Mortality and cause of death during inpatient psychiatric care in New South Wales, Australia: A retrospective linked data study

BACKGROUND

Premature mortality in people with mental illness is well-documented, yet deaths during inpatient psychiatric care have received little research attention. This study investigates mortality rates and causes of death during inpatient psychiatric care in New South Wales (NSW), Australia. Risk factors for inpatient death were also explored.

METHODS

A retrospective cohort study using linked administrative datasets with complete capture of psychiatric admissions in NSW from 2002 to 2012 (n = 421,580) was conducted. Univariate and multivariate random-effects logistic regression analyses were used to explore risk factors for inpatient death.

RESULTS

The mortality rate during inpatient psychiatric care was 1.12 deaths per 1000 episodes of care and appeared to decline over the study period. Suicide accounted for 17% of inpatient deaths, while physical health causes accounted for 75% of all deaths. Thirty percent of these deaths were considered potentially avoidable. In the multivariate model, male sex, unknown address and several physical health diagnoses were associated with increased deaths.

CONCLUSIONS

The mortality rate and number of avoidable deaths during inpatient psychiatric care were substantial and warrant further systemic investigation. This was driven by a dual burden of physical health conditions and suicide. Strategies to improve access to physical health care on psychiatric inpatient wards and prevent inpatient suicide are necessary. A coordinated approach to monitoring psychiatric inpatient deaths in Australia is not currently available and much needed.

The lived experience of colorectal cancer patients with a temporary ileostomy and the patient's perception of the ostomy nurses' educational interventions

PURPOSE

This study is aimed at exploring the lived experiences of colorectal cancer patients regarding temporary ileostomy and the educational interventions of ostomy nurses.

METHODS

This study is conducted using Heideggerian phenomenological focus group. Focus group interviews were conducted from November 2021 to February 2022 using a semi-structured guide with nine colorectal cancer patients having a temporary ileostomy. The interview data were analyzed using latent content analysis RESULTS: Four main categories and 13 sub-categories are identified as the result of data analysis. Main categories were "colorectal cancer and ileostomy: patient's adaptation," "supporting resources for the patient with ileostomy," "ileostomy closure: hope and concerns," and "ostomy nurse's professionalism." The main categories reflect the shared experiences and perceptions of colorectal cancer patients, across the timeline from colorectal cancer diagnosis to ileostomy closure.

CONCLUSION

This study provides a timely response to a pilot project for recognizing ostomy nurse's education for patients with stomas. Also, the findings of this study contribute to nursing knowledge by providing patients' perspectives on the education provided to them by the ostomy nurse. Lastly, this study inspires future studies to evaluate and recognize ostomy nurse's practice by using various methodological approaches.

Phenotypic Characterisation of Staphylococcus aureus Isolated from Patients in Healthcare Institutions in Zaria Metropolis, Kaduna State, Nigeria

BACKGROUND

Staphylococcus aureus is a cosmopolitan and pathogenic microorganism associated with various diseases spectra and antimicrobial resistance of public health importance.

AIM

This study determined the phenotypic characteristics of S. aureus isolated from patients in healthcare institutions in Zaria metropolis.

STUDY DESIGN

A cross-sectional hospital-based study was carried out in 5 healthcare institutions. Four hundred and twenty clinical samples were collected and analyzed.

RESULTS

Majority of the patients (54.3%) were within the age range 21-40 years and mean age of 26.04 ± 12 years. Approximately, 70% of the respondents had history of antibiotic use prior to consultation in the hospitals and were self-prescribed, and 91.2% were outpatients. The most commonly abused antibiotics were ampicillin-cloxacillin (19.5%) and cotrimoxazole (10.0%), and the mean duration of their use was 3.5 ± 1.3 days. The detection rate for S. aureus was 10% and 5.2% for MRSA. The S. aureus isolates showed the highest frequency of resistance against ampicillin 42 (100%), followed by penicillin G 39 (92.9%) and least was to gentamicin 5 (11.9%). The frequency of resistance for the MRSA were ampicillin 22 (100%), penicillin G 21(95.5%) and least was to gentamicin 2 (9.1%). The minimum inhibitory concentrations of oxacillin were greater than 128 μg /ml.

CONCLUSION

The detection rate of S. aureus and MRSA strains are of great public health concern which requires continuous health education on rational use of antibiotics among others.

Effectiveness of a best practice guideline to manage pain in surgical patients

BACKGROUND

The prevention and control of acute postoperative pain is essential, not only to avoid unnecessary suffering, but to reduce postoperative morbidity, recovery time, hospital stay and associated costs.

AIM

To evaluate the effectiveness of implementing the Clinical Best Practice Guideline (BPG) "Assessment and Management of Pain" recommendations for pain control in surgical patients.

METHODS

Prospective, observational, longitudinal study.

SUBJECTS

Surgical patients over 14 admitted to the University Hospital Complex of Albacete, and discharged during the last working days of every month.

VARIABLES

1) demographic data, hospital stay. 2) The process indicators of BPG implementation. 3) Patient outcomes: prevalence and intensity of pain in the first 24 postsurgical hours, maximum intensity of pain during hospitalization.

TOOLS

Scales of assessment of pain intensity (0-10).

DATA COLLECTION

Database of BPSO/CCEC® Program.

ETHICAL ASPECTS

Anonymous data. DATA ANALYSIS (SPSS® V12): Descriptive during four periods: baseline (T0: December 2012); initial (T1: June-December 2013); intermediate (T2: 2014-2015); consolidation (T3: 2016-2017). Measurements of central tendency and dispersion, absolute and relative frequencies, according to variables. Comparison of proportions (Chi-Square) and averages (Student t-test, ANOVA). STATISTICAL SIGNIFICANCE: p < 0.05.

RESULTS

Included 3934 patients, 52.3% (2058) men. Daily intervention of pain detection was performed in 73.5% (2890) of patients (28% T0; 67.4% T1; 66.7% T2; 89.9% T3; p < 0.0001), assessment of pain with a scale in 65.2% (2567) (0% T0; 48.8% T1; 59.4% T2; 85.6% T3; p < 0.0001); 35.3% (1389) had a care plan for assessment and management of pain (0% T0; 34.6% T1; 32.3% T2; 42.3% T3; p < 0.0001). The percentage of patients who had serious pain (>5) during the first 24 h was reduced from 12.4% (T1) to 5.3% (T3) (p < 0.0001).

CONCLUSION

Implementation of recommendations has led to a statistically significant improvement over the periods in the study. Pain intensity and the percentage of patients with severe pain have decreased in a significant way.

Molecular identification and subtyping of Blastocystis sp. in hospital patients in Central China

Blastocystis is a common enteric protist that inhabits the gastrointestinal tract of approximately 1 billion people worldwide. In this study, a total of 1,070 patients from two hospitals in Zhengzhou, Central China were enrolled to know molecular characteristics of Blastocystis sp. The microorganism was identified and subtyped with a PCR amplification and sequencing of the small subunit ribosomal deoxyribonucleic acid (SSU-rDNA). The overall minimum prevalence of Blastocystis sp. in participants was 3.1% (33/1070). Although there were no significant differences on Blastocystis sp. infections among study sites, age groups, and gender, the higher infection was observed in the patients with gastrointestinal diseases (8.8%, 15/170). Sequence analysis of the 33 isolates revealed three known subtypes, such as ST1 (n = 7), ST3 (n = 23), and ST7 (n = 3). Among them, ST3 was the dominant subtype being detected in 23 isolates (69.7%), followed by ST1 (21.2%, 7/33) and ST7 (9.1%, 3/33). The phylogenetic analysis demonstrated that three subtypes (ST1, ST3 and ST7) were clustered with their reference sequences with good bootstrap support. The subtype determination of Blastocystis sp. isolates by the phylogenetic analysis was well supported by online platform. The present study provides the first molecular report of Blastocystis sp. infections in hospital patients in Central China.

Engaging hospitalised patients in their nutrition care using technology: development of the NUTRI-TEC intervention

Background

Nutrition is vital for health and recovery during hospitalisation, however most patients fail to meet minimum dietary requirements and up to 50% of patients are malnourished in hospital. When patients participate in nutrition care, their dietary intakes are improved. Advances in health information technology (HIT) have broadened the ways by which patients can participate in care. Our team has developed an innovative, HIT-based intervention (called NUTRI-TEC; engaging patients in their nutrition care using technology), facilitating patient participation in their nutrition care in hospital. This paper aims to describe the systematic and iterative process by which the intervention was developed.

Methods

NUTRI-TEC development was informed by the Medical Research Council guidance for developing complex interventions and underpinned by theoretical frameworks and concepts (i.e. integrated knowledge translation and patient participation in care), existing evidence and a rigorous program of research. The intervention was co-developed by the multidisciplinary research team and stakeholders, including health consumers (patients), health professionals and industry partners. We used an iterative development and evaluation cycle and regularly tested the intervention with hospital patients and clinicians.

Results

The NUTRI-TEC intervention involves active patient participation in their nutrition care during hospitalisation. It has two components: 1) Patient education and training; and 2) Guided nutrition goal setting and patient-generated dietary intake tracking. The first component includes brief education on the importance of meeting energy/protein requirements in hospital; and training on how to use the hospital’s electronic foodservice system, accessed via bedside computer screens. The second component involves patients recording their food intake after each meal on their bedside computer and tracking their intakes relative to their goals. This is supported with brief, daily goal-setting sessions with a health care professional.

Conclusions

NUTRI-TEC is a HIT intervention designed to enable patient participation in their nutrition care in hospital. As research on HIT interventions to engage patients in health care in the hospital setting is in its infancy, and as gaps and inconsistencies in the development of such interventions exist, this paper will inform future development of HIT-based interventions in the hospital setting.

Utility of fecal immunochemical test vs guaiac fecal occult blood test for assessment of gastrointestinal bleed in hospitalized patients

BACKGROUND

Guaiac fecal occult blood testing (gFOBT) is often used "off-label" for gastrointestinal (GI) bleeding. Fecal Immunochemical Test (FIT) is increasingly replacing gFOBT in colorectal cancer screening and may play a role in assessment for significant bowel disease. We examined the concordance of FIT with gFOBT (Hemoccult Sensa II) among inpatients and between day 1 and day 3 gFOBT results.

METHODS

FIT was performed alongside gFOBT on all inpatient stool sent for occult blood to the Winnipeg Health Sciences Centre laboratory over 1 y. gFOBT was performed on days 1 and 3 post stool collection, while FIT was performed on day 1 only.

RESULTS

Positivity rates were highest for Day 1 gFOBT (27.7%), and lowest for FIT (18.3%). Concordance between FIT and Days 1 and 3 gFOBT for negative test results (96.4% and 94.1%) was significantly higher than that expected by chance alone (58.7% and 61.3%, P < .001). Similarly, concordance for positive test results (55.8% and 55.6%) was significantly higher as well as for days 1 and 3 gFOBT results.

CONCLUSIONS

We found no benefit in delayed testing for 3 days post collection. FIT provides equivalent results to gFOBT in hospitalized patients.

Mortality in hospital patients with and without mental disorders: A data-linkage cohort study

OBJECTIVE

In the general population, people with mental disorders have increased mortality. This association, however, has not been explored in a population who at some time were inpatients of a public hospital.

METHODS

The sampling frame was patients admitted to an Australian regional public hospital 1996-2010. Those with known mental disorder were compared with an equal number of randomly selected patients without known mental disorder, matched for age, sex, and year of admission. Mortality outcomes were determined by linkage of hospital data and the National Death Index.

RESULTS

We identified 15,356 patients with mental disorder and 15,356 without known mental disorder, 25.2% of the former and 17.3% of the latter died during the study period. The odds ratio (OR) for death in those with mental disorder was 2.20 (95% confidence interval: 2.01-2.41) after adjusting for confounders, and their mean age at death was 4.6 years younger (p < 0.001). Other independent risk factors for mortality were being Indigenous (OR 1.72, 1.32-2.24), not partnered (OR 1.55, 1.36-1.76) or having multiple comorbidities (OR 1.65, 1.43-1.90). In the model that included multiple interactions, the ORs for death in Indigenous patients with mental disorder were markedly higher (6.6-9.5), regardless of other risk factors.

DISCUSSION

Among patients with a history of public hospital admission, those with mental disorders have higher mortality than those without mental disorders. This gap in life expectancy mandates increased attention, by clinicians and health services alike, to preventable causes of death in people with mental illness.

Association of short-term exposure to ambient air pollutants with exhaled nitric oxide in hospitalized patients with respiratory-system diseases

BACKGROUND

Previous studies have suggested that exposure to ambient air pollutants may adversely affect human health. However, few studies have examined the health effects of exposure to ambient air pollutants in hospitalized patients.

OBJECTIVES

To evaluate the association between short-term exposure to ambient air pollutants and exhaled nitric oxide fraction (FeNO) in a large cohort of hospitalized patients.

METHODS

FeNO was detected for 2986 hospitalized patients (ages 18-88 years). Daily average concentrations of SO₂, NO₂, O₃, CO, PM_2.5 and PM₁₀ in 2014 and 2015 were obtained from nine fixed-site monitoring stations. Multiple linear regression models were chosen to assess the associations of exposure to ambient air pollutants with FeNO while adjusting for confounding variables. Lagged variable models were selected to determine the association between FeNO and ambient air pollutants concentrations with lags of up to 7 days prior to FeNO testing.

RESULTS

Interquartile-range (IQR) increases in the daily average SO₂ (8.00 μg/m³) and PM_2.5 (37.0 μg/m³) were strongly associated with increases in FeNO, with increases of 3.41% [95% confidence interval (CI), 0.94-5.93%] and 2.72% (95%CI, -0.09% to 5.61%), respectively. However, FeNO levels were not statistically associated with PM₁₀, NO₂, O₃ or CO. In the two-pollutant models, the maximum correlation was for ambient SO₂. We also found that FeNO was associated with IQR increases in daily average ambient concentrations of SO₂ up to 3 and 4 days after the exposure events.

CONCLUSIONS

Short-term exposure to SO₂ and PM_2.5 were positively correlated with FeNO levels in hospitalized patients in Shanghai.

Pre-and post-pandemic trends in antiviral use in hospitalized patients with laboratory-confirmed influenza: 2004/05-2013/14, Toronto, Canada

BACKGROUND

Data on factors associated with the use of antiviral medication to treat influenza in both children and adults are limited.

OBJECTIVES

To describe trends in antiviral use, analyze factors associated with antiviral treatment of hospitalized patients with influenza, and to compare use based on guidelines.

STUDY DESIGN

A retrospective observational cohort of hospitalized patients with laboratory confirmed influenza in southern Ontario hospitals for the 2004/05-2013/14 seasons.

RESULTS

Of the 7967 patients, 18% of the 1779 children (<15 years) and 66% of the 6188 adults received antiviral therapy. The percentage treated increased from 29% pre-pandemic to 74% during the pandemic, decreased to 55% in 2011/12 and then increased to 65% in 2013/14. Factors significantly associated with antiviral prescription across all age groups during the non-pandemic seasons include influenza type, disease severity, interval between symptom onset and test sample submission, and clinician suspicion of influenza. Rate of treatment of patients meeting guideline criteria was low for children and moderate for adults.

CONCLUSIONS

Since the pandemic, there has been a sustained increase in the use of antiviral medication for all age groups of hospitalized patients with influenza, but much higher for adults than children. The odds of treatment are higher for patients with more severe disease as well as for those tested within 48 h of symptom onset, both of which are part of the guidelines for treatment with anti-influenza medications.

Emotional communication in medical consultations with native and non-native patients applying two different methodological approaches

OBJECTIVE

To explore the potential agreement between two different methods to investigate emotional communication of native and non-native patients in medical consultations.

METHODS

The data consisted of 12 videotaped hospital consultations with six native and six non-native patients. The consultations were coded according to coding rules of the Verona Coding definitions of Emotional Sequences (VR-CoDES) and afterwards analyzed by discourse analysis (DA) by two co-workers who were blind to the results from VR-CoDES.

RESULTS

The agreement between VR-CoDES and DA was high in consultations with many cues and concerns, both with native and non-native patients. In consultations with no (or one cue) according to VR-CoDES criteria the DA still indicated the presence of emotionally salient expressions and themes.

CONCLUSION

In some consultations cues to underlying emotions are communicated so vaguely or veiled by language barriers that standard VR-CoDES coding may miss subtle cues. Many of these sub-threshold cues could potentially be coded as cues according to VR-CoDES main coding categories, if criteria for coding vague or ambiguous cues had been better specified.

PRACTICE IMPLICATIONS

Combining different analytical frameworks on the same dataset provide us new insights on emotional communication.