Current Issue : July - September Volume : 2020 Issue Number : 3 Articles : 7 Articles
Background: Tuberculosis (TB) treatment loss to follow up (LTFU) plays an important contributory role to the\nstaggering TB epidemic in South Africa. Reasons for treatment interruption are poorly understood. Treatment\ninterruption appears to be the culmination of poor health literacy of patients and inadequate health education\nprovided by clinicians. We explored clinician and patient perspectives of the gaps in TB messaging that influence\nTB treatment LTFU.\nMethods: We conducted semi-structured in-depth interviews between January and May 2018 with a sample of 15\nclinicians managing TB and 7 patients identified as LTFU in public clinics in the Free State Province, South Africa.\nThematic analysis using a mixed deductive/inductive thematic approach was used.\nResults: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU.\nPatients felt that the TB messaging received was inadequate. Many of the clinicians interviewed felt that improving\npatientâ??s TB knowledge would reinforce adherence to treatment and thus focused on sharing information on\ntreatment completion, side effects and infection control. However, the inability of clinicians to establish rapport\nwith patients or to identify social support challenged TB treatment adherence by patients. Clinicians perceived this\nas patients not following their instructions despite what they considered lengthy TB education. Having said this,\nclinicians concurred that their medical management of TB lacked the psycho-social dimension to treat a social\ndisease of this magnitude.\nConclusions: Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment\nLTFU. Clinicians concurred that poor patient understanding of TB and that biomedical management lacking a\npsycho-social dimension further exacerbated the poor treatment outcome. TB remains a social disease, the\nsuccessful management of which hinges on patient-centred care....
Background. Measuring physical activity behaviours of stroke survivors in the inpatient setting is challenging. Authors of\nobservational studies of early poststroke report that stroke survivors are â??inactive and aloneâ?. Using activity monitoring devices\nmay help refine clinical practice and inform therapeutic activity targets. Aim. To measure the physical activity behaviour of\nstroke survivors during acute inpatient hospitalisation. We hypothesized that greater levels of inactivity would be positively\nassociated with stroke severity and age. Method. Using a cross-sectional study design, consecutive stroke patients admitted to an\nacute stroke unit (Geelong, Australia) and recruited within 48 hours of admission had their physical activity recorded using an..............
Background. Emergency department (ED) overcrowding is a worldwide problem that poses a threat to patient safety by causing\ntreatment delays and increasing mortality. Consultations are common and important in the emergency medicine profession and\nare associated with longer ED length of stay (LOS). The purpose of this study was to evaluate the impact of admission decisions by\nemergency physicians without consultations on the ED LOS and other quality indicators. Methods. The study was a retrospective\nobservational study comparing the ED LOS of patients admitted to the internal medicine (IM) department before and after the\npolicy change regarding admission decisions that was implemented in October 2016. During and after the policy change,\nemergency physicians decided how to arrange for and treat medical patients by processing their admission and providing followup\ncare without consultations. The ED LOS and other indicators of patients admitted to the IM department were compared\nbetween the study period (January to June 2017) and the control period (January to June 2016). Results. The median ED LOS of\npatients admitted to the IM department decreased from 673 (IQR: 347â??1,369) minutes in the control period to 237 (IQR: 166â??364)\nminutes in the study period. There were no significant differences in the interdepartmental transfer rate or in-hospital mortality\nbetween the two periods. Conclusions. Theadmission decisions regarding medical patients made by emergency physicians without\nspecialty consultations reduced the ED LOS without a significant negative effect on mortality or hospital LOS....
Background: The likelihood of inpatient mortality has been found to be reduced by increased nurse staffing in\nseveral settings, including general wards, emergency departments, and intensive care units. However, less research\nhas investigated cases where patients die in the community setting due to a health problem that occurred after\nthey were discharged post-surgery, because it is difficult to integrate hospital data and local community data.\nTherefore, this study investigated the association between the bed-to-nurse ratio and 30-day post-discharge\nmortality in patients undergoing surgery using national administrative data.\nMethods: The study analyzed data from 129,923 patients who underwent surgery between January 2014 and\nDecember 2015. The bed-to-nurse ratio was categorized as level 1 (less than 2.5), level 2 (2.5â??3.4), level 3 (3.5â??4.4),\nand level 4 (4.5 or greater). The chi-square test and GEE logistic regression analyses were used to explore the\nassociation between the bed-to-nurse ratio and 30-day post-discharge mortality.\nResults: 1355 (0.01%) patients died within 30 days post-discharge. The 30-day post-discharge mortality rate in\nhospitals with a level 4 was 2.5%, representing a statistically significant difference from the rates of 0.8, 2 and 1.8%\nin hospitals with level 1, level 2, and level 3 staffing, respectively. In addition, the death rate was significantly lower\nat hospitals with a level 1 (OR = 0.62) or level 2 (OR = 0.63) bed-to-nurse ratio, using level 4 as reference.\nConclusion: The results of this study are highly meaningful in that they underscore the necessity of in-hospital\ndischarge nursing and continued post-discharge nursing care as a way to reduce post-discharge mortality risk.\nFurthermore, the relationship between nurse staffing levels and 30-day post-discharge mortality implies the need\nfor a greater focus on discharge education. Policies are required to achieve proper nurse staffing levels in Korea,\nand thereby to enhance patient outcomes....
Background: Pyogenic liver abscess (PLA) is an inflammatory disease with increasing incidence. When it occurs\nwith diabetes mellitus (DM), the risk of recurrence and mortality may increase. However, the effect of DM on the\nshort-term prognosis of PLA patients after hospitalization remained unknown.\nMethods: Two hundred twenty-seven PLA patients who received treatment at the First Affiliated Hospital of Xiâ??an\nJiaotong University from January 2011 to January 2018 were retrospectively enrolled. They were divided into two\ngroups as the DM group (n = 61) and the Non-DM group (n = 166). In the DM group, HbA1C level < 7% was\nconsidered to be good-control of glycaemia (n = 23). The clinical characteristics and overall short-term survival were\nanalyzed.\nResults: The proportion of PLA patients with DM was 26.87%. In the DM group, there was a higher incidence of\nhypertension and Candida spp. infection. Conservative administration and percutaneous drainage were mainly used\nin patients with good- (60.87%) and poor-control (60.53%) of glycaemia, respectively. During follow-up, 24 (10.57%)\ndied due to uncontrolled systemic infections and other serious complications. Compared with PLA patients without\nDM, patients in the DM group had significantly increased 6-month mortality rate after discharge (Log-Rank test, P =\n0.021). Poor-control of glycaemia did not reduce the six-month survival, while the recurrence rate of PLA within 3\nmonths showed an almost 3-fold increase (13.16% vs. 4.35%). Further multivariate analyses found that DM was the\nonly independent risk factor for the PLA six-month survival (odds ratio [OR]: 3.019, 95% confidence interval [CI]:\n1.138â??8.010, P = 0.026). However, the blood glucose level had no significant effect on the short-term survival of PLA\npatients with DM (Log-Rank test, P = 0.218)....
Pain is one of the commonest reasons why children visit the hospital. Inadequately treated pain in children can negatively\naffect their physical, psychological, and social well-being; it also places financial burden on families of affected children and\nhealthcare systems in general. Considering the eventual suffering of vulnerable children and their families if nursing students\nare insufficiently educated and ill-prepared, the current study aimed at assessing final year nursing studentâ??s knowledge and\nattitudes pertaining to pediatric pain. A descriptive cross-sectional study was conducted among 100 final year undergraduate\nnursing students at a private university college in Ghana. In addition to their ages and gender, the students responded to the\n42 individual items on the Pediatric Nursesâ?? Knowledge and Attitudes Survey regarding pain (PNKAS) instrument. Descriptive\nstatistical analysis was aided by the Statistical Package for Social Sciences version 25 software. The mean age of the\nfinal year nursing students was 29 years (range of 21 to 47 years); a majority of them were females (78%). Participants had an\naverage (SD) correct answer score of 44.0% (10.6%). Good pediatric pain knowledge and attitudes were observed in items that\nwere related to the individualized and multidimensional nature of the pain experience and its treatment, benefits of preemptive\nanalgesia, pharmacodynamics, and pain assessment. Poor pediatric pain knowledge and attitudes occurred in items\nthat focused on pain perceptions, opioid drug administration, useful pain medications, pain physiology, and nonpharmacological\npain management interventions. Final year nursing students have insufficient knowledge and attitudes\ntoward childrenâ??s pain management. Areas of good and poor pediatric pain knowledge and attitudes should be considered\nwhen designing and implementing educational interventions on this subject. Curricular revisions should be made on existing\nnursing curriculum to lay more emphasis on childrenâ??s pain management and use educational interventions that support\nknowledge translation for improved care....
This study provided an update concerning programs for reduction of inpatient\nlengths of stay in the three Syracuse hospitals. The study included evaluation\nof the impact of these programs by severity of illness. The Difficult to\nPlace program involved the identification of patients with extended stays in\nthe hospitals because of the need for long term care services in the community.\nA community wide list of Difficult to Place patients was distributed by the\nHospital Executive Council each week. In addition, the Syracuse hospitals and\nthe Hospital Executive Council implemented the Subacute and Complex Care\nPrograms for patients with extended stays. These inpatients included those\nwho required expensive medication or patients with infectious diseases and\noffsite transportation. The study data indicated that Difficult to Place patients\nin the combined Syracuse hospitals amounted to 20.4 - 20.5 percent of new\nadmissions to nursing homes between 2017 and 2019. The data also demonstrated\nthat the number of Subacute and Complex Care patients for the combined\nhospitals amounted to 5.7 to 6.6 percent of the Difficult to Place populations.\nThe study data indicated that adult medicine lengths of stay declined\nby 0.10 patient days, from 4.91 to 4.81 days between 2017 and 2019, a reduction\nof 12,622 patient days or an average daily census of 34.6. The study data\nindicated that adult surgery lengths of stay declined by 0.22 patient days,\nfrom 5.55 to 5.33 days between 2017 and 2019, a reduction of 8681 patient\ndays, or an average daily census of 23.8....
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