COVID-19 in three waves in a tertiary referral hospital in Belgium: a comparison of patient characteristics, management, and outcome.

PURPOSE: Few studies have compared patient characteristics, clinical management, and outcome of patients with COVID-19 between the different epidemic waves. In this study, we describe patient characteristics, treatment, and outcome of patients admitted for COVID-19 in the Antwerp University Hospital over the first three epidemic waves of 2020-2021. METHODS: Retrospective observational study of COVID-19 patients in a Belgian tertiary referral hospital. All adult patients with COVID-19, hospitalized between February 29, 2020, and June 30, 2021, were included. Standardized routine medical data was collected from patient records. Risk factors were assessed with multivariable logistic regression. RESULTS: We included 722 patients, during the first (n = 179), second (n = 347) and third (n = 194) wave. We observed the lowest disease severity at admission during the first wave, and more elderly and comorbid patients during the second wave. Throughout the subsequent waves we observed an increasing use of corticosteroids and high-flow oxygen therapy. In spite of increasing number of complications throughout the subsequent waves, mortality decreased each wave (16.6%,15.6% 11.9% in 1st, 2nd and 3rd wave respectively). C-reactive protein above 150 mg/L was predictive for the need for intensive care unit admission (odds ratio (OR) 3.77, 95% confidence interval (CI) 2.32-6.15). A Charlson comorbidity index ≥ 5 (OR 5.68, 95% CI 2.54-12.70) and interhospital transfers (OR 3.78, 95% CI 2.05-6.98) were associated with a higher mortality. CONCLUSIONS: We observed a reduction in mortality each wave, despite increasing comorbidity. Evolutions in patient management such as high-flow oxygen therapy on regular wards and corticosteroid use may explain this favorable evolution.

Development and psychometric property testing of a skin tear knowledge assessment instrument (OASES) in 37 countries.

AIM: To develop and psychometrically evaluate a skin tear knowledge assessment instrument (OASES). DESIGN: Prospective psychometric instrument validation study. METHOD: The skin tear knowledge assessment instrument was developed based on a literature review and expert input (N = 19). Face and content validity were assessed in a two-round Delphi procedure by 10 international experts affiliated with the International Skin Tear Advisory Panel (ISTAP). The instrument was psychometrically tested in a convenience sample of 387 nurses in 37 countries (April-May 2020). Validity of the multiple-choice test items (item difficulty, discriminating index, quality of the response alternatives), construct validity, and test-retest reliability (stability) were analysed and evaluated in light of international reference standards. RESULTS: A 20-item instrument, covering six knowledge domains most relevant to skin tears, was designed. Content validity was established (CVI = 0.90-1.00). Item difficulty varied between 0.24 and 0.94 and the quality of the response alternatives between 0.01-0.52. The discriminating index was acceptable (0.19-0.77). Participants with a theoretically expected higher knowledge level had a significantly higher total score than participants with theoretically expected lower knowledge (p < .001). The 1-week test-retest intraclass correlation coefficient (ICC) was 0.83 (95% CI = 0.78-0.86) for the full instrument and varied between 0.72 (95% CI = 0.64-0.79) and 0.85 (95% CI = 0.81-0.89) for the domains. Cohen's Kappa coefficients of the individual items ranged between 0.21 and 0.74. CONCLUSION: The skin tear knowledge assessment instrument is supported by acceptable psychometric properties and can be applied in nursing education, research, and practice to assess knowledge of healthcare professionals about skin tears. IMPACT: Prevention and treatment of skin tears are a challenge for healthcare professionals. The provision of adequate care is based on profound and up-to-date knowledge. None of the existing instruments to assess skin tear knowledge is psychometrically tested, nor up-to-date. OASES can be used worldwide to identify education, practice, and research needs and priorities related to skin tears in clinical practice.

Measurement properties of classifications for skin tears: A systematic review.

BACKGROUND: Skin tear classifications support the assessment and reporting of skin tears in a consistent way. The measurement properties of skin tear classifications have not been compared so far. OBJECTIVES: To critically appraise, compare and summarise the quality of the measurement properties of available skin tear classifications. DESIGN: Systematic review. METHODS: The databases MEDLINE, EMBASE, CINAHL and CENTRAL were systematically searched until January 2020. Studies reporting the development and/or the evaluation of measurement properties of skin tear classifications were included. The COSMIN Risk of Bias checklist was applied to evaluate the methodological quality of the included studies. Each reported measurement property was rated against criteria for good measurement properties. The evidence was summarised and the quality of the evidence was graded using a modified GRADE approach. Study selection, data extraction and quality appraisal were conducted independently by two reviewers and double-checked by a third reviewer. RESULTS: Fourteen studies, describing five classifications, were included. Content validity was examined in five studies, reliability in nine studies, measurement error in two studies, and criterion validity in four studies. For three classification systems, no measurement properties were reported. CONCLUSIONS: Five skin tear classifications exist, of which only two have been psychometrically tested. The quality of evidence on their measurement properties varied between very low to moderate. To date, the ISTAP classification is the most commonly evaluated system with moderate quality evidence to support its reliability, measurement error and criterion validity. More well-designed studies using direct skin observations are needed. Protocol registration number: CRD42019138138 (PROSPERO). Tweetable abstract: A systematic review of the measurement properties of skin tear classifications.

An exploration of nursing home residents' experiences of a non-powered static air mattress overlay to prevent pressure ulcers.

Pressure ulcers are injuries to the skin and underlying tissue and are associated with a negative impact on well-being and health-related quality of life. This explorative, qualitative study aimed to explore the true meaning of elderly nursing home residents' perspectives and critical success factors when implementing a new non-powered static air mattress overlay to prevent pressure ulcers. Individual, loosely structured interviews were conductedin 12 nursing homes in Flanders, the Northern region of Belgium, a convenience sampling of 14 nursing home residents were selected based on the following eligibility criteria: high risk for pressure ulcer and/or with category 1 pressure ulcer, being bedbound and/or chair-bound, aged >65 years, and use of an alternating air pressure mattress previous to the application of the non-powered static air mattress overlay. Interviews were conducted in the participants' personal rooms between June 2017 and March 2018. Interviews included broad, open-ended questions, to invite and encourage participants to openly discuss their perspectives and experiences. Participants were interviewed once during the 14-day observation period between day 3 and day 14. All interviews were audio-recorded and fully transcribed by an experienced transcriber. Interviews were read several times to reveal emerging patterns and were marked with codes into NVivo 10 qualitative data analysis software. During the process, (sub) themes were discussed by the authors until a consensus was reached. Three main themes emerged from the analysis process: rest and sleep; mobility; and discomfort and pain associated with the use of the support surface. Themes were divided into multiple subthemes: motion, noise, sensation, repositioning, and transfer in and out of bed. Through interviews, critical success factors associated with the implementation were identified, including the lack of information and time needed to evaluate the functionality and effects of a new mattress overlay. Implementation of a non-powered static air mattress overlay to prevent pressure ulcers has a far-reaching impact on nursing home residents' experiences. This study provides insight into the true meaning of patients' perspectives by focusing on learning from the patients' experiences that provide valuable information for healthcare professionals and other stakeholders.

A multicentre prospective randomised controlled clinical trial comparing the effectiveness and cost of a static air mattress and alternating air pressure mattress to prevent pressure ulcers in nursing home residents.

BACKGROUND: Pressure ulcers are a global issue and substantial concern for healthcare systems. Various types of support surfaces that prevent pressure ulcer are available. Data about the effectiveness and cost of static air support surfaces and alternating air pressure mattresses is lacking. OBJECTIVES: To compare the effectiveness and cost of static air support surfaces versus alternating air pressure support surfaces in a nursing home population at high risk for pressure ulcers. DESIGN: Prospective, multicentre, randomised controlled clinical, non-inferiority trial. SETTING: Twenty-six nursing homes in Flanders, Belgium. PARTICIPANTS: A consecutive sample of 308 participants was selected based on the following eligibility criteria: high risk for pressure ulcer and/or with category 1 pressure ulcer, being bedbound and/or chair bound, aged > 65 years, and use of an alternating air pressure mattress. METHODS: The participants were allocated to the intervention group (n = 154) using static air support surfaces and the control group (n = 154) using alternating air pressure support surfaces. The main outcome measures were cumulative incidence and incidence density of the participants developing a new category II-IV pressure ulcer within a 14-day observation period, time to develop a new pressure ulcer, and purchase costs of the support surfaces. RESULTS: The intention-to-treat analysis revealed a significantly lower incidence of category II-IV pressure ulcer in the intervention group (n = 8/154, 5.2%) than in the control group (n = 18/154, 11.7%) (p = 0.04). The median time to develop a pressure ulcer was significantly longer in the intervention group (10.5 days, interquartile range [IQR]: 1-14) than in the control group (5.4 days, [IQR]: 1-12; p = 0.05). The probability to remain pressure ulcer free differed significantly between the two study groups (log-rank X²â€¯= 4.051, df = 1, p = 0.04). The overall cost of the mattress was lower in the intervention group than in the control group. CONCLUSIONS: A static air mattress was significantly more effective than an alternating air pressure mattress in preventing pressure ulcer in a high-risk nursing home population. Considering multiple lifespans and purchase costs, static air mattresses were more cost-effective than alternating air pressure mattresses.

The prevalence and associated factors of skin tears in Belgian nursing homes: A cross-sectional observational study.

BACKGROUND: Although skin tears are among the most prevalent acute wounds in nursing homes, their recognition as a unique condition remains in its infancy. Elderly patients are at risk of developing skin tears due to increased skin fragility and other contributing risk factors. In order to provide (cost-) effective prevention, patients at risk should be identified in a timely manner. OBJECTIVES: (1) To determine the point prevalence of skin tears and (2) to identify factors independently associated with skin tear presence in nursing home residents. METHODS: A cross-sectional observational study was set up, including 1153 residents in 10 Belgian nursing homes. Data were collected by trained researchers and study nurses using patient records and skin observations. A multiple binary logistic regression model was designed to explore independent associated factors (significance level α < 0.05). RESULTS: The final sample consisted of 795 nursing home residents, of which 24 presented with skin tears, resulting in a point prevalence of 3.0%. Most skin tears were classified as category 3 (defined as complete flap loss) according to the International Skin Tear Advisory Panel (ISTAP) Classification System and 75.0% were located on the lower arms/legs. Five independent associated factors were identified: age, history of skin tears, chronic use of corticosteroids, dependency for transfers, and use of adhesives/dressings. CONCLUSIONS: This study revealed a skin tear prevalence of 3.0% in nursing home residents. Age, history of skin tears, chronic use of corticosteroids, dependency for transfers, and use of adhesives/dressings were independently associated with skin tear presence.

Independent risk factors for pressure ulcer development in a high-risk nursing home population receiving evidence-based pressure ulcer prevention: Results from a study in 26 nursing homes in Belgium.

The aim of this study was to identify independent risk factors for pressure ulcer (PU) development in a high-risk nursing home population receiving evidence-based PU prevention. This study was part of a randomised controlled trial examining the (cost-)effectiveness of static air support surfaces compared with alternating pressure air mattresses. The sample consisted of 308 residents at a high risk of PU development (presence of non-blanchable erythema, Braden score ≤ 12 or Braden subscale "mobility" ≤ 2). PU incidence was monitored for 14 days. Demographic variables; functional, physical, and psychological characteristics; and data on skin assessment were collected. Independent risk factors were identified using multiple logistic regression analysis. The overall PU incidence (category II-IV) was 8.4% (n = 26), and 1.9% (n = 6) of the residents developed a deep PU (category III-IV). PUs (category II-IV) were significantly associated with non-blanchable erythema, a lower Braden score, and pressure area-related pain in high-risk residents even if preventive care was provided. These results highlight the need of a systematic risk assessment, including pain assessment and skin observations, in order to determine and tailor preventive care to the needs of high-risk individuals.

Patient perspectives on electronic health record accessibility and patient participation: a questionnaire survey.

Objectives To explore patient perceptions on personal comfort with participation in their own care process and on support of this patient participation through electronic health record (EHR) accessibility. Methods Explorative quantitative questionnaire study in ambulatory patients visiting the departments of General Internal Medicine or Head, Neck and Maxillo-Facial Surgery of a Belgian tertiary referral center. Results Patients were recruited by convenience sampling of 438 out of the total of 1270 patients visiting either one of these departments within a time period of two weeks. Overall response rate was 97.3% (n = 426; 45.3% male; mean age 42.5 ± 15.4 years). Most patients (89.7%) indicated a desire to make healthcare decisions in partnership with their physician. They were in need of transparent and comprehensible health information. The EHR was perceived as a suitable and effective means to inform patients about their health and to increase involvement in care and treatment (77.6%). Furthermore, access to the EHR was perceived to result in a more effective communication transfer between physician and patient (65.5%), increased patient compliance (64.3%), and satisfaction (57.4%). Conclusion Patients indicate a desire for proactive participation in their individual care process. They felt that medical record accessibility could support decision-making and assist in managing and coordinating individual and personalized care choices.

The patient perspective on the effects of medical record accessibility: a systematic review.

BACKGROUND: Health care is shifting from a paternalistic to a participatory model, with increasing patient involvement. Medical record accessibility to patients may contribute significantly to patient comanagement. OBJECTIVES: To systematically review the literature on the patient perspective of effects of personal medical record accessibility on the individual patient, patient-physician relationship and quality of medical care. METHODS: Screening of PubMed, Web of Science, Cinahl, and Cochrane Library on the keywords 'medical record', 'patient record', 'communication', 'patient participation', 'doctor-patient relationship', 'physician-patient relationship' between 1 January 2002 and 31 January 2016; systematic review after assessment for methodological quality. RESULTS: Out of 557 papers screened, only 12 studies qualified for the systematic review. Only a minority of patients spontaneously request access to their medical file, in contrast to frequent awareness of this patient right and the fact that patients in general have a positive view on open visit notes. The majority of those who have actually consulted their file are positive about this experience. Access to personal files improves adequacy and efficiency of communication between physician and patient, in turn facilitating decision-making and self-management. Increased documentation through patient involvement and feedback on the medical file reduces medical errors, in turn increasing satisfaction and quality of care. Information improvement through personal medical file accessibility increased reassurance and a sense of involvement and responsibility. CONCLUSION: From the patient perspective medical record accessibility contributes to co-management of personal health care.