Hospital practice (1995)最新文献

Objectives: Trauma poses a significant health burden in Saudi Arabia, with high rates of morbidity and mortality rates. We evaluated the trends among trauma team (TT) physicians in Saudi Arabia regarding their awareness and referral practices for percutaneous endovascular arterial embolization (EAE) in bleeding patients.

Methods: A 13-question survey developed by consultants from various specialties assessed the knowledge of TT physicians regarding decision-making and appropriate approaches for managing traumatic bleeding. The surveys were administered in person to 135 TT physicians.

Results: Among them, 38.52% had five or more years of independent practice, and 87.41% routinely encountered patients with bleeding patients. Physicians who routinely treated patients with bleeding patients exhibited higher median scores, in line with current management standards (p = 0.634). Tertiary care physicians and academic- and military-affiliated physicians exhibited higher median scores (p =  <0.001 and p < 0.006, respectively). Amongst TT physicians, 47.41% preferred EAE for unstable pelvic ring fractures with active bleeding, while 68.15% favored splenectomy for unstable patients with grade V splenic injuries. For traumatic aortic injuries, 67.42% considered TEVAR/EVAR safer options. Notably, 84.44% viewed an INR > 3 as a contraindication for EAE in hemodynamically stable patients. General surgeons scored the highest in management decision-making, followed by neurosurgeons (p = 0.001). Orthopedics, emergency medicine, intensive care (ICU), and anesthesia specialists exhibited similarly high median scores for appropriate management approaches (p = 0.003). Overall, general surgeons, orthopedic surgeons, and ICU specialists exhibited the highest median correct responses, adhering to the current standard of practice (p = 0.001).

Conclusions: To address the potentially life-threatening condition of traumatic bleeding, raising awareness of the appropriate management and referral patterns for EAE is crucial.

Introduction: Venous thromboembolism, including deep vein thrombosis and pulmonary embolism, is the third leading cause of death from cardiovascular conditions. Very limited research has been done on venous thromboembolism prevention in clinical practice in orthopedic surgery patients in Ethiopia. Thus, this study aims to evaluate the prevention practice against venous thromboembolism and its identified associated factors among orthopedic surgery patients.

Method: A cross-sectional study was conducted among orthopedic surgery patients. The appropriateness of prevention practice was evaluated using the 2012 VTE guidelines from the American College of Chest Physicians. This guideline helps as a blueprint to determine whether the available prevention strategies are in line with the standard recommendation for providing better patient care. Data was entered using Epidata 7 and exported to SPSS version 25. In a multivariate logistic regression model, a p-value ≤0.05 was used to claim statistical significance.

Result: From a total of 375 study subjects, the majority (88.3%) were males, and the mean age was 29 ± 10.4 years. Overall, 176 (46.4%) participants received appropriate venous thromboembolism prevention practices. Unfractionated heparin was the most widely used thromboprophylaxis regimen. Having restricted mobility (low level of physical activity) [AOR = 9.73 (95% CI 2.0-45.7, p = 0.004)], being bedridden [AOR = 8.86 (95% CI 2.0-39.2, p = 0.01)] and having ASA classification score of >3 [AOR = 9.6 (95% CI 1.7-52.1, p = 0.009)] were associated with inappropriate VTE prevention practice.

Conclusion: Our study revealed that only 46.4% orthopedic surgical patients at risk of developing venous thromboembolism received adequate VTE prevention practices. Factors that contribute to inadequate prevention include low levels of physical activity, bedridden, and higher ASA classification scores. Hence, by addressing these risk factors and increasing awareness and application of standard VTE prevention protocols, it's possible to reduce contributing factors, improve the utilization of thromboprophylaxis, and lower the rate of VTE.

Objectives: Influenza is a viral infection, and the inappropriate use of antibiotics in its management is a global challenge. This study focused on antibiotic prescription patterns in patients with influenza symptoms and the level of compliance with international guidelines.

Methods: This retrospective, one-year cross-sectional study included patients with influenza symptoms admitted to a tertiary teaching hospital in Iran. The antibiotic prescription patterns were compared with the recommendations of the Infectious Diseases Society of America and the American Thoracic Society. In addition, the effects of antibiotic use on ICU admission, the need for vasopressors and mechanical ventilation, and mortality rates were assessed.

Results: Data were obtained from the hospital records of 102 patients with influenza admitted during the study period. Of these, 92 (89.2%) received antibiotics, whereas only 66 (64.7%) were eligible according to the guidelines. The guideline adherence rate was only 17.6% after evaluating the type, dose, and duration of antibiotic treatment. Our findings showed that regardless of other treatment modalities, timely use of antibiotics in eligible patients was associated with reduced mortality (59.6% vs. 23.9%, p = 0.04).

Conclusion: Our findings indicated a tendency toward antibiotic overuse in treating influenza, with clinical practice not adhering to guideline recommendations in most patients. Nevertheless, the timely use of antibiotics in eligible patients was associated with reduced mortality.

Introduction: Decisions about whether to admit patients with pulmonary embolism (PE) are often guided by risk stratification tools, such as the simplified Pulmonary Embolism Severity Index (sPESI). Patients deemed low-risk are typically treated as outpatients; however, some still experience complications. This study compares characteristics of low-risk PE patients managed as outpatients versus inpatients and evaluates patient-level factors associated with admission decisions.

Methods: We conducted a retrospective cohort study of adults (≥18 years) with objectively confirmed acute PE diagnosed between 1 June 2014, and 31 May 2019. Patients classified as low-risk (sPESI = 0) and without right ventricular dysfunction (RVD) were included. Clinical data were abstracted from records, and patients were categorized by initial sites of care (inpatient versus outpatient). Data analysis included descriptive statistics as well as multivariate logistic regression to identify factors associated with hospitalization.

Results: Of 229 eligible patients, 140 (61.1%) were admitted, and 89 (38.9%) managed as outpatients. Baseline characteristics were similar between groups; however, hospitalized patients often had heart rates (HR) ≥90 beats per minute (bpm), lower oxygen saturation, and more medical conditions requiring inpatient care. Among low-risk patients, HR 90-109 bpm (OR 1.78, 95% CI: 1.10-3.04), oxygen saturation between 90% and 94% (OR 1.10, 95% CI: 1.01-1.27), and medical indications for hospitalization >24 hours (OR 33.97, 95% CI: 8.47-236.09) were significantly associated with admission.

Conclusions: Although classified as low-risk, over half of patients with acute PE were hospitalized. Elevated HR, reduced oxygen saturation, and comorbid conditions significantly influenced site-of-care decisions in this population. Outpatient management was associated with comparable 90-day safety outcomes, reinforcing its viability when patients are appropriately selected.

Introduction: Alectinib, a second-generation anaplastic lymphoma kinase (ALK) inhibitor, is pivotal in managing ALK-positive non-small cell lung cancer (NSCLC) due to its efficacy and favorable safety profile. However, severe renal toxicity, including acute kidney injury (AKI), remains a rare but significant adverse effect.

Case report: We present the case of a 71-year-old female with a history of diabetes and recently diagnosed ALK-positive NSCLC. She had been on alectinib therapy (600 mg twice daily) for two months. The patient was admitted with symptoms of shortness of breath and anuria. Initial laboratory results revealed a significant rise in serum creatinine from a baseline of 1.0 mg/dL to 3.64 mg/dL, indicating AKI. Alectinib was discontinued, and the patient underwent a single session of hemodialysis. The patient exhibited rapid clinical improvement with significant recovery of renal function, and she was discharged without the need for further dialysis. A subsequent switch to brigatinib was well-tolerated, with stable renal function observed at the 4-month follow-up.

Conclusion: This case underscores the potential for severe AKI associated with alectinib therapy, highlighting the importance of vigilant renal function monitoring in patients undergoing treatment, especially those with predisposing conditions. Early recognition and prompt intervention are crucial to mitigate renal complications and optimize patient outcomes. Brigatinib may serve as a suitable alternative for patients intolerant to alectinib.

Objectives: In patients hospitalized following hip fracture, basic mobility status early after surgery and at discharge is associated with long-term outcomes. Getting in and out of bed is the basic mobility activity identified as one of the most challenging. Therefore, this study described strategies used by patients when getting in and out of bed early after hip fracture surgery.

Methods: We conducted an observational cross-sectional study (the HIP-ME-UP cohort; NCT05756517) at Copenhagen University Hospital Hvidovre. We filmed patients getting in and out of bed during physiotherapy sessions on post operative days 3-5 by using an iPad. We analyzed the recordings using a quantitative film analysis with all recordings structured into three phases: preparation, lie-to-sit (out of bed)/sit-to-lie (into bed) and positioning.

Results: 42 patients (23 women) with a mean (SD) age of 78.7 (7.6) years were enrolled. For getting out of bed, we identified five strategies in the preparation phase, seven strategies in the lie-to-sit phase, and two strategies in the positioning phase. For getting into bed, we identified five strategies within each of the three phases. The choice of strategies for patients who were independent in getting in/out of bed was similar to patients in need of assistance.

Conclusion: Patients hospitalized following hip fracture surgery use different strategies when getting in and out of bed. Patients requiring assistance and those being independent used similar strategies, which suggests that it is important to tailor rehabilitation to each patient's specific needs rather than their level of independence.

Clinical trial registration: www.clinicaltrials.gov identifier is NCT05756517.

Objectives: This study delves into implementing Global Provider's phone-lessness phobia (Global 3-P Study) within the healthcare sector in Africa through a multinational, cross-sectional, web-based survey from April 1st to 30 June 2023.

Methods: Utilizing a modified Nomophobia Questionnaire (NMP-Q), the research explores four dimensions of nomophobia: the inability to communicate, loss of connectedness, difficulty accessing information, and sacrificing convenience. The Global Remote Research Scholars Program (GRRSP) conducted the study, employing a 'snowball technique' for survey dissemination.

Results: A total of 1636 responses were collected from healthcare professionals in Africa, predominantly aged 26-45, with a majority identifying as Black-African (86.5%) and residing mainly in Kenya (61.6%). The survey revealed a higher prevalence of Android smartphone users (71.4%) than Apple iOS (25.6%). Participants reported spending substantial time on personal (3.1-5 hours) and work-related (up to 3 hours) smartphone activities. A significant portion of respondents felt uncomfortable (74.3%), annoyed (72.0%), and nervous (61.4%) at the prospect of not having constant smartphone access to information. Concerns about disruptions to smartphone connections, such as running out of battery or data, were prevalent among participants. Analysis of nomophobia levels revealed that 46.9% experienced moderate Nomophobia Level I and 41.1% reported severe levels, while Nomophobia Level II was reported by 51.8% with moderate levels and 37.2% with severe levels. Comparative analysis based on gender and age groups showed statistically significant differences. Males exhibited lower severity levels of nomophobia compared to females, and the 36-45 age group reported the highest prevalence of severe nomophobia.

Conclusion: This study highlights the significant impact of nomophobia among healthcare professionals in Africa, indicating a need for interventions to mitigate its effects and promote healthy smartphone habits in this critical sector.

Objectives: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce cardiovascular death and heart failure (HF) hospitalizations in patients with reduced and mildly reduced or preserved ejection fraction. This study assesses the effectiveness of SGLT2 inhibitors in reducing HF readmission rates and examines prescription patterns in hospitalized patients.

Methods: This single-center retrospective cross-sectional study evaluated the impact of SGLT2 inhibitors on HF readmission rates when initiated during index hospitalization or within 14 days of discharge. Patients were divided into an SGLT2 group and a non-SGLT2 group, with 6-month readmission rates compared to the groups.

Results: Of the 234 patients, 85 (36.3%) were prescribed SGLT2 inhibitors, while 149 (63.7%) were not. SGLT2 inhibitors were prescribed less frequently to patients with chronic kidney disease (CKD) and patients admitted under cardiology services were more likely to receive SGLT2 inhibitors. Among those prescribed SGLT2 inhibitors, the median ejection fraction was significantly lower compared to those not prescribed, while the median estimated glomerular filtration rate was higher. There were 107 total readmissions (45.7%), with most (55%) occurring within 30 days of the index hospitalization. Total readmissions and 30-day readmissions were significantly lower in the SGLT2 inhibitor group (31.8% vs 53.7%, p = 0.001) and (33.33% vs 62.50%, p = 0.029), respectively. Heart failure readmissions were also lower in the SGLT2 group (29.6% vs 21.3%, p = 0.37).

Conclusion: Our study demonstrated a significant reduction in heart failure readmission rates among patients prescribed with SGLT2 inhibitors. However, we also observed a gap in the prescription of SGLT2 inhibitors.

Background: Seamless collaboration is key to effective healthcare, yet cross-sector partnerships often struggle due to structural and professional differences. This study aimed to explore the dynamics of cross-sector partnership through the experiences and perspectives of hospital physicians, general practitioners (GPs), and patients managing multiple chronic conditions.

Method: Data were gathered from 41 semi-structured interviews (14 hospital physicians, 10 GPs, and 17 patients with type 2 diabetes and at least one comorbidity). The Interpretive Description methodological approach guided the study, with the concept of Boundary Work providing the theoretical framework for examining how professional roles, boundaries, and collaboration were shaped and navigated across sectors.

Results: Four main themes were identified: (1) Mapping Current Collaboration: Contexts, Patients, and Channels, (2) Perceiving Collaboration: Positive Views and Shortcomings, 3) Expectations and Roles: Imbalanced Responsibilities, and 4) Tackling Collaboration Challenges and Acknowledging Barriers. Informants shared mixed views on cross-sector partnerships. While some reported successful collaboration, hospital physicians anticipated fewer patient referrals from GPs, whereas GPs often felt unsupported and left to handle complex cases alone. Cross-sector collaboration was widely perceived as frustrating and, at times, disappointing, highlighting the need for improvement.

Conclusion: Hospital physicians, GPs, and patients alike advocate for improved cross-sectoral collaboration. Despite strong interest in enhancing cooperation, there is a need for professional consensus on which complex cases require cross-sector involvement. Moreover, clarifying the distribution of responsibilities and addressing the practical dimensions of collaboration and patient engagement are crucial for improving outcomes.

Introduction: Interprofessional collaboration (IPC), involving multidisciplinary teams of physicians, nurses, pharmacists, and other allied healthcare professionals, has been recognized as a strategy to streamline patient management and reduce systemic inefficiencies. IPC may help reduce hospital wait times (HWT), patients' length of stay (LOS) while enhancing overall quality of care.

Objective: This study explores how IPC, patient demographics, and admission characteristics influence HWT and LOS.

Methods: Data were drawn from the 2022 National Hospital Ambulatory Medical Care Survey (NHAMCS), n = 2,121 admitted patients in the United States. Multiple linear regression models were used to analyze the associations between IPC, patient demographics, urgency of admission, admission characteristics, and hospital wait times and length of stay.

Results: Increased IPC was significantly associated with shorter HWT (p < 0.05) but a marginal increase in LOS (p < 0.05). High-urgency admission was associated with reduced HWT (p < 0.05). Older patients experienced modestly shorter waits (p < 0.001) but longer stays (p < 0.001). Admission to a stepdown unit correlated with longer wait times (p < 0.05).

Conclusions: Strengthening IPC and effectively managing high-urgency admissions may help reduce HWT. Further research is needed to explore why IPC is linked to longer hospital stays and how to optimize resource allocation in stepdown units. These insights hold prospects to guide strategies for improving hospital efficiency and patient experiences.