The Confusion Assessment Method in action: Implementation of a protocol to increase delirium screening and diagnosis.

The use of the Confusion Assessment Method (CAM) for delirium assessment in real-life can be inconsistent. We examined the impact of a protocol on delirium screening and detection in hospitalized older adults using the CAM. We analyzed data from 32,338 admissions to a quaternary hospital between 2018 and 2022. We assessed the percentage of admissions screened for delirium, adherence to daily screening, positive screening, and overlap with ICD-10 coding. The percentage of admissions screened for delirium increased from 74% in 2018 to 98.7% in 2022. Adherence to daily screening was achieved in 24.5% of admissions, and the percentage of positive screenings fluctuated between 8.4% and 11.5%. Among the admissions with a delirium-related ICD-10 code, 32% had a positive screening, 62% were negative, and 6% remained unscreened. While implementing a protocol increased the proportion of admissions screened for delirium, adherence to daily screening and consistency of positive delirium screenings remain areas for improvement.

Impact of implementing good care and management practice guidelines in carotid revascularization procedures.

BACKGROUND: Studies assessing the effect of implementing good practice management guidelines (GPMG) in carotid revascularization within the same hospital are scarce. Thus, we aimed to evaluate the impact of GPMG implementation on the clinical outcomes of carotid revascularization procedures within a quaternary hospital. METHOD: We retrospectively studied 177 patients with atherosclerotic carotid disease who underwent revascularization (carotid endarterectomy and carotid artery stenting) at a quaternary hospital between January 2012 and December 2019. The patients were divided into two groups: the pre-guideline group with 73 patients and the post-guideline group with 104 patients who underwent the procedures before and after the implementation of GPMG, respectively. RESULTS: Twelve (16.4%) and 3 (2.9%) patients had neurological complications in the pre- and post-guideline groups, respectively (p = 0.001); most complications were cases of ischemic stroke. There were fewer complications in men than in women (OR = 0.22; 95% CI 0.06-0.77). A significant decrease in neurological complications was observed in the carotid artery stenting group (pre-guideline 25.7% vs post-guideline 13.2%; p = 0.004). Logistic regression analysis of the predisposing factors for neurological complications in carotid endarterectomy and carotid artery stenting demonstrated that the implementation of GPMG was a determining factor for the improved results (odds ratio = 0.11, 95% CI 0.02-0.59). CONCLUSIONS: Implementing GPMG for carotid revascularization resulted in better clinical results, with decreased neurological complications in patients that underwent angioplasty and endarterectomy.

Patterns of Care and Temporal Trends in Ischemic Stroke Management: A Brazilian Perspective.

BACKGROUND AND PURPOSE: Demonstration of an improvement process of quality indicators in stroke care is essential to obtain certification as a primary stroke center (PSC). Our aim was to evaluate factors that influence temporal trends in quality indicators of ischemic stroke (IS) in a Brazilian hospital. METHODS: We evaluated patients discharged with IS from a tertiary hospital from January 2009 to December 2013. Ten predefined performance measures selected by the Get With the Guidelines-Stroke program were assessed. We also compared 5 quality indicators available from a secondary community hospital for the first year of the series to those found in the tertiary hospital. RESULTS: We evaluated 551 patients at the tertiary stroke center (median age 77.0 years [interquartile range 64.0-84.0]; 58.4% were men). The quality indicators that improved with time were the use of cholesterol-lowering therapy (P = .02) and stroke education (P = .04). The median composite perfect care did not consistently improve throughout the period (P = .13). After a multivariable adjustment, only thrombolytic treatment (odds ratio [OR] 2.06, P < .01), dyslipidemia (OR 2.03, P < .01), and discharge in a Joint Commission International's (JCI) visit year (OR 1.8, P < .01) remained as predictors of a perfect care index of 85% or higher. The quality indicators with worse performance (anticoagulation for atrial fibrillation and cholesterol reduction) were similar in the tertiary and secondary community hospitals. CONCLUSIONS: We found a significant improvement in some quality indicators across the years in a PSC located in Latin America. The overall perfect care measure did not improve and was influenced by being discharged in a JCI visit year, having dyslipidemia, and having undergone thrombolytic treatment.

Importância da visita de animais de estimação na recuperação de crianças hospitalizadas / The importance of pets’ visit in recovery of hospitalized children

Objetivo: Compreender o significado da experiência vivenciada por crianças internadas em relação à visita de animais no hospital. Métodos: Pesquisa exploratória descritiva, de abordagem qualitativa,realizada em um hospital pediátrico privado da cidade de São Paulo,sendo a amostra constituída por 13 crianças entre três e seis anosde idade. A observação da criança antes, durante e após a visita dos animais e a entrevista com desenho foram as estratégias empregadas na coleta dos dados, que foram submetidos à técnica de análise de conteúdo de Bardin. Resultados: Três categorias de significados foram identificadas, evidenciando alguns dos benefícios dessa experiência para a criança, “obtendo prazer no contato com o animal”, “passando a interagir mais facilmente com a equipe e outras crianças” e “obtendo alívio da dor e desconforto”. Conclusões: A visita dos animaisdescontrai o ambiente, propiciando maior interação da criança com os profissionais e demais crianças; contribui para que ela se torne mais cooperativa nos procedimentos hospitalares, além de atuar como estratégia alternativa no alívio da dor e do desconforto. Constata-se,ainda, que essa atividade traz benefícios não só para a criança, mas também para os adultos que cuidam dela.