Fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática / Intervening factors in the management of nursing care for children hospitalized with rheumatic heart disease / Factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática

Objetivo: analisar os fatores intervenientes na gerência do cuidado de enfermagem à criança hospitalizada com cardiopatia reumática. Método: estudo descritivo-exploratório com abordagem qualitativa, que utilizou a Teoria Fundamentada em Dados e o Interacionismo Simbólico, respectivamente, como referencial metodológico e teórico. A coleta de dados foi realizada em uma instituição especializada em atendimento cardiológico, no munícipio do Rio de Janeiro. Foram entrevistados 19 profissionais de enfermagem através de um roteiro semiestruturado. Resultado: emergiram os seguintes fatores intervenientes na prática da gerência do cuidado: condição socioeconômica da família, comportamento da criança, condições de trabalho, comunicação ineficaz, educação permanente, trabalho em equipe e experiência profissional. Conclusão: os resultados apontam para a necessidade de proposição de estratégias de ação e interação que facilitem a prática gerencial de cuidado à criança com cardiopatia reumática e sua família face aos fatores intervenientes identificados.

Objective: to analyze the factors involved in the management of nursing care for children hospitalized with rheumatic heart disease. Method: this is a descriptive-exploratory study with a qualitative approach, which used Data-Based Theory and Symbolic Interactionism, respectively, as methodological, and theoretical references. Data was collected in an institution specializing in cardiac care in the city of Rio de Janeiro. Nineteen nursing professionals were interviewed using a semi-structured script. Result: the following intervening factors in the practice of care management emerged: the family's socioeconomic status, the child's behavior, working conditions, ineffective communication, continuing education, teamwork, and professional experience. Conclusion: the results point to the need to propose strategies for action and interaction that facilitate management practice in caring for children with rheumatic heart disease and their families, given the intervening factors identified.

Objetivo: analizar los factores que intervienen en la gestión del cuidado de enfermería al niño hospitalizado con cardiopatía reumática. Método: estudio descriptivo-exploratorio con enfoque cualitativo, cuyos marcos metodológico y teórico fueron la Teoría Fundamentada y el Interaccionismo Simbólico, respectivamente. La recolección de datos se realizó en una institución especializada en atención cardiológica, en la ciudad de Río de Janeiro. Fueron entrevistados 19 profesionales de enfermería mediante un cuestionario semiestructurado. Resultado: surgieron los siguientes factores intervinientes en la práctica de la gestión del cuidado: condición socioeconómica de la familia, comportamiento del niño, condiciones de trabajo, comunicación ineficaz, educación continua, trabajo en equipo y experiencia profesional. Conclusión: los resultados indican que es necesario proponer estrategias de acción e interacción que faciliten la práctica de la gestión del cuidado al niño con cardiopatía reumática y a sus familiares, con respecto a los factores intervinientes identificados.

Primary nursing in the intensive care unit.

Background: Primary nursing (Process Responsible Nursing; PRN) is a nursing organization model, practiced in intensive care units (ICUs), but implementation is challenging. This paper focuses on the qualitative process analysis of the development and implementation of PRN in an ICU at a German university hospital. Aims: Aim was to record the perception of changes in nursing practice due to the introduction of PRN and obtain information on implementation and further optimization perceived by nurses. Method: A qualitative process analysis was done. Data collection took place at three defined times (immediately before implementation and 6 and 12 months after) and each included a focus group interview (FG) and a 5-day ICU ward process analysis (WA) in the form of participant observation. The analysis of FG and WA was carried out according to Kuckartz's content-structuring qualitative content analysis. Findings: The main categories communication, care planning and integration of patients and relatives in care and 13 subcategories with a cross-sectional category could be identified. Positive effects of PRN were found, particularly concerning relatives. The optimization potential included handover, visit appointments, the documentation system and adjustments to the visiting times. Conclusion: The qualitative analysis was able to show changes during the introduction of PRN, e.g. in communication and care planning, but also challenges like visit appointments or the documentation system in nursing practice.

Lesbian and bisexual breast cancer survivors' post-treatment resource needs.

PURPOSE: The purpose of our study was to identify and describe determinants of lesbian and bisexual breast cancer survivors' post-treatment resources. METHODS: We used a cross-sectional descriptive study design. The data reported here were gathered as part of OUT: The National Cancer Survey, administered electronically from September 2020 to March 2021 via social media and community partners. We used descriptive statistics, Fisher's exact tests, and thematic analysis to analyze survivor perceptions of information availability, treatment environment, care plans, social support, and health. RESULTS: Of those who participated in the survey, (N =430) 366 identified as lesbian, and 64 identified as bisexual. Mean age was 58.6 years (range 21 - 91 years). Fewer than 11% of our sample indicated they could find helpful information about being a queer person with cancer during their treatment. Over 75% of our sample that received a cancer survivorship care plan indicated that their plan did not include resources for queer individuals. CONCLUSIONS: Affirming cancer treatment environments and resources tailored to the needs of lesbian and bisexual breast cancer survivors are critical for reducing disparities. IMPLICATIONS FOR CANCER SURVIVORS: Survivorship care plans should include resources for queer individuals as a part of holistic cancer care.

Evaluation of the appropriateness of nursing case studies using the CARE checklist.

Case report is a narrative description of the problem of one or several patients. The CARE checklist (CAse REport) is the consensus document for reporting clinical case reports and through adaptations to the different CARE disciplines is used to define standards for authors in scientific journals; however, the specificity of the nursing process makes it difficult to adjust nursing case reports to CARE. The aim was to analyze the publications of clinical cases with a nursing perspective in scientific journals, as well as the quality standards and evaluation systems used. Few journals reviewed agreed to publish nursing case reports or stated standards for authors to adjust to CARE. Preliminary results indicated average or poor adherence to CARE, with the most reported elements being: Keywords, patient information and introduction. Adherence was lower for the elements: Timeline, therapeutic intervention, follow-up and outcomes, and patient perspective. The characteristics of the nursing process implies a low adherence to CARE, so it is necessary to unify criteria to guide researchers, authors, reviewers and editors of scientific journals, as well as to improve the rigor and quality of the reports. Currently, there are no specific guidelines for reporting clinical case reports with a nursing perspective available. These normative gaps could be solved by developing a CARE extension adapted to the methodological characteristics of the nursing process.

Experiences and preferences of people with stroke and caregivers, around supports provided at the transition from hospital to home: a qualitative descriptive study.

BACKGROUND: Transitioning home from the structured hospital setting poses challenges for people with stroke (PWS) and their caregivers (CGs), as they navigate through complex uncertainties. There are gaps in our understanding of appropriate support interventions for managing the transition home. In this qualitative study, we explored the perspectives of PWS and their CGs regarding their support experiences and preferences during this period. METHODS: Between November 2022 and March 2023, and within six months of hospital discharge, audio-recorded, semi-structured interviews were conducted with PWS and CGs. All interviews were transcribed, imported into NVivo software, and analysed using reflexive thematic analysis. RESULTS: Sixteen interviews were conducted, nine with PWS and seven with CGs. Four themes relevant to their collective experiences and preferences were identified: (i) Need for tailored information-sharing, at the right time, and in the right setting; (ii) The importance of emotional support; (iii) Left in limbo, (iv) Inequity of access. Experiences depict issues such as insufficient information-sharing, communication gaps, and fragmented and inequitable care; while a multi-faceted approach is desired to ease anxiety and uncertainty, minimise delays, and optimise recovery and participation during transition. CONCLUSIONS: Our findings highlight that regardless of the discharge route, and even with formal support systems in place, PWS and families encounter challenges during the transition period. The experiences of support at this transition and the preferences of PWS and CGs during this important period highlights the need for better care co-ordination, early and ongoing emotional support, and equitable access to tailored services and support. Experiences are likely to be improved by implementing a partnership approach with improved collaboration, including joint goal-setting, between PWS, CGs, healthcare professionals and support organisations.

Evaluating the Utility of the Surprise Question Among General Physicians for Appropriate Palliative Care Indication in Brazil.

Objectives: This study aimed to assess the agreement between established tools, such as the Palliative Performance Scale (PPS) and Brazilian version of the Supportive and Palliative Care Indicators Tool (SPICT-BR), and the subjective assessment of palliative care (PC) need using the Surprise Question (SQ) administered by resident physicians. This assessment was conducted among hospitalized patients, with and without cancer, to determine the efficacy of these tools in indicating the need for PC. Methods: A six-month cross-sectional study in 2019 of medical records of patients hospitalized in a single center in IAMSPE-Brazil. The SPICT-BR and PPS were applied to the medical record data, and the SQ was posed to each resident physician. Comparisons for categorical data were made using the chi-square test, with p < 0.05 considered statistically significant. Results: Of 203 patients evaluated, 57.6% were male and 81.2% were older adults (≥60 years). The mean age was 67.40 ± 9.72 years. Chronic disease was nonneoplastic in 78.32% of patients, and 56.65% had not been hospitalized in the preceding year. The PPS score was <70% in 69.4% of patients, and 51.2% met at least one SPICT-BR criterion. Among patients with cancer, 40.9% had over two positive SPICT-BR criteria; 97.5% of these patients received NO responses to SQ by residents (p < 0.0001). Similarly, 90.6% of patients with one SPICT-BR criterion received NO responses to SQ, with no significant difference between groups. Conclusion: The SQ proved to be a valuable tool for PC indication, particularly when administered by untrained professionals. Consistent with SPICT-BR findings, our study highlights the SQ's role in facilitating early identification of patients in need of PC.

[Effects of nursing visits on primary nursing : An evaluation study in an intensive care unit]. / Auswirkungen der Pflegevisite auf die Prozessverantwortliche Pflege : Eine Evaluationsstudie auf der Intensivstation.

BACKGROUND: After a pilot phase in 2017, nursing visits (PV) were implemented in an intensive care unit (ICU) at a university hospital. So far, published findings on the impact of PV on the primary nursing organisation system (process-responsible nursing [PP]) could not be identified. AIM: Primary aim was to investigate the effects of PV on PP from the nurses perspective. Secondary aims included comparison with the results of the pilot phase (t0) to determine further effects, general conditions of the PP and the overall evaluation. METHODS: A quantitative evaluation study using a standardised questionnaire was used. RESULTS: The survey was conducted in September to October 2023 (t1) with a response rate of 74.6% (n = 47). On a scale of 1-6 (strongly agree; strongly disagree), 100.0% of the process-responsible nurses (PP; n = 8) and 77.0% of the nurses without process responsibility (P; n = 30) rated the PV at levels 1-3 (p = 0.328) as contributing to the evaluation of care planning for patients with process responsibility. PV provided support for the implementation of PP (PP: 100.0%, n = 8; P: 79.5%, n = 31; p = 0.318) and had a statistically significant effect (r = 0.97, p = 0.035) on improving the quality of care and care planning for patients with procedural responsibility. The nurses indicated with levels 1-3 that the patients were more consciously brought into the focus of nursing care through the PV (t1: 74.4%, n = 35; t0: 86.4%, n = 38; p = 0.953). The PV should take place weekly and was rated with a median of 2 (IQR t1: 1-3; t0:1-2). CONCLUSION: PV support the implementation of PP and patient-centred care in the ICU.

Critical care outcomes in decompensated cirrhosis: a United States national inpatient sample cross-sectional study.

BACKGROUND: Prior assessments of critical care outcomes in patients with cirrhosis have shown conflicting results. We aimed to provide nationwide generalizable results of critical care outcomes in patients with decompensated cirrhosis. METHODS: This is a retrospective study using the National Inpatient Sample from 2016 to 2019. Adults with cirrhosis who required respiratory intubation, central venous catheter placement or both (n = 12,945) with principal diagnoses including: esophageal variceal hemorrhage (EVH, 24%), hepatic encephalopathy (58%), hepatorenal syndrome (HRS, 14%) or spontaneous bacterial peritonitis (4%) were included. A comparison cohort of patients without cirrhosis requiring intubation or central line placement for any principal diagnosis was included. RESULTS: Those with cirrhosis were younger (mean 58 vs. 63 years, p < 0.001) and more likely to be male (62% vs. 54%, p < 0.001). In-hospital mortality was higher in the cirrhosis cohort (33.1% vs. 26.6%, p < 0.001) and ranged from 26.7% in EVH to 50.6% HRS. Mortality when renal replacement therapy was utilized (n = 1580, 12.2%) was 46.5% in the cirrhosis cohort, compared to 32.3% in other hospitalizations (p < 0.001), and was lowest in EVH (25.7%) and highest in HRS (51.5%). Mortality when cardiopulmonary resuscitation was used was increased in the cirrhosis cohort (88.0% vs. 72.1%, p < 0.001) and highest in HRS (95.7%). CONCLUSIONS: One-third of patients with cirrhosis requiring critical care did not survive to discharge in this U.S. nationwide assessment. While outcomes were worse than in patients without cirrhosis, the results do suggest better outcomes compared to previous studies.

Nursing home residents' perspectives on oral health: An in-depth interview study.

Background: Oral health is associated with general health and care dependency, but is often neglected in nursing homes. Integration of oral care into general care is necessary, but is hampered by multiple barriers at different levels. This study is part of research into the implementation of the new Oral Health Section for use within the interRAI Long-Term Care Facilities instrument, which is used to assess care needs of nursing home residents. This new Oral Health Section evaluates nine aspects of oral health and results in two Collaborative Action Points. Objective: To identify residents' perspectives on oral health, oral care, and on the assessment of their oral health using the new Oral Health Section. Design: Qualitative design using in-depth interviews. Settings: Three nursing homes. Participants: Residents were selected using purposeful sampling in nursing homes participating in research evaluating the use of the new Oral Health Section. The selection was based on their oral status for maximum variation and on their cognitive performance score. Twenty-two residents from three Flemish nursing homes agreed to participate. Methods: Residents' oral health was assessed using the new Oral Health Section and dental indices. In-depth interviews were conducted, including the validated short-form Oral Health Impact Profile to evaluate the impact of oral conditions on residents' well-being. The interviews were coded and analysed by three researchers and mapped into a model to understand participants' oral health behaviours. Results: Low Oral Health Impact Profile scores indicated a low impact of oral health issues on participants' lives. However, despite 77.3 % of the participants reporting satisfaction with their oral health, 86.4 % had poor oral hygiene and 68.2 % required referral to a dentist, suggesting a tendency to overestimate their oral health. Their oral health behaviour was determined by a lack of oral health knowledge (Capability), positive attitudes towards oral health and autonomy (Motivation), upbringing and social support (Opportunity). Participants considered assessments with the new Oral Health Section acceptable. Conclusions: This study shows how older people perceive their oral health and oral healthcare. Understanding their wishes and needs will not only facilitate their involvement in their oral care, but is also likely to enable the improvement of their oral hygiene and the development of effective oral care strategies for the future. Policy makers and managers of care organisations may use these results to foster integration of oral care guidelines into care protocols within nursing homes, including collaboration with dentists and dental hygienists. Tweetable abstract: Oral health assessments with the new Oral Health Section for use within interRAI were positively perceived by nursing home residents.

Use of the supportive and palliative care indicators tool (SPICT™) for end-of-life discussions: a scoping review.

BACKGROUND: In order to mitigate the distress associated with life limiting conditions it is essential for all health professionals not just palliative care specialists to identify people with deteriorating health and unmet palliative care needs and to plan care. The SPICT™ tool was designed to assist with this. AIM: The aim was to examine the impact of the SPICT™ on advance care planning conversations and the extent of its use in advance care planning for adults with chronic life-limiting illness. METHODS: In this scoping review records published between 2010 and 2024 reporting the use of the SPICT™, were included unless the study aim was to evaluate the tool for prognostication purposes. Databases searched were EBSCO Medline, PubMed, EBSCO CINAHL, APA Psych Info, ProQuest One Theses and Dissertations Global. RESULTS: From the search results 26 records were reviewed, including two systematic review, two theses and 22 primary research studies. Much of the research was derived from primary care settings. There was evidence that the SPICT™ assists conversations about advance care planning specifically discussion and documentation of advance care directives, resuscitation plans and preferred place of death. The SPICT™ is available in at least eight languages (many versions have been validated) and used in many countries. CONCLUSIONS: Use of the SPICT™ appears to assist advance care planning. It has yet to be widely used in acute care settings and has had limited use in countries beyond Europe. There is a need for further research to validate the tool in different languages.

Effectiveness of the socioecological informed contextual treatment summary and care plan (TSSCP-P, Brazil) for breast cancer survivors: a randomized, controlled study.

OBJECTIVE: This study aimed to evaluate the impact of an intervention using the Treatment Summary and Survivorship Care Plan (TSSCP-P) on self-efficacy and quality of life (QoL) in breast cancer survivors. METHOD: A clinical study, randomized and controlled, conducted to assess self-efficacy and QOL in breast cancer survivors. The participants were randomly assigned to either an intervention group or a control group. The intervention group received individualized nursing consultations guided by the TSSCP-P, while the control group received standard care. Self-efficacy and QoL were assessed at three evaluation moments using validated scales: Functional Assessment of Cancer Therapy-Breast Plus Anm Morbidity (FACT B + 4) and Perceived General Self-Efficacy Scale. Statistical analyses, including regression analysis and hypothesis tests, were conducted to examine the effects of the intervention on self-efficacy and QoL. RESULTS: Female breast cancer survivors (N = 101) were recruited. The intervention group demonstrated a significant improvement in self-efficacy over time compared to the control group (p = 0.01). However, no significant differences were observed in the overall QoL scores between the two groups. Subscale analysis revealed a significant improvement in physical well-being for the intervention group (p = 0.04), while emotional well-being showed a non-significant improvement (p = 0.07). The study suggests that individualized care plans and support strategies, such as the TSSCP-P, can positively influence breast cancer survivors' self-efficacy and certain aspects of their QoL. CONCLUSION: These findings highlight the potential benefits of the TSSCP-P intervention in enhancing self-efficacy among breast cancer survivors. However, further research is needed to explore its impact on overall QoL and its effectiveness across different stages of breast cancer, as well as with longer follow-up periods. CLINICAL TRIAL REGISTRATION NUMBER: Brazilian Registry of Clinical Trials (ReBEC- RBR-2m7qkjy; UTN code: U1111-1257-3560), registered in April 19th, 2022.

Cost of Hospitalization Associated with Inpatient Goals-of-Care Program Implementation at a Comprehensive Cancer Center: A Propensity Score Analysis.

The impact of goals-of-care programs on acute hospitalization costs is unclear. We compared the hospitalization cost in an 8-month period before implementation of a multimodal interdisciplinary goals-of-care program (1 May 2019 to 31 December 2019) to an 8-month period after program implementation (1 May 2020 to 31 December 2020). Propensity score weighting was used to adjust for differences in potential covariates. The primary outcome was total direct cost during the hospital stay for each index hospitalization. This analysis included 6977 patients in 2019 and 5964 patients in 2020. The total direct cost decreased by 3% in 2020 but was not statistically significant (ratio 0.97, 95% CI 0.92, 1.03). Under individual categories, there was a significant decrease in medical oncology (ratio 0.58, 95% CI 0.50, 0.68) and pharmacy costs (ratio 0.86, 95% CI 0.79, 0.96), and an increase in room and board (ratio 1.06, 95% CI 1.01, 1.10). In subgroup analysis, ICU patients had a significant reduction in total direct cost after program implementation (ratio 0.83, 95% CI 0.72, 0.94). After accounting for the length of ICU admission, we found that the total direct cost per hospital day was no longer different between 2019 and 2020 (ratio 0.986, 95% CI 0.92, 1.05), suggesting that shorter ICU admissions likely explained much of the observed cost savings. This study provides real-world data on how "in-the-moment" GOC conversations may contribute to reduced hospitalization costs among ICU patients.

Using interoperable nursing care data to improve outcomes for multiple traumas patients with Impaired Physical Mobility.

AIM(S): To demonstrate how interoperable nursing care data can be used by nurses to create a more holistic understanding of the healthcare needs of multiple traumas patients with Impaired Physical Mobility. By proposing and validating linkages for the nursing diagnosis of Impaired Physical Mobility in multiple trauma patients by mapping to the Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC) equivalent terms using free-text nursing documentation. DESIGN: A descriptive cross-sectional design, combining quantitative analysis of interoperable data sets and the Kappa's coefficient score with qualitative insights from cross-mapping methodology and nursing professionals' consensus. METHODS: Cross-mapping methodology was conducted in a Brazilian Level 1 Trauma Center using de-identified records of adult patients with a confirmed medical diagnosis of multiple traumas and Impaired Physical Mobility (a nursing diagnosis). The hospital nursing free-text records were mapped to NANDA-I, NIC, NOC and NNN linkages were identified. The data records were retrieved for admissions from September to October 2020 and involved medical and nursing records. Three expert nurses evaluated the cross-mapping and linkage results using a 4-point Likert-type scale and Kappa's coefficient. RESULTS: The de-identified records of 44 patients were evaluated and then were mapped to three NOCs related to nurses care planning: (0001) Endurance; (0204) Immobility Consequences: Physiological, and (0208) Mobility and 13 interventions and 32 interrelated activities: (6486) Environmental Management: Safety; (0840) Positioning; (3200) Aspiration Precautions; (1400) Pain Management; (0940) Traction/Immobilization Care; (3540) Pressure Ulcer Prevention; (3584) Skincare: Topical Treatment; (1100) Nutrition Management; (3660) Wound Care; (1804) Self-Care Assistance: Toileting; (1801) Self-Care Assistance: Bathing/Hygiene; (4130) Fluid Monitoring; and (4200) Intravenous Therapy. The final version of the constructed NNN Linkages identified 37 NOCs and 41 NICs. CONCLUSION: These valid NNN linkages for patients with multiple traumas can serve as a valuable resource that enables nurses, who face multiple time constraints, to make informed decisions efficiently. This approach of using evidence-based linkages like the one developed in this research holds high potential for improving patient's safety and outcomes. NO PATIENT OR PUBLIC CONTRIBUTION: In this study, there was no direct involvement of patients, service users, caregivers or public members in the design, conduct, analysis and interpretation of data or preparation of the manuscript. The study focused solely on analysing existing de-identified medical and nursing records to propose and validate linkages for nursing diagnoses.

Factors Associated with Preferred Place of Care and Death in Patients with Parkinson's Disease: A Cross-Sectional Study.

Background: A significant proportion of people with Parkinson's disease (PwPD) die in hospital settings. Although one could presume that most PwPD would favor being cared for and die at home, there is currently no evidence to support this assumption. Objective: We aimed at exploring PwPD's preferences for place of end-of-life care and place of death, along with associated factors. Methods: A cross-sectional study was conducted to investigate PwPD's end-of life wishes regarding their preferred place of care and preferred place of death. Using different approaches within a generalized linear model framework, we additionally explored factors possibly associated with preferences for home care and home death. Results: Although most PwPD wished to be cared for and die at home, about one-third reported feeling indifferent about their place of death. Preferred home care was associated with the preference for home death. Furthermore, a preference for dying at home was more likely among PwPD's with informal care support and spiritual/religious affiliation, but less likely if they preferred institutional care towards the end of life. Conclusions: The variation in responses regarding the preferred place of care and place of death highlights the need to distinguish between the concepts when discussing end-of-life care. However, it is worth noting that the majority of PwPD preferred care and death at home. The factors identified in relation to preferred place of care and death provide an initial understanding of PwPD decision-making, but call for further research to confirm our findings, explore causality and identify additional influencing factors.

Associations with Discharge to Post-Acute Care Facilities Among Patients Undergoing Open Reduction Internal Fixation of Distal Radius Fractures.

Introduction: Distal radius fractures are a common injury of the hand and wrist that often require intensive rehabilitation. We sought to identify risk factors associated with discharge to a post-acute care facility following distal radius fracture repair. Methods: The 2011 to 2016 National Surgical Quality Improvement Program® (NSQIP) database was queried for all Current Procedural Terminology (CPT) codes that corresponded with open distal radius fracture repair. Patients with concomitant traumatic injuries were excluded. Patient demographics, comorbidities, perioperative factors, laboratory data, and surgical details were collected. Our primary outcome was to determine postoperative discharge destination: home versus a post-acute care facility, and to identify factors that predict discharge to post-acute care facility. Secondary outcomes included unplanned readmission, reoperation, and complications. Results: Between 2011 and 2016, a total of 12,001 patients underwent open distal radius fracture repair and had complete information for their discharge. Of these analyzed patients, 3.24% (n = 389) were discharged to rehabilitation facilities. The following factors were identified on multivariate analysis to have an association with discharge to a post-acute care facility: 65 years or older, White race, underweight, using steroids preoperatively, American Society of Anesthesiologists (ASA) classification > 2, admitted from a nursing home or already hospitalized, anemic, undergoing bilateral surgery, wound classification other than clean, and complications prior to discharge. Conclusion: Factors identified by our study to have associations with discharge to post-acute care facilities following distal radius fracture repair can help in appropriate patient counseling and triage from the hospital to home versus a post-acute care facility.

Introduction: Les fractures du radius distal sont des blessures courantes de la main et du poignet qui exigent souvent une réadaptation intensive. Les chercheurs ont voulu déterminer les facteurs de risque associés au congé dans un établissement de soins post-aigus après la réparation d'une fracture du radius distal. Méthodologie: Les chercheurs ont fouillé la base de données 2011-2016 des NSQIP pour extraire tous les codes CPT (terminologie procédurale actuelle) qui correspondaient aux réparations des fractures ouvertes du radius distal. Les patients atteints d'autres blessures traumatiques ont été exclus. Les chercheurs ont colligé les caractéristiques démographiques des patients, leurs maladies sous-jacentes, les facteurs périopératoires, les données de laboratoire et l'information chirurgicale. Le résultat primaire consistait à déterminer la destination du congé postopératoire, soit le domicile ou l'établissement de soins postaigus, et à établir quels facteurs permettent de prédire un congé dans un établissement de soins postaigus. Les résultats secondaires incluaient des réadmissions non planifiées, la reprise de l'opération et les complications. Résultats: Entre 2011 et 2016, un total de 12 001 patients ont subi la réparation d'une fracture ouverte du radius distal et reçu de l'information complète lors de leur congé. De ce nombre, 3,24% (n = 389) ont obtenu leur congé dans des établissements de réadaptation. L'analyse multivariée a établi que les facteurs suivants étaient associés à un congé dans un établissement de soins postaigus : un âge de 65 ans ou plus, la race blanche, l'insuffisance pondérale, la prise de stéroïdes après l'opération, une classification d'ASA supérieure à 2, l'admission à partir d'un centre de soins de longue durée ou le fait d'être déjà hospitalisé, l'anémie, la chirurgie bilatérale, une classification des plaies autres que propre et des complications avant le congé. Conclusion: La présente étude a déterminé que certains facteurs associés au congé dans un établissement de soins postaigus après une réparation du radius distal peuvent contribuer à des conseils appropriés aux patients et à un triage de l'hôpital vers le domicile plutôt que vers un autre établissement.

Primary Palliative Care in Urology: Quality Improvement Summit 2021-2022.

INTRODUCTION: The AUA convened a 2021-2022 Quality Improvement Summit to bring together interdisciplinary providers to inform the current state and to discuss potential strategies for integrating primary palliative care into urology practice. We hypothesized that the Summit findings would inform a scalable primary palliative care model for urology. METHODS: The 3-part summit reached a total of 160 interdisciplinary health care professionals. Webinar 1, "Building a Primary Palliative Care Model for Urology," focused on a urologist's role in palliative care. Webinar 2, "Perspectives on Increasing the Use of Palliative Care in Advanced Urologic Disease," addressed barriers to possible implementation of a primary palliative care model. The in-person Summit, "Laying the Foundation for Primary Palliative Care in Urology," focused on operationalization of primary palliative care, clinical innovations needed, and relevant metrics. RESULTS: Participants agreed that palliative care is needed early in the disease course for patients with advanced disease, including those with benign and malignant conditions. The group agreed about the important domains that should be addressed as well as the interdisciplinary providers who are best suited to address each domain. There was consensus that a primary "quarterback" was needed, encapsulated in a conceptual model-UroPal-with a urologist at the hub of care. CONCLUSIONS: The Summit provides the field of urology with a framework and specific steps that can be taken to move urology-palliative care integration forward. Urologists are uniquely positioned to provide primary palliative care for their many patients with serious illness, both in the surgical and chronic care contexts.

The Value of Using Patient-Specific 3D-Printed Anatomical Models in Surgical Planning for Patients With Complex Multifibroid Uteri.

OBJECTIVES: To compare surgeon responses regarding their surgical plan before and after receiving a patient-specific three-dimensional (3D)-printed model of a patient's multifibroid uterus created from their magnetic resonance imaging. METHODS: 3D-printed models were derived from standard-of-care pelvic magnetic resonance images of patients scheduled for surgical intervention for multifibroid uterus. Relevant anatomical structures were printed using a combination of transparent and opaque resin types. 3D models were used for 7 surgical cases (5 myomectomies, 2 hysterectomies). A staff surgeon and 1 or 2 surgical fellow(s) were present for each case. Surgeons completed a questionnaire before and after receiving the model documenting surgical approach, perceived difficulty, and confidence in surgical plan. A postoperative questionnaire was used to assess surgeon experience using 3D models. RESULTS: Two staff surgeons and 3 clinical fellows participated in this study. A total of 15 surgeon responses were collected across the 7 cases. After viewing the models, an increase in perceived surgical difficulty and confidence in surgical plan was reported in 12/15 and 7/15 responses, respectively. Anticipated surgical time had a mean ± SD absolute change of 44.0 ± 47.9 minutes and anticipated blood loss had an absolute change of 100 ± 103.5 cc. 2 of 15 responses report a change in pre-surgical approach. Intra-operative model reference was reported to change the dissection route in 8/15 surgeon responses. On average, surgeons rated their experience using 3D models 8.6/10 for pre-surgical planning and 8.1/10 for intra-operative reference. CONCLUSIONS: Patient-specific 3D anatomical models may be a useful tool to increase a surgeon's understanding of complex gynaecologic anatomy and to improve their surgical plan. Future work is needed to evaluate the impact of 3D models on surgical outcomes in gynaecology.

Care Plan Templates in Adult Community Mental Health Teams in England and Wales: An Evaluation.

Adults accessing community mental health services are required to have a care plan, developed in collaboration with the person accessing the service. The variation in care plan templates in use in England and Wales, and their impact on care planning, is unknown. This study evaluates the community mental health care plan templates in use across England and Wales. Data were obtained from a Freedom of Information request to 50 NHS Mental Health Trusts. An evaluation tool was designed and used to extract data. Data were rated red, amber, or green against clinical and design standards. Forty-seven care plan templates were obtained. The clinical aspect of the care plan template had 60% adherence to the national standards, and the design aspects had 87% adherence. A 'high/low' typology is proposed against the design/clinical standards. The study identifies priority areas for improvement in the care plan templates as space to record the actions that service users and carers will take to contribute to their care plan, space to record the name and contact details for their care coordinator or lead professional, plus others involved in the person's care. This study was not registered.

Desempenho de discentes monitores do curso de Odontologia na construção do diagnóstico e plano de tratamento de pacientes odontológicos / Desempeño de los estudiantes tutores del curso de odontología en la construcción del plan de diagnóstico y tratamiento de pacientes odontológicos / Dentistry course student-monitors'performance in the construction of the diagnosis and treatment plan for dental patients

O objetivo no presente estudo foi avaliar o desempenho de discentes, que participaram do Programa de Monitoria no Curso de Odontologia da Universidade Federal de Juiz de Fora em disciplinas com práticas clínicas, em relação à construção do diagnóstico e plano de tratamento, comparando essas habilidades com as apresentadas por alunos não monitores. Para isso foi aplicado um questionário a 12 alunos que haviam participado do programa de monitoria em disciplinas com práticas clínicas e a 12 alunos não monitores. O questionário foi composto por seis questões sobre o perfil dos discentes monitores e a experiência desses alunos com o programa; e por três casos clínicos fictícios, que permitiram a avaliação da construção do diagnóstico e do plano de tratamento. As respostas das questões sobre o perfil dos discentes foram apresentadas em frequências absolutas e relativas. Testes t para amostras independentes foram utilizados para comparar as notas dos discentes monitores e não monitores para cada caso clínico. Os resultados obtidos mostraram que não houve diferença significativa entre os dois grupos avaliados nas pontuações obtidas pelas respostas aos casos clínicos. Dentre os motivos que levaram os discentes a participar dos programas de monitoria, destacam-se: "oportunidade de reforçar o conhecimento", "aumentar a pontuação do currículo" e "por causa da remuneração". O interesse pela docência foi a justificativa menos prevalente. Pode-se concluir que, mesmo queo resultado não tenha mostrado diferença entre os discentes, a prática da monitoria tem sido relevante, colaborando para o desenvolvimento de competências e habilidades que são indispensáveis à formação do cirurgião-dentista (AU).

El objetivo del presente estudio fue evaluar el desempeño de los estudiantes que participaron del Programa de Tutoría de la Carrera de Odontología de la Universidade Federal de Juiz de Foraen materias con prácticas clínicas, en relación a la construcción del plan dediagnóstico y tratamiento, comparando estas habilidades con las presentadas por estudiantes no tutores. Para ello se aplicó un cuestionario a 12 estudiantes que habían participado en el programa de tutoría en asignaturas con prácticas clínicas y a 12 estudiantes no tutores. El cuestionario constaba de seis preguntas sobre el perfil de los estudiantes tutores y su experiencia con el programa; y tres casos clínicos ficticios, que permitieron evaluar la construcción del diagnóstico y plan de tratamiento. Las respuestas a las preguntas sobre el perfil de los estudiantes se presentaron en frecuencias absolutas y relativas. Se utilizaron pruebas T para muestras independientes para comparar las puntuaciones de los estudiantes tutores y no tutores para cada caso clínico. Los resultados obtenidos mostraron que no hubo diferencia significativa entre los dos grupos evaluados en las puntuaciones obtenidas de las respuestas a los casos clínicos. Entre los motivos que llevaron a los estudiantes a participar en programasde tutoría destacan: "oportunidad de reforzar conocimientos", "aumentar la puntuación del currículo" y "por la remuneración". El interés por la enseñanza fue la justificación menos frecuente. Se puede concluir que, si bien el resultado no mostró diferencia entre los estudiantes, la práctica de tutoría ha sido relevante, contribuyendo al desarrollo de habilidades y habilidades esenciales para la formación de los cirujanos dentistas (AU).

The aim of the present study was to evaluate the performance of students, who participated in the Monitoring Program of the Dentistry Course at the Federal University of Juiz de Fora, in subjects with clinical practices, relative to construction of the diagnosis and treatment plan, to compare these skills with those presented by non-monitor students. For this purpose, a questionnaire was applied to 12 students who had participated in the monitoring program in subjects with clinical practices, and to 12 students who werenot monitors. The questionnaire consisted of six questions about the profile of student monitors and their experience with the program; and three fictitious clinical cases that allowed evaluation of the construction of the diagnosis and treatment plan. The answers to the questions about the students' profile were presented in absolute and relative frequencies. For each clinical case, T-tests for independent samples were used to compare the scores of student monitors and students who were not monitors. The results obtained showed that there was no significant difference between the two groups evaluated, relative to the scores attributed to the responses to the clinical cases. Among the reasons that led students to participating in monitoring programs, the following were outstanding: "opportunity to reinforce knowledge", "increase the CV score" and "because of the remuneration". Interest in teaching was the least prevalent justification. It can be concluded that although the result did not show a difference between students, the practice of monitoring has been relevant, by contributing to the development of skills and abilities that are essential to the training of dental surgeons (AU).

Early Prediction of Poststroke Rehabilitation Outcomes Using Wearable Sensors.

OBJECTIVE: Inpatient rehabilitation represents a critical setting for stroke treatment, providing intensive, targeted therapy and task-specific practice to minimize a patient's functional deficits and facilitate their reintegration into the community. However, impairment and recovery vary greatly after stroke, making it difficult to predict a patient's future outcomes or response to treatment. In this study, the authors examined the value of early-stage wearable sensor data to predict 3 functional outcomes (ambulation, independence, and risk of falling) at rehabilitation discharge. METHODS: Fifty-five individuals undergoing inpatient stroke rehabilitation participated in this study. Supervised machine learning classifiers were retrospectively trained to predict discharge outcomes using data collected at hospital admission, including patient information, functional assessment scores, and inertial sensor data from the lower limbs during gait and/or balance tasks. Model performance was compared across different data combinations and was benchmarked against a traditional model trained without sensor data. RESULTS: For patients who were ambulatory at admission, sensor data improved the predictions of ambulation and risk of falling (with weighted F1 scores increasing by 19.6% and 23.4%, respectively) and maintained similar performance for predictions of independence, compared to a benchmark model without sensor data. The best-performing sensor-based models predicted discharge ambulation (community vs household), independence (high vs low), and risk of falling (normal vs high) with accuracies of 84.4%, 68.8%, and 65.9%, respectively. Most misclassifications occurred with admission or discharge scores near the classification boundary. For patients who were nonambulatory at admission, sensor data recorded during simple balance tasks did not offer predictive value over the benchmark models. CONCLUSION: These findings support the continued investigation of wearable sensors as an accessible, easy-to-use tool to predict the functional recovery after stroke. IMPACT: Accurate, early prediction of poststroke rehabilitation outcomes from wearable sensors would improve our ability to deliver personalized, effective care and discharge planning in the inpatient setting and beyond.