Pub Date : 2023-12-01Epub Date: 2024-01-10DOI: 10.1080/21548331.2023.2277682
Fadi Farhat, Marwa Hussein, Eman Sbaity, Abdullah Alsharm, Kakil Rasul, Saad Khairallah, Tarek Assi, Niloofar Allahverdi, Ahmad Othman, Joseph Kattan
Objectives: This study described the epidemiological, clinical, and survival profiles of patients with gastrointestinal stromal tumor (GIST) in North Africa and the Middle East (AfME).
Methods: 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.
Results: 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.
Conclusion: 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.
{"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":null,"pages":null},"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}
Pub Date : 2023-12-01Epub Date: 2024-01-10DOI: 10.1080/21548331.2023.2284635
Sofia Al Farizi, Dewi Setyowati, Dyah Ayu Fatmaningrum, Azra Fauziyah Azyanti
Background: 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.
Methods: 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.
Results: 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.
Conclusions: 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.
背景:COVID-19疫情限制了孕产妇保健服务的使用,包括产前护理。远程保健和远程医疗是在发生COVID-19大流行时可以提供帮助的远程服务。在本研究中,我们调查了COVID-19大流行期间各国在产前护理中使用远程医疗和远程医疗的情况。方法:检索2019年12月31日至2021年7月31日PUBMED、Science Direct、Scopus、Web of Sciences和谷歌Scholar 5个电子书数据库的相关标题。文章的选择基于以下标准:关注孕妇,与COVID-19大流行的联系,以及关注远程医疗和远程医疗。采用叙事综合法来综合数据。结果:远程医疗和远程医疗降低了将COVID-19传播给孕妇和卫生工作者的风险。实现过程遇到了各种挑战,例如缺乏服务组合、有限的技术可及性、通信困难和访问方面的差异。结论:政府和卫生组织必须制定全面的政策和立法,有效地规范服务的提供。同样重要的是要强调减少不平等的重要性,例如通过平等获得技术和基础设施。
{"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":null,"pages":null},"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}
Pub Date : 2023-12-01Epub Date: 2024-01-10DOI: 10.1080/21548331.2023.2277676
Hannah Ra, Hye Young Lee, Dong Kyun Park, Oh Sang Kwon, Yoon Jae Kim
Objectives: 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.
Methods: 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.
Results: The study found that there was no significant difference in LOS between infections (P = 0.422) and other GI diseases like bleeding (P = 0.226). There was no significant difference in the rates of in-hospital mortality (P = 0.865) and transfer to the intensive care unit (P = 0.486) between the two teams. However, the hospitalist team had notably lower readmission rates than the conventional care team (P = 0.002) as well as a lower unscheduled readmission rate (P = 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 (P < 0.001).
Conclusions: This study indicates that having GI hospitalists work weekday daytime hours improves patient care, and treatment and reduces readmission rates.
{"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":null,"pages":null},"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}
Pub Date : 2023-12-01Epub Date: 2024-01-10DOI: 10.1080/21548331.2023.2277677
Umberto Di Vita, Pier Paolo Bocchino, Tullio Usmiani, Gaetano Maria De Ferrari
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.
{"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":null,"pages":null},"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}
Pub Date : 2023-12-01Epub Date: 2024-01-10DOI: 10.1080/21548331.2023.2298185
Karoline Kjærgaard, Jesper Mølgaard, Søren M Rasmussen, Christian Sylvest Meyhoff, Eske Kvanner Aasvang
Objectives: 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.
Methods: 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.
Results: 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% (p < 0.001) for values without artifact removal (137 alerts) vs. the duration criteria and a reduction (19 alerts) of 81.5% (p < 0.001) for the criteria with artifact removal (101 alerts) vs. the duration criteria (19 alerts).
Conclusion: We conclude that a combination of artifact removal and duration-severity criteria approach substantially reduces alerts generated by continuous vital sign monitoring.
{"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":null,"pages":null},"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}
Pub Date : 2023-12-01Epub Date: 2024-01-10DOI: 10.1080/21548331.2023.2277680
Vanessa Esquissato Pinheiro, Alex Silva Ribeiro, Carlos Augusto Marçal Camillo, Juliano Casonatto
Objective: 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.
Methods: 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 P < 0.05 were subjected to Poisson regression to identify the prevalence ratio.
Results: 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.
Conclusion: The risk of undernutrition is independently associated with worsened indicators of hospital rehabilitation in patients with COVID-19, including higher prevalence of mortality.
{"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":null,"pages":null},"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}
Pub Date : 2023-12-01Epub Date: 2024-01-10DOI: 10.1080/21548331.2023.2287431
Fnu Jaydev, Warren Gavin, Jason Russ, Emily Holmes, Vinod Kumar, Joshua Sadowski, Areeba Kara
Background: Discharges against medical advice (DAMA) increase the risk of death.
Methods: We retrieved DAMA from five hospitals within a large health system and reviewed 10% of DAMA from the academic site between 2016 and 2021.
Results: DAMA increased at the onset of the pandemic. Patients who discharged AMA multiple times accounted for a third of all DAMA. Detailed review was completed for 278 patients who discharged AMA from the academic site. In this sample, women comprised 52% of those who discharged AMA multiple times. Relative to the proportion of all discharges from the academic site during the study period, Black patients were overrepresented among DAMA (21% vs. 34%, p < .05). Patients with multiple AMA discharges were younger, more likely to be unmarried, or have substance use disorders (SUD) than those who discharged AMA once. The most common reason for requesting premature discharge noted in n = 77, 28% of instances was related to patient obligations outside the hospital. Hospital policies and procedures contributed in n = 29, 10% of instances. Reasons for requesting premature discharge and documentation of key safety processes were similar by gender and race however the sample may be underpowered to detect differences. Capacity was evaluated in 109 (39%). Among those who consumed alcohol (n = 81 (29%)) or had SUDs (n = 112 (40%)), information on the amount or timing of last use was missing in n = 39 (48%) and n = 74 (66%), respectively. Critical tools to manage illness were provided in 45 (16%) of DAMA reviewed.
Conclusions: Drivers of AMA discharge may differ by AMA discharge frequency. Recognition of the common reasons for requesting premature discharge may help destigmatize AMA discharges and also identifies early assessments by social work colleagues as an important prevention strategy. Opportunities also exist in anticipating and preventing withdrawal symptoms and in revising hospital practices that contribute to DAMA.
背景:不遵医嘱出院(DAMA)增加死亡风险。方法:我们从一个大型卫生系统内的五家医院检索了DAMA,并回顾了2016-2021年间学术网站中10%的DAMA。结果:DAMA在大流行开始时增加。多次出院的患者占所有DAMA的三分之一。我们完成了278名从学术中心出院的AMA患者的详细回顾。在这个样本中,女性占多次服用AMA的患者的52%。相对于研究期间所有学术场所的出院比例,黑人患者在DAMA中的比例过高(21% vs.34%, p n = 77), 28%的病例与患者在医院外的义务有关。医院政策和程序占29.10%。要求提前出院和记录关键安全流程的原因在性别和种族上是相似的,但样本可能不足以发现差异。109家(39%)进行了容量评估。在饮酒者(n = 81(29%))或sud患者(n = 112(40%))中,分别有n = 39(48%)和n = 74(66%)缺少关于最后一次使用的数量或时间的信息。在审查的45个(16%)DAMA中提供了管理疾病的关键工具。结论:AMA放电的驱动因素可能因AMA放电频率而异。认识到要求提前出院的常见原因可能有助于消除AMA出院的污名,并确定社会工作同事的早期评估是一项重要的预防策略。在预测和预防戒断症状以及修订有助于DAMA的医院做法方面也存在机会。
{"title":"Discharges against medical advice: time to take another look. A retrospective review of discharges against medical advice focused on prevention.","authors":"Fnu Jaydev, Warren Gavin, Jason Russ, Emily Holmes, Vinod Kumar, Joshua Sadowski, Areeba Kara","doi":"10.1080/21548331.2023.2287431","DOIUrl":"10.1080/21548331.2023.2287431","url":null,"abstract":"<p><strong>Background: </strong>Discharges against medical advice (DAMA) increase the risk of death.</p><p><strong>Methods: </strong>We retrieved DAMA from five hospitals within a large health system and reviewed 10% of DAMA from the academic site between 2016 and 2021.</p><p><strong>Results: </strong>DAMA increased at the onset of the pandemic. Patients who discharged AMA multiple times accounted for a third of all DAMA. Detailed review was completed for 278 patients who discharged AMA from the academic site. In this sample, women comprised 52% of those who discharged AMA multiple times. Relative to the proportion of all discharges from the academic site during the study period, Black patients were overrepresented among DAMA (21% vs. 34%, <i>p</i> < .05). Patients with multiple AMA discharges were younger, more likely to be unmarried, or have substance use disorders (SUD) than those who discharged AMA once. The most common reason for requesting premature discharge noted in <i>n</i> = 77, 28% of instances was related to patient obligations outside the hospital. Hospital policies and procedures contributed in <i>n</i> = 29, 10% of instances. Reasons for requesting premature discharge and documentation of key safety processes were similar by gender and race however the sample may be underpowered to detect differences. Capacity was evaluated in 109 (39%). Among those who consumed alcohol (<i>n</i> = 81 (29%)) or had SUDs (<i>n</i> = 112 (40%)), information on the amount or timing of last use was missing in <i>n</i> = 39 (48%) and <i>n</i> = 74 (66%), respectively. Critical tools to manage illness were provided in 45 (16%) of DAMA reviewed.</p><p><strong>Conclusions: </strong>Drivers of AMA discharge may differ by AMA discharge frequency. Recognition of the common reasons for requesting premature discharge may help destigmatize AMA discharges and also identifies early assessments by social work colleagues as an important prevention strategy. Opportunities also exist in anticipating and preventing withdrawal symptoms and in revising hospital practices that contribute to DAMA.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138296091","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}
Pub Date : 2023-10-01Epub Date: 2023-11-16DOI: 10.1080/21548331.2023.2267983
Rodrigo Lami Pereira, Leyla Bojanini Molina, Kaeli Wilger, Mary S Hedges, Leila Tolaymat, Clare Haga, Ashley Walker, Melinda Gillis, Mingyuan Yin, Nancy L Dawson
Objective: Delirium is a clinical diagnosis that can occur frequently in hospitalized patients. A retrospective study was completed to identify the incidence of patients aged greater than 65 developing delirium during hospitalization.
Methods: This study was conducted at a single tertiary care teaching hospital. Charts of discharged patients from November to December 2018 were evaluated and patients less than age 65 or with delirium present on admission were excluded. The search terms altered, delirium, encephalopathy, and confusion were used to identify patients who developed delirium during the hospitalization. Characteristics of the patients with delirium were also collected.
Results: The incidence of new-onset delirium in patients over age 65 during hospitalization was 10%. Patients who developed delirium during their hospital stay were found to have a higher risk of mortality (p = 0.0028) and severity of illness (p = 0.014). A strong correlation between the length of stay (LOS) and incidence of delirium was also noted.
Conclusion: The strong correlation between a longer LOS and a higher incidence of delirium should guide the development of new innovative strategies to shorten the LOS and thus reduce the risk of delirium, in high-risk older hospitalized patients.
{"title":"New-onset delirium during hospitalization in older adults: incidence and risk factors.","authors":"Rodrigo Lami Pereira, Leyla Bojanini Molina, Kaeli Wilger, Mary S Hedges, Leila Tolaymat, Clare Haga, Ashley Walker, Melinda Gillis, Mingyuan Yin, Nancy L Dawson","doi":"10.1080/21548331.2023.2267983","DOIUrl":"10.1080/21548331.2023.2267983","url":null,"abstract":"<p><strong>Objective: </strong>Delirium is a clinical diagnosis that can occur frequently in hospitalized patients. A retrospective study was completed to identify the incidence of patients aged greater than 65 developing delirium during hospitalization.</p><p><strong>Methods: </strong>This study was conducted at a single tertiary care teaching hospital. Charts of discharged patients from November to December 2018 were evaluated and patients less than age 65 or with delirium present on admission were excluded. The search terms altered, delirium, encephalopathy, and confusion were used to identify patients who developed delirium during the hospitalization. Characteristics of the patients with delirium were also collected.</p><p><strong>Results: </strong>The incidence of new-onset delirium in patients over age 65 during hospitalization was 10%. Patients who developed delirium during their hospital stay were found to have a higher risk of mortality (<i>p</i> = 0.0028) and severity of illness (<i>p</i> = 0.014). A strong correlation between the length of stay (LOS) and incidence of delirium was also noted.</p><p><strong>Conclusion: </strong>The strong correlation between a longer LOS and a higher incidence of delirium should guide the development of new innovative strategies to shorten the LOS and thus reduce the risk of delirium, in high-risk older hospitalized patients.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41104228","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}
Pub Date : 2023-10-01Epub Date: 2023-11-16DOI: 10.1080/21548331.2023.2274307
Lily L Ackermann, Eric S Schwenk, Chris J Li, John R Vaile, Howard Weitz
Objectives: To determine if a multidisciplinary pathway focused on non-opioid pain management, delirium assessment, and resource utilization improved outcomes in geriatric hip fracture patients. The goal was to reduce opioid usage, consultation not congruent with guidelines, and increase use of regional anesthesia to reduce delirium and improve outcomes.
Methods: An observational study was performed on hip fracture patients before and after the intervention. Hospitalists were educated on indications for preoperative cardiac consultation and specialized preoperative cardiac testing according to evidence-based guidelines with the inpatient cardiology service. Additional education on multimodal analgesia, limiting opioids, and peripheral nerve blocks was provided by the acute pain service. Pre-intervention outcomes from 1 July 20171 July 2017 to 31 May 201831 May 2018 (N = 92) were compared to post-intervention outcomes from 1 July 20181 July 2018 to 31 May 201931 May 2019 (N = 98) and included delirium, length of stay, 30-day readmission rate, time from arrival to procedure start time, time to first physical therapy session, and completion of cardiology consult time. We examined adherence, use of nerve blocks, and pre- and post-operative pain scores and opioid use.
Results: Delirium was reduced from 50.0% (N = 46/92) to 28.6% (N = 28/98); p = 0.002. Postoperative opioid use (IV morphine milligram equivalents) decreased from an average of 57.2 mg (±67.7) to 42.6 mg (±58.2),P < .0001. There was a significant decrease in mean pre-operative (5.4 ± 4.14 to 5.05 ± 2.8, P < .0001) and post-operative pain scores (4.3 ± 5.2 to 3.2 ± 2.2, P < .0001). There was a significant reduction in time to cardiology consultation from 18 h] to 12 h ; p < .001).
Conclusions: A multidisciplinary collaboration between hospitalists, anesthesiologists, and cardiologists for hip fracture patients was associated with a reduction in pain and delirium and time to cardiologist evaluation. Prospective studies focusing on additional patient-centered outcomes are warranted.
目的:确定专注于非阿片类药物疼痛管理、谵妄评估和资源利用的多学科途径是否能改善老年髋部骨折患者的预后。目标是减少阿片类药物的使用,咨询不符合指南,并增加区域麻醉的使用,以减少谵妄并改善结果。方法:对髋部骨折患者进行干预前后的观察研究。根据住院心脏病学服务的循证指南,对住院医生进行了术前心脏咨询和专门术前心脏测试的适应症教育。急性疼痛服务提供了关于多模式镇痛、限制性阿片类药物和外周神经阻滞的额外教育。2017年7月1日至2018年5月31日干预前结果(N = 92)与2018年7月1日至2018年5月31日干预后的结果进行了比较9312019年5月(N = 98),包括谵妄、住院时间、30天再次入院率、从到达到手术开始的时间、到第一次物理治疗的时间以及完成心脏病学咨询的时间。我们检查了依从性、神经阻滞的使用、术前和术后疼痛评分以及阿片类药物的使用情况。结果:谵妄从50.0%(N = 46/92)至28.6%(N = 28/98);p = 0.002。术后阿片类药物的使用量(静脉注射吗啡毫克当量)从平均57.2下降 mg(±67.7)至42.6 mg(±58.2),P P P p 结论:髋部骨折患者的住院医生、麻醉师和心脏病专家之间的多学科合作与疼痛和谵妄的减少以及心脏病专家评估的时间有关。有必要对以患者为中心的其他结果进行前瞻性研究。
{"title":"The effects of a multidisciplinary pathway for perioperative management of patients with hip fracture.","authors":"Lily L Ackermann, Eric S Schwenk, Chris J Li, John R Vaile, Howard Weitz","doi":"10.1080/21548331.2023.2274307","DOIUrl":"10.1080/21548331.2023.2274307","url":null,"abstract":"<p><strong>Objectives: </strong>To determine if a multidisciplinary pathway focused on non-opioid pain management, delirium assessment, and resource utilization improved outcomes in geriatric hip fracture patients. The goal was to reduce opioid usage, consultation not congruent with guidelines, and increase use of regional anesthesia to reduce delirium and improve outcomes.</p><p><strong>Methods: </strong>An observational study was performed on hip fracture patients before and after the intervention. Hospitalists were educated on indications for preoperative cardiac consultation and specialized preoperative cardiac testing according to evidence-based guidelines with the inpatient cardiology service. Additional education on multimodal analgesia, limiting opioids, and peripheral nerve blocks was provided by the acute pain service. Pre-intervention outcomes from 1 July 20171 July 2017 to 31 May 201831 May 2018 (<i>N</i> = 92) were compared to post-intervention outcomes from 1 July 20181 July 2018 to 31 May 201931 May 2019 (<i>N</i> = 98) and included delirium, length of stay, 30-day readmission rate, time from arrival to procedure start time, time to first physical therapy session, and completion of cardiology consult time. We examined adherence, use of nerve blocks, and pre- and post-operative pain scores and opioid use.</p><p><strong>Results: </strong>Delirium was reduced from 50.0% (<i>N</i> = 46/92) to 28.6% (<i>N</i> = 28/98); <i>p</i> = 0.002. Postoperative opioid use (IV morphine milligram equivalents) decreased from an average of 57.2 mg (±67.7) to 42.6 mg (±58.2),<i>P</i> < .0001. There was a significant decrease in mean pre-operative (5.4 ± 4.14 to 5.05 ± 2.8, <i>P</i> < .0001) and post-operative pain scores (4.3 ± 5.2 to 3.2 ± 2.2, <i>P</i> < .0001). There was a significant reduction in time to cardiology consultation from 18 h] to 12 h ; <i>p</i> < .001).</p><p><strong>Conclusions: </strong>A multidisciplinary collaboration between hospitalists, anesthesiologists, and cardiologists for hip fracture patients was associated with a reduction in pain and delirium and time to cardiologist evaluation. Prospective studies focusing on additional patient-centered outcomes are warranted.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486827","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}
Pub Date : 2023-10-01Epub Date: 2023-07-28DOI: 10.1080/21548331.2023.2241344
Israel Abebrese Sefah, David Nyamadi, Amanj Kurdi, Amos Adapalala Bugri, Frances Kerr, Peter Yamoah, Giuseppe Pichierri, Brian Godman
Objective: There is a need to assess the quality of antimicrobial prescribing in hospitals as a first step toward improving future prescribing to reduce antimicrobial resistance (AMR). This is in line with Ghana's National Action Plan.
Methods: A point prevalence survey of antimicrobial use was undertaken at the adult medical, surgical, and pediatric wards of Tamale Teaching Hospital using the standardized Global Point Prevalence Survey (GPPS) tool. Key target areas include adherence to current guidelines, limiting the prescribing of 'Watch' antibiotics with their greater resistance potential, and limiting the prescribing of antibiotics post-operatively to prevent surgical site infections (SSIs).
Results: Out of 217 patients' medical records assessed, 155 (71.4%) patients were prescribed antimicrobials. The rates were similar among children (73.9%) and adults (70.3%). Most of the antibiotics prescribed were in the WHO 'Watch' group (71.0%) followed by those in the 'Access' group (29%). Out of the 23 cases indicated for surgical antimicrobial prophylaxis to prevent SSIs, the majority (69.6%) were given doses for more than 1 day, with none receiving a single dose. This needs addressing to reduce AMR and costs. Guideline compliance with the current Ghanaian Standard Treatment Guidelines (GSTG) for managing infections was also low (28.7%). The type of indication was the only independent predictor of guideline compliance (aOR = 0.013 CI 0.001-0.127, p-value = 0.001).
Conclusion: Given current concerns with antimicrobial prescribing in this hospital, deliberate efforts must be made to improve the appropriateness of prescribing to reduce AMR via targeted antimicrobial stewardship programs.
目的:有必要对医院抗菌药物处方质量进行评估,作为改善未来处方以减少抗菌药物耐药性(AMR)的第一步。这符合加纳的国家行动计划。方法:采用标准化的全球点流行率调查(GPPS)工具,对Tamale教学医院成人内科、外科和儿科病房的抗菌药物使用情况进行点流行调查。关键目标领域包括遵守现行指南,限制使用耐药潜力较大的“观察”抗生素,以及限制术后使用抗生素以预防手术部位感染。结果:在217例患者的医疗记录中,155例(71.4%)患者获得了抗菌素处方。儿童(73.9%)和成人(70.3%)的发病率相似。大多数抗生素处方在世卫组织“观察”组(71.0%),其次是“获取”组(29%)。在23例需要外科抗菌药物预防ssi的病例中,大多数(69.6%)的用药时间超过1天,没有人接受单剂治疗。这需要解决,以减少抗菌素耐药性和成本。现行加纳标准治疗指南(GSTG)在管理感染方面的指南依从性也很低(28.7%)。适应症类型是指南依从性的唯一独立预测因子(aOR = 0.013 CI 0.001-0.127, p值= 0.001)。结论:鉴于该医院目前对抗菌药物处方的担忧,必须有意识地努力通过有针对性的抗菌药物管理项目来提高处方的适宜性,以减少抗生素耐药性。
{"title":"Assessment of the quality of antimicrobial prescribing among hospitalized patients in a teaching hospital in Ghana: findings and implications.","authors":"Israel Abebrese Sefah, David Nyamadi, Amanj Kurdi, Amos Adapalala Bugri, Frances Kerr, Peter Yamoah, Giuseppe Pichierri, Brian Godman","doi":"10.1080/21548331.2023.2241344","DOIUrl":"10.1080/21548331.2023.2241344","url":null,"abstract":"<p><strong>Objective: </strong>There is a need to assess the quality of antimicrobial prescribing in hospitals as a first step toward improving future prescribing to reduce antimicrobial resistance (AMR). This is in line with Ghana's National Action Plan.</p><p><strong>Methods: </strong>A point prevalence survey of antimicrobial use was undertaken at the adult medical, surgical, and pediatric wards of Tamale Teaching Hospital using the standardized Global Point Prevalence Survey (GPPS) tool. Key target areas include adherence to current guidelines, limiting the prescribing of 'Watch' antibiotics with their greater resistance potential, and limiting the prescribing of antibiotics post-operatively to prevent surgical site infections (SSIs).</p><p><strong>Results: </strong>Out of 217 patients' medical records assessed, 155 (71.4%) patients were prescribed antimicrobials. The rates were similar among children (73.9%) and adults (70.3%). Most of the antibiotics prescribed were in the WHO 'Watch' group (71.0%) followed by those in the 'Access' group (29%). Out of the 23 cases indicated for surgical antimicrobial prophylaxis to prevent SSIs, the majority (69.6%) were given doses for more than 1 day, with none receiving a single dose. This needs addressing to reduce AMR and costs. Guideline compliance with the current Ghanaian Standard Treatment Guidelines (GSTG) for managing infections was also low (28.7%). The type of indication was the only independent predictor of guideline compliance (aOR = 0.013 CI 0.001-0.127, p-value = 0.001).</p><p><strong>Conclusion: </strong>Given current concerns with antimicrobial prescribing in this hospital, deliberate efforts must be made to improve the appropriateness of prescribing to reduce AMR via targeted antimicrobial stewardship programs.</p>","PeriodicalId":35045,"journal":{"name":"Hospital practice (1995)","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10257821","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}