Epidemiological and etiological characteristics of 1266 patients with severe acute respiratory infection in central China, 2018-2020: a retrospective survey.

BACKGROUND: Severe acute respiratory infection (SARI), a significant global health concern, imposes a substantial disease burden. In China, there is inadequate data concerning the monitoring of respiratory pathogens, particularly bacteria, among patients with SARI. Therefore, this study aims to delineate the demographic, epidemiological, and aetiological characteristics of hospitalised SARI patients in Central China between 2018 and 2020. METHODS: Eligible patients with SARI admitted to the First Affiliated Hospital of Zhengzhou University between 1 January 2018 and 31 December 2020 were included in this retrospective study. Within the first 24 h of admission, respiratory (including sputum, nasal/throat swabs, bronchoalveolar lavage fluid, thoracocentesis fluid, etc.), urine, and peripheral blood specimens were collected for viral and bacterial testing. A multiplex real-time polymerase chain reaction (PCR) diagnostic approach was used to identify human influenza virus, respiratory syncytial virus, parainfluenza virus, adenovirus, human bocavirus, human coronavirus, human metapneumovirus, and rhinovirus. Bacterial cultures of respiratory specimens were performed with a particular focus on pathogenic microorganisms, including S. pneumoniae, S. aureus, K. pneumoniae, P. aeruginosa, Strep A, H. influenzae, A. baumannii, and E. coli. In cases where bacterial culture results were negative, nucleic acid extraction was performed for PCR to assay for the above-mentioned eight bacteria, as well as L. pneumophila and M. pneumoniae. Additionally, urine specimens were exclusively used to detect Legionella antigens. Furthermore, epidemiological, demographic, and clinical data were obtained from electronic medical records. RESULTS: The study encompassed 1266 patients, with a mean age of 54 years, among whom 61.6% (780/1266) were males, 61.4% (778/1266) were farmers, and 88.8% (1124/1266) sought medical treatment in 2020. Moreover, 80.3% (1017/1266) were housed in general wards. The most common respiratory symptoms included fever (86.8%, 1122/1266) and cough (77.8%, 986/1266). Chest imaging anomalies were detected in 62.6% (792/1266) of cases, and 58.1% (736/1266) exhibited at least one respiratory pathogen, with 28.5% (361/1266) having multiple infections. Additionally, 95.7% (1212/1266) of the patients were from Henan Province, with the highest proportion (38.3%, 486/1266) falling in the 61-80 years age bracket, predominantly (79.8%, 1010/1266) seeking medical aid in summer and autumn. Bacterial detection rate (39.0%, 495/1266) was higher than viral detection rate (36.9%, 468/1266), with the primary pathogens being influenza virus (13.8%, 175/1266), K. pneumoniae (10.0%, 127/1266), S. pneumoniae (10.0%, 127/1266), adenovirus (8.2%, 105/1266), P. aeruginosa (8.2%, 105/1266), M. pneumoniae (7.8%, 100/1266), and respiratory syncytial virus (7.7%, 98/1266). During spring and winter, there was a significant prevalence of influenza virus and human coronavirus, contrasting with the dominance of parainfluenza viruses in summer and autumn. Respiratory syncytial virus and rhinovirus exhibited higher prevalence across spring, summer, and winter. P. aeruginosa, K. pneumoniae, and M. pneumoniae were identified at similar rates throughout all seasons without distinct spikes in prevalence. However, S. pneumoniae showed a distinctive pattern with a prevalence that doubled during summer and winter. Moreover, the positive detection rates of various other viruses and bacteria were lower, displaying a comparatively erratic prevalence trend. Among patients admitted to the intensive care unit, the predominant nosocomial bacteria were K. pneumoniae (17.2%, 43/249), A. baumannii (13.6%, 34/249), and P. aeruginosa (12.4%, 31/249). Conversely, in patients from general wards, predominant pathogens included influenza virus (14.8%, 151/1017), S. pneumoniae (10.4%, 106/1017), and adenovirus (9.3%, 95/1017). Additionally, paediatric patients exhibited significantly higher positive detection rates for influenza virus (23.9%, 11/46) and M. pneumoniae (32.6%, 15/46) compared to adults and the elderly. Furthermore, adenovirus (10.0%, 67/669) and rhinovirus (6.4%, 43/669) were the primary pathogens in adults, while K. pneumoniae (11.8%, 65/551) and A. baumannii (7.1%, 39/551) prevailed among the elderly, indicating significant differences among the three age groups. DISCUSSION: In Central China, among patients with SARI, the prevailing viruses included influenza virus, adenovirus, and respiratory syncytial virus. Among bacteria, K. pneumoniae, S. pneumoniae, P. aeruginosa, and M. pneumoniae were frequently identified, with multiple infections being very common. Additionally, there were substantial variations in the pathogen spectrum compositions concerning wards and age groups among patients. Consequently, this study holds promise in offering insights to the government for developing strategies aimed at preventing and managing respiratory infectious diseases effectively.

Early supported discharge for older adults admitted to hospital after orthopaedic surgery: a systematic review and meta-analysis.

BACKGROUND: Early supported discharge (ESD) aims to link acute and community care, allowing hospital inpatients to return home, continuing to receive the necessary input from healthcare professionals that they would otherwise receive in hospital. Existing literature demonstrates the concept having a reduced length of stay in stroke inpatients and medical older adults. This systematic review aims to explore the totality of evidence for the use of ESD in older adults hospitalised with orthopaedic complaints. METHODS: A literature search of Cochrane Central Register of Controlled Trials in the Cochrane Library (CENTRAL), EMBASE, CINAHL and MEDLINE in EBSCO was carried out on January 10th, 2024. Randomised controlled trials or quasi-randomised controlled trials were the study designs included. For quality assessment, The Cochrane Risk of Bias Tool 2.0 was used and GRADE was applied to evaluate the certainty of evidence. Acute hospital length of stay was the primary outcome. Secondary outcomes included the numbers of fallers and function. A pooled meta-analysis was conducted using RevMan software 5.4.1. RESULTS: Seven studies with a population of older adults post orthopaedic surgery met inclusion criteria, with five studies included in the meta-analysis. Study quality was predominantly of a high risk of bias. Statistically significant effects favouring ESD interventions were only seen in terms of length of stay (FEM, MD = -5.57, 95% CI -7.07 to -4.08, I2 = 0%). No statistically significant effects favouring ESD interventions were established in secondary outcomes. CONCLUSION: In the older adult population with orthopaedic complaints, ESD can have a statistically significant impact in reducing hospital length of stay. This review identifies an insufficient existing evidence base to establish the key benefits of ESD for this population group. There is a need for further higher quality research in the area, with standardised interventions and outcome measures used.

Nutritional factors and pressure injury risk in hospitalised patients post-stroke.

OBJECTIVE: This study aimed to analyse the nutritional factors and pressure injury (PI) risk in hospitalised patients post-stroke. METHOD: The research employed a descriptive observational method in which patients ≥18 years of age were followed for six days. Nutritional evaluation was based on anthropometric and dietary factors. The nutritional risk was assessed via anthropometric measurements, Braden nutrition subscale and daily dietary intake. PI risk was evaluated through the Braden Scale. The Wilcoxon test, paired t-test, and Kruskal-Wallis test were applied and corrected with Bonferroni correction or analysis of variance, followed by the post hoc Tukey test. RESULTS: During their hospital stays, the participating 59 patients had an increase in sensory perception (p=0.02) and nutrition (p=0.005) scores. It was observed that patients at high risk of PI did not meet daily nutritional recommendations for calories, proteins, carbohydrates, lipids and micronutrients (zinc, selenium and copper) compared with patients at low-to-moderate risk. Weight (p<0.001), body mass index (p<0.001), calf (p=0.01) and arm (p=0.04) circumferences, and subscapular (p=0.003) and triceps (p<0.001) skinfolds decreased during the six days of hospitalisation. CONCLUSION: From the findings of this study, it was concluded that nutritional factors, such as unmet recommended daily nutritional requirements of macronutrients and micronutrients, and nutritional status are associated with a higher risk of developing a PI.

Nurses' knowledge and beliefs on pain management practices with hospitalised persons living with dementia: A qualitative descriptive study.

AIM: To understand nurses' knowledge, beliefs and experiences affect pain management practices in hospitalised persons living with dementia (PLWD). DESIGN: Naturalistic inquiry using qualitative descriptive design. METHODS: Semi-structured interviews were conducted with 12 registered nurses who worked in one acute care hospital in Southern California from October to November 2022. Data were analysed using content analysis to identify themes. RESULTS: Two themes were developed: improvising pain assessment, which included how pain was documented, and administration hesitancy referring to nurse's concerns about PLWD's confusion. Nurses described the challenges of assessing pain in hospitalised PLWD particularly if they were non-verbal and/or demonstrating responsive behaviours. Nurse's years of experience, dementia stigma, and their unconscious biases affected nurses' pain management practices. CONCLUSIONS: The study findings highlight the complex challenges of pain management in hospitalised PLWD that are exacerbated by nurses' knowledge deficits, negative stereotypical beliefs, dementia stigma and unconscious biases towards older people that contributes to undermanaged pain in hospitalised PLWD. IMPLICATIONS: A comprehensive strategy using an implementation framework is needed to address nurse's knowledge gaps, unconscious bias, dementia stigma and techniques that enhance communication skills is suggested. Building a foundation in these areas would improve pain management in hospitalised PLWD. IMPACT: Improving pain management in hospitalised PLWD would improve the quality of life, decrease hospital length of stay, prevent readmissions, and improve nurse satisfaction. REPORTING METHOD: The study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT CONTRIBUTIONS: Improving pain management in hospitalised PLWD would prevent long term confusion, episodes of delirium and improve quality of life as they recover from their acute illness for which they required hospital care.

Nurses' views on the presence of family members during invasive procedures in hospitalised children: A questionnaire survey.

AIMS AND OBJECTIVES: (I) To identify the opinion and practices of nursing professionals regarding the presence of family members during invasive procedures in hospitalised children; (II) to determine the knowledge of nursing professionals about the patient-and family-centred care model. BACKGROUND: Family presence in invasive procedures benefits the patient and their relatives, but varied attitudes exist among healthcare personnel, with some being favourable and others unfavourable toward family presence. DESIGN: Observational, descriptive, cross-sectional study. METHODS: Study population: Nurses from paediatric critical care services, emergency services, hospital wards, day hospitals and outpatient clinics at a Catalan tertiary hospital who participated voluntarily between September 2021 and July 2022. Data collection instrument: A questionnaire prepared by the researchers, based on the literature and reviewed by experts. REDCap link with access to the questionnaire was sent out to potential respondents through the institutional email. Bivariate analysis was performed with the R 4.2 program. The study was approved by the hospital's Clinical Research Committee and participants gave informed consent before responding to the questionnaire. RESULTS: A total of 172 nurses participated, and 155 valid responses were obtained. All respondents consider the family as a key element in paediatric care and report inviting family members to participate in the care given to their child. However, 12.0% of nurses do not invite the family to be present in invasive procedures. Almost all respondents note the need for training to acquire communication skills and improve the management of emotions. CONCLUSIONS: The results show a favourable opinion towards the presence of family members and highlight the need to train nurses to develop communication skills. RELEVANCE TO CLINICAL PRACTICE: The data provided can favour the design of measures to improve and promote the presence of parents during invasive procedures, reinforcing the patient-and family-centred care model and improving the quality of care provided. One example is the creation of family care protocols where the inclusion of parents and the roles of each individual involved in the care process appears.

The perception of healthcare professionals, through their own personal experiences, of the use of music therapy in hospitalised children and adolescents.

BACKGROUND: Music therapy is an emerging and useful methodology for improving patient environments within healthcare fields. However, although it has been shown that music therapy interventions with hospitalised children and adolescents have been used for decades with positive effects, there are currently very few studies that specifically describe the perspectives of healthcare professionals regarding the value of music therapy when applied in these patients. OBJECTIVES: To describe the insights of healthcare professionals regarding music therapy, both on a personal level and in terms of its usefulness in the care of hospitalised children and adolescents. DESIGN: This was a qualitative descriptive-exploratory study with focus groups. PARTICIPANTS: Eighteen healthcare professionals. METHODS: In January 2023, two focus groups, containing nine healthcare professionals each, were created to collect data regarding their experiences concerning the effect of music therapy on hospitalised children and adolescents. Before recording their opinions, all these professionals participated in an interactive music therapy session. The thematic analysis in this work was performed using MAXQDA® software. RESULTS: Two main categories emerged: (a) the effects of music therapy on healthcare professionals, and (b) the benefits of music therapy to patients (children and adolescents). CONCLUSIONS: Music therapy was valued positively by healthcare professionals who described the benefits its use has for hospitalised children and adolescents. They also expressed positive viewpoints regarding the use of music therapy to improve their own self-knowledge and self-care. IMPLICATIONS TO PRACTICE: Healthcare professionals may utilise music therapists to improve patient outcomes and reduce the negative effects of hospitalisation.

The risk of under-nutrition in hospitalised Malaysian children: Use of 3-minute nutrition screening-paediatrics (Paediatric 3-MinNS).

Objectives: To evaluate the under-nutrition risk of children admitted to hospitals using a validated tool. METHODS: The cross-sectional study was conducted from September 2017 to June 2018 in the paediatrics wards of a tertiary referral paediatric government hospital, a tertiary teaching hospital and a government district hospital in Malaysia. The sample comprised paediatric patients aged 2-12 years within 24-72 hours of hospital admission. Data was collected using the 3-Minute Nutrition Screening-Paediatrics tool. Data was analysed using SPSS 20. RESULTS: Of the 341 patients screened, 284(83.3%) were included; 170(59.9%) boys and 114(40.1%) girls. The overall median age was 4.85 years (interquartile range: 4.33 years). The median length of hospital stay was 3 days (interquartile range: 3 days). There were 72(25.4%) participants at high under-nutrition risk, with the highest proportion being at the district government hospital 31(33%). Among those with high risk, 5.4% subjects had severe acute malnutrition, 9.7% had severe chronic malnutrition, and 11.1% had severe thinness. Conclusion: The 3-Minute Nutrition Screening-Paediatrics scale was found to be effective as a nutrition screening tool for hospitalised children in Malaysia.

Poor sleep quality may contribute to dysfunctional illness perception, physical and emotional distress in hospitalised patients: results of a national survey of the Italian Society of Consultation-Liaison Psychiatry.

Distress associated with physical illness is a well-known risk factor for adverse illness course in general hospitals. Understanding the factors contributing to it should be a priority and among them dysfunctional illness perception and poor sleep quality may contribute to it. As poor sleep quality is recognised as a major risk factor for health problems, we aimed to study its association with illness perception and levels of distress during hospitalisation. This cross-sectional study included a consecutive series of 409 individuals who were hospitalised in medical and surgical units of different hospitals located throughout the Italian national territory and required an assessment for psychopathological conditions. Sleep quality was assessed with the Pittsburgh (Sleep Quality Index), emotional and physical distress with the Edmonton Symptom Assessment System (ESAS), and illness perception with the Brief Illness Perception Questionnaire (BIPQ). Differences between groups, correlations and mediations analyses were computed. Patients with poor sleep quality were more frequently females, with psychiatric comorbidity, with higher scores in the ESAS and BIPQ. Poor sleep quality was related to dysfunctional illness perception, and to both emotional and physical distress. In particular, by affecting cognitive components of illness perception, poor sleep quality may, directly and indirectly, predict high levels of distress during hospitalisation. Poor sleep quality may affect >70% of hospitalised patients and may favour dysfunctional illness perception and emotional/physical distress.Assessing and treating sleep problems in hospitalised patients should be included in the routine of hospitalised patients.

EuCARE-hospitalised study protocol: a cohort study of patients hospitalised with COVID-19 in the EuCARE project.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), can lead to hospitalisation, particularly in elderly, immunocompromised, and non-vaccinated or partially vaccinated individuals. Although vaccination provides protection, the duration of this protection wanes over time. Additional doses can restore immunity, but the influence of viral variants, specific sequences, and vaccine-induced immune responses on disease severity remains unclear. Moreover, the efficacy of therapeutic interventions during hospitalisation requires further investigation. The study aims to analyse the clinical course of COVID-19 in hospitalised patients, taking into account SARS-CoV-2 variants, viral sequences, and the impact of different vaccines. The primary outcome is all-cause in-hospital mortality, while secondary outcomes include admission to intensive care unit and length of stay, duration of hospitalisation, and the level of respiratory support required. METHODS: This ongoing multicentre study observes hospitalised adult patients with confirmed SARS-CoV-2 infection, utilising a combination of retrospective and prospective data collection. It aims to gather clinical and laboratory variables from around 35,000 patients, with potential for a larger sample size. Data analysis will involve biostatistical and machine-learning techniques. Selected patients will provide biological material. The study started on October 14, 2021 and is scheduled to end on October 13, 2026. DISCUSSION: The analysis of a large sample of retrospective and prospective data about the acute phase of SARS CoV-2 infection in hospitalised patients, viral variants and vaccination in several European and non-European countries will help us to better understand risk factors for disease severity and the interplay between SARS CoV-2 variants, immune responses and vaccine efficacy. The main strengths of this study are the large sample size, the long study duration covering different waves of COVID-19 and the collection of biological samples that allows future research. TRIAL REGISTRATION: The trial has been registered on ClinicalTrials.gov. The unique identifier assigned to this trial is NCT05463380.

Use of prokinetic agents in hospitalised adult patients: A scoping review.

BACKGROUND: Gastrointestinal motility is important for adequate uptake of fluids and nutrition but is often impaired in hospitalised patients. Prokinetic agents enhance gastrointestinal motility and are prescribed for many hospitalised patients. In this scoping review, we aimed to systematically describe the body of evidence on the use of prokinetic agents in hospitalised patients. We hypothesised, that the body of evidence would be limited and derive from heterogeneous populations. METHODS: We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement. We searched Medline, Embase, Epistemonikos and the Cochrane Library for studies assessing the use of prokinetic agents on any indication and outcome in adult hospitalised patients. We used a modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of evidence. RESULTS: We included 102 studies with a total of 8830 patients. Eighty-six studies were clinical trials (84%), and 52 (60%) of these were conducted in the intensive care unit, with feeding intolerance as the main indication. In the non-intensive care setting the indications were wider; most studies assessed use of prokinetic agents before gastroscopy to improve visualisation. The most studied prokinetic agent was metoclopramide (49% of studies) followed by erythromycin (31%). In total 147 outcomes were assessed with only 67% of the included studies assessing patient-centred outcomes, and with gastric emptying as the most frequently reported outcome. Overall, the data provided no firm evidence on the balance between the desirable and undesirable effects of prokinetic agents. CONCLUSIONS: In this scoping review, we found that the studies addressing prokinetic agents in hospitalised adults had considerable variations in indications, drugs and outcomes assessed, and that the certainty of evidence was judged to be low to very low.

Observational study of peripheral intravenous catheter outcomes in an internal medicine department.

BACKGROUND: In elderly patients hospitalised in internal medicine departments, risk factors, preferable placement area and methods of securement of short peripheral venous catheters (SPVC) a unclear. AIM: To determine the incidence and risk factors of adverse events using a transparent bordered dressing for securement in the dorsum of the hand or cubital fossa in consecutive patients hospitalised in an internal medicine department. METHODS: In a prospective observational study of patients admitted to a regional hospital with a SPVC, the dependent variable was the need to replace the catheter because of an adverse event (phlebitis, accidental removal, infiltration/occlusion). The independent variables were age, gender, disorientation, placement area, intravenous antibiotic therapy and indwelling time. Risk factors were determined by Cox regression model analysis. RESULTS: There were 709 catheters placed in 499 patients. Per catheter placed the mean age was 75 ± 17 years. Accidental removal, infiltration/obstruction and phlebitis occurred in 21.5, 16.2 and 15.0 events per 1000 days respectively. There was a significantly increased risk on Day 3 compared to Days 2 and 4. An older age, intravenous antibiotics and disorientation increased the hazard for accidental displacement, whereas phlebitis was associated only with intravenous antibiotics and occlusion/infiltration only with age. CONCLUSIONS: The observed low rates of adverse events suggests that placement in the dorsum of the hand or cubital fossa secured by a transparent dressing is acceptable. It is important to consider the indwelling catheter time when studying adverse events, and elderly patients, disoriented patients and/or patients receiving intravenous antibiotics deserve special attention.

Perspectives of health professionals on physical activity and sedentary behaviour in hospitalised adults: A systematic review and thematic synthesis.

OBJECTIVE: To explore health professionals' perspectives on physical activity and sedentary behaviour of hospitalised adults to understand factors that contribute to these behaviours in this environment. DATA SOURCES: Five databases (PubMed, MEDLINE, Embase, PsycINFO and CINAHL) were searched in March 2023. REVIEW METHODS: Thematic synthesis. Included studies explored perspectives of health professionals on the physical activity and/or sedentary behaviour of hospitalised adults using qualitative methods. Study eligibility was assessed independently by two reviewers and results thematically analysed. Quality was assessed using the McMaster Critical Review Form and confidence in findings assessed using GRADE-CERQual. RESULTS: Findings from 40 studies explored perspectives of over 1408 health professionals from 12 health disciplines. The central theme identified was that physical activity is not a priority in this setting due to the complex interplay of multilevel influences present in the interdisciplinary inpatient landscape. Subthemes, the hospital is a place for rest, there are not enough resources to make movement a priority, everyone's job is no one's job and policy and leadership drives priorities, supported the central theme. Quality of included studies was variable; critical appraisal scores ranged from 36% to 95% on a modified scoring system. Confidence in findings was moderate to high. CONCLUSION: Physical activity in the inpatient setting is not a priority, even in rehabilitation units where optimising function is the key. A shift in focus towards functional recovery and returning home may promote a positive movement culture that is supported by appropriate resources, leadership, policy, and the interdisciplinary team.

Evaluation of an electronic medical record-based Paediatric Nutrition Screening Tool.

BACKGROUND: Nutrition screening is recommended to identify children at risk for malnutrition. A unique screening tool was developed based on American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations and embedded in the electronic medical record to assess for nutrition risk. METHODS: The components of the tool included the Paediatric Nutrition Screening Tool (PNST) and other elements recommended by ASPEN. To evaluate the screening tool, retrospective data were analysed on all patients admitted to acute care units of Children's Wisconsin in 2019. Data collected included nutrition screen results, diagnosis and nutrition status. All patients who received at least one full nutrition assessment by a registered dietitian (RD) were included in analysis. RESULTS: One thousand five hundred seventy-five patients were included in analysis. The following screen elements were significantly associated with a diagnosis of malnutrition: any positive screen (p < 0.001), >2 food allergies (p = 0.009), intubation (p < 0.001), parenteral nutrition (p = 0.005), RD-identified risk (p < 0.001), positive risk per the PNST (p < 0.001), BMI-for-age or weight-for-length z-score (p < 0.001), intake <50% for 3 days (p = 0.012) and NPO > 3 days (p = 0.009). The current screen had a sensitivity of 93.9%, specificity of 20.3%, positive predictive value (PPV) of 30.9% and negative predictive value (NPV) of 89.8%. This is compared with the PNST which had a sensitivity of 32%, specificity of 94.2%, PPV of 71% and NPV of 75.8% in this study population. CONCLUSION: This unique screening tool is useful for predicting nutrition risk and has a greater sensitivity than the PNST alone.

Comparing the impact of two contact isolation modes for hospitalised patients with Clostridioides difficile infection on the quality of care.

BACKGROUND: Clostridioides difficile causes healthcare-associated infections. Environmental spore acquisition is a major mode of transmission. Patient cohorting to prevent cross-transmission in healthcare-institutions is a reasonable component of an enhanced infection control strategy. OBJECTIVE: The purpose of the study was to assess the effect of two different contact isolation modes on the quality of care of hospitalised patients with Clostridioides difficile infection (CDI). METHODS: A retrospective cohort-study of patients with CDI hospitalised under one of two contact isolation modes: contact isolation in a multi-patient room without a dedicated nursing team vs. contact isolation in a permanent cohort isolation unit with a dedicated nursing team. Patients' files were reviewed for demographics, clinical characteristics, risk-assessment scores, clinical quality measures including the number of blood tests collected per day, the number of radiological tests applied per day and the time at which a radiological test was conducted, as process measurements, along with the length of stay and mortality, as outcome measures. The STROBE checklist for reporting observational studies was followed. RESULTS: One hundred and seventy-eight patients with CDI were included; 100 in a permanent cohort isolation unit and 78 under contact isolation in a multi-patient room. No difference was found in all clinical quality process measures and in all outcome measures. Multivariable logistic regression showed that nursing home residence was associated with in-hospital mortality (OR, 2.51; CI, 1.29-4.97; p = .007), whereas the mode of hospitalisation was not. CONCLUSIONS: The different contact isolation modes of hospitalisation did not compromise the quality of care of patients with CDI. RELEVANCE TO CLINICAL PRACTICE: Cohorting of patients with CDI is used to prevent cross-transmission, though it raises a major concern regarding quality of care. In this study we show there was no compromise in patient care, therefore it is a reasonable component of an enhanced infection control strategy in a hospital setting.

Exploring the experience of health professionals who cared for patients with coronavirus infection: Hospitalised isolation and self-image.

AIMS AND OBJECTIVES: This study aimed to examine the lived experience of physicians and nurses who underwent hospitalised isolation during the Middle East respiratory syndrome coronavirus outbreak that hit Korea in 2015, and how it may have affected their professional self-image. BACKGROUND: Health professionals caring for patients during infectious outbreaks such as the Middle East respiratory syndrome have reported negative psychological effects. However, little is known about how the experience influences their professional self-image. DESIGN: An interpretive phenomenological approach was applied using individual in-depth interviews. METHODS: Through purposeful and snowball sampling, 11 health professionals who had experienced hospital isolation due to suspicious symptoms of Middle East respiratory syndrome during the outbreak, participated in face-to-face interviews (50-90 min). We adhered to the Consolidated Criteria for Reporting Qualitative Research guideline for reporting. RESULTS: Six themes were identified: (a) engulfed in chaos and exhaustion; (b) feeling hurt and constrained by the rejection and blame; (c) anxiety induced by the enclosed environment; (d) dread of this uncertain and critical disease; (e) sustained by family and colleagues; and (f) reflection at this turning point, expanding self-understanding and seeking a balance. CONCLUSION: Hospitalised isolation was a "turning point" that appeared to change health professionals' sense of identity and direction. RELEVANCE TO CLINICAL PRACTICE: Preparedness for infectious epidemics should ensure tangible assistance, protection, and clear communication with health professionals, with careful attention to their psychological needs and affirmation of their self-image in the aftermath.

Nurses' and Families' perceptions and practices and factors influencing the implementation of family-centred care for hospitalised children and their families.

AIMS AND OBJECTIVES: To explore the perceptions of family-centred care among nurses and the family members of hospitalised children and investigate the facilitators of and barriers to the implementation of family-centred care in Malawi. BACKGROUND: In Malawi, approximately 34% of children have long-term illnesses that require hospitalisation. Family-centred care ensures that the delivery of healthcare is grounded in partnerships between healthcare providers, patients and their families, which can improve the psychological well-being of families. However, there is lack a good understanding of how families and nurses perceive this concept, its facilitators and the barriers. DESIGN: This was an exploratory qualitative study. Data were analysed deductively and inductively using the five-step qualitative content analysis method. METHODS: Twenty-nine nurses and 31 families were recruited. Data were collected through in-depth, semi-structured and face-to-face individual interviews. The study was reported using the COREQ checklist. RESULTS: Both nurses and families of hospitalised children recognised the importance of nurse-family partnerships in family-centred care. Four themes emerged as follows: Perceptions of family-centred care, elements of family-centred care, facilitators of family-centred care and barriers to family-centred care. Specific information to families and the religious beliefs of families were identified as important facilitator and barrier to family-centred care, respectively. CONCLUSION: The implementation of family-centred care is promising in Malawi, as it is positively perceived by nurses and families, and its implementation is consistent with the Institute for Patient and Family-Centred Care Framework. RELEVANCE TO CLINICAL PRACTICE: Our findings present the best practices, gaps and challenges in the context of a low-income country regrading implementation of family-centred care. Education programmes on family-centred care are crucial for sustaining the current gains.

Neurological and neuropsychiatric manifestations in hospitalised patients with COVID-19.

Background: Although literature globally indicates varied neurological and/or neuropsychiatric manifestations (NNM) and complications associated with coronavirus disease 2019 (COVID-19), information about NNM in infected hospitalised patients on the African continent remains limited. Aim: To describe the presentation of NNM and compare patients with and without NNM considering demographic and clinical profiles, treatment, and outcomes. Setting: Tygerberg Hospital, Cape Town, South Africa. Methods: Retrospective medical record review of the first 100 consecutively admitted COVID-19 patients (64 females, mean age 47.6 years) between March and June 2020. Results: Of the 98 patients included in the analysis, 56.1% had at least one NNM. The most common NNM were myalgia (32.7%), headache (21.4%), loss of smell and/or taste (15.3%), and delirium (10.2%). Patients with and without NNM did not differ with respect to demographic characteristics. Patients with NNM had significantly more constitutional symptoms (p = 0.017) and were more likely to have neurological and/or neuropsychiatric comorbid conditions (10.9% vs. 0.0%, p = 0.033) than those without NNM. Patients without documented NNM were more likely to have abnormalities on chest X-ray (p = 0.009) than those with NNM. Coronavirus disease 2019 related treatment and mortality did not differ between the groups. Conclusion: Neurological and/or neuropsychiatric manifestations were common in hospitalised patients with COVID-19. The results suggest that while COVID-19 patients with NNM may have less of a respiratory phenotype they nonetheless have equivalent mortality rates. Contribution: This study highlights the common NNM in patients with COVID-19 admitted to Tygerberg Hospital early in the pandemic and adds to the growing evidence of COVID-19 NNM.

Slipping through the cracks: a qualitative study to explore pathways of HIV care and treatment amongst hospitalised patients with advanced HIV in Kenya and the Democratic Republic of the Congo.

Advanced HIV causes substantial mortality in sub-Saharan Africa despite widespread antiretroviral therapy coverage. This paper explores pathways of care amongst hospitalised patients with advanced HIV in rural Kenya and urban Democratic Republic of the Congo, with a view to understanding their care-seeking trajectories and poor health outcomes. Thirty in-depth interviews were conducted with hospitalised patients with advanced HIV who had previously initiated first-line antiretroviral therapy, covering their experiences of living with HIV and care-seeking. Interviews were audio-recorded, transcribed and translated before being coded inductively and analysed thematically. In both settings, participants' health journeys were defined by recurrent, severe symptoms and complex pathways of care before hospitalisation. Patients were often hospitalised after multiple failed attempts to obtain adequate care at health centres. Most participants managed their ill-health with limited support networks, lived in fragile economic situations and often experienced stress and other mental health concerns. Treatment-taking was sometimes undermined by strict messaging around adherence that was delivered in health facilities. These findings reveal a group of patients who had "slipped through the cracks" of health systems and social support structures, indicating both missed opportunities for timely management of advanced HIV and the need for interventions beyond hospital and clinical settings.

The efficacy of pivmecillinam in oral step-down treatment in hospitalised patients with E. coli bacteremic urinary tract infection; a single-arm, uncontrolled treatment study.

BACKGROUND: The role of oral beta-lactam antibiotics in treating febrile urinary tract infections (UTI) is not yet definite. Today, fluoroquinolones together with trimethoprim-sulfamethoxazole (TMP-MTX) are considered standard of care and often the only available evidence-based oral treatment for febrile UTI. This study clarifies the efficacy and safety of pivmecillinam (PIV) used as step-down therapy for bacteremic urinary tract infection (UTI). METHODS: A single-arm, uncontrolled treatment trial was conducted in the period September 2017-March 2020. Candidates for inclusion were men and women suffering from E. coli bacteremia due to UTI and were consecutively included in a Norwegian hospital. Exclusion criteria were among others: other ongoing bacterial infection, septic shock, pyonephrosis/abscess and pregnancy. After 3 days of parenteral antibiotic, the treatment was converted to the study drug; oral PIV 400 mg QID for 1 week. Primary endpoint was a combination of three elements; afebrility, no need for retreatment and improvement in self-reported health status. Test Of Cure (TOC) was 1 week post-treatment. Secondary endpoints included among others microbiological efficacy and CRP value < 30 mg/L. RESULTS: Of 476 screened subjects, 53 patients were included. Median age was 67 years, 28 (56%) were women. 50 patients were evaluated for per-protocol analysis. 44 of 50 patients (88%) (95% CI [75.7-95.5]) reached the primary endpoint on TOC. 14 of 48 patients (29.2%) had significant growth (> 103 CFU/mL) of E.coli on TOC. CRP-level was strongly associated to treatment outcome, (OR 0.006 [95% CI 0.00-0.11], p < 0.001). CONCLUSIONS: This trial documents that PIV 400 mg QID given for 1 week following 3 days of parenteral antibiotics, is a suitable treatment option in patients suffering from bacteremic UTI due to E. coli. Randomised clinical trials studying the efficacy of PIV vs standard of care of febrile UTI are warranted. Trial registration The trial was registered at ClinicalTrials.gov under the identifier: NCT03282006 13/09/2017 and approved by The Regional Committees for Medical Research Ethics South East Norway (2015/2384/REK sør-øst) and the Norwegian Medicines Agency (SLV; reference No 16/06018-09; EudraCT No 2016-000984-18) before initiation.

Mood and physical activity are associated with appetite in hospitalised older men and women.

BACKGROUND: The anorexia of ageing is important in the development of malnutrition, frailty and sarcopenia amongst the older population and is a particular problem for hospital inpatients. This study assessed appetite-related factors in a group of hospitalised older adults, to identify potential preventive strategies. DESIGN: Cross sectional observational study. SETTING: Eleven wards in one large hospital in England. SUBJECTS: Older inpatients aged ≥70 years, admitted non-electively. METHODS: Appetite was assessed using the four-item Simplified Nutritional Appetite Questionnaire (SNAQ). Associations between SNAQ score and appetite-related factors present in the dataset were assessed in continuous analyses, including habitual physical activity, mood, medication, cognition and living circumstances. RESULTS: 200 participants, mean age of 80.7 years (SD 6.9); 40% were women. Prevalence of poor appetite was 43%. In univariate analyses, lower medication count, higher habitual physical activity and better mood were associated with higher SNAQ scores during admission. In a multivariate analysis, independent associations of higher habitual physical activity and better mood with higher SNAQ scores during hospital admission remained. CONCLUSION: In this group of older adults, better mood and higher habitual physical activity were independently associated with better appetite during hospital admission. These are potentially modifiable factors and could be targets for future research into interventions for the anorexia of ageing in the hospitalised older population.