardiac and lung disorders, was created. A pilot evaluation project was conducted on consecutive patients hospitalized for heart or lung disorders. Patients were asked to complete an assessment questionnaire. RESULTS The FTGM app provides information on diagnostic and therapeutic investigations, hospital and healthcare personnel, and includes content for entertainment and learning. It was tested on 215 consecutive patients (75% men, 66% aged >60 years, and 40% with a primary or middle school degree). Sixty-nine percentage of patients used the FTGM app, including 67% of patients aged >80 years and 65% of those with an elementary education (65%). Patients gave positive feedback on the app layout. Many (76%) looked for information on doctors and nurses in the 'People' section. Sixty-five percent of responders had used at least one of the sections called 'Music' and 'Museum visits'. The app helped many patients perceive the hospital as a more liveable place (68%), and to feel less anxious (76%), and more engaged in the diagnostic and therapeutic workup (65%). Overall, the majority of responders (87%) rated the app as 'excellent' or 'good', and almost all (95%) would have recommended other patients to use the app. CONCLUSIONS The FTGM app is a possible tool to improve patient wellbeing during hospitalization.
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Affiliation(s)
- Alberto Aimo
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Fondazione Toscana Gabriele Monasterio
| | - Ilaria Tono
- Fondazione Toscana Gabriele Monasterio
- Istituto di Management e Sanità
| | | | - Paolo Morfino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
| | - Giorgia Panichella
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
| | | | | | | | | | - Claudio Passino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Fondazione Toscana Gabriele Monasterio
| | | | - Sabina De Rosis
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Istituto di Management e Sanità
| | - Sabina Nuti
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Istituto di Management e Sanità
| | | | - Chiara Evangelista
- Istituto di Intelligenza Meccanica, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | - Michele Emdin
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna
- Fondazione Toscana Gabriele Monasterio
| | - Massimo Bergamasco
- Istituto di Intelligenza Meccanica, Scuola Superiore Sant'Anna, Pisa, Italy
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15
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Qian Y, Wang X, Huang X, Li J, Jin C, Chen J, Sha M. Bounded rationality in healthcare: unraveling the psychological factors behind patient satisfaction in China. Front Psychol 2024; 15:1296032. [PMID: 38605837 PMCID: PMC11008602 DOI: 10.3389/fpsyg.2024.1296032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/19/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Patient satisfaction is a crucial metric to gauge the quality of medical services, but the psychological factors influencing patient satisfaction remain insufficiently explored. Methods This study examines these psychological factors by applying the theory of bounded rationality to 1,442 inpatients in Hangzhou, China, whose data were collected using a questionnaire. One-way ANOVA, correlation analysis, and hierarchical regression were used to analyze patient satisfaction and its associated factors. Additionally, the path analysis of the structural equation model revealed the mechanisms behind the key psychological factors that influenced patient satisfaction. Results Medical risk perception, the social cognition of the medical environment, and social desirability bias had significant positive impacts on patient satisfaction. By contrast, negative emotions had a significant negative impact on patient satisfaction. Notably, patients' negative emotions had both a suppressive effect and a positive moderating effect on the relationship between medical risk perception and patient satisfaction. Similarly, social desirability bias had a suppressive effect on the correlation between the social cognition of the medical environment and patient satisfaction, albeit with a negative moderating effect. Discussion These results suggest that when evaluating and improving patient satisfaction, accounting only for the factors that directly influence medical service quality is insufficient, as the indirect and moderating effects of patients' negative emotions and the social cognition of the medical environment must also be considered. Medical service providers should thus address patients' negative emotions, establish good doctor-patient relationships, optimize service environments, provide managers with medical risk education and training on negative emotions, and prioritize patient-centered care. Additionally, the government and relevant health departments should optimize medical policies, enhance fairness and accessibility, and create a positive social cognitive environment through public education and awareness campaigns.
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Affiliation(s)
- Yu Qian
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China
| | - Xiaohe Wang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Xianhong Huang
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jinwen Li
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Chen Jin
- Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jie Chen
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - MengYi Sha
- Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou, China
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Herrero-Montes M, Parás-Bravo P, Ferrer-Pargada D, Fernández-de-las-Peñas C, Fernández-Cacho LM, Palacios-Ceña D. Coping with the hospital environment during the COVID-19 pandemic: A qualitative study of the survivors' perspective during their stay at the ICU and inpatient ward. Heliyon 2024; 10:e24661. [PMID: 38298692 PMCID: PMC10828673 DOI: 10.1016/j.heliyon.2024.e24661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/18/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Abstract
The COVID-19 pandemic has significantly affected the clinical practice of healthcare professionals. This study aimed to explore the perspectives of COVID-19 survivors regarding the healthcare they received during their stay in the Intensive Care Unit (ICU) and the inpatient COVID-19 ward. A qualitative case-study approach was implemented. Participants were recruited using non-probabilistic purposeful sampling strategy. Inclusion criteria included patients aged ≥18 years who received follow-up from the Pulmonology service at a Hospital in de North of Spain, were diagnosed with COVID-19 and bilateral pneumonia, and were admitted to the ICU before being transferred to a COVID-19 inpatient ward. Data was collected through in-depth interviews and researchers' field notes, and thematic analysis was performed. Techniques such as credibility, transferability, dependability, and confirmability were employed to ensure the trustworthiness of the data. A total of 25 individuals (six women) were included in the study. Three main themes emerged from the analysis: common challenges faced in both units, coping with the hospital stay, and developing strategies. Findings highlighted the need to improve information dissemination, individualize care, and enhance direct patient interaction. Moreover, the study shed light on the psychological impact of hospitalization and ICU experience, including feelings of loneliness, confinement, and the lack of memories from the ICU stay, as well as the influence of care and healthcare language. Finally, strategies such as keeping the mind occupied and maintaining self-discipline were identified as crucial during hospitalization. These findings provide valuable insights for healthcare professionals in delivering care to individuals with COVID-19 in the ICU and hospital ward settings.
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Affiliation(s)
- Manuel Herrero-Montes
- Departamento de Enfermería, Universidad de Cantabria. Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Grupo de Investigación en Enfermería, Santander, Spain
| | - Paula Parás-Bravo
- Departamento de Enfermería, Universidad de Cantabria. Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Grupo de Investigación en Enfermería, Santander, Spain
| | - Diego Ferrer-Pargada
- Servicio de Neumología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - César Fernández-de-las-Peñas
- Research Group of Manual Therapy, Dry Needling and Therapeutic Exercise (GITM-URJC), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
| | | | - Domingo Palacios-Ceña
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Spain
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17
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Leung CK, Walton NC, Kheder E, Zalpour A, Wang J, Zavgorodnyaya D, Kondody S, Zhao C, Lin H, Bruera E, Manzano JGM. Understanding Potentially Preventable 7-day Readmission Rates in Hospital Medicine Patients at a Comprehensive Cancer Center. Am J Med Qual 2024; 39:14-20. [PMID: 38127668 PMCID: PMC10841441 DOI: 10.1097/jmq.0000000000000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
This study aimed to describe the potentially preventable 7-day unplanned readmission (PPR) rate in medical oncology patients. A retrospective analysis of all unplanned 7-day readmissions within Hospital Medicine at MD Anderson Cancer Center from September 1, 2020 to February 28, 2021, was performed. Readmissions were independently analyzed by 2 randomly selected individuals to determine preventability. Discordant reviews were resolved by a third reviewer to reach a consensus. Statistical analysis included 138 unplanned readmissions. The estimated PPR rate was 15.94%. The median age was 62.50 years; 52.90% were female. The most common type of cancer was noncolon GI malignancy (34.06%). Most patients had stage 4 cancer (69.57%) and were discharged home (64.93%). Premature discharge followed by missed opportunities for goals of care discussions were the most cited reasons for potential preventability. These findings highlight areas where care delivery can be improved to mitigate the risk of readmission within the medical oncology population.
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Affiliation(s)
- Cerena K. Leung
- Department of Hospital Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Natalie C. Walton
- Department of Hospital Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Ed Kheder
- Department of Hospital Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Ali Zalpour
- Department of Pharmacy Clinical Programs, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Justine Wang
- Department of Pharmacy Clinical Programs, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sonia Kondody
- Department of Hospital Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Christina Zhao
- Department of Hospital Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Heather Lin
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Joanna-Grace M. Manzano
- Department of Hospital Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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Leung C, Andersen CR, Wilson K, Nortje N, George M, Flowers C, Bruera E, Hui D. The impact of a multidisciplinary goals-of-care program on unplanned readmission rates at a comprehensive cancer center. Support Care Cancer 2023; 32:66. [PMID: 38150077 PMCID: PMC11391928 DOI: 10.1007/s00520-023-08265-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/17/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE This study examined the 30-day unplanned readmission rate in the medical oncology population before and after the implementation of an institution-wide multicomponent interdisciplinary goals of care (myGOC) program. METHODS This retrospective study compared the 30-day unplanned readmission rates in consecutive medical patients during the pre-implementation period (May 1, 2019, to December 31, 2019) and the post-implementation period (May 1, 2020, to December 31, 2020). Secondary outcomes included 7-day unplanned readmission rates, inpatient do-not-resuscitate (DNR) orders, and palliative care consults. We randomly selected a hospitalization encounter for each unique patient during each study period for statistical analysis. A multivariate analysis model was used to examine the association between 30-day unplanned readmission rates and implementation of the myGOC program. RESULTS There were 7028 and 5982 unique medical patients during the pre- and post-implementation period, respectively. The overall 30-day unplanned readmission rate decreased from 24.0 to 21.3% after implementation of the myGOC program. After adjusting for covariates, the myGOC program implementation remained significantly associated with a reduction in 30-day unplanned readmission rates (OR [95% CI] 0.85 [0.77, 0.95], p = 0.003). Other factors significantly associated with a decreased likelihood of a 30-day unplanned readmission were an inpatient DNR order, advanced care planning documentation, and an emergent admission type. We also observed a significant decrease in 7-day unplanned readmission rates (OR [95% CI] 0.75 [0.64, 0.89]) after implementation of the myGOC program. CONCLUSION The 30-day and 7-day unplanned readmission rates decreased in our hospital after implementation of a system-wide multicomponent GOC intervention.
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Affiliation(s)
- Cerena Leung
- Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Clark R Andersen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kaycee Wilson
- Department of Inpatient Analytics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nico Nortje
- Department of Critical Care Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marina George
- Department of Hospital Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher Flowers
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Yang ST, Kuo SC, Liu HH, Huang KM, Liu CH, Chen SF, Wang PH. Early oral diet may enhance recovery from benign gynecologic surgery: A single center prospective study. J Chin Med Assoc 2023; 86:917-922. [PMID: 37603887 DOI: 10.1097/jcma.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Early dietary intake enhanced recovery after surgery (ERAS). There remains a gap in the recognition and implementation of early diet after surgery in medical institutions in Taiwan. This study aimed to investigate whether early oral intake after benign gynecologic surgery results in favorable outcomes in Taiwanese patients. METHODS This was a prospective controlled nonrandomized cohort study. Patients who underwent benign gynecological surgery were included in the early- and conventional-diet groups. The primary outcome was length of hospital stay, and the secondary outcome was postoperative complications. RESULTS Forty and 38 patients were included in the early and conventional-diet groups, respectively. The early-diet group demonstrated significantly reduced length of hospital stay (the early-diet group, 2.58 ± 0.93 days; conventional-diet group, 4.16 ± 1.13 days; p < 0.001). No increase in postoperative complications was observed in the early-diet group. Laparoscopic surgery reduced the length of hospital stay (β, -0.65; 95% confidence interval [CI], -1.22 to -0.08; p = 0.027), while an increased length of hospital stay was associated with higher visual analog scales (VAS, β, 0.21; 95% CI, 0.03-0.39; p = 0.026) and the conventional-diet group (β, 1.13; 95% CI, 0.65-1.61; p < 0.001) as assessed by multivariate regression analysis. CONCLUSION Patients who underwent benign gynecologic surgery tolerated an early oral diet well without an increase in complications. Laparoscopic surgery and lower pain scores also enhanced postoperative recovery.
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Affiliation(s)
- Szu-Ting Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shu-Chen Kuo
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hung-Hsien Liu
- Department of Medical Imaging and Intervention, Tucheng Hospital, New Taipei City, Taiwan, ROC
| | - Kuan-Min Huang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shu-Fen Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Female Cancer Foundation, Taipei, Taiwan, ROC
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Burridge N, Sillence A, Teape L, Clark B, Bruce E, Armoogum J, Leloch D, Spathis A, Etkind S. Virtual reality reduces anxiety and pain in acute hospital palliative care: service evaluation. BMJ Support Palliat Care 2023:spcare-2023-004572. [PMID: 37709365 DOI: 10.1136/spcare-2023-004572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES Virtual reality (VR) might improve symptom management, but there is limited evidence regarding VR in palliative care. We evaluated the feasibility of VR and impact on anxiety and pain for patients in a hospital palliative care consultation service. METHODS Patients referred to a hospital specialist palliative care team, with anxiety or pain, were offered a VR intervention (a short audiovisual experience). Participants rated anxiety and pain on a 0-10 Likert severity scale pre intervention/post intervention and completed an evaluation form. Change in symptom scores was analysed by parametric statistics. RESULTS 28 participants used VR a total of 42 times with no adverse events. Mean pain score reduced by 29% from 4.10 (SD=2.71) pre intervention to 2.93 (SD=2.45) post intervention (t(27)=5.150, p<0.001). Mean anxiety scores reduced by 40% from 4.43 (SD=2.56) to 2.65 (SD=2.24) (t(27)=5.058, p<0.001). Patients rated the experience on average 4.75/5 and all would recommend use to a friend. VR was described as absorbing and relaxing. CONCLUSION VR may improve anxiety and pain and was acceptable in this setting. Large-scale evaluation will generate important data on feasibility and implementation.
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Affiliation(s)
- Nancy Burridge
- Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Alison Sillence
- Department of Psychological medicine, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Lynda Teape
- Department of Psychological medicine, Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Ben Clark
- Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emma Bruce
- Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Anna Spathis
- Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon Etkind
- Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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de Araujo Kaji P, de Lucena Ferretti-Rebustini RE, Bosco Aprile DC, de Lima Lopes J, Batista Santos V, Takao Lopes C. Control Attitudes Scale-Revised-Brazilian Version. J Cardiovasc Nurs 2023:00005082-990000000-00123. [PMID: 37661304 DOI: 10.1097/jcn.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Heart failure demands self-care skills and behaviors that can be negatively impacted by a low level of perceived control (PC), a belief about having the necessary resources to deal with negative events. Having valid and reliable instruments to measure PC is important to support interventions that improve self-care and related outcomes. The Control Attitudes Scale-Revised (CAS-R) was developed in the United States to measure PC in cardiac conditions. In Brazil, there are no instruments available to measure this construct. OBJECTIVE The aims of this study were to translate and adapt the CAS-R to the Brazilian population and to assess the content validity of the adapted version. METHODS The CAS-R was translated, back-translated, and assessed by an expert committee for linguistic equivalences. An agreement > 80% was considered adequate. Content validity (clarity, theoretical relevance, and practical pertinence) was assessed by both an expert professional panel (n = 6-8) and a panel of patients with heart failure (n = 40). A content validity coefficient > 0.70 was considered acceptable. RESULTS The translations to Brazilian Portuguese were considered consistent with the original CAS-R. In the third round of linguistic equivalence assessment, all items achieved acceptable agreement, except for 2 items. After modifications to the instrument to achieve adequate equivalences, the adapted version had a final content validity coefficient of 0.93. Most patients were able to understand the instrument. CONCLUSIONS The CAS-R-Brazilian version is equivalent to the original CAS-R and has satisfactory evidence of content validity. Additional psychometric testing will be performed to allow for the assessment of PC in individuals with heart failure in Brazil.
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Hobbs FDR, Montgomery H, Padilla F, Simón-Campos JA, Kim K, Arbetter D, Padilla KW, Reddy VP, Seegobin S, Streicher K, Templeton A, Viani RM, Johnsson E, Koh GCKW, Esser MT. Outpatient Treatment with AZD7442 (Tixagevimab/Cilgavimab) Prevented COVID-19 Hospitalizations over 6 Months and Reduced Symptom Progression in the TACKLE Randomized Trial. Infect Dis Ther 2023; 12:2269-2287. [PMID: 37751015 PMCID: PMC10581960 DOI: 10.1007/s40121-023-00861-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/16/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION We assessed effects of AZD7442 (tixagevimab/cilgavimab) on deaths from any cause or hospitalizations due to coronavirus disease 2019 (COVID-19) and symptom severity and longer-term safety in the TACKLE adult outpatient treatment study. METHODS Participants received 600 mg AZD7442 (n = 452) or placebo (n = 451) ≤ 7 days of COVID-19 symptom onset. RESULTS Death from any cause or hospitalization for COVID-19 complications or sequelae through day 169 (key secondary endpoint) occurred in 20/399 (5.0%) participants receiving AZD7442 versus 40/407 (9.8%) receiving placebo [relative risk reduction (RRR) 49.1%; 95% confidence interval (CI) 14.5, 69.7; p = 0.009] or 50.7% (95% CI 17.5, 70.5; p = 0.006) after excluding participants unblinded before day 169 for consideration of vaccination). AZD7442 reduced progression of COVID-19 symptoms versus placebo through to day 29 (RRR 12.5%; 95% CI 0.5, 23.0) and improved most symptoms within 1-2 weeks. Over median safety follow-up of 170 days, adverse events occurred in 174 (38.5%) and 196 (43.5%) participants receiving AZD7442 or placebo, respectively. Cardiac serious adverse events occurred in two (0.4%) and three (0.7%) participants receiving AZD7442 or placebo, respectively. CONCLUSIONS AZD7442 was well tolerated and reduced hospitalization and mortality through 6 months, and symptom burden through 29 days, in outpatients with mild-to-moderate COVID-19. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov, NCT04723394. ( https://beta. CLINICALTRIALS gov/study/NCT04723394 ).
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Affiliation(s)
- F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hugh Montgomery
- Department of Medicine, University College London, London, UK
| | - Francisco Padilla
- Centro de Investigación en Cardiología y Metabolismo, Guadalajara, Jalisco, Mexico
| | | | | | - Douglas Arbetter
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Boston, MA, USA
| | - Kelly W Padilla
- Clinical Development, Late-Stage Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Durham, NC, USA
| | - Venkatesh Pilla Reddy
- Clinical Pharmacology and Safety Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Seth Seegobin
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Katie Streicher
- Translational Medicine, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Alison Templeton
- Biometrics, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Rolando M Viani
- Late-Stage Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, USA
| | - Eva Johnsson
- Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Gavin C K W Koh
- Clinical Development, Late-Stage Development, Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Mark T Esser
- Vaccines & Immune Therapies, BioPharmaceuticals R&D, AstraZeneca, Gaithersburg, MD, 20878, USA.
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Hudon A, Rosca MA, La Charité-Harbec O, Allard JM, Borduas Pagé S. The Use of Alternative Rooms in Forensic and Regular Psychiatric Units: A Scoping Review. Healthcare (Basel) 2023; 11:2432. [PMID: 37685466 PMCID: PMC10487261 DOI: 10.3390/healthcare11172432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: Emotional regulation, distress and relational conflicts often occur during hospitalization and rehabilitation on psychiatric units, especially in patients suffering from severe and persistent mental disorders. While widely used in children and geriatric patients, little literature exists on the use and outcomes of alternative rooms in the context of forensic and regular psychiatric units for adult patients. Considering the scarcity of the literature on alternative use, this study is motivated by the following research question: what are the main uses and outcomes of alternative rooms in the context of forensic and regular psychiatric units? The main objective of this study is to conduct a scoping review of the use and outcomes of alternative rooms for the context of psychiatric inpatients. (2) Methods: A systematic search was performed in the electronic databases of MedLine, Web of Science, PsycNet (PsycINFO) and Google Scholar from their inception dates until 2022. (3) Results: A total of nine studies were analyzed. Sensory, multisensory rooms, Snoezelen, and comfort rooms are the types of alternative rooms discussed in these studies. Distress and anxiety reduction, increase in self-esteem, impact on seclusion rates, patient-staff communication and alliances, heart and respiration rate reduction, and improvement of alexithymia were identified among the main uses and outcomes of these rooms. (4) Conclusions: The scarcity of literature available to draw information from for this review and possible impact on improving patient outcomes and quality of treatment in psychiatric units opens the door to future studies to better understand the efficacy of such rooms. Research into the ideal implementation tactics of such rooms, long-term outcomes, and the influence on diverse patient demographics could be areas of improvement in the use of alternative rooms.
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Affiliation(s)
- Alexandre Hudon
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada
| | - Maria Alexandra Rosca
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | - Olivier La Charité-Harbec
- Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3M5, Canada; (O.L.C.-H.); (J.-M.A.)
| | - Jeanne-Marie Allard
- Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3M5, Canada; (O.L.C.-H.); (J.-M.A.)
| | - Stéphanie Borduas Pagé
- Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3M5, Canada; (O.L.C.-H.); (J.-M.A.)
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Dasari PB, Verma H, Madishetty H, Pagidimarri J, Balaji J. Transadaptation and Validation of the Telugu Version of the Dysphagia Handicap Index. Semin Speech Lang 2023; 44:230-239. [PMID: 37524105 DOI: 10.1055/s-0043-1771510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Dysphagia Handicap Index (DHI) is a clinically effective, concise, and user-friendly tool for assessing the functional impact of dysphagia in clinical populations. The present study aims to trans-adapt the DHI in the Telugu language and assesses its psychometric properties. The present study was conducted in two phases. The first phase includes translating and adapting the DHI tool into Telugu (T-DHI). The second phase includes an analysis of the psychometric properties of the trans-adapted Telugu version of the DHI. The DHI was translated into the Telugu language using the forward-backward translation method. The psychometric analysis was done on 100 participants. All the participants underwent a detailed clinical swallow examination after filling the T-DHI. The overall internal consistency and Guttmann split-half reliability for the Telugu version of the DHI were good. The correlation between the T-DHI subscales and the self-perceived severity of dysphagia was found to be high. The comparison of the T-DHI scores of the control and experimental groups revealed a significant difference. The T-DHI is a reliable and valid tool to assess the quality of life of the Telugu-speaking dysphagia population.
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Affiliation(s)
| | - Himanshu Verma
- Speech & Hearing Unit, Department of Otolaryngology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harisha Madishetty
- Department of Speech Language Pathology, 1Special Place, Hyderabad, Telangana, India
| | | | - Janaki Balaji
- Department of Speech-Language Pathology, Communicate with Us, Chennai, Tamil Nadu, India
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Pontré JC, Nathan E, Goldsmith H, McElhinney B. Does the New National Cervical Screening Programme Guideline Detect Cases of High-Grade Squamous Intraepithelial Lesions That Previously Would Have Been Missed? J Low Genit Tract Dis 2023; 27:230-235. [PMID: 37379440 DOI: 10.1097/lgt.0000000000000751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVE The aim of this study was to determine the number of patients undergoing large loop excision of the transformation zone (LLETZ), for biopsy-confirmed high-grade squamous intraepithelial lesions (HSIL), where the original cervical screening test (CST) reported oncogenic human papillomavirus (HPV) and negative liquid-based cytology (LBC). This reflects the number of patients where a LLETZ procedure would not have occurred under the previous guideline. METHODS Retrospective observational chart review of all patients (n = 477) who underwent LLETZ procedure in a single tertiary unit over a 36-month period. Prevalence of negative histopathology, positive margins, incidental cervical cancer, and accuracy of HSIL identification at colposcopy were measured. Diagnostic accuracy of HSIL diagnosis from initial colposcopic impression was calculated; factors influencing accuracy were evaluated using multivariable logistic regression analysis. There were no comparators. RESULTS Of 477 LLETZs, 5.9% (n = 28) were for oncogenic HPV and normal LBC on referral CST. Demographics between the "study" (oncogenic HPV and normal LBC on referral CST) and the "standard" group were similar, except the study group was less likely to be using contraception (25% vs 47%, p = .023). In the study group, initial colposcopic cervical biopsy confirmed HSIL in 91.6% (n = 27) and low-grade squamous intraepithelial lesions in 3.6% (n = 1). Histopathological analysis of LLETZ specimens confirmed HSIL in 20 patients (71.4%) and low-grade squamous intraepithelial lesions in 2 (7.1%). No microinvasion was detected. CONCLUSIONS The renewed National Cervical Screening Programme (NCSP), is detecting more "at risk" patients, predicted to lead to a further reduction in incidence of cervical cancer in adequately screened patients.
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Affiliation(s)
| | - Elizabeth Nathan
- Division of Obstetrics and Gynaecology, University of Western Australia, Perth, Western Australia, Australia
| | - Hilary Goldsmith
- King Edward Memorial Hospital, Perth, Western Australia, Australia
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Moog P, Jiang J, Buchner L, Suhova I, Schmauss D, Machens HG, Kükrek H. Aesthetic training concept during plastic surgery residency - Opportunity or risk? Heliyon 2023; 9:e17398. [PMID: 37416684 PMCID: PMC10320284 DOI: 10.1016/j.heliyon.2023.e17398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
Background Aesthetic surgery training renders to be challenging to acquire sufficient hands-on experience during residency. To resolve this problem, the "Munich Model" was established in our clinic: Senior residents perform aesthetic surgeries, supervised by an experienced plastic surgeon while patients benefit from reduced surgery costs. With this model, we hypothesize no significant differences in the postoperative outcome between procedures performed by residents and plastic surgeons. Methods Between August 2012 and December 2017, 481 aesthetic surgeries were included in this retrospective single-center study, of which 283 were performed by residents and 198 by plastic surgeons. Procedures included mastopexy, abdominoplasty, extremity lift, breast reduction, breast augmentation, facial surgery, aesthetic liposuction and lipedema liposuction. Postoperative outcomes were compared regarding surgery time, time of drain removal, inpatient length of stay, duration of wound healing, perioperative blood loss and occurrence of major (surgical revision needed) and minor complications (no surgery needed). Results We found no significant differences in aesthetic surgical procedures between residents and board-certified plastic surgeons in the outcome measures of surgery duration, time of drain removal, inpatient length of stay, perioperative blood loss and complication rate, including major and minor complications. Only the inpatient stay was prolonged in aesthetic liposuctions performed by residents. Conclusion This study demonstrates comparatively that supervised aesthetic surgeries at a university hospital utilizing the "Munich Model" widely meet the specialist surgeons' standards.
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Affiliation(s)
- Philipp Moog
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Jun Jiang
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Lara Buchner
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Inessa Suhova
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Daniel Schmauss
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Hans-Günther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
| | - Haydar Kükrek
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany
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Gonçalves ALP, Grisante DL, Silva RA, Santos VB, Lopes CT. Relationship Between Frailty, Sociodemographic and Clinical Characteristics, and Disease Severity of Older Adults With Acute Coronary Syndrome. Clin Nurs Res 2023; 32:677-687. [PMID: 35927950 DOI: 10.1177/10547738221115231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to evaluate the relationship between frailty, sociodemographic and clinical characteristics, and disease severity of older adults with acute coronary syndrome (ACS). A total of 57 hospitalized patients ≥60 years with ACS were assessed for frailty through the Tilburg Frailty Indicator. Disease severity was assessed by the Global Registry of Acute Coronary Events, by the maximum troponin level, and by the number of severely obstructed coronary arteries. The relationship between variables was assessed by Mann Whitney's test, Pearson's chi-square test, likelihood-ratio test, Fisher's exact test, or Student's t test. Analyses were bootstrapped to 1,000 to reduce potential sample bias. About 54.4% were frail. Frailty was associated with ethnicity (p = .02), marital status (p = .05), ischemic equivalents (p = .01), self-perceived health (p = .002), arthritis/rheumatism/arthrosis (p = .002), and number of severely obstructed coronary arteries (p = .05). These relationships can support intensified surveillance planning for the elderly at greatest risk, structuring of transitional care, appropriate nurse-coordinated secondary prevention delivery in primary care, and cardiac rehabilitation following ACS.
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Affiliation(s)
- Alexia Louisie Pontes Gonçalves
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil.,Programa de Residência Multiprofissional em Saúde Cardiovascular, Instituto de Cardiologia Dante Pazzanese, São Paulo, Brazil
| | - Daiane Lopes Grisante
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil.,Hospital São Paulo, São Paulo, Brazil
| | - Renan Alves Silva
- Centro de Formação de Professores, Universidade Federal de Campina Grande, Cajazeiras, Paraíba, Brazil
| | | | - Camila Takao Lopes
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
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Jung D, Pollack HA, Konetzka RT. Predicting Hospitalization among Medicaid Home- and Community-Based Services Users Using Machine Learning Methods. J Appl Gerontol 2023; 42:241-251. [PMID: 36164857 PMCID: PMC10069559 DOI: 10.1177/07334648221129548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
We compare multiple machine learning algorithms and develop models to predict future hospitalization among Home- and Community-Based Services (HCBS) Users. Furthermore, we calculate feature importance, the score of input variables based on their importance to predict the outcome, to identify the most relevant variables to predict hospitalization. We use the 2012 national Medicaid Analytic eXtract data and Medicare Provider Analysis and Review data. Predicting any hospitalization, Random Forest appears to be the most robust approach, though XGBoost achieved similar predictive performance. While the importance of features varies by algorithm, chronic conditions, previous hospitalizations, as well as use of services for ambulance, personal care, and durable medical equipment were generally found to be important predictors of hospitalization. Utilizing prediction models to identify those who are prone to hospitalization could be useful in developing early interventions to improve outcomes among HCBS users.
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Affiliation(s)
- Daniel Jung
- Department of Health Policy and Management, 1355University of Georgia, Athens, USA
| | - Harold A Pollack
- School of Social Service Administration, 278762University of Chicago, IL, USA
| | - R Tamara Konetzka
- Division of Biological Sciences, Department of Public Health Sciences, University of Chicago, IL, USA
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Alharbi HF, Alzahrani NS, Almarwani AM, Asiri SA, Alhowaymel FM. Patients' satisfaction with nursing care quality and associated factors: A cross-section study. Nurs Open 2022; 10:3253-3262. [PMID: 36585398 PMCID: PMC10077356 DOI: 10.1002/nop2.1577] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 12/10/2022] [Indexed: 01/01/2023] Open
Abstract
AIM This research aimed to evaluate patients' satisfaction with the nursing care quality during their hospitalization. DESIGN Quantitative cross-sectional descriptive design. METHODS A convenience sample of 238 patients were recruited from hospitals in two provinces in Saudi Arabia. Patient satisfaction was measured by the Arabic version of the Patients' Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ-Ar). RESULTS Significant differences were found between Saudi provinces regarding the overall quality of nursing care (M = 4.65, p < 0.001). The study revealed mean significant variations between patient satisfaction with nursing care and sociodemographic factors, including age (p = 0.002), education level (p = 0.047), marital status (p = 0.017), employment status (p = 0.038), urban vs. suburban residence (p = 0.006), length of hospitalization (p = 0.001), and accompaniment by a family member (p = 0.014). Improving patients' experience during their hospitalization requires regular examination of the quality of nursing care services. PATIENT CONTRIBUTION This research enhances our understanding of patients satisfaction toward the quality of nursing care received during hospitalization.
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Affiliation(s)
- Hanan Fahad Alharbi
- Department of Maternity and Child Health Nursing, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Naif S Alzahrani
- Department of Medical Surgical Nursing, College of Nursing, Taibah University, Medina, Saudi Arabia
| | | | - Saeed A Asiri
- Department of Nursing Administration and Education, College of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Fahad M Alhowaymel
- Department of Nursing, College of Applied Medical Sciences, Shaqra University, Shaqra, Saudi Arabia
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Qureshi SM, Bookey-Bassett S, Purdy N, Greig MA, Kelly H, Neumann WP. Modelling the impacts of COVID-19 on nurse workload and quality of care using process simulation. PLoS One 2022; 17:e0275890. [PMID: 36228015 PMCID: PMC9560613 DOI: 10.1371/journal.pone.0275890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Higher acuity levels in COVID-19 patients and increased infection prevention and control routines have increased the work demands on nurses. To understand and quantify these changes, discrete event simulation (DES) was used to quantify the effects of varying the number of COVID-19 patient assignments on nurse workload and quality of care. Model testing was based on the usual nurse-patient ratio of 1:5 while varying the number of COVID-19 positive patients from 0 to 5. The model was validated by comparing outcomes to a step counter field study test with eight nurses. The DES model showed that nurse workload increased, and the quality of care deteriorated as nurses were assigned more COVID-19 positive patients. With five COVID-19 positive patients, the most demanding condition, the simulant-nurse donned and doffed personal protective equipment (PPE) 106 times a shift, totaling 6.1 hours. Direct care time was reduced to 3.4 hours (-64% change from baseline pre-pandemic case). In addition, nurses walked 10.5km (+46% increase from base pre-pandemic conditions) per shift while 75 care tasks (+242%), on average, were in the task queue. This contributed to 143 missed care tasks (+353% increase from base pre-pandemic conditions), equivalent to 9.6 hours (+311%) of missed care time and care task waiting time increased to 1.2 hours (+70%), in comparison to baseline (pre-pandemic) conditions. This process simulation approach may be used as potential decision support tools in the design and management of hospitals in-patient care settings, including pandemic planning scenarios.
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Affiliation(s)
- Sadeem Munawar Qureshi
- Human Factors Engineering Lab, Toronto Metropolitan University (Formerly, Ryerson University), Toronto, Canada
| | - Sue Bookey-Bassett
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly, Ryerson University), Toronto, Canada
| | - Nancy Purdy
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (Formerly, Ryerson University), Toronto, Canada
| | - Michael A. Greig
- Human Factors Engineering Lab, Toronto Metropolitan University (Formerly, Ryerson University), Toronto, Canada
| | | | - W. Patrick Neumann
- Human Factors Engineering Lab, Toronto Metropolitan University (Formerly, Ryerson University), Toronto, Canada
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Mason DJ, Naylor M, Reinhard S. Considering Caregivers’ Needs in Hospital at Home Programs. JAMA HEALTH FORUM 2022; 3:e223467. [DOI: 10.1001/jamahealthforum.2022.3467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This JAMA Forum discusses the Hospital at Home movement in the US and need for this model to better include and provide support for family caregivers.
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Affiliation(s)
- Diana J. Mason
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC
| | - Mary Naylor
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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Irwin E, Chapman T, Johanson E, Robinson L. Early Intervention Eye Movement Desensitization and Reprocessing Following Major Musculoskeletal Trauma: How Soon Is Too Soon? JOURNAL OF EMDR PRACTICE AND RESEARCH 2022. [DOI: 10.1891/emdr-2021-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Major trauma centers have increased survival following serious physical injury, resulting in increased demand for specialist multidisciplinary rehabilitation. We aimed to explore the feasibility of using early intervention eye movement desensitization and reprocessing (EMDR) therapy in an acute inpatient setting, using a non-concurrent, multiple-baseline, pre-post test case-series design. Unfortunately, no patients were recruited. This paper sets out the challenges and reflections of setting up a psychological intervention study in this setting and provides suggestions for further research.
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An AI-Empowered Home-Infrastructure to Minimize Medication Errors. JOURNAL OF SENSOR AND ACTUATOR NETWORKS 2022. [DOI: 10.3390/jsan11010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents an Artificial Intelligence (AI)-based infrastructure to reduce medication errors while following a treatment plan at home. The system, in particular, assists patients who have some cognitive disability. The AI-based system first learns the skills of a patient using the Actor–Critic method. After assessing patients’ disabilities, the system adopts an appropriate method for the monitoring process. Available methods for monitoring the medication process are a Deep Learning (DL)-based classifier, Optical Character Recognition, and the barcode technique. The DL model is a Convolutional Neural Network (CNN) classifier that is able to detect a drug even when shown in different orientations. The second technique is an OCR based on Tesseract library that reads the name of the drug from the box. The third method is a barcode based on Zbar library that identifies the drug from the barcode available on the box. The GUI demonstrates that the system can assist patients in taking the correct drug and prevent medication errors. This integration of three different tools to monitor the medication process shows advantages as it decreases the chance of medication errors and increases the chance of correct detection. This methodology is more useful when a patient has mild cognitive impairment.
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