Hospital practice (1995)最新文献

Cutibacterium acnes is a low-virulence pathogen that can cause prosthetic valve endocarditis (PVE), presenting significant diagnostic challenges due to its slow growth and indolent clinical course. We report a case of a 57-year-old male with a history of tissue aortic valve replacement, who presented with 6 months of intermittent fever and a nonproductive cough. Initial tests showed elevated inflammatory markers and moderate aortic regurgitation, but no vegetations were identified on transthoracic or transoesophageal echocardiography. After 13 months of symptoms, a PET scan showed significant FDG uptake around the bioprosthetic valve, and a single blood culture grew C. acnes. Transoesophageal echocardiography revealed abnormal rocking motion of the valve and severe paravalvular regurgitation, suggesting near-complete valve dehiscence. The patient underwent redo surgery for aortic root and valve replacement, and intraoperative cultures confirmed C. acnes infection. This case highlights the importance of considering low-virulence pathogens like C. acnes in patients with prolonged, nonspecific symptoms and initially negative cultures. Advanced imaging, particularly PET/CT, is crucial for early diagnosis and intervention. Early recognition and appropriate treatment are vital for preventing severe complications such as valve dehiscence and tissue destruction.

Background: There is little known about the prevalence and outcomes of medical patients requiring early intensive care unit upgrade (EIU) following interhospital transfer, and previous studies of EIU focus on patients admitted through the emergency room. We aimed to examine the characteristics and risk factors for poor outcome among medical patients undergoing EIU after interhospital transfer.

Materials and methods: The publicly available Medical Information Mart for Intensive Care (MIMIC) IV database (2008-2019) was queried to identify non-surgical patients undergoing interhospital transfer. Patients who subsequently underwent EIU, defined as ICU admission within 24 hours of arrival after interhospital transfer, were compared to those who did not experience EIU for differences in mortality and length-of-stay (LOS.) We used multivariate logistic regression to identify risk factors for hospital death in this population and negative binomial regression to estimate the impact of EIU on hospital LOS.

Results: We identified 5,619 patients who underwent interhospital transfer, of which 339 (6.0%) experienced EIU and 5280 (94.0%) did not. Patients undergoing EIU after interhospital transfer were significantly older (median age 69 vs. 64 years; p = 0.001,) but there was no difference in sex. After risk-adjustment, we found an association between EIU and a higher risk of mortality (aOR 6.9, 95%CI 5.24-9.08). Increased comorbidity burden as measured by Charlson Comorbidity Index (CCI) was linked to higher odds of death (aOR 1.26, 95% CI 1.22-1.31,) as was nonwhite race (aOR 1.69, 95% CI 1.34-2.14). EIU was associated with a longer hospital LOS (IRR 1.40, 95%CI 1.28-1.54).

Conclusion: EIU after interhospital transfer is associated with higher mortality and longer LOS. Further study will help identify process features of transfer and patient characteristics contributing to poor outcome after arrival from an outlying facility and guide efforts to mitigate risk and provide equitable care across the transfer continuum.

High-risk pulmonary thromboembolism (PTE) is a form of venous thromboembolism that refers to severe obstruction of pulmonary vessels, which causes right ventricular failure and hemodynamic instability. High-risk PTE has a high mortality rate unless immediate reperfusion treatment is done. Systemic thrombolysis is recommended for patients with high-risk PTE. The approved regimen for high-risk PTE is the accelerated intravenous administration of recombinant tissue-type plasminogen activator (rtPA) 100 mg over 2 hours. Herein, we present a case of high-risk PTE in a 74-year-old woman with a high risk of bleeding due to a recent pelvic fracture and head trauma who was successfully treated with a slower infusion of 100 mg rtPA over 4 hours. The modified infusion rate of 100 mg rtPA over 4 hours is an effective regimen for thrombolysis in acute high-risk PTE. It might have a lower risk of bleeding complications, which makes it a good option for patients with high bleeding risk.

Introduction: Liver cirrhosis, a complex and progressive disease, imposes a significant global health burden, characterized by irreversible liver tissue scarring and various life-threatening complications. Traditionally linked to factors like chronic alcohol consumption and viral hepatitis infections, the rising prevalence of obesity introduces a new dimension to its etiology. As obesity rates continue to climb worldwide, the confluence of liver cirrhosis and bariatric surgery has become an increasingly pertinent and clinically relevant topic of inquiry.

Methods: In this study, we aimed to investigate the impact of liver cirrhosis on patients who underwent bariatric surgery, using data from the 2020 National Inpatient Sample (NIS) database. We compared the outcomes of 82,414 patients who had bariatric surgery, stratifying them based on the presence or absence of liver cirrhosis. We assessed baseline demographic characteristics and comorbidities, in-hospital outcomes, and complications related to the surgery.

Results: Patients with liver cirrhosis who underwent bariatric surgery demonstrated several distinct trends. On average, they were older (mean age 63 years) and predominantly female (52%) compared to those without cirrhosis (mean age 52, 71% female). Furthermore, comorbidities such as hypertension, diabetes with chronic complications, and alcohol abuse were more prevalent in the cirrhosis group. In terms of outcomes, patients with liver cirrhosis faced significantly higher inpatient mortality rates (4%) compared to those without cirrhosis (1%) with p < 0.001. They also experienced a notably longer average length of hospital stay (2.35 days longer, 95% CI: -3.46 --1.25, p < 0.001) and incurred higher hospitalization costs (add AOR and p value here). Additionally, patients with cirrhosis had increased odds of experiencing acute heart failure (adjusted odds ratio: 1.87, 95% CI: 1.14-2.57, p = 0.01) and requiring blood transfusions (adjusted odds ratio: 1.71,95% CI: 1.13-3.09, p = 0.009). Although the adjusted odds ratio for inpatient mortality was higher in cirrhosis patients (1.58, 95% CI: 0.76-3.30, p = 0.21), it did not reach statistical significance.

Conclusion: This study highlights the substantial impact of liver cirrhosis on post-bariatric surgery outcomes. Patients with cirrhosis who undergo bariatric surgery face higher inpatient mortality rates and a greater risk of complications, particularly acute heart failure and the need for blood transfusions. The longer hospital stays and increased costs further emphasize the challenges in managing this unique patient population. These findings emphasize the need for careful patient selection, risk assessment, and a multidisciplinary approach when considering bariatric surgery for individuals with both liver cirrhosis and obesity.

Objectives: This study aimed to assess Jordanian healthcare providers' preparedness for crises and disasters.

Methods: A descriptive design was utilized, recruiting a convenience sample of 282 healthcare providers from five governmental hospitals. Data were collected using the Emergency Preparedness Information Questionnaire (EPIQ).

Results: The results indicate that Jordan's healthcare providers have a moderate crisis and disaster preparedness level. The average total score was 136.51, SD ± 31.26, with scores ranging from 47 to 205. The score at the 50th percentile for healthcare providers' crisis and disaster preparedness was 135. The highest score was for the ethical issues in the triage dimension, while the lowest score was for the participant's overall familiarity dimension. There was no relationship between the level of crisis and disaster preparedness and the healthcare providers demographic characteristics age, gender, years of experience, hospital experience, monthly income, and education level. The crises and disaster preparedness scores were significantly different across the various job specializations.

Conclusions: The findings indicated that the level of preparedness among health providers was moderate, and they perceived themselves to be familiar with crisis and disaster preparedness. Significant differences were found based on job specialization, with high preparedness levels among midwives and doctors, while the lowest was found among pharmacists and technicians. However, training in the competencies specified in the Emergency Preparedness Information Questionnaire (EPIQ) may enhance preparedness for crises and disasters, along with proactive planning and scenario-based drills and exercises.

Objectives: Medication errors pose a significant threat to patient safety globally, including in Saudi Arabia. This study aimed to assess healthcare professionals' (HCPs) understanding, attitudes, and challenges regarding medication error reporting in Saudi hospitals.

Methods: A cross-sectional study was conducted using a self-administered online questionnaire among HCPs (physicians, pharmacists, and nurses) from various hospitals across Saudi Arabia. The questionnaire explored their knowledge, attitudes, and experiences related to medication error reporting.

Results: A total of 170 hCPs participated in the study, with the majority being under 35 years old (67.06%), female (70.59%), and Saudi nationals (74.71%). A majority of participants (87.06%) had heard of the medication error report form, and 73.53% reported medication errors before. Participants aged less than 35 years had significantly lower knowledge scores compared to those aged 35-45 years (p = 0.021), and male participants had significantly higher knowledge scores compared to female participants (p = 0.005). Pharmacists had the highest knowledge scores among all health professions (p < 0.001), and participants working in government hospitals had significantly higher knowledge scores compared to those working in private hospitals (p = 0.034). In terms of attitude scores, male participants had significantly higher attitude scores compared to female participants (p = 0.046).

Conclusions: This study highlights progress in medication error reporting among HCPs in Saudi Arabia but identifies gaps in knowledge, reporting, and systemic barriers. Addressing these challenges through education, process optimization, and a non-punitive reporting culture is key to improving safety. Future research should expand beyond hospitals and assess policy and training impacts over time.

Objectives: Nearly two-thirds of older adults experience sleeping difficulties in the hospital setting, which can lead to delirium, mood instability, and delayed healing. Many members of the interprofessional hospital team are positioned to promote restorative sleep, but knowledge about how to intervene is limited. The purpose of this review is to provide members of the hospital care team with specific interventions to promote restorative sleep in hospitalized older adults.

Methods: A narrative literature review was performed in PubMed and CINAHL to identify studies focusing on pharmacological and non-pharmacological sleep promoting interventions in hospitalized older adults. A review of basic sleep biology is also provided to create a common understanding of this phenomenon for a wide range of interprofessional hospital care team members.

Results: A three-pronged approach focused on interventions related to staff culture, specific patient care activities, and hospital policies provides an organizing framework of non-pharmacological sleep promoting interventions. A judicious and cautious approach to the use of pharmacological and nutraceutical interventions is provided.

Conclusion: The hospital care team should implement patient-centered and customized interventions to promote sleep for hospitalized older adults. Sleep promotion should include, at a minimum, non-pharmacological interventions (e.g. increasing familiarity, reducing sensory stimulation as bedtime approaches, maintaining environmental and behavioral zeitgebers). Pharmacological (e.g. ramelteon, trazadone, doxepin, dual orexin receptor antagonists) and nutraceutical (e.g. melatonin, magnesium) interventions may be appropriate, Certain pharmacological options are considered potentially unsafe for older adults (e.g. benzodiazepines, Z-drugs, antihistamines) and should be avoided in this population.

Background: Posterior spinal fixation (PSF) of the lumbosacral region is a commonly performed procedure for managing various spinal pathologies. Deep vein thrombosis (DVT) is a potential complication that can lead to serious outcomes such as thromboembolism. This study aimed to determine the prevalence of DVT and identify associated risk factors in patients undergoing lumbosacral PSF at Firoozgar Hospital, Tehran.

Methods: This prospective cohort study included patients who underwent lumbosacral PSF for degenerative diseases or trauma. All participants underwent lower limb color Doppler ultrasonography before surgery to rule out preexisting DVT. Postoperatively, they were monitored for clinical signs of DVT for two weeks and underwent a follow-up Doppler ultrasound. Demographic and clinical data were collected and analyzed using univariate and multivariate statistical methods to identify risk factors associated with DVT.

Results: DVT occurred in 5 of 109 patients (4.6%), of which 3 (2.8%) were symptomatic and 2 (1.8%) asymptomatic on routine postoperative ultrasound. DVT occurrence was significantly associated with factors including motor impairment, neurological deficits, duration of preoperative hospitalization, intraoperative blood loss, and the need for transfusion. Additional factors such as level of consciousness, severity of pain, time to postoperative mobilization, duration of surgery, age, underlying medical conditions, surgical history and cause, number of spinal fusion levels, and BMI also showed significant associations with DVT. No significant correlation was found with gender or preoperative anticoagulant use.

Conclusion: Identifying risk factors for DVT in patients undergoing lumbosacral PSF can help inform targeted preventive strategies and improve patient outcomes. These findings underscore the importance of early mobilization, careful perioperative management, and individualized risk assessment in spinal surgery patients.

Background: There is a lack of evidence regarding direct oral anticoagulant (DOAC) assay plasma concentrations and their association with bleeding events or transfusion requirements. This multicenter study aimed to characterize the use and plasma levels of DOAC assays of anticoagulated patients who present to emergency with a bleeding event and their association with bleeding severity.

Methods: A multicenter retrospective cohort study of consecutive emergency bleeding presentations with a DOAC assay over a five-year period was conducted. Linear regressions were performed for continuous outcomes, binary logistic regression for categorical outcomes.

Results: There were 86 patients on a DOAC, who presented with a major bleeding event, and had a DOAC assay performed. Assays were performed within a median time of 4.8 hours (IQR = 9,14.4) from presentation and had a median result of 122.9 ng/ml(IQR = 42,160). DOAC assay plasma level was not significantly associated with type or severity of bleed however, for every 10 unit increase in DOAC assay plasma level, the odds of administering reversal increases by 4% (OR = 1.04, 95%CI:1.00-1.08).

Conclusion: A wide range of plasma levels can be expected in patients who present with bleeding events. Higher DOAC plasma levels do not necessarily confer a worse bleeding event or increased transfusion requirements; however, it is associated with an increased likelihood of anticoagulant reversal administration.