Hospital practice (1995)最新文献

{"title":"Compliance with maternal sepsis guidelines in a tertiary hospital in the Netherlands.","authors":"Baukje S de Vries, Kim J C Verschueren, Sophie Jansen, Vincent Bekker, Marieke B Veenhof, Thomas van den Akker","doi":"10.1080/21548331.2024.2320068","DOIUrl":"10.1080/21548331.2024.2320068","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis is a common cause of maternal mortality and morbidity. Early detection and rapid management are essential. In this study, we evaluate the compliance with the implemented maternity-specific Early Warning Score (EWS), Rapid Response Team (RRT) protocol and the Surviving Sepsis Campaign (SSC) Hour-1 Bundle in a tertiary hospital in the Netherlands.</p><p><strong>Methods: </strong>We performed a retrospective patient chart review from July 2019 to June 2020 at the Leiden University Medical Centre. We included women who received therapeutic antibiotics and were admitted for at least 24 hours.</p><p><strong>Results: </strong>We included 240 women: ten were admitted twice and one woman three times, comprising 252 admissions. A clinical diagnosis of sepsis was made in 22 women. The EWS was used in 29% (<i>n</i> = 73/252) of admissions. Recommendations on the follow-up of the EWS were carried out in 53% (<i>n</i> = 46/87). Compliance with the RRT protocol was highest for assessment by a medical doctor within 30 minutes (<i>n</i> = 98/117, 84%) and lowest for RRT involvement (<i>n</i> = 7/23, 30%). In women with sepsis, compliance with the SSC Bundle was highest for acquiring blood cultures (<i>n</i> = 19/22, 85%), while only 64% (<i>n</i> = 14/22) received antibiotics within 60 minutes of the sepsis diagnosis.</p><p><strong>Conclusion: </strong>The adherence to the maternity-specific EWS and the SSC Hour-1 bundle was insufficient, even within this tertiary setting in a high-income country.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"29-33"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The reverse stethoscope technique: a rapid intervention for old age hearing loss.","authors":"Alexander Hodson, Noah Clancy, Irwin Foo","doi":"10.1080/21548331.2024.2320067","DOIUrl":"10.1080/21548331.2024.2320067","url":null,"abstract":"<p><strong>Objectives: </strong>Presbycusis is highly prevalent, affecting between a third and two-thirds of elderly populations. Effective communication between patient and physician has been shown to directly correlate with the quality of patient care. The Reverse Stethoscope Technique (RST) involves placing the earpieces into the patient's ears and speaking into the diaphragm. Here, we aim to show the RST is a simple and effective method to communicate with patients suffering from presbycusis in inpatient settings.</p><p><strong>Methods: </strong>Medical inpatients aged >60 years old without cognitive impairment were included in the study. A simple repetition exercise of basic English sentences was performed with and without the RST to assess hearing ability. Patients then undertook a short questionnaire.</p><p><strong>Results: </strong>Our study included 109 patients with varied 'self-reported' hearing. 50.5% of our cohort reported past communication difficulties with health-care professionals due to hearing difficulties. We identified that the RST increased the mean number of sentences a patient could repeat from 2.6 to 3.5 representing a statistically significant increase (<i>p</i> < 0.001). The technique was most beneficial for patients with 'okay' and 'poor' hearing. The majority of patients (77/109) also stated the technique reduced background noise. The RST was equally effective with facemasks.</p><p><strong>Conclusion: </strong>Current techniques to enhance communication with patients with hearing loss are often underutilized or poorly accessible. Our study identified that the RST is a quick and effective solution that can be easily implemented for patients struggling to communicate with health-care professionals in inpatient scenarios.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"23-28"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Model melee: understanding models of addiction.","authors":"Ezra Kalmowitz","doi":"10.1080/21548331.2024.2348988","DOIUrl":"10.1080/21548331.2024.2348988","url":null,"abstract":"","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of vitamin K for coagulopathy in critically ill children.","authors":"Christina J Smith, Ryan Valencia, Caroline M Sierra, Merrick Lopez","doi":"10.1080/21548331.2023.2277679","DOIUrl":"10.1080/21548331.2023.2277679","url":null,"abstract":"<p><strong>Objectives: </strong>Coagulopathy is associated with increased mortality in children in the intensive care unit (ICU). Recommended management of vitamin K-deficient coagulopathy is vitamin K administration. The goal of this study was to evaluate vitamin K administration for coagulopathy in critically ill children and determine a relationship between vitamin K dose and change in prothrombin time (PT) and international normalized ratio (INR).</p><p><strong>Methods: </strong>This retrospective cohort study reviewed electronic medical records of patients ≤17 years who received vitamin K for acute coagulopathy in the pediatric ICU from January 2013 to January 2021. Patients receiving vitamin K antagonists were excluded. Effectiveness data included change in PT/INR after vitamin K administration. Safety data included incidence of hypersensitivity or anaphylaxis.</p><p><strong>Results: </strong>A total of 310 patients (median age 6.8 years, range 22 days-17.7 years) received vitamin K. A median of three doses (range 1-8) and 0.14 mg/kg per dose (range 0.09-0.22 mg/kg) were given, most frequently intravenously (892/949, 94%). Most patients (304/310, 98%) had at least one risk factor for vitamin K deficiency. Mean PT/INR was 21.5/2.1 prior to vitamin K administration, which decreased by 4.4 (SD = 9.0, 95% CI 16.011 to 18.015, <i>p</i> < 0.001) and 0.5 (SD = 1.0, 95% CI 1.490 to 1.705, <i>p</i> < 0.001) to means of 17.0 and 1.6, respectively, after the first vitamin K dose. No linear relationship was found between vitamin K dose and change in PT/INR. No hypersensitivity or anaphylaxis occurred following vitamin K administration; 27% (84/310) of patients died.</p><p><strong>Conclusions: </strong>Administration of vitamin K is effective and safe for the management of vitamin K-deficient coagulopathy in critically ill pediatric patients. Further study is needed to determine a relationship between vitamin K dose and change in PT/INR.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"262-266"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrointestinal stromal tumor in North Africa and the middle east: updates in presentation and management from an 11-year retrospective cohort.","authors":"Fadi Farhat, Marwa Hussein, Eman Sbaity, Abdullah Alsharm, Kakil Rasul, Saad Khairallah, Tarek Assi, Niloofar Allahverdi, Ahmad Othman, Joseph Kattan","doi":"10.1080/21548331.2023.2277682","DOIUrl":"10.1080/21548331.2023.2277682","url":null,"abstract":"<p><strong>Objectives: </strong>This study described the epidemiological, clinical, and survival profiles of patients with gastrointestinal stromal tumor (GIST) in North Africa and the Middle East (AfME).</p><p><strong>Methods: </strong>This regional, multicenter, observational, retrospective study collected 11-year data on demographics, medical history, disease characteristics, current treatment approaches of GIST, the safety of the most common tyrosine kinase inhibitors (TKIs), second cancers, and survival status.</p><p><strong>Results: </strong>Data of 201 eligible patients were analyzed: mean age was 56.9 ± 12.6 years; 111 (55.2%) patients were men, 21 (10.4%) patients had previous personal malignancy. The most common clinical presentation of GIST was dysphagia [92 (45.8%) patients]. The stomach was the most common primary site in 120 (60.7%) patients, 171 (85.1%) patients had localized disease at diagnosis. 198 (98.5%) GIST cases were CD117/CD34-positive. Imatinib was used in the neoadjuvant (18/21 patients), adjuvant (85/89 patients), and first-line metastatic treatment (28/33 patients) settings. The most common non-hematological toxicity associated with TKIs was vomiting in 32/85 (37.6%) patients. Overall, 100 (49.8%) patients (95%CI: 42.8-56.7%) were alive and disease-free while 30 (14.9%) patients were alive with active disease.</p><p><strong>Conclusion: </strong>Presentation of GIST in our AfME population is consistent with global reports, being more frequent in patients >50 years old and having the stomach as the most common primary site. Unlike what is usually reported, though, we did have more patients with lymphatic spread of the disease. Despite the global trend and advances in the treatment of GIST according to molecular profile, this is still far to happen in our population given the lack of access to molecular profiles and the high associated cost.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"275-287"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138811382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telehealth and telemedicine prenatal care during the COVID-19 pandemic: a systematic review with a narrative synthesis.","authors":"Sofia Al Farizi, Dewi Setyowati, Dyah Ayu Fatmaningrum, Azra Fauziyah Azyanti","doi":"10.1080/21548331.2023.2284635","DOIUrl":"10.1080/21548331.2023.2284635","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 epidemic has restricted the use of maternal health services, including prenatal care. Telehealth and telemedicine are remote services that can help in the event of a COVID-19 pandemic. In this study, we examined the use of telehealth and telemedicine in prenatal care in various countries during the COVID-19 pandemic.</p><p><strong>Methods: </strong>Relevant titles were searched in five e-book databases from 31 December 2019 to 31 July 2021: PUBMED, Science Direct, Scopus, Web of Sciences, and Google Scholar. Articles were chosen based on the following criteria: a focus on pregnant women, a connection to the COVID-19 pandemic, and a focus on telehealth and telemedicine. A narrative synthesis was used to synthesize the data.</p><p><strong>Results: </strong>Telehealth and telemedicine reduced the risk of transmitting COVID-19 to pregnant women and health workers. The implementation process encountered various challenges, such as the absence of service composition, limited technological accessibility, communication difficulties, and disparities in access.</p><p><strong>Conclusions: </strong>It is imperative for the government and health organizations to have a comprehensive policy and legislation that effectively regulates the provision of services. It is also important to emphasize the importance of reducing inequality, such as by equalizing access to technology and infrastructure.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"241-254"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Better medical care quality in weekday daytime schedule with gastrointestinal hospitalists than conventional care teams.","authors":"Hannah Ra, Hye Young Lee, Dong Kyun Park, Oh Sang Kwon, Yoon Jae Kim","doi":"10.1080/21548331.2023.2277676","DOIUrl":"10.1080/21548331.2023.2277676","url":null,"abstract":"<p><strong>Objectives: </strong>This study sought to uncover whether having a gastrointestinal (GI) hospitalist available during weekday daytime hours results in higher-quality medical care compared to care provided by a team of residents.</p><p><strong>Methods: </strong>Our hospitalist GI team consisted of two gastroenterologists working weekday daytime hours and two physician assistants. The team of conventional care headed by thirteen professors, comprised twelve residents and eight physician assistants. We conducted a retrospective cohort study in South Korea between March 2 and December 9, 2020 The hospitalist team treated 528 patients, while the conventional care team treated 2,335. We assessed the medical parameters of length of stay (LOS), rates of in-hospital mortality, transfer to the intensive care unit, and readmission rate within 30 days. Furthermore, we gathered feedback from nurses working with both teams.</p><p><strong>Results: </strong>The study found that there was no significant difference in LOS between infections (<i>P</i> = 0.422) and other GI diseases like bleeding (<i>P</i> = 0.226). There was no significant difference in the rates of in-hospital mortality (<i>P</i> = 0.865) and transfer to the intensive care unit (<i>P</i> = 0.486) between the two teams. However, the hospitalist team had notably lower readmission rates than the conventional care team (<i>P</i> = 0.002) as well as a lower unscheduled readmission rate (<i>P</i> = 0.046). Furthermore, the survey results indicated that nurses who worked with the hospitalist team had significantly better responses than those who worked with the conventional care team (<i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>This study indicates that having GI hospitalists work weekday daytime hours improves patient care, and treatment and reduces readmission rates.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"255-261"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pickering syndrome in a patient with Takayasu's arteritis.","authors":"Umberto Di Vita, Pier Paolo Bocchino, Tullio Usmiani, Gaetano Maria De Ferrari","doi":"10.1080/21548331.2023.2277677","DOIUrl":"10.1080/21548331.2023.2277677","url":null,"abstract":"<p><p>Takayasu arteritis (TA) is a chronic granulomatous large vessel arteritis. The renal arteries are affected in up to 60% of patients with TA, with renal artery stenosis (RAS) potentially leading to ischemic nephropathy, severe arterial hypertension, and heart failure. Bilateral RAS may rarely present with recurrent flash pulmonary edema, a life-threatening association which has been termed Pickering syndrome. In this report, we describe a 55-year-old woman with severe refractory arterial hypertension admitted for acute pulmonary edema, initially treated unsuccessfully with medical therapy with vasodilators and diuretics. Given the instrumental findings of bilateral RAS and suggestive signs and symptoms, the diagnosis of TA was made, resulting as the first described case of Pickering syndrome being the clinical presentation of TA. Interventional therapy with renal artery angioplasty procedure was performed with stenting of both right and left renal arteries, leading to the resolution of the clinical scenario and the successful discharge of the patient. At the 1 year follow-up visit the patient was asymptomatic and in good clinical conditions; a significant reduction in antihypertensive therapy was achieved while immunosuppressive therapy was continued. This case highlights that secondary causes of TA should always be sought in patients with refractory hypertension who do not respond to standard treatment; also, TA should be suspected in young patients with bilateral RAS, especially when other typical signs of TA are present; lastly, a thorough investigation is essential in complicated cases, as rare diseases like TA may manifest in unusual ways.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"303-305"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107606239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of technical filtering and clinical criteria on alert rates from continuous vital sign monitoring in the general ward.","authors":"Karoline Kjærgaard, Jesper Mølgaard, Søren M Rasmussen, Christian Sylvest Meyhoff, Eske Kvanner Aasvang","doi":"10.1080/21548331.2023.2298185","DOIUrl":"10.1080/21548331.2023.2298185","url":null,"abstract":"<p><strong>Objectives: </strong>Continuous vital sign monitoring at the general hospital ward has major potential advantages over intermittent monitoring but generates many alerts with risk of alert fatigue. We hypothesized that the number of alerts would decrease using different filters.</p><p><strong>Methods: </strong>This study was an exploratory analysis of the alert reducing effect from adding two different filters to continuously collected vital sign data (peripheral oxygen saturation, blood pressure, heart rate, and respiratory rate) in patients admitted after major surgery or severe medical disease. Filtered data were compared to data without artifact removal. Filter one consists of artifact removal, filter two consists of artifact removal plus duration criteria adjusted for severity of vital sign deviation. Alert thresholds were based on the National Early Warning Score (NEWS) threshold.</p><p><strong>Results: </strong>A population of 716 patients admitted for severe medical disease or major surgery with continuous wireless vital sign monitoring at the general ward with a mean monitoring time of 75.8 h, were included for the analysis. Without artifact removal, we found a median of 137 [IQR: 87-188] alerts per patient/day, artifact removal resulted in a median of 101 [IQR: 56-160] alerts per patient/day and with artifact removal combined with a duration-severity criterion, we found a median of 19 [IQR: 9-34] alerts per patient/day. Reduction of alerts was 86.4% (<i>p</i> < 0.001) for values without artifact removal (137 alerts) vs. the duration criteria and a reduction (19 alerts) of 81.5% (<i>p</i> < 0.001) for the criteria with artifact removal (101 alerts) vs. the duration criteria (19 alerts).</p><p><strong>Conclusion: </strong>We conclude that a combination of artifact removal and duration-severity criteria approach substantially reduces alerts generated by continuous vital sign monitoring.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"295-302"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138831958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Undernutrition risk is independently associated with worsened indicators of hospital rehabilitation in COVID-19 patients.","authors":"Vanessa Esquissato Pinheiro, Alex Silva Ribeiro, Carlos Augusto Marçal Camillo, Juliano Casonatto","doi":"10.1080/21548331.2023.2277680","DOIUrl":"10.1080/21548331.2023.2277680","url":null,"abstract":"<p><strong>Objective: </strong>This study was designed to analyze the association between the risk of undernutrition and indicators of hospital rehabilitation in patients with COVID-19 while controlling for confounding variables.</p><p><strong>Methods: </strong>This was an analytical study conducted by analyzing the medical records of patients with COVID-19. A total of 562 adult patients were eligible for the study. In addition to the risk of undernutrition (independent variable), indicators of hospital rehabilitation (dependent variables) were evaluated. These indicators included the length of hospital stay, clinical outcome (discharge or death), food intake, mobility (bedridden status), the use of mechanical ventilation, and the need for enteral nutrition. Pre-existing comorbidities (confounding/control variables) were grouped into cardiovascular, metabolic/endocrine, neurological, chronic obstructive pulmonary disease, and other categories (neoplasms, multiple sclerosis, and kidney disease). A dichotomization model was applied for data analysis. The Chi-Square test was used to verify the association between the risk of undernutrition and the dependent variables. Associations with a significance level of <i>P</i> < 0.05 were subjected to Poisson regression to identify the prevalence ratio.</p><p><strong>Results: </strong>Patients at risk of undernutrition had a 90% higher chance of being bedridden and were 35 times more likely to experience a decrease in food intake. They also had an 89% higher chance of using invasive mechanical ventilation and a 91% higher chance of requiring enteral nutrition. Additionally, individuals at risk of undernutrition had a 73% higher chance of death. Adjustment for comorbidities did not alter these associations, demonstrating that the risk of undernutrition is independently associated with indicators of hospital rehabilitation.</p><p><strong>Conclusion: </strong>The risk of undernutrition is independently associated with worsened indicators of hospital rehabilitation in patients with COVID-19, including higher prevalence of mortality.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":" ","pages":"267-274"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66784404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}