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AIM: The neutrophil-to-lymphocyte ratio (NLR) is commonly used as a prognostic indicator for microbiological and inflammatory conditions in clinical settings. However, the quotient to albumin levels, which is another nutritional and clinical predictor, may also have an interesting diagnostic and prognostic value. This study aimed to primarily investigate the predictive performances of the neutrophils to albumin and lymphocytes ratio (NALR) compared to the NLR in predicting poor outcomes during hospital admission, particularly the decomposition of respiratory, renal, liver, and circulatory systems, resulting in longer hospital stays or mortality. METHODS: An observational study was performed on a cohort of 270 hospitalised patients admitted to Rashid bin Al-Hussein Military Hospital during the period from October 2023 to early November 2023. The study specifically targeted adult patients (age >17 years) who had a minimum of 80% availability of their initial and follow-up data during admission. We dichotomised all eligible test patients into two groups: Group I, which represented better outcomes of interest, and Group II, which represented poorer outcomes of interest. Statistically, we conducted binary logistic, receiver operating, and sensitivity analyses to explore the predictive performances and indices for NALR and NLR. We also conducted chi-square and independent T analyses to uncover the distribution rates of the independent variables across Groups I and II. We considered a p-value of less than 0.05 as the level of significance. RESULTS: Out of a total sample size of 270, 82 patients (30.37%) were allocated to Group I, and 188 patients (69.63%) were allocated to Group II. Males outnumbered females in this study by 184 (68.1%) to 86 (31.9%). Patients in the study had an average age of 58.08±10.02 years. The average hospitalisation took 13.71±6.38 days, significantly longer in Group II compared to Group I (15.43±6.76 days vs. 9.77±2.69 days, p-value<0.05). We found that the area under the receiver operating characteristic (ROC) curves was estimated at [0.808±0.031 (0.748-0.868), p-value=0.000] and [0.667±0.034 (0.601-0.733), p-value=0.000] for NALR and NLR, respectively. The optimal operating thresholds for NALR and NLR were 1.5 and 5.37, with sensitivities and specificities of 86.7% versus 73.4% and 70.73% versus 70.73%, respectively. CONCLUSION: The proposed NALR showed superior predictive performance, sensitivity, and correlation compared to the parent NLR. Both tools can be used in clinical practice to prioritise clinical and pharmacotherapeutics for hospitalised patients based on unfavourable outcomes.
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AIM: In Japan, an additional system for patients with suspected or diagnosed dementia during hospitalization for physical illness began in 2016. We examined the clinical characteristics of older patients with suspected or diagnosed dementia during hospitalization. METHODS: The study participants consisted of 569 patients. Current age, sex, comorbidities, causative disease for admission, body mass index (BMI), blood tests, environment before admission, prescription history before admission and rate of delirium were examined. Simple regression analysis for high-frequency diseases was carried out with the respective risk factors as independent variables. Multiple regression analysis was then carried out. RESULTS: Infection had the highest frequency in the causative diseases for admission. A total of 48% of patients had delirium during hospitalization. The delirium group had the highest frequency of being at home. In the infection group, BMI and serum albumin were lower in the non-infection group (BMI 19.0 ± 3.7 vs 20.4 ± 4.1; P < 0.001, albumin 2.1 ± 0.7 vs 3.3 ± 0.6 g/dL; P < 0.001 respectively). White blood cell count and C-reactive protein were higher than in the non-infection group, respectively (white blood cell count 11181.4 ± 6533.3 vs 8765.8 ± 111 424.3/µL; P = 0.007, C-reactive protein 8.6 ± 8.6 vs 3.0 ± 5.2 mg/dL; P < 0.001 respectively). Using independent factors associated with infection, multiple regression analysis was performed. BMI (P = 0.013), serum albumin (P < 0.001) and nursing home care before admission (P < 0.001) had significant correlations. CONCLUSIONS: Assessment of delirium and the environment before admission of older patients with suspected or diagnosed dementia when hospitalized are necessary. Furthermore, evaluation of nutrition might also contribute to reducing deterioration due to physical illness. Geriatr Gerontol Int 2024; 24: 641-645.
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Demência , Hospitalização , Humanos , Feminino , Masculino , Demência/diagnóstico , Demência/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Japão/epidemiologia , Fatores de Risco , Delírio/diagnóstico , Delírio/epidemiologia , Índice de Massa Corporal , Avaliação Geriátrica/métodos , ComorbidadeRESUMO
Streptococcus pneumoniae is the leading cause of bacterial pneumonia, bacteremia, and meningitis. Indonesia introduced the pneumococcal conjugate vaccine (PCV) nationwide in 2022. In this study, we present whole genome sequence (WGS) data of 94 S. pneumoniae isolates that were obtained from hospitalized patients, healthy children, and adult groups from different regions prior to PCV program in Indonesia. DNA sequences of S. pneumoniae were obtained using the TruSeq Nano DNA kit (Illumina NovaSeq6000 Platform). The genome data of S. pneumoniae features a 1,969,562 bp to 2,741,371 bp circular chromosome with 39-40% G+C content. The genome includes 1935-3319 coding sequences (CDS), 2 to 5 rRNA genes, 43 to 49 tRNA genes, and 56 to 71 ncRNA. These data will be useful for analyzing the serotype, sequence type, virulence genes, antimicrobial resistance genes, and the impact of pneumococcal vaccination in Indonesia. The FASTQ raw files of these sequences are available under BioProject accession number PRJNA995903 and Sequence Read Archive accession numbers SRR25316461-SRR25316554.
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BACKGROUND: International experience shows that the suitability of a high-performance healthcare system for its given purposes is reflected in its ability to provide a continuum of services that match the changing health status of the given population. Although many low- and middle-income countries have sought to bring movement away from hospital-centered and towards patient-centered healthcare, such efforts have often had poor results, and one of the major reasons for this is the inability to accurately identify which inpatients need continuing care and what kind of continuing of care is needed. OBJECTIVES: To measure and assess the continuing care needs of discharged patients and its influencing factors in rural China. METHODS: Data were obtained from the hospital database of Medical Center M in County Z from May to July 2022. County Z is a county of 1 million people in central China. The database includes basic patient information, disease-related information, and information on readiness for hospital discharge. Factors related to the need for continuing care were included in the analysis. The Readiness for Hospital Discharge Scale was used to assess the need for continuing care. The statistical data are expressed in terms of both frequency and composition ratio. Finally, linear regression was used to analyze the factors influencing the need for continuing care. RESULTS: The analysis included a total of 3,791 patients, 123 of whom (3.25%) had continuing nursing needs. The need of continuing nursing was related to patients' age group, mode of admission, occupation and major diagnostic categories (P < 0.05). CONCLUSIONS: Developing continuing care is an important initiative for bridging the fragmentation of health services, and an appropriate supply system for continuing care, interconnected with inpatient services, should be established in rural areas in China as soon as possible. And provide more appropriate care for patients in need.
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Hospitalização , Pacientes Internados , Humanos , Atenção à Saúde , Alta do Paciente , ChinaRESUMO
BACKGROUND: Hospitalization for ulcerative colitis (UC) is potentially life-threatening. Severe disease in the Japanese criteria which modifies the Truelove-Witts' criteria might encompass more fulminant cases than the definition for acute severe UC. However, few studies have investigated the predictive factors for clinical remission (CR) after medical treatments for severe hospitalized patients by Japanese criteria. METHODS: Medical treatment selection, CR rates, and factors contributing to CR on day 14 were assessed in severe patients by Japanese criteria. We also investigated whether the reduction rate in patient-reported outcome 2 (PRO2) on day 3 could predict short-term prognosis. RESULTS: Eighty-five severe hospitalized patients were selected. Corticosteroids, tacrolimus, and infliximab were mainly selected as first-line treatments (76/85; 89.4%). The CR rates on day 14 were 26.8%, 21.4%, and 33.3% in patients receiving corticosteroids, tacrolimus, and infliximab, respectively. Extensive disease (odds ratio [OR] 0.022; 95% confidence interval [CI] 0.002-0.198), higher PRO2 (OR 0.306; 95% CI 0.144-0.821), and higher reduction rate in PRO2 on day 3 (OR 1.047; 95% CI 1.019-1.075) were independent factors predicting CR on day 14. If the cutoff value for the reduction rate in PRO2 on day 3 was 18.3%, sensitivity was 0.714 and specificity was 0.731 to predict CR on day 14. A higher reduction rate in PRO2 on day 3 (OR 0.922; 95% CI 0.853-0.995) was a negative factor to predict surgery within 28 days. CONCLUSIONS: Tacrolimus and infliximab in addition to corticosteroids were used as first-line treatment in severe hospitalized patients. PRO2 on day 3 is a useful marker for switching to second-line therapy or colectomy.
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Colite Ulcerativa , Humanos , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/induzido quimicamente , Infliximab/uso terapêutico , Imunossupressores/uso terapêutico , Tacrolimo/uso terapêutico , Japão , Corticosteroides/uso terapêutico , Resultado do Tratamento , Colectomia , Estudos RetrospectivosRESUMO
Introduction: Body composition (BC) assessment can supply accurate information for in-hospital nutritional evaluation. The aim of this study was to explore in the literature how the studies assessed BC, for what purpose, and investigate the role of BC findings in COVID-19 hospitalized patients' outcomes. Methods: A scoping review was conducted according to the methodology available on the Joanna Briggs Institute website. We used the PCC acronym for the systematic search (population: adults with COVID-19, concept: assessment of BC, context: hospital setting) and performed it on PubMed, Scopus, and the Web of Science on 16 September 2022. Eligibility criteria consisted of the utilization of BC assessment tools in COVID-19 patients. Studies in which BC was solely measured with anthropometry (perimeters and skinfolds) were excluded. No language restriction was applied. Results: Fifty-five studies were eligible for the review. Out of the 55 studies, 36 used computed tomography (CT), 13 used bioelectrical impedance (BIA), and 6 used ultrasound (US). No studies with D3-creatinine, 24 h urine excretion, dual-energy X-ray absorptiometry, or magnetic resonance were retrieved. BC was mainly assessed to test associations with adverse outcomes such as disease severity and mortality. Discussion: Studies assessing BC in hospitalized patients with COVID-19 used mainly CT and BIA and associated the parameters with severity and mortality. There is little evidence of BC being assessed by other methods, as well as studies on BC changes during hospitalization.
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Opioid-induced constipation (OIC), an adverse event that occurs due to opioid analgesics, reportedly causes poor quality of life and adherence to opioid analgesics in patients. Therefore, this issue must be addressed appropriately. Naldemedine (NAL), a peripherally-acting µ-opioid receptor antagonist, is currently recommended for treating OIC when other laxatives are ineffective, but there have been no clinical reports of NAL being used prophylactically for OIC. Therefore, we conducted a retrospective survey of hospitalized patients who received NAL as prophylaxis for OIC with strong opioid analgesics to clarify the reality of this situation and to consider points to be taken into account in its clinical implementation. In this study, 61.7% of the subjects had an Eastern Cooperative Oncology Group performance status score of 3 or higher. The rate of addition of new laxatives and increased laxatives during seven days of NAL prophylaxis was 46.8%, and the rate of diarrhea was 6.1%. This study suggests that patients initiated with strong opioid analgesics during hospitalization often presented with poor performance status, and it is important to pay attention to constipation even under NAL prophylaxis. However, the incidence of diarrhea was low, and the safety of NAL prophylaxis was considered to be good.
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Analgésicos Opioides , Constipação Induzida por Opioides , Humanos , Analgésicos Opioides/efeitos adversos , Constipação Induzida por Opioides/tratamento farmacológico , Laxantes/uso terapêutico , Qualidade de Vida , Estudos Retrospectivos , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/prevenção & controle , Constipação Intestinal/tratamento farmacológico , Antagonistas de Entorpecentes/farmacologia , Antagonistas de Entorpecentes/uso terapêutico , Diarreia/induzido quimicamenteRESUMO
Recent studies suggest that extracellular vesicles (EVs) play a role in the pathogenesis of SARS-CoV-2 infection and the severity of COVID-19. However, their role in the interaction between COVID-19 and type 2 diabetes (T2D) has not been addressed. Here, we characterized the circulating EV proteomic and phosphoproteomic landscape in patients with and without T2D hospitalized with COVID-19 or non-COVID-19 acute respiratory illness (RSP). We detected differentially expressed protein and phosphoprotein signatures that effectively characterized the study groups. The trio of immunomodulatory and coagulation proteins C1QA, C1QB, and C1QC appeared to be a central cluster in both the COVID-19 and T2D functional networks. PKCß appeared to be retained in cells by being diverted from EV pathways and contribute to the COVID-19 and T2D interaction via a PKC/BTK/TEC axis. EV-shuttled CASP3 and ROCK1 appeared to be coregulated and likely contribute to disease interactions in patients with COVID-19 and T2D. Predicted activation of AMPK, MAPK, and SYK appeared to also play important roles driving disease interaction. These results suggest that activated cellular kinases (i.e., PKC, AMPK, MAPK, and SYK) and multiple EV-shuttled kinases (i.e., PKCß, BTK, TEC, MAP2K2, and ROCK1) may play key roles in severe COVID-19, particularly in patients with comorbid diabetes.
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COVID-19 , Diabetes Mellitus Tipo 2 , Vesículas Extracelulares , Humanos , COVID-19/metabolismo , Diabetes Mellitus Tipo 2/patologia , SARS-CoV-2 , Proteômica , Proteínas Quinases Ativadas por AMP/metabolismo , Vesículas Extracelulares/metabolismo , Quinases Associadas a rho/metabolismoRESUMO
Objetivo: identificar as temáticas dos checklists de segurança do paciente utilizados na assistência à criança hospitalizada. Método: revisão integrativa de literatura, realizada em agosto de 2019 nas bases de dados LILACS, BDENF, MEDLINE/PubMed, Web of Science, CINAHL e SciELO. Resultados: foram identificados 396 artigos, sendo selecionados 24 estudos após a aplicação dos critérios de elegibilidade. As áreas temáticas dos checklists foram: cirurgia, medicação, comunicação efetiva, terapia intensiva, intubação traqueal, transfusão sanguínea e radiologia digital, sendo que a maioria dos estudos aborda a cirurgia segura (45,8%). Conclusão: o uso de checklist na assistência à criança hospitalizada contribui para a identificação de falhas em processos de segurança do paciente; padronização de técnicas e processos; redução de erros relacionados aos cuidados em saúde; melhoria do trabalho em equipe; comunicação precisa e consistente; adesão às medidas de processo; e, consequentemente, melhoria da qualidade da assistência prestada.
Objective: to identify the themes of patient safety checklists used in the care of hospitalized children. Method: integrative literature review, conducted in August 2019 in the LILACS, BDENF, MEDLINE/PubMed, Web of Science, CINAHL and SciELO databases. Results: a total of 396 articles were identified, and 24 studies were selected after applying the eligibility criteria. The thematic areas of the checklists were: surgery, medication, effective communication, intensive care, tracheal intubation, blood transfusion and digital radiology, with most studies addressing safe surgery (45.8%). Conclusion: the use of checklist in the care of hospitalized children contributes to the identification of failures in patient safety processes; standardization of techniques and processes; reduction of errors related to health care; improvement of teamwork; accurate and consistent communication; adherence to process measures; and, consequently, improvement in the quality of care provided.
Objetivo: identificar los temas de las listas de verificación de seguridad del paciente utilizadas en la atención de niños hospitalizados. Método: revisión bibliográfica integradora, conducida en agosto de 2019 en las bases de datos LILACS, BDENF, MEDLINE/PubMed, Web of Science, CINAHL y SciELO. Resultados: se identificaron un total de 396 artículos y se seleccionaron 24 estudios después de aplicar los criterios de elegibilidad. Las áreas temáticas de las listas de verificación fueron: cirugía, medicación, comunicación efectiva, cuidados intensivos, intubación traqueal, transfusión de sangre y radiología digital, siendo la mayoría de los estudios sobre cirugía segura (45,8%). Conclusión: la mayoría demostró que la utilización de listas de verificación contribuye a la identificación de fallas en los procesos de seguridad del paciente; estandarización de técnicas y procesos; reducción de errores relacionados con la atención médica; mejora del trabajo en equipo; comunicación precisa y coherente; adhesión a las medidas procesales; y, como consecuencia, mejora de la calidad de la atención ofrecida.
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Drug administration is one of the riskiest areas of healthcare provision, accompanied by several possible mistakes. Patient and family involvement is crucial for patient safety in a hospital environment. The research study aimed to evaluate the subjective perception of the safety of the drug administration process from hospitalized patients point of view and their involvement in drug administration. A structured questionnaire of its own design was used to obtain data. Three hundred twenty-nine respondents from 4 hospitals in the South Bohemian Region in the Czech Republic were included in the research, including patients hospitalized in the internal medicine, surgery, and follow-up and rehabilitation care departments. We found different perceptions and individual understandings of the safety of the drug delivery process by other groups of patients. Interest in participating in drug administration also varies between groups of patients. Women control the medication given to them by the nurse to a much greater extent than men. Patients under the age of 60, patients with higher professional and university education, and patients from the surgical department would like to be more involved in deciding which aplikovadrugs to use. Patients with a low level of education want to involve their family members more in their treatment decisions. Both healthcare professionals and patients should be led by hospital management to increase patient involvement in the hospitalization process.
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Hospitalização , Hospitais , Masculino , Humanos , Feminino , Segurança do Paciente , República Tcheca , Sistemas de Liberação de MedicamentosRESUMO
Background: Sleep is essential for recovery from illness. As a result, researchers have shown a growing interest in the sleep of hospitalized patients. Although many studies have been conducted over the past years, an up to date systematic review of the results is missing. Objective: The objective of this systematic review was to assess sleep quality and quantity of hospitalized patients and sleep disturbing factors. Methods: A systematic literature search was conducted within four scientific databases. The search focused on synonyms of 'sleep' and 'hospitalization'. Papers written in English or Dutch from inception to April 25th,2022 were included for hospitalized patients >1 year of age. Papers exclusively reporting about patients receiving palliative, obstetric or psychiatric care were excluded, as well as patients in rehabilitation and intensive care settings, and long-term hospitalized geriatric patients. This review was performed in accordance with the PRISMA guidelines. Results: Out of 542 full text studies assessed for eligibility, 203 were included, describing sleep quality and/or quantity of 17,964 patients. The median sample size of the studies was 51 patients (IQR 67, range 6-1472). An exploratory meta-analysis of the Total Sleep Time showed an average of 7.2 h (95%-CI 4.3, 10.2) in hospitalized children, 5.7 h (95%-CI 4.8, 6.7) in adults and 5.8 h (95%-CI 5.3, 6.4) in older patients (>60y). In addition, a meta-analysis of the Wake After Sleep Onset (WASO) showed a combined high average of 1.8 h (95%-CI 0.7, 2.9). Overall sleep quality was poor, also due to nocturnal awakenings. The most frequently cited external factors for poor sleep were noise and number of patients in the room. Among the variety of internal/disease-related factors, pain and anxiety were most frequently mentioned to be associated with poor sleep. Conclusion: Of all studies, 76% reported poor sleep quality and insufficient sleep duration in hospitalized patients. Children sleep on average 0.7-3.8 h less in the hospital than recommended. Hospitalized adults sleep 1.3-3.2 h less than recommended for healthy people. This underscores the need for interventions to improve sleep during hospitalization to support recovery.
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BACKGROUND: Certain types of cancer and treatment increase the risk of falls among cancer patients, particularly patients with hematologic cancer undergoing bone marrow transplant (BMT). Nurses are integral to preventing falls and maintaining patient safety. Understanding patients undergoing BMT fall risk factors may help nurses identify high fall risk patients and develop fall prevention interventions. PURPOSE: This systematic review aims to identify risk factors for falls among hospitalized adult patients receiving BMT treatment. METHODS: Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of the literature was conducted by searching databases PubMed and CINAHL. Study quality was evaluated using the Crowe Critical Appraisal Tool form (v1.4). FINDINGS: An initial search yielded 829 articles; six were included for final review after removing duplicates and screening for inclusion criteria: specific to patients undergoing BMT, measure fall outcome, in hospital, and original research. The identified risk factors include age of 65 and older, leukemia diagnosis, days of diarrhea, incontinence of urine or stool, increased pulse rate, muscle weakness, hypnotic, anxiolytic medication, recent steroid use, allogenic transplant, and post-engraftment period. CONCLUSIONS: Risk factors for falls among patients undergoing BMT are multifactorial and are related to muscle weakness, medication administration, pulse rate, type of transplant, age, engraftment period, and bathroom use. IMPLICATIONS FOR NURSING: Nurses providing care to patients undergoing BMT need to assess and increase nurse surveillance on allogeneic transplant patients, specifically those on anxiolytic, hypnotic, and steroid medications. Nurses providing care to patients undergoing BMT should implement more fall prevention strategies in patients undergoing BMT who develop diarrhea and urine or stool incontinence. Identifying specific patients undergoing BMT fall risk factors and applying multifaceted individualized fall prevention strategies has the potential to improve allogeneic transplant patient care and prevent fall-related complications.
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Cognitive impairment and dementia can negatively impact the nutritional capacities of older people. Malnutrition is common in hospitalized frail elderly people with cognitive impairment and negatively affects prognosis. Malnutrition worsens the quality of life and increases morbidity and mortality. This scoping review aimed to identify factors affecting the risk of malnutrition and preventive strategies in hospitalized patients with cognitive impairment, focusing on nursing interventions. The authors researched population, context, and concept in international databases of nursing interest. Full texts that met the inclusion criteria were selected and reviewed. The extracted data were subject to thematic analysis. A five-stage approach, already reported in the scientific literature, was utilized in the following scoping review. Of 638 articles yielded, 9 were included. Two focus areas were identified as follows: (1) prevalence and risk factors of malnutrition in older patients with cognitive decline; (2) nursing strategies used to enhance clinical outcomes. Nursing health interventions aim to recognize and reduce malnutrition risk, positively impacting this phenomenon. A multidisciplinary team is essential to meet the nutritional needs of these patients.
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Disfunção Cognitiva , Desnutrição , Idoso , Disfunção Cognitiva/terapia , Idoso Fragilizado , Humanos , Desnutrição/epidemiologia , Apoio Nutricional , Qualidade de VidaRESUMO
Background: Hypertensive and heart failure patients frequently require multiple drug therapy which may be associated with drug-related problems (DRPs). Aim: To determine the frequency, types, and predictors of DRPs, and acceptance of pharmacists' interventions among hospitalized hypertensive and heart failure patients. Method: It was a prospective cross-sectional study at the internal medicine department wards of Korle Bu Teaching Hospital (KBTH) between January and June 2019 using a validated form (the pharmaceutical care form used by clinical pharmacists at the medical department). DRPs were classified based on the Pharmaceutical Care Network Europe (PCNE) Classification scheme for DRPs V8.02. Descriptive and inferential statistics were used for data analysis. Results: A total of 247 DRPs were identified in 134 patients. The mean number of DRPs was 1.84 (SD: 1.039) per patient. Most DRPs occurred during the prescribing process (40.5%; n(DRPs) = 100), and the highest prescribing problem was untreated indication (11.7%; n = 29). Other frequent DRPs were medication counseling need (25.1%; n = 62), administration errors 10.1%(n = 25), drug interaction (10.5%; n = 26), and "no" or inappropriate monitoring (10.5%; n = 26). The number of drugs received significantly predicted the number of DRPs (adjusted odds ratio [AOR]: 9.85; 95% CI: 2.04-47.50; p < 0.001). Clinical variables were significant predictors of number of DRPs (diabetic status: AOR: 0.41, 95% CI: 0.18-0.98, p < 0.05; statin use: AOR: 0.34, 95% CI: 0.14-0.81, p < 0.05; antiplatelet use: AOR: 5.95, 95% CI: 2.03-17.48, p < 0.01). Average acceptance of interventions by physicians was 71.6% (SD: 11.7). Most (70.6%; n = 48) accepted interventions were implemented by physicians (resolved). Conclusion: DRPs frequently occur, with most problems identified in the prescribing process. Medication counseling was frequently needed. Patients' number of drugs and clinical factors predicted the occurrence of DRPs. Physicians accepted and implemented most interventions. Our findings suggest that clinical pharmacists have an important role in cardiovascular patient care, but this study should be replicated in other hospitals in Ghana to corroborate these findings.
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Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of hospital-acquired infection, which is difficult to treat because of antibiotic resistance. There is scant data on MRSA from southern parts of Ethiopia. Objective: The aim of this study was to determine the prevalence of MRSA nasal carriage, antibiotic susceptibility profiles, and associated factors among hospitalized patients attending Hawassa University Comprehensive Specialized Hospital (HUCSH), Hawassa, Ethiopia. Methods: A hospital-based cross-sectional study was conducted from December 11, 2019 to February 15, 2020. Background and clinical data were captured by an interviewer-administered questionnaire. Nasal swabs were collected aseptically and inoculated onto mannitol salt agar and sheep blood agar, which was incubated for 24 hours at 37°C. S. aureus was confirmed using standard bacteriological methods. MRSA was identified using the cefoxitin Kirby-Bauer disk diffusion method. Results: Of the 280 included hospitalized patients, 38 (13.6%) were colonized with S. aureus. The prevalence of MRSA carriage was 9.3% (95% CI 6.1â12.2). Twenty-six (68.4%) of the S. aureus isolates were methicillin resistant. Participants with a monthly income > 4000 Ethiopian Birr were four times more likely to be colonized with MRSA (p = 0.022). A high proportion of patients with a history of admission to the surgical ward was colonized with MRSA. Over 10% of MRSA isolates were resistant to all antibiotics except clindamycin and erythromycin. Of the 26 MRSA isolates, 88.5% showed multidrug resistance. Conclusions: The prevalence of MRSA was relatively high among hospitalized patients at HUCSH. Factors such as weight and monthly income were significantly associated with the occurrence of MRSA.
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BACKGROUND: There is pressing need to improve hospital-based addiction care. Various models for integrating substance use disorder care into hospital settings exist, but there is no framework for describing, selecting, or comparing models. We sought to fill that gap by constructing a taxonomy of hospital-based addiction care models based on scoping literature review and key informant interviews. METHODS: Methods included a scoping review of the literature on US hospital-based addiction care models and interventions for adults, published between January 2000 and July 2021. We conducted semi-structured interviews with 15 key informants experienced in leading, implementing, evaluating, andpracticing hospital-based addiction care to explore model characteristics, including their perceived strengths, limitations, and implementation considerations. We synthesized findings from the literature review and interviews to construct a taxonomy of model types. RESULTS: Searches identified 2,849 unique abstracts. Of these, we reviewed 280 full text articles, of which 76 were included in the final review. We added 8 references from reference lists and informant interviews, and 4 gray literature sources. We identified six distinct hospital-based addiction care models. Those classified as addiction consult models include (1) interprofessional addiction consult services, (2) psychiatry consult liaison services, and (3) individual consultant models. Those classified as practice-based models, wherein general hospital staff integrate addiction care into usual practice, include (4) hospital-based opioid treatment and (5) hospital-based alcohol treatment. The final type was (6) community-based in-reach, wherein community providers deliver care. Models vary in their target patient population, staffing, and core clinical and systems change activities. Limitations include that some models have overlapping characteristics and variable ways of delivering core components. DISCUSSION: A taxonomy provides hospital clinicians and administrators, researchers, and policy-makers with a framework to describe, compare, and select models for implementing hospital-based addiction care and measure outcomes.
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Comportamento Aditivo , Psiquiatria , Transtornos Relacionados ao Uso de Substâncias , Adulto , Comportamento Aditivo/diagnóstico , Comportamento Aditivo/epidemiologia , Comportamento Aditivo/terapia , Hospitais , Humanos , Psiquiatria/métodos , Encaminhamento e Consulta , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
In Taiwan, the national research on homicide is rare, mostly discussing the issue of child abuse. We sought to better understand the characteristics and risk factors of homicide through a retrospective cohort study from 1998 to 2015. "Child battering and other maltreatment" ranked first for the 0-4 age group and second for the 5-14 age group. The hospital mortality was 511 deaths. We found that the 25-44 age group had the highest risk and accounted for 44.76% of hospitalization. The most common causes were "fight, brawl, and rape" (49.12%), "cutting and piercing instruments," (13.16%) and "child battering and other forms of maltreatment" (4.72%). Additionally, the percentages of "fight, brawl, and rape," "firearms and explosives," and "cutting and piercing instruments" were significantly higher among males than among females. The percentages of "hanging and strangulation," "corrosive or caustic substance," "child battering and other maltreatment," "submersion," and "poisoning" were significantly higher among females than males. Factors associated with homicide in-hospital mortality included gender, age, low income, catastrophic disease, Charlson comorbidity index score, urbanization level, hospital level, classification of hospitalization, and surgery. Overall, the trend of hospitalization rates due to homicide decreased both by gender and age group, except for the 0-4 age group: cause of homicide first, hanging and strangulation second, firearms and explosives third; type of injury, hospitalized patients with "vascular injuries" first, joint and muscle sprain, and intracranial, chest, and abdominal pelvic injuries second, and "burns" third with a higher risk of death. Homicide reduction requires a comprehensive strategy beyond specific victim groups. Interagency collaboration should be strengthened, especially between law enforcement/criminal justice and public health.
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Substâncias Explosivas , Suicídio , Asfixia , Causas de Morte , Criança , Feminino , Homicídio , Hospitalização , Humanos , Masculino , Vigilância da População , Estudos Retrospectivos , Taiwan/epidemiologiaRESUMO
Orthostatic hypotension is a frequent cause of falls and syncope, impairing quality of life. It is an independent risk factor of mortality and a common cause of hospitalizations, which exponentially increases in the geriatric population. We present a management plan based on a systematic literature review and understanding of the underlying pathophysiology and relevant clinical pharmacology. Initial treatment measures include removing offending medications and avoiding large meals. Clinical assessment of the patients' residual sympathetic tone can aid in the selection of initial therapy between norepinephrine "enhancers" or "replacers." Role of splanchnic venous pooling is overlooked, and applying abdominal binders to improve venous return may be effective. The treatment goal is not normalizing upright blood pressure but increasing it above the cerebral autoregulation threshold required to improve symptoms. Hypertension is the most common associated comorbidity, and confining patients to bed while using pressor agents only increases supine blood pressure, leading to worsening pressure diuresis and orthostatic hypotension. Avoiding bedrest deconditioning and using pressors as part of an orthostatic rehab program are crucial in reducing hospital stay.
Assuntos
Hipotensão Ortostática/terapia , Gerenciamento Clínico , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/fisiopatologia , Pacientes InternadosRESUMO
AIMS: This study aimed to review systematically all available prediction tools identifying adult hospitalized patients at risk of drug-related problems, and to synthesize the evidence on performance and clinical usefulness. METHODS: PubMed, Scopus, Web of Science, Embase, and CINAHL databases were searched for relevant studies. Titles, abstracts and full-text studies were sequentially screened for inclusion by two independent reviewers. The Prediction Model Risk of Bias Assessment Tool (PROBAST) and the Revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) checklists were used to assess risk of bias and applicability of prediction tools. A narrative synthesis was performed. RESULTS: A total of 21 studies were included, 14 of which described the development of new prediction tools (four risk assessment tools and ten clinical prediction models) and six studies were validation based and one an impact study. There were variations in tool development processes, outcome measures and included predictors. Overall, tool performance had limitations in reporting and consistency, with the discriminatory ability based on area under the curve receiver operating characteristics (AUROC) ranging from poor to good (0.62-0.81), sensitivity and specificity ranging from 57.0% to 89.9% and 30.2% to 88.0%, respectively. The Medicines Optimisation Assessment tool and Assessment of Risk tool were prediction tools with the lowest risk of bias and low concern for applicability. Studies reporting external validation and impact on patient outcomes were scarce. CONCLUSION: Most prediction tools have limitations in development and validation processes, as well as scarce evidence of clinical usefulness. Future studies should attempt to either refine currently available tools or apply a rigorous process capturing evidence of acceptance, usefulness, performance and outcomes.