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1.
Braz. j. biol ; 84: e253065, 2024. tab
Artigo em Inglês | LILACS, VETINDEX | ID: biblio-1350311

RESUMO

Abstract Routine blood culture is used for the detection of bloodstream infections by aerobic and anaerobic bacteria and by common pathogenic yeasts. A retrospective study was conducted in a public hospital in Maceió-AL, by collecting data of all medical records with positive blood cultures. Out of the 2,107 blood cultures performed, 17% were positive with Staphylococcus coagulase negative (51.14%), followed by Staphylococcus aureus (11.21%) and Klebsiella pneumoniae (6.32%). Gram-positive bacteria predominated among positive blood cultures, highlighting the group of Staphylococcus coagulase-negative. While Gram-negative bacteria had a higher number of species among positive blood cultures.


Resumo A cultura sanguínea de rotina é usada para a detecção de infecções na corrente sanguínea por bactérias aeróbias e anaeróbias e por leveduras patogênicas comuns. Estudo retrospectivo realizado em hospital público de Maceió-AL, por meio da coleta de dados de todos os prontuários com culturas sanguíneas positivas. Das 2.107 culturas sanguíneas realizadas, 17% foram positivas com Staphylococcus coagulase negativo (51,14%), seguido por Staphylococcus aureus (11,21%) e Klebsiella pneumoniae (6,32%). As bactérias Gram-positiva predominaram entre as culturas de sangue positivas, destacando-se o grupo das Staphylococcus coagulase-negativo. Enquanto as bactérias Gram-negativas apresentaram um número maior de espécies entre as culturas de sangue positivas.


Assuntos
Humanos , Sepse , Bactérias Gram-Negativas , Brasil , Estudos Retrospectivos , Hospitais
2.
Sensors (Basel) ; 23(2)2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36679541

RESUMO

Coronavirus Disease 2019 (COVID-19) is still a threat to global health and safety, and it is anticipated that deep learning (DL) will be the most effective way of detecting COVID-19 and other chest diseases such as lung cancer (LC), tuberculosis (TB), pneumothorax (PneuTh), and pneumonia (Pneu). However, data sharing across hospitals is hampered by patients' right to privacy, leading to unexpected results from deep neural network (DNN) models. Federated learning (FL) is a game-changing concept since it allows clients to train models together without sharing their source data with anybody else. Few studies, however, focus on improving the model's accuracy and stability, whereas most existing FL-based COVID-19 detection techniques aim to maximize secondary objectives such as latency, energy usage, and privacy. In this work, we design a novel model named decision-making-based federated learning network (DMFL_Net) for medical diagnostic image analysis to distinguish COVID-19 from four distinct chest disorders including LC, TB, PneuTh, and Pneu. The DMFL_Net model that has been suggested gathers data from a variety of hospitals, constructs the model using the DenseNet-169, and produces accurate predictions from information that is kept secure and only released to authorized individuals. Extensive experiments were carried out with chest X-rays (CXR), and the performance of the proposed model was compared with two transfer learning (TL) models, i.e., VGG-19 and VGG-16 in terms of accuracy (ACC), precision (PRE), recall (REC), specificity (SPF), and F1-measure. Additionally, the DMFL_Net model is also compared with the default FL configurations. The proposed DMFL_Net + DenseNet-169 model achieves an accuracy of 98.45% and outperforms other approaches in classifying COVID-19 from four chest diseases and successfully protects the privacy of the data among diverse clients.


Assuntos
COVID-19 , Neoplasias Pulmonares , Humanos , Raios X , COVID-19/diagnóstico por imagem , Radiografia , Tórax/diagnóstico por imagem , Hospitais
3.
PLoS One ; 18(1): e0280137, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36662714

RESUMO

The burden of cardiovascular disease (CVD) is rising in Kenya and non-adherence to cardiovascular pharmacotherapy is a growing global public health issue that leads to treatment failure, an increased risk of cardiac events and poor clinical outcomes. This study assessed adherence to selected cardiovascular therapy medications among CVD patients attending outpatient clinics at Kenyatta National Hospital, Kenya by determining drug concentration(s) in patient dried blood spot (DBS) samples. Patients who had been taking one or more of the five commonly prescribed CVD medications (amlodipine, atenolol, atorvastatin, losartan, and valsartan) for at least six months were enrolled. Each patient completed a short questionnaire about their medication history and then provided a finger-prick blood spot sample from which drug concentrations were determined by liquid chromatography-high resolution mass spectrometry analysis. Two hundred and thirty-nine patients (62.3% female) participated in the study. The median number of medications used by patients was 2 (IQR 75%-25% is 3-1). Less than half (117; 49.0%) of patients were adherent to their prescribed CVD pharmacotherapy. Binary regression analysis revealed a significant correlation between non-adherence and the number of medications in the treatment regimen (Odds Ratio (OR) 1.583; 95%CI: 0.949-2.639; P-value = 0.039) and that gender was not an independent predictor of medication adherence (OR 1.233; 95%CI: 0.730-2.083; P-value = 0.216). Valuable information about adherence to each medication in the patient's treatment regimen was obtained using quantitative DBS analysis showing that adherence to CVD medications was not uniform. DBS sampling, due its minimally invasive nature, convenience and ease of transport is a useful alternative matrix to monitor adherence to pharmacotherapies objectively, when combined with hyphenated mass spectrometry analytical techniques. This information can provide physicians with an evidence-based novel approach towards personalization and optimization of CVD pharmacotherapy and implementing interventions in the Kenyan population, thereby improving clinical outcomes.


Assuntos
Fármacos Cardiovasculares , Doenças Cardiovasculares , Humanos , Feminino , Masculino , Quênia , Teste em Amostras de Sangue Seco , Doenças Cardiovasculares/tratamento farmacológico , Atenolol , Hospitais , Adesão à Medicação
4.
Artigo em Inglês | MEDLINE | ID: mdl-36674133

RESUMO

Patients with comorbidities and obesity are more likely to be hospitalized with coronavirus disease 2019 (COVID-19), to have a higher incidence of severe pneumonia and to also show higher mortality rates. Between 15 March 2020 and 31 December 2021, a retrospective, single-center, observational study was conducted among patients requiring hospitalization for COVID-19 infection. Our aim was to investigate the impact of comorbidities and lifestyle risk factors on mortality, the need for intensive care unit (ICU) admission and the severity of the disease among these patients. Our results demonstrated that comorbidities and obesity increased the risk for all investigated endpoints. Age over 65 years and male sex were identified as independent risk factors, and cardiovascular diseases, cancer, endocrine and metabolic diseases, chronic kidney disease and obesity were identified as significant risk factors. Obesity was found to be the most significant risk factor, associated with considerable odds of COVID-19 mortality and the need for ICU admission in the under-65 age group (aOR: 2.95; p < 0.001 and aOR: 3.49, p < 0.001). In our study, risk factors that increased mortality and morbidity among hospitalized patients were identified. Detailed information on such factors may support therapeutic decision making, the proper targeting of vaccination campaigns and the effective overall management of the COVID-19 epidemic, hence reducing the burden on the healthcare system.


Assuntos
COVID-19 , Humanos , Masculino , Idoso , COVID-19/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Hungria , Obesidade/complicações , Obesidade/epidemiologia , Hospitalização , Fatores de Risco , Unidades de Terapia Intensiva , Hospitais
5.
Artigo em Inglês | MEDLINE | ID: mdl-36674294

RESUMO

This study presents architectural designers' perception of the importance of healthcare environmental criteria in the implementation of user-centered, therapeutic hospital design. Architectural designers with over three years of professional experience (N = 182) in South Korea were surveyed using an empirical questionnaire. The extensive interviews of 15 hospital design experts followed to interpret the survey results and discuss the barriers and suggestions for the successful delivery of therapeutic healthcare design practice. Among the 27 variables selected from the preliminary literature review, factor analyses revealed seven important therapeutic environmental criteria (i.e., management, interior design, spatial quality, service, nature and rest, ambient indoor comfort, and social program and space; χ2 = 1783.088, df = 300, p < 0.001). Analyses of variance revealed the level of importance among these criteria related to respondents' personal and professional characteristics. Significant differences were found for the variables from the management, interior design, and spatial quality factors in relation to the respondents sex and age. For the successful delivery of therapeutic healthcare design, the design experts highlighted the implementation of evidence-based design practice that integrates local and international knowledge from various hospital users and multi-disciplinary specialists participating in the healthcare design process.


Assuntos
Arquitetura Hospitalar , Inquéritos e Questionários , Decoração de Interiores e Mobiliário , Hospitais , Atenção à Saúde
6.
Artigo em Inglês | MEDLINE | ID: mdl-36674344

RESUMO

Clostridioides difficile is an anaerobic, Gram-positive bacterium widely present in the hospital environment due to its ability to generate spores. The transfer of spores to patients through the hands of medical personnel is one of the most frequent paths of C. difficile transmission. In paediatric patients burdened with a serious primary illness requiring long-term hospitalisation and antibiotic therapy, C. difficile may be a significant risk factor for antibiotic-associated diarrhoea. The goal of the study was to assess the state of hospital environments as a potential source of C. difficile spores and to establish the share of hyperepidemic strains at the two paediatric units. The survey for C. difficile was conducted with a C. diff Banana BrothTM medium, used to detect spores and to recover vegetative forms of the bacteria. Environmental samples (n = 86) and swabs from the clothing of medical personnel (n = 14) were collected at two units of a paediatric hospital, where the cases of antibiotic-associated diarrhoea with a C. difficile aetiology constitute a significant clinical problem. In 17 samples, a change in the broth's colour was observed, indicating the presence of spores. Out of seven samples, C. difficile strains were cultured. The pathogenic isolates of C. difficile were obtained from swabs collected from elements of beds, a toilet, a door handle and a doctor's uniform. In our study, we indicated points of increased risk of pathogen transmission, which could constitute a source of infection. The clothing of medical personnel may be a dangerous carrier of pathogenic spores. Periodical surveys of hospital environments with the use of specialist microbiological mediums successfully indicate the direction of corrective actions to be undertaken by the medical facility in order to increase patient safety.


Assuntos
Clostridioides difficile , Infecções por Clostridium , Gastroenterologia , Neoplasias , Humanos , Criança , Clostridioides , Esporos Bacterianos , Hospitais , Diarreia/epidemiologia , Infecções por Clostridium/epidemiologia
7.
Artigo em Inglês | MEDLINE | ID: mdl-36674385

RESUMO

In Saudi Arabia, the older adult population is growing and is projected to increase three-fold by 2030. Potentially inappropriate medications (PIMs) are harmful to older adults' and have a direct impact on clinical, health and economic outcomes. Pharmacists have a vital role in medication tailoring for older adults as multidisciplinary team members. However, there is also a paucity of research regarding pharmacists' participation in detecting and avoiding PIMs use among older adults in Saudi Arabia. A cross-sectional, self-administered survey was conducted to assess the knowledge, practices, and attitude of pharmacists from seven hospitals and ten community pharmacies in Jeddah, Saudi Arabia. The survey comprised three sections; (i) identifying participants' general characteristics, (ii) assessing their knowledge of PIMs use in older adults and (iii) examining the pharmacist's attitude towards the procedures followed in dispensing for older adults. Inferential and descriptive statistics were used to analyse the survey data. A total of 157 community and hospital pharmacists participated in this study. Most of them dispensed medication weekly to older adults (85.4%), and 43.3% had relevant work experience of six to ten years. Though 44.6% of the participants were aware of PIMs that older adults should avoid, only 10.8% claimed adequate knowledge about PIMs. From the given three clinical case scenarios, a minority of pharmacists (21.7%) chose the correct answers, with a mean score of 2.38 ± 2.91 (95% CI 2.35-3.15). Participants who claimed to have knowledge of PIMs had a significantly higher mean score than those who did not, 4.59 ± 2.81 25 (95% CI 2.35-2.61). A minority of the pharmacists (14.7%) used screening tools such as STOPP, Beers criteria, or Medication Appropriateness Index (MAI) to detect PIMs in older adults. No statistically significant differences were detected when comparing the levels of knowledge of pharmacists with 1 to 5 years of practice to pharmacists with 6 to 15 and more years of experience (p = 0.431). Pharmacists' knowledge, attitude and practices toward PIMs use in older adults in Saudi Arabia should be improved. The application of PIMs detection tools such as STOPP/START or Beers criteria currently has no place in day-to-day pharmacists' roles in Saudi Arabia. Therefore, concerned stakeholders should develop educational programs to improve pharmacists' knowledge of PIMs and promote the effective use of PIM screening tools such as Beers and STOPP criteria in their practice.


Assuntos
Prescrição Inadequada , Farmacêuticos , Humanos , Idoso , Prescrição Inadequada/prevenção & controle , Estudos Transversais , Arábia Saudita , Conhecimentos, Atitudes e Prática em Saúde , Hospitais
8.
Br J Nurs ; 32(1): 38-39, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36626259

RESUMO

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers the use of hospital and limitation directions when sentencing a person with a mental disorder who has been found guilty of a crime.


Assuntos
Saúde Mental , Transtornos Psicóticos , Humanos , Hospitais , Reino Unido , Competência Mental
9.
BMJ Open ; 13(1): e064445, 2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36596637

RESUMO

OBJECTIVES: To evaluate how costs of healthcare can be reduced, there is an increasing need to gain insight into the main drivers of such costs. We evaluated drivers of costs of predefined subgroups of patients who had a stroke by linking cost registration with clinical data. METHODS: We retrospectively selected 555 consecutive patients with ischaemic stroke participating between June 2011 and December 2016 in the Dutch Parelsnoer Initiative. Patient characteristics and costs of healthcare activities during hospital admission and the first 3 months after discharge were linked. Patients were divided in subgroups based on age, severity of stroke, stroke subtype, discharge destination and functional outcome. Unit cost per healthcare activity was based on 2018 rates for mutual service in euros. Mean total costs per subgroup were calculated. Multivariate analysis was performed to identify factors associated with costs. RESULTS: Number of admitted days was the main driver of total hospital costs (range 82%-93%) in all predefined subgroups of patients. Second driver was radiological diagnostic investigations (range 2%-9%). Highest costs were observed in patients with a younger age at the time of admission, a higher modified Rankin Scale at the time of discharge and a nursing home as discharge destination. The distribution of costs over the different healthcare activities was associated with stroke subtype; for example, in patients with a cardiac embolism most costs were spent on cardiology-related healthcare activities. CONCLUSION: The number of admitted days was the most important driver of costs in all subgroups of patients with ischaemic stroke. This implicates that to reduce healthcare costs for patients who had a stroke, focus should be on reducing length of hospital stay.


Assuntos
Isquemia Encefálica , AVC Isquêmico , Acidente Vascular Cerebral , Humanos , Acidente Vascular Cerebral/diagnóstico , Isquemia Encefálica/terapia , Estudos Retrospectivos , Custos de Cuidados de Saúde , Tempo de Internação , Custos Hospitalares , Hospitais
11.
BMC Med ; 21(1): 1, 2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36600273

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) disproportionately affects minority populations in the USA. Sweden - like other Nordic countries - have less income and wealth inequality but lacks data on the socioeconomic impact on the risk of adverse outcomes due to COVID-19. METHODS: This population-wide study from March 2020 to March 2022 included all adults in Stockholm, except those in nursing homes or receiving in-home care. Data sources include hospitals, primary care (individual diagnoses), the Swedish National Tax Agency (death dates), the Total Population Register "RTB" (sex, age, birth country), the Household Register (size of household), the Integrated Database For Labor Market Research "LISA" (educational level, income, and occupation), and SmiNet (COVID data). Individual exposures include education, income, type of work and ability to work from home, living area and living conditions as well as the individual country of origin and co-morbidities. Additionally, we have data on the risks associated with living areas. We used a Cox proportional hazards model and logistic regression to estimate associations. Area-level covariates were used in a principal component analysis to generate a measurement of neighborhood deprivation. As outcomes, we used hospitalization and death due to COVID-19. RESULTS: Among the 1,782,125 persons, male sex, comorbidities, higher age, and not being born in Sweden increase the risk of hospitalization and death. So does lower education and lower income, the lowest incomes doubled the risk of death from COVID-19. Area estimates, where the model includes individual risks, show that high population density and a high percentage of foreign-born inhabitants increased the risk of hospitalization. CONCLUSIONS: Segregation and deprivation are public health issues elucidated by COVID-19. Neighborhood deprivation, prevalent in Stockholm, adds to individual risks and is associated with hospitalization and death. This finding is paramount for governments, agencies, and healthcare institutions interested in targeted interventions.


Assuntos
COVID-19 , Adulto , Humanos , Masculino , COVID-19/epidemiologia , Estudos de Coortes , Pandemias , Fatores de Risco , Hospitalização , Hospitais
12.
BMC Health Serv Res ; 23(1): 19, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624513

RESUMO

BACKGROUND: Very limited empirical research has been done on operational flexibility management in the healthcare industry, especially in hospital settings. This study aimed to propose a model of the effects of operational flexibility on hospital performance through management capability and employee engagement as mediating variables. METHODS: The proposed model is validated through an empirical study among 480 clinical and administrative staff from five hospitals in Jordan. Structural equation modeling and confirmatory factor analysis were the main techniques used to validate the model and examine the hypotheses. RESULTS: Operational flexibility was demonstrated to have a positively significant impact on hospital performance, management capability, and employee engagement. Employee engagement was demonstrated to positively impact hospital performance. Management capability had a significant result on hospital performance without having a clear impact. In addition, management capability and employee engagement played a major role as partial mediating effects between operational flexibility and hospital performance, and there is a role for employee engagement as a partial mediating effect between management capability and hospital performance. CONCLUSION: Significant progress has been achieved in hospital management, especially in terms of operational flexibility, management capability, and staff engagement.


Assuntos
Administração Hospitalar , Engajamento no Trabalho , Humanos , Hospitais , Jordânia
14.
PLoS One ; 18(1): e0280140, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36649250

RESUMO

AIM: To assess contemporary in-hospital management of octogenarians and nonagenarians with ureteral calculi. MATERIALS AND METHODS: Review of patients aged ≥80 years hospitalized due to ureteral calculi. Data was extracted from eight Austrian centers of urology. Stone and patient related data were recorded. Treatment patterns in acute and elective settings were assessed. RESULTS: A total of 759 patients hospitalized with ureteral calculi were analyzed. Out of them, 643 were octogenarians (80-89years) and 116 nonagenarians (90-99 years). In an acute setting, simple de-obstruction with urinary diversions outnumbered active stone treatments like URS and SWL (62.6% vs. 26.9% vs. 10.5%). Decision making whether patients underwent active stone treatment was driven by stone location (OR = 0.28, p<0.0001), impaired renal function (OR = 0.28, p = 0.01) and indwelling urethral catheters (OR = 0.23, p = 0.01) but not by age or extend of mobility (all p>0.05). In elective settings, 81.5% of procedures were active stone treatments-mainly URS (76.9%), while DJ stent or nephrostomy replacements were noted in 14.2% and 4.3%. Octogenarians (OR = 14, p<0.0001) and patients capable of walking (OR = 4.51, p = 0.01) had significantly higher odds of receiving active stone. Stone free rates and complications rates with URS were similar between octogenarians and nonagenarians (p = 0.98 and p = 0.58). CONCLUSION: In acute settings, age and extend of mobility were not found to be independent predictors for active stone treatment. In elective settings, after having received urinary diversions, reduced mobility and nonagenarians were less likely to undergo stone removal treatments. Safety and efficacy of URS seems to be similar in octogenarians and nonagenarians.


Assuntos
Litotripsia , Cálculos Ureterais , Urologia , Idoso de 80 Anos ou mais , Humanos , Cálculos Ureterais/terapia , Octogenários , Nonagenários , Áustria , Litotripsia/métodos , Ureteroscopia/métodos , Hospitais , Resultado do Tratamento , Estudos Retrospectivos
15.
BMC Health Serv Res ; 23(1): 34, 2023 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-36641465

RESUMO

BACKGROUND: A quality framework for hospital-based physiotherapy is lacking. This study aims to design a framework, building on the currently available literature, to improve the quality of hospital-based physiotherapy. METHODS: A multidisciplinary panel of six representatives of hospital-based physiotherapy and their key stakeholders (patients, medical specialists, hospital management and professional association) was set up. We used brainwriting to sample ideas and the 'decision-matrix' to select the best ideas. RESULTS: The first round of brainwriting with an online panel of six experienced participants yielded consensus on seven possible methods for quality improvement of hospital-based physiotherapy [1]: continuing education [2] ,feedback on patient reported experience measures and patient reported outcome measures [3] ,a quality portfolio [4] ,peer observation and feedback [5] ,360 degree feedback [6] ,a management information system, and [7] intervision with intercollegiate evaluation. Placing these methods in a decision matrix against four criteria (measurability, acceptability, impact, accessibility) resulted in a slight preference for a management information system, with almost equal preference for five other methods immediately thereafter. The least preference was given to a 360-degree feedback. CONCLUSIONS: In the design of a framework for improving the quality of hospital-based physiotherapy, all seven suggested methods were perceived as relevant but differed in terms of advantages and disadvantages. This suggests that, within the framework, a mixture of these methods may be desirable to even out respective advantages and disadvantages.


Assuntos
Medicina , Modalidades de Fisioterapia , Humanos , Educação Continuada , Melhoria de Qualidade , Hospitais
16.
CMAJ Open ; 11(1): E45-E53, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36649982

RESUMO

BACKGROUND: Patients with multimorbidity require coordinated and patient-centred care. Telemedicine IMPACT Plus provides such care for complex patients in Toronto, Ontario. We conducted a randomized controlled trial (RCT) comparing health care utilization and costs at 1-year postintervention for an intervention group and 2 control groups (RCT and propensity matched). METHODS: Data for 82 RCT intervention and 74 RCT control participants were linked with health administrative data. We created a second control group using health administrative data-derived propensity scores to match (1:5) intervention participants with comparators. We evaluated 5 outcomes: acute hospital admissions, emergency department visits, costs of all insured health care, 30-day hospital readmissions and 7-day family physician follow-up after hospital discharge using generalized linear models for RCT controls and generalized estimating equations for propensity-matched controls. RESULTS: There were no significant differences between intervention participants and either control group. For hospital admissions, emergency department visits, costs and readmissions, the relative differences ranged from 1.00 (95% confidence interval [CI] 0.39-2.60) to 1.67 (95% CI 0.82-3.38) with intervention costs at about Can$20 000, RCT controls costs at around Can$15 000 and propensity controls costs at around Can$17 000. There was a higher rate of follow-up with a family physician for the intervention participants compared with the RCT controls (53.13 v. 21.43 per 100 hospital discharges; relative difference 2.48 [95% CI 0.98-6.29]) and propensity-matched controls (49.94 v. 28.21 per 100 hospital discharges; relative difference 1.81 [95% CI 0.99-3.30]). INTERPRETATION: Despite a complex patient-centred intervention, there was no significant improvement in health care utilization or cost. Future research requires larger sample sizes and should include outcomes important to patients and the health care system, and longer follow-up periods. ONTARIO: ClinicalTrials.gov : 104191.


Assuntos
Multimorbidade , Aceitação pelo Paciente de Cuidados de Saúde , Humanos , Ontário/epidemiologia , Hospitalização , Hospitais
17.
Age Ageing ; 52(1)2023 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-36633298

RESUMO

BACKGROUND: Virtual wards are being rapidly developed within the National Health Service in the UK, and frailty is one of the first clinical pathways. Virtual wards for older people and existing hospital at home services are closely related. METHODS: In March 2022, we searched Medline, CINAHL, the Cochrane Database of Systematic Reviews and medRxiv for evidence syntheses which addressed clinical-effectiveness, cost-effectiveness, barriers and facilitators, or staff, patient or carer experience for virtual wards, hospital at home or remote monitoring alternatives to inpatient care. RESULTS: We included 28 evidence syntheses mostly relating to hospital at home. There is low to moderate certainty evidence that clinical outcomes including mortality (example pooled RR 0.77, 95% CI 0.60-0.99) were probably equivalent or better for hospital at home. Subsequent residential care admissions are probably reduced (example pooled RR 0.35, 95% CI 0.22-0.57). Cost-effectiveness evidence demonstrated methodological issues which mean the results are uncertain. Evidence is lacking on cost implications for patients and carers. Barriers and facilitators operate at multiple levels (organisational, clinical and patient). Patient satisfaction may be improved by hospital at home relative to inpatient care. Evidence for carer experience is limited. CONCLUSIONS: There is substantial evidence for the clinical effectiveness of hospital at home but less evidence for virtual wards. Guidance for virtual wards is lacking on key aspects including team characteristics, outcome selection and data protection. We recommend that research and evaluation is integrated into development of virtual ward models. The issue of carer strain is particularly relevant.


Assuntos
Hospitalização , Medicina Estatal , Humanos , Idoso , Revisões Sistemáticas como Assunto , Hospitais , Resultado do Tratamento
18.
J Nurs Adm ; 53(2): 69-70, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36692994

RESUMO

"Not expressing gratitude is like wrapping a present and never giving it." -William Ward Regular expressions of gratitude and meaningful recognition are beginning to make a difference for nurse managers. Beyond Gratitude: A Tribute to Nurse Managers illustrates how the power of a partnership of 2 foundations can make a difference.


Assuntos
Enfermeiras Administradoras , Humanos , Hospitais
19.
J Nurs Adm ; 53(2): 110-115, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36693001

RESUMO

OBJECTIVE: The purposes of this scoping review are: 1) to identify instances in the literature that describe measuring individual nurse performance and 2) characterize those metrics. BACKGROUND: The impact of nurses on patient outcomes has been demonstrated at the unit or hospital level, with nurses measured in aggregate. There is an opportunity to evaluate individual nurse performance by creating metrics that capture it. METHODS: A scoping review based on the framework published by the Joanna Briggs Institute was performed. RESULTS: Researchers identified 12 articles. Three themes were trended: the emerging nature of these metrics in the literature, variability in their applications, and performance implications. CONCLUSIONS: Individual nurse performance metrics is an emerging body of research with variability in the types of metrics developed. There is an opportunity for future researchers to work with nurse leaders and staff nurses to optimize these metrics and to use them to support nursing practice and patient care.


Assuntos
Benchmarking , Enfermeiras e Enfermeiros , Humanos , Hospitais
20.
J Trauma Acute Care Surg ; 94(2): 264-272, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36694335

RESUMO

BACKGROUND: Emergency general surgery (EGS) diseases are time-sensitive conditions that require urgent surgical evaluation, yet the effect of geographic access to care on outcomes remains unclear. We examined the association of spatial access with outcomes for common EGS conditions. METHODS: A retrospective analysis of twelve 2014 State Inpatient Databases, identifying adults admitted with eight EGS conditions, was performed. We assessed spatial access using the spatial access ratio (SPAR)-an advanced spatial model that accounts for travel distance, hospital capacity, and population demand, normalized against the national mean. Multivariable regression models adjusting for patient and hospital factors were used to evaluate the association between SPAR with (a) in-hospital mortality and (b) major morbidity. RESULTS: A total of 877,928 admissions, of which 104,332 (2.4%) were in the lowest-access category (SPAR, 0) and 578,947 (66%) were in the high-access category (SPAR, ≥1), were analyzed. Low-access patients were more likely to be White, male, and treated in nonteaching hospitals. Low-access patients also had higher incidence of complex EGS disease (low access, 31% vs. high access, 12%; p < 0.001) and in-hospital mortality (4.4% vs. 2.5%, p < 0.05). When adjusted for confounding factors, including presence of advanced hospital resources, increasing spatial access was protective against in-hospital mortality (adjusted odds ratio, 0.95; 95% confidence interval, 0.94-0.97; p < 0.001). Spatial access was not significantly associated with major morbidity. CONCLUSION: This is the first study to demonstrate that geospatial access to surgical care is associated with incidence of complex EGS disease and that increasing spatial access to care is independently associated with lower in-hospital mortality. These results support the consideration of spatial access in the development of regional health systems for EGS care. LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level III.


Assuntos
Serviços Médicos de Emergência , Cirurgia Geral , Procedimentos Cirúrgicos Operatórios , Adulto , Humanos , Masculino , Estados Unidos/epidemiologia , Estudos Retrospectivos , Tratamento de Emergência , Hospitais , Mortalidade Hospitalar , Acesso aos Serviços de Saúde , Emergências
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