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Background: Hip fracture is a common event in older adults, leading to an increased risk of mortality, disability, and higher healthcare costs. Early in-hospital rehabilitation after surgery within orthogeriatric units may improve outcomes with limited incident complications even in the oldest old. We aimed to determine the prevalence and predictors of non-adherence to early rehabilitation in the orthogeriatric unit of an Italian tertiary hospital and its impact on outcomes and setting at discharge. Methods: Retrospective observational single-centered cohort study. Patients aged ≥ 65 years admitted to the orthogeriatric unit for hip fracture who underwent surgery between April 2019 and October 2020 were considered eligible if able to walk autonomously or with assistance and independent in at least 2 Basic Activities of Daily Living. Along with sociodemographic and geriatric variables, characteristics of surgery and rehabilitation, in-hospital complications and functional outcomes at discharge were collected. The primary outcome was non-adherence to the early in-hospital rehabilitation program. Results: Among 283 older patients (mean age 82.7 years, 28.6% male), non-compliance with physical therapy was assessed in 49 cases (17.3%), characterized by worse pre-fracture clinical, cognitive, and functional status and showing worse outcomes in terms of mobilization at discharge. After multivariable analysis, non-adherence was independently associated with the onset of delirium (OR 5.26, 95%CI 2.46–11.26; p < 0.001) or infections after surgery (OR 3.26, 95%CI 1.54–6.89; p < 0.001) and a systolic blood pressure at admission < 120 mmHg (OR 4.52, 95%CI 1.96–10.43, p < 0.001). Conclusions: Pre-fracture poor cognitive and functional status, along with lower systolic blood pressure, seem to make some patients more vulnerable to in-hospital complications (mainly delirium and infections) and negatively affect the adherence to physical therapy and, by consequence, clinical outcomes of rehabilitation. [ABSTRACT FROM AUTHOR]

As chaplaincy is increasingly practiced in outpatient settings, further understanding is needed of what it entails and is accomplishing within this unique context. This scoping review summarizes 42 articles that describe the types of spiritual care interventions and programs offered by chaplains in outpatient settings, and their outcomes. Findings support that chaplaincy is practiced in outpatient settings, especially in palliative care, oncology, and primary care. Interventions are delivered by chaplains as the sole interventionist, and by interdisciplinary teams with chaplain participants. Results show that outpatient chaplain interventions are feasible and acceptable, with positive psychological and spiritual outcomes. More studies with consistent outcome measurements, and structured chaplain interventions are needed to draw further conclusions about the effectiveness of outpatient chaplain interventions. [ABSTRACT FROM AUTHOR]

Introduction: Uninsured patients have limited options to pay for necessary medical services. Most United States hospitals offer financial assistance programs (FAPs) to help patients pay for care, but the challenges of accessing these programs demonstrate a need for more solutions. Methods: This study was a retrospective review of 200 randomly sampled HAVEN Free Clinic patients from September 2022 to September 2023. Patients were eligible to be seen at HAVEN if 18–65 years old, without health insurance, and living in New Haven County, Connecticut. Application histories to Medicaid and hospital FAP at a non-profit tertiary care center in Connecticut were assessed. Results: In the 200-patient sample, average age was 43.4 ± 11.2 years old, 61.0% were female, and 86.5% were Hispanic or Latino. 68% were employed with a median household yearly income of $18,200 [$7,293-$26,741]. 80% had applied for a hospital FAP—71.1% were currently approved for Free Care or Discounted Care. 6% were approved for Medicaid; 2.5% were approved for Emergency Medicaid. Of those who applied for a hospital FAP, 28.3% received ≥ 1 application denial. Most common hospital FAP denial reasons were missing, wrong, or outdated proof of income (93.9%), and incomplete application (6.1%). Conclusion: Hospital FAPs and Medicaid provide important access to care for uninsured patients, but are not without barriers and should not be viewed as the only solution. Improving hospital FAP access involves assessing eligibility at presentation, extending approval duration, and advocating for more funding. Addressing these barriers can advance equitable care for all. [ABSTRACT FROM AUTHOR]

Background: World falls guidelines recommend that hospitalised older patients receive individualised falls prevention education, yet no studies have sought older people's feedback on how best to deliver falls prevention education in hospitals. The objective of the study was to explore the perspectives of older people and their caregivers about barriers and enablers to implementation of a tailored hospital falls education program. Methods: A qualitative descriptive design was used. Three focus groups and 16 semi-structured interviews were conducted. A purposive sample of older people who had previous hospital admissions and caregivers of older people were selected to review a co-designed patient falls education program (the revised Safe Recovery program). They provided feedback on how to implement the program in hospital settings. Data were thematically analysed taking an deductive-inductive approach. Results: Participants were 37 older people [female n = 24 (64.9%), age range 64 to 89 years] and nine caregivers (female n = 8). The first theme was that the Safe Recovery Program resources were of high quality, enabling strong patient engagement and increased knowledge and awareness about falls prevention in hospitals. The second theme identified practical strategies to enable program delivery in hospital wards. The key enablers identified were: timing of delivery around wellness and the patient's mobility; tailoring messages for each older patient; key staff members being assigned to lead program delivery. Participants recommended that staff assist older patients to set appropriate behavioural goals in relation to preventing falls in hospitals. They also recommended that staff raise older patients' confidence and motivation to take action to reduce the risk of falls. Providing resources in other languages and alternative shorter versions was recommended to enable broad dissemination. Conclusions: Older people and their caregivers advised that implementing falls education in hospitals can be enabled by using high quality resources, delivering falls education in a timely manner and personalising the education and support to individual needs. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers (HCWs) including community health extension workers (CHEWs) in the Federal Capital Territory, Nigeria participated in a hypertension training series following the Extension for Community Healthcare Outcomes (ECHO) model which leverages technology and a practical peer-to-peer learning framework to virtually train healthcare practitioners. We sought to evaluate the patient-level effects of the hypertension ECHO series. Methods: HCWs from 12 of 33 eligible primary healthcare centers (PHCs) in the Hypertension Treatment in Nigeria Program (NCT04158154) were selected to participate in a seven-part hypertension ECHO series from August 2022 to April 2023. Concurrent Hypertension Treatment in Nigeria Program patient data were used to evaluate changes in hypertension treatment and control rates, and adherence to Nigeria's hypertension treatment protocol. Outcomes were compared between the 12 PHCs in the ECHO program and the 21 which were not. Results: Between July 2022 and June 2023, 16,691 PHC visits were documented among 4340 individuals (ECHO: n = 1428 [33%], non-ECHO: n = 2912 [67%]). Patients were on average (SD) 51.5 (12.0) years old, and one-third were male (n = 1372, 32%) with no differences between cohorts in either characteristic (p ≥ 0.05 for both). Blood pressures at enrollment were higher in the ECHO cohort compared to the non-ECHO cohort (systolic p < 0.0001 and diastolic p = 0.0001), and patients were less likely to be treated with multiple medications (p < 0.0001). Treatment rates were similar at baseline (ECHO: 94.0% and Non-ECHO: 94.7%) and increased at a higher rate (interaction p = 0.045) in the ECHO cohort over time. After adjustment for baseline and within site variation, the difference was attenuated (interaction p = 0.37). Over time, control rates increased and medication protocol adherence decreased, with no differences between cohorts. Staffing levels, adult patient visits, and rates of hypertension screening and empanelment were similar between ECHO and non-ECHO cohorts (p ≥ 0.05 for all). Conclusions: The ECHO series was associated with moderately increased hypertension treatment rates and did not adversely affect staffing or clinical capacity among PHCs in the Federal Capital Territory, Nigeria. These results may be used to inform strategies to support scaling hypertension education among frontline HCWs throughout Nigeria, and use of the ECHO model for CHEWs. Trial Registration: The Hypertension Treatment in Nigeria Program was prospectively registered on November 8, 2019 at www.clinicaltrials.gov (NCT04158154; https://clinicaltrials.gov/ct2/show/NCT04158154). [ABSTRACT FROM AUTHOR]

Introduction: Social medicine seeks to incorporate patients’ social contexts into their medical care. Emergency physicians are uniquely positioned to address social determinants of health (SDoH) on the frontlines of the healthcare system. Miami-Dade County (MDC) is a diverse and socially vulnerable area. In 2020, the University of Miami-Jackson Health System (UM-JHS) emergency medicine (EM) residency program launched a multimodal, resident-led Social EM program to identify and address SDoH in the emergency department (ED). Methods: We use a four-pillar approach to SDoH in the ED: Curriculum Integration; Community Outreach; Access to Care; and Social Justice. Residents graduate with a knowledge of Social EM principles through an 18-month curriculum, an elective, and a longitudinal track. We developed sustainable initiatives through interdepartmental and community-based partnerships, including a Narcan distribution initiative, an ED-based program linking uninsured patients to follow-up care, a human trafficking education initiative, and a quality improvement initiative for incarcerated patients. Results: Given that the 18-month curriculum was launched in 2022, a full rotation of the curriculum had not been completed as of this writing, and data collection and analysis is an ongoing process. The initial pretest and post-test survey data show improvement in knowledge and confidence in managing Social EM topics. The Narcan initiative has screened 1,188 patients, of whom 144 have received Narcan. The ED-based patient navigation program has enrolled 31 patients to date, 18 of whom obtained outpatient care. Analysis of the impact/effectiveness of the program’s other initiatives is ongoing. Conclusion: To our knowledge, this is one of the most robust social EM programs to date, as many other programs primarily focus on service opportunities. Rooted in the revised principles of Bloom’s taxonomy of cognitive learning, this program moves beyond understanding Social EM tenets to generating solutions to address SDoH in and outside the ED. [ABSTRACT FROM AUTHOR]

This paper reviews the evidence base for an in-hospital 12-month training program in neurodiagnostic technology utilizing two educational tracks: Electroencephalography (EEG) or Polysomnography (PSG), employing standardized didactic courses via the ASET – The Neurodiagnostic Society EEGCore Curriculum EEG 200–211 and the A-STEP online sleep self-study modules by the American Academy of Sleep Medicine (AASM). Specifically, we examine the purpose, strategy, and outcomes for the training program that was established in 2016 at Ann & Robert H. Lurie Children's Hospital of Chicago to support mission sustaining service lines. In addition, we report the results from a series of student course evaluations and an independent assessment of the program by ABRET Neurodiagnostic Credentialing and Accreditation through the application for programmatic recognition for EEG. Finally, we present a set of recommendations for organizations looking to develop a neurodiagnostic technology training program. [ABSTRACT FROM AUTHOR]

In this case study, we describe a client, pseudonymously named Kai, who suffered multiple firearm injuries and was enrolled in a hospital-based violence intervention program (HVIP). Kai required multi-disciplinary care in pediatric and adult Level I Trauma Centers. His care was complicated by behavioral health issues, poverty, and a lack of adequate access to community-based healthcare and social support, leading to deteriorating health, frequent hospitalizations, and high health care utilization. Providers from the HVIP repeatedly worked with Kai, advocated for enhanced care, and provided him with the support necessary to heal and recover. This case report details the exceptional work HVIPs can do to support at-risk individuals, disrupt the cycle of violence, and promote healing and safety. [ABSTRACT FROM AUTHOR]

Summary: This research conducts a comparative analysis and scoping review of 105 studies in the field of Fracture Liaison Service (FLS). The resulting two-dimensional framework represents a significant step toward FLS implementation. Purpose: The primary goal is to review interventions in real world settings in order to provide the FLS framework that specifies the essential elements of its implementation and offers different perspectives on that. Method: This study encompasses two phases: a comparative analysis of existing FLS models, including "Capture the Fracture," "5IQ," and "Ganda," and a scoping review from 2012 to 2022 in PubMed, Web of Science, Scopus, ProQuest, and IEEE databases limited to publications in English. Results: The resulting model of comparative analysis identifies patient identification, investigation, intervention and integration or continuity of care as the four main stages of FLS. Additionally, the elements of quality and information span across all stages. Following comparative analysis, the framework is designed to be used for content analysis of the included studies in the scoping review. The intersection of columns (Who, Where, When, What, How, Quality) with rows (Identification, Investigation, Intervention, and continuity of care) yields a set of questions, answered in tabular form based on the scoping review. Conclusion: The framework offers potential benefits in facilitating the adoption of effective approaches for FLS implementation. It is recommended to undertake an in-depth review of each of these components in order to uncover novel and innovative approaches for improving their implementation. [ABSTRACT FROM AUTHOR]

BACKGROUND: When treating acute respiratory failure, both hypoxemia and hyperoxemia should be avoided. ... should be monitored closely and O2 flows adjusted accordingly. Achieving this goal might be easier with automated O2 titration compared with manual titration of fixed-flow O2. We evaluated the feasibility of using an automated O2 titration device in subjects treated for acute hypoxemic respiratory failure in a tertiary care hospital. METHODS: Health-care workers received education and training about oxygen therapy, and were familiarized with an automated O2 titration device (FreeO2,). A coordinator was available from 8:00 AM to 5:00 PM during weekdays to provide technical assistance. The ability of the device to maintain ... within the prescribed therapeutic window was recorded. Basic clinical information was recorded. RESULTS: Subjects were enrolled from November 2020 to August 2022. We trained 508 health-care workers on the use of automated O2 titration, which was finally used on 872 occasions in 763 subjects, distributed on the respiratory, COVID-19, and thoracic surgery wards, and in the emergency department. Clinical information could be retrieved for 609 subjects (80%) who were on the system for a median (interquartile range) of 3 (2-6) d, which represented 2,567 subject-days of clinical experience with the device. In the 82 subjects (14%) for whom this information was available, the system maintained ... within the prescribed targets 89% of the time. Ninety-six subjects experienced clinical deterioration as defined by the need to be transferred to the ICU and/or requirement of high flow nasal oxygen but none of these events were judged to be related to the O2 device. CONCLUSIONS: Automated O2 titration could be successfully implemented in hospitalized subjects with hypoxemic respiratory failure from various causes. This experience should foster further improvement of the device and recommendations for an optimized utilization. [ABSTRACT FROM AUTHOR]

Background: The South Korean government implemented a multidisciplinary nutritional support team (NST) system to focus on the proper evaluation and supply of nutritional status in hospitalized patients who are at a higher risk of malnutrition. Methods: This nationwide population-based cohort study included patients diagnosed with sepsis who were admitted to hospitals from 2016 to 2020. The NST should consist of four professional personnel (physicians, full-time nurses, full-time pharmacists, and full-time clinical dietitians). The NST group included patients with sepsis admitted to a hospital with an NST system, whereas the non-NST group included patients with sepsis admitted to a hospital without an NST system. Results: A total of 323,841 patients with sepsis were included in the final analysis, and 120,274 (37.1%) admitted to a hospital with an NST system were included in the NST group. In the multivariable Cox regression analysis, the NST group showed a 15% lower 90-day mortality than the non-NST group (hazard ratio [HR]:0.85, 95% confidence interval [CI]:0.83, 0.86; P < 0.001). The NST group shows 11% lower 1-year all-cause mortality than the non-NST group (HR:0.89, 95% CI:0.87, 0.90; P < 0.001). In subgroup analyses, a more evident association of the NST group with lower 90-day mortality was shown in the intensive care unit admission group and age ≥65 years old group. Conclusions: Multidisciplinary NST intervention is associated with improved survival outcomes in patients with sepsis. Moreover, this association was more evident in patients with sepsis aged ≥65 years old who were admitted to the ICU. [ABSTRACT FROM AUTHOR]

Background: Telemedicine is a means of providing efficient treatment for children with complex chronic conditions and/or subsidiary palliative paediatric care. Aim: To evaluate how satisfied families and healthcare professionals are with a telemedicine programme. Methodology: This is a qualitative study of narrative design. Ten interviews were conducted with family members and professionals who had been using telemedicine for a year. Sampling was intentional and a discourse and content analysis was conducted. Results: Six thematic categories emerged from the analysis of the interviews: degree of satisfaction; usefulness; benefits according to patient needs and attention; technical and human difficulties; and implantation of the system and proposals for improvement. Conclusions: The study shows that telemedicine is a very useful complementary tool for healthcare professionals in a palliative care context. It is necessary to take into account the perception and needs of both families and healthcare professionals with regard to this tool since it can improve patient care. [ABSTRACT FROM AUTHOR]

Folate-mediated one-carbon metabolism (FOCM) plays an important role in colorectal carcinogenesis. Previous studies have assessed the role of folate-mediated one-carbon metabolism (FOCM)-related gene-diet interaction in the aetiology of colorectal cancer (CRC), however, the results remained inconclusive. Thus, this study aimed to investigate dietary factors and genetic variants related to FOCM, as well as potential nutrient-gene and nutrient-lifestyle interactions, on CRC risk. This observational study included 229 patients diagnosed with CRC and 229 age- and sex-matched subjects as controls from a population-based bowel cancer screening program. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95%CI) for CRC risk. A Bonferroni-corrected threshold of α = 0.005 was considered significant, and P values less than 0.05 were considered to be suggestive of an association. After Bonferroni correction, a high dietary intake of betaine was associated with a decreased risk of CRC in the adjusted model (OR, 95% CI: 0.21, 0.10–0.40, P < 0.001). Two SNPs, rs1476413 and rs17824591, exhibited significant gene-diet interactions with total choline ad vitamin B12 intakes, respectively, in adjusted models (total choline, tertile 3 vs. 1, OR, 95% CI: 0.25, 0.11–0.66, Pinteraction = 0.012; vitamin B12, tertile 2 vs. tertile 1, OR, 95% CI: 2.48, 1.04-5.00, Pinteraction = 0.003). These findings suggest that betaine intake and interactions between some dietary factors and variants in MTHFR and MTHFD1 genes have an influence on CRC risk in the population studied. If these results are confirmed, specific nutritional intervention strategies could be designed. [ABSTRACT FROM AUTHOR]

Background: Patients requiring admission to the general medicine wards in a public hospital are usually assessed by a medical registrar. This study is based at a metropolitan public hospital in Melbourne where the majority of general medicine patients in the emergency department (ED) are not seen by a consultant physician until they are transferred to the ward. Aims: To assess the impact of general medicine consultant‐led ward rounds (CWRs) in the ED on patient length of stay (LOS). Methods: One‐month audit was conducted of all patients admitted to general medicine and awaiting transfer to ward from ED at a metropolitan public hospital in Melbourne. A general medicine CWR was then implemented in the ED, followed by another 1‐month audit, with the primary outcome being LOS and the secondary outcome being 30‐day readmission rate. Additionally, admitting medical registrars were invited to complete a survey before and after the implementation of CWRs to assess satisfaction rate. Results: Data from electronic medical records were analysed for 162 patients (90 preimplementation group and 72 postimplementation group). The median LOS was 6 days in the preimplementation group and 4 days in the postimplementation group (P = 0.014). There was no significant difference in 30‐day readmission rates. Surveys showed admitting medical registrars reported a reduced level of stress and fewer barriers to seeking consultant input following implementation. Conclusions: A CWR in the ED has led to decreased LOS for general medicine patients and improved satisfaction among junior medical staff. [ABSTRACT FROM AUTHOR]

The article evaluates the implementation of opt-out HIV screening in the University of Miami Health Tower Emergency Department to enhance HIV detection and linkage to care. Topics discussed include the effectiveness of opt-out testing in increasing screening rates, the demographic disparities observed in HIV-positive results, and the integration of opt-out testing into routine emergency department workflows.

Objective: To describe the implementation, feasibility and safety of a day‐stay joint replacement pathway in a regional public hospital in Australia. Method: Over a 12‐month pilot period, a prospective descriptive analysis of consecutive patients undergoing total knee and hip arthroplasty was conducted. The number of eligible day‐stay patients, proportion of successful same‐day discharges and reasons for same‐day failure to discharge were recorded. Outcome measures captured for all joint replacements across this period included length of stay (LoS), patient reported outcomes, complications and patient satisfaction. The implementation pathway as well as patient and staff identified success factors derived from interviews were outlined. Results: Forty‐one/246 (17%) patients booked for joint replacement surgery were eligible for day‐stay and 21/41 (51%) achieved a successful same‐day discharge. Unsuccessful same‐day discharges were due to time of surgery too late in the day (7/20), no longer meeting same‐day discharge criteria (11/20) and declined discharge same‐day (2/20). Over the implementation period 65% (162/246) of all patients were discharged with a LoS of 2 days or less. Patient satisfaction for the day‐stay pathway was high. Complication rates and patient‐reported outcomes were equivalent across LoS groups. Conclusion: The day‐stay joint replacement surgery pathway was feasible to implement, safe and acceptable to patients. Day‐stay pathways have potential patient and system‐level efficiency benefits. [ABSTRACT FROM AUTHOR]

Elder mistreatment is common, serious, and under-recognized, with Emergency Department and hospital clinical encounters offering a potential but currently unrealized opportunity to identify and help older adults experiencing mistreatment. Interdisciplinary emergency department and hospital-based response teams represent a promising care model to address this. This manuscript describes two such teams and introduces a special issue dedicated to this work. [ABSTRACT FROM AUTHOR]

Elder mistreatment (EM) is a complex problem, with response and prevention requiring contributions from professionals from many disciplines. Community-based multi-disciplinary teams (MDTs) that conduct meetings to discuss challenging cases and coordinate services are a common strategy to ensure effective collaboration. Though they play an important role in EM identification, intervention, and prevention, hospitals and hospital-based healthcare professionals have been particularly difficult to engage in MDTs. Two hospitals in different communities recently launched Emergency Department (ED)/hospital-based response teams to consult in cases of potential EM, and both participate in MDTs. We explored similarities and differences between the MDTs in these communities including in the role of the ED/hospital-based response team. The comparison demonstrates both core common features as well as large variations. These differences reflect different circumstances in the models on which they were based, on MDT development in these communities, available resources and infrastructure, and the ED/hospital program's role. [ABSTRACT FROM AUTHOR]

(1) Background: We aim to examine and improve phosphate prescribing as part of a quality assurance program by examining the change in the proportion of patients receiving phosphate with normal or high preceding serum phosphate concentrations before and after the introduction of the 24 h time limit to default phosphate prescription. (2) Methods: This was a quality assurance study conducted across three Australian adult intensive care units (ICUs). All adult patients with ICU lengths of stay greater than or equal to 48 h who had their serum phosphate concentrations measured were included. A 24 h time limit was introduced to the protocolised prescription in the electronic clinical information system for enteral and intravenous phosphate at participating ICUs. Patient characteristics, phosphate administration, and outcomes were compared before and after this time limit was introduced. The primary outcome was the proportion of patients to whom phosphate was prescribed after measurement of a normal or high serum phosphate level. Secondary outcomes were ICU length of stay, mortality, and discharge destination. (3) Results: A total of 1192 patients were included from three ICUs over the two periods. The proportion of patients with a normal or high measured phosphate level who then received phosphate supplementation was significantly lower in the second study period (30.3% vs. 9.9%; p < 0.001). This difference persisted when adjusted for potential confounders in a mixed-effects logistic regression model (an adjusted odds ratio for receiving phosphate with normal or high serum concentration 0.214, 95% confidence interval of 0.132–0.347; p < 0.001). No significant difference was seen in the typical ICU length of stay, in-hospital case–fatality rate, and hospital discharge destination between these groups. (4) Conclusions: This multicentre before–after study has demonstrated that the introduction of a 24 h limit on electronic phosphate prescriptions resulted in significantly fewer patients receiving phosphate when their serum phosphate concentration was normal or high, without any adverse impact on patient outcomes. [ABSTRACT FROM AUTHOR]

Multi‐family therapy for children and adolescents with anorexia nervosa (MFT‐AN) draws on the same principles as family therapy for AN (FT‐AN), but is delivered in a more intensive format to help families overcome a sense of isolation and stigmatisation and to maximise their own resources. In Japan, the main treatment for AN is inpatient care, and family‐based treatment that is based on the practice at the Maudsley Hospital in the 1980s has started to be introduced at an inpatient level in Japan. MFT‐AN could offer more opportunities to practice managing AN symptoms and reduce the family's anxiety. It may also act as a step‐down intervention during transition from inpatient to outpatient care or a step‐up in intensity if outpatient treatment is stalling. This article reports on MFT‐AN's theoretical underpinnings, the current Japanese eating disorder treatment context, and the way MFT‐AN may be adapted for the unique Japanese socio‐cultural context. [ABSTRACT FROM AUTHOR]

Physical activity (PA) promotes survival and mitigates symptoms in older breast cancer survivors (BCS), especially to reduce joint pain associated with adjuvant hormonal treatment. The purpose is to describe the adaptation process for an evidence-based exercise and education curriculum (i.e., Fit & Strong!) to support older BCS participating in the Using Exercise to Relieve Joint Pain and Improve Aromatase Inhibitor Adherence in Older Breast Cancer Survivors trial. We reviewed all educational materials with scientific/clinical experts to identify necessary content changes. Next, we conducted semistructured phone interviews with BCS to review all educational materials and conducted a real-time pretest for the trial. Overall, BCS found the adapted materials and experience acceptable (mean score of 9.2/10 for satisfaction). Content changes included simplifying exercise instructions, prioritizing content related to the trial goals, and updating photographs. Because of COVID, the pretest was conducted via Zoom. Our multistep adaptation process provided an acceptable intervention to meet the needs of older BCS. Lessons learned will be applied to the forthcoming pilot trial. [ABSTRACT FROM AUTHOR]

Background: The death of a child is one of the most devastating events a family can face, resulting in significant physical and psychosocial morbidity. Bereavement support programs have been developed in high-income contexts to address this need. However, little is known about implementing bereavement programs in low-and middle-income countries (LMICs). Here, we describe the implementation of a bereavement program for parents whose children died due to cancer or other catastrophic illnesses. Methods: We conducted a retrospective analysis to describe the implementation of a hospital-based End of Life (EoL) care and bereavement program. This program was developed in several stages, including an assessment of bereaved families, development program guidelines, staff training, piloting of the program, refinement, and standardization. The program was developed between 2019 and 2021 in a nonprofit, teaching hospital and referral center for southwestern Colombia. Results: Several tools were developed as key components of the bereavement program: a virtual bereavement course; guidance for EoL and bereavement communication and care, memory making, and follow-up calls; a condolence letter template, and group support workshops. A total of 956 healthcare professionals were trained, 258 follow-up calls to bereaved parents were made, 150 individual psychological follow-ups to parents with complicated grief occurred, 79 condolence letters were sent, and 10 support group workshops were carried out. Challenges were identified and overcome, such as limited resources and staff, and cultural perceptions of death. In 2021, this program received an award by the hospital as the Best Strategy to Humanize Healthcare. Conclusions: This study highlights the feasibility of developing and implementing EoL and bereavement care programs for parents and families within hospitals in LMICs. Lack of resources, staff, and training are some of the identified challenges to implementation. Utilizing methodological tools allows us to identify facilitator factors and deliverable outcomes of our EoL and bereavement program. This model provides a valuable framework for resource-limited settings. [ABSTRACT FROM AUTHOR]

Introduction: Blood culture is the gold standard for diagnosing bacteremia and direct the physicians to select appropriate antimicrobials. In hospitals, blood culture contamination (BCC) is a common problem that has a detrimental effect on patient outcomes. Hence, we implemented strategies in our tertiary care setup, for training phlebotomists and nurses in proper blood sampling techniques, and assessed their effectiveness in reducing BCC rates. Methods: This interventional study was conducted at the Indus Hospital, Karachi, Pakistan from 1st January 2021 to 30th June 2023. All blood cultures received from different departments of the hospital were included. The 2.5-year study period was divided into pre-intervention and intervention periods, with monthly monitoring of BCC. The BCC data between 1st January 2021 and 31st December 2021 was taken as the baseline pre-intervention period and the next 1.5 years comprised the intervention period (1st January 2022-30th June 2023). To improve compliance, various strategies were implemented, such as regular training sessions, didactic sessions, and re-competencies. Results: A total of 86 774 Blood cultures were received from all departments of the hospital, out of which n = 30 672 were received in the pre-intervention period whereas, n = 56 102 were received in the intervention period. Mean BCC rate in the pre-intervention period was found to be 4.6%. However, after the implementation of different measures to reduce BCC, the contamination rate decreased to a mean of 3.1% by the end of the intervention period. Emergency department accounted for the highest proportion of BCC in the pre-intervention and intervention periods. Conclusion: We decreased BCC in our tertiary care setup by implementing a simple and inexpensive collaborative intervention, and came to the conclusion that the higher incidence of BCC was probably caused by factors unique to the emergency department and provided measures to successfully address them. [ABSTRACT FROM AUTHOR]

Background: Paediatric palliative and hospice care aims to improve the quality of life of children with life-limiting and life-threatening conditions and their families. The number of these patients has risen significantly in recent years, resulting in an increased need for palliative care for this population. Although the need for paediatric palliative and hospice care is growing, meaningful outcome evaluation to demonstrate its effectiveness as a complex healthcare intervention is in its early stages. For complex interventions (programmes), theory-based evaluations have grown in prominence in recent years. They seek to understand how and why an intervention works by uncovering its underlying mechanisms by means of programme theory. To support both outcome evaluation in paediatric palliative care and a reflective practice of programme theorizing, we aimed to describe the construction of a programme theory for a specialist paediatric palliative and hospice care programme in Austria and to offer a reflective account of its development process. Methods: We drew on a combination of theory-based evaluation frameworks to construct a programme theory consisting of an action and a change component. Through multiple iterations, incorporating different stakeholders' perspectives and drawing on different sources of knowledge and theory, we theorized how and why the programme likely achieves its intended outcomes. Results: The programme theory outlines the proposed chains of events, causal mechanisms and outcomes of a specialist paediatric palliative and hospice care programme for children and families in several areas corresponding to its main conceptual tenets. Through a range of activities and interventions, the programme triggers coping and adaptation mechanisms that ultimately contribute to family and child wellbeing in physical, psychological, social, and spiritual dimensions. Established trust and partnership between children/families and healthcare professionals as well as a person-centered and family-centered approach were identified as enabling factors. Conclusions: Our findings provide insights into how a specialized paediatric palliative and hospice care programme works to achieve its intended outcomes for children and families. This helps demonstrate its impact, contributing to meaningful outcome evaluation and service improvement. [ABSTRACT FROM AUTHOR]

Introduction: Methadone is a medically necessary and lifesaving medication for many patients with opioid use disorder. To adequately address these patients’ needs, methadone should be offered in the hospital, but barriers exist that limit its continuation upon discharge. The code of federal regulations allows for methadone dosing as an inpatient as well as outpatient dispensing for up to three days to facilitate linkage to treatment. As a quality initiative, we created a new workflow for discharging patients on methadone to return to the emergency department (ED) for uninterrupted dosing. Methods: Our addiction medicine team changed hospital methadone policy to better allow hospitalization as a window of opportunity to start methadone. This necessitated the creation of a warmhandoff process to link patients to methadone clinics if that linkage could not happen immediately on discharge. Thus, our team created the “ED Bridge” process, which uses the “3-day rule” to dispense methadone from the ED post hospital discharge. We then followed every patient we directed through this workflow as an observational cohort for outcomes and trends. Results: Of the patients for whom ED bridge dosing was planned, 40.4% completed all bridge dosing and an additional 17.3% received at least one but not all bridge doses. Established methadone patients made up 38.1% of successful linkages, and 61.9% were patients who were newly started on methadone in the hospital. Conclusion: Improving methadone as a treatment option remains an ongoing issue for policymakers and advocates. Our ED bridge workflow allows us to expand access and continuation of methadone now using existing laws and regulations, and to better use hospitals as a point of entry into methadone treatment. [ABSTRACT FROM AUTHOR]

Background/Aims: For people living with acquired brain injury from stroke or trauma, clinical practice guidelines recommend high-intensity physical rehabilitation to optimise motor outcomes. There is an acknowledged evidence–practice gap between routine clinical practice and the amount, intensity and type of active upper limb rehabilitation recommended in research-informed guidelines. The aims of this study were to identify methods used to facilitate high doses of upper limb practice in published trials, understand stakeholder perspectives of the barriers and enablers to these methods in hospital settings, and to synthesise findings to form an evidence-based action plan for rehabilitation professionals, service providers and adults living with an acquired brain injury. Methods: A rapid systematic literature review and a series of qualitative interviews with service users and rehabilitation clinicians explored the evidence on intensity and the experience of high intensity rehabilitation following brain injury and stroke. Triangulating this mixed method evidence, recommendations were generated on how to increase upper limb rehabilitation intensity during inpatient therapy. Results: There was consensus in the literature that high-dose motor training improves a person's ability to move their hand and arm after brain injury and stroke. Trials mostly delivered therapy programmes as a replacement to usual care; however, it was unclear how high-intensity therapy was integrated into usual rehabilitation. Methods employed to increase the intensity of upper limb rehabilitation included strategies to optimise engagement (eg encourage independent practice and more practice); clinician-related processes (eg self-auditing, use of groups); environmental factors (eg equipment, dedicated space); and organisational influences (eg professional development, dedicated research positions and mentoring). Qualitative data showed that barriers and facilitators stem from service user factors (eg cognitive ability, advanced age, cultural mores) as well as clinician factors (eg quality of the therapeutic relationship, type and quality of therapist instructions). Organisational factors such as a strong research culture and a commitment to evidence-based practice positively influenced outcomes. Conclusions: There is capacity to increase the intensity of upper limb rehabilitation by optimising organisational support and systems, as well as greater service user engagement in therapy processes. Implications for practice: Rehabilitation clinicians have long understood that dose is a critical component of motor training. Findings may assist with structuring upper limb rehabilitation programs and addressing clinician factors to increase the intensity of therapy. [ABSTRACT FROM AUTHOR]

Responsive feeding serves as an important protective factor for infant growth and overall health development. This study based on self‐determination theory (SDT) aimed to assess the effects of a responsive breastfeeding (RBF) intervention programme on maternal breastfeeding and infant growth and development. A total of 110 mother–infant pairs were recruited and randomly divided into an intervention group (n = 55) and a control group (n = 55). The primary outcomes were breastfeeding motivation score, breastfeeding self‐efficacy (BSE) and exclusive breastfeeding rate; the secondary outcomes were infant physical development at 6 weeks and 3 months. A repeated measures ANOVA indicated that the intervention group had significantly higher Enjoyment scores compared to the control group at three time points: at discharge (MD: 5.28; 95% CI: 3.68 to 6.89; p < 0.001), 6 weeks post‐partum (MD: 5.06; 95% CI: 3.80 to 6.31; p < 0.001) and 3 months post‐partum (MD: 5.24; 95% CI: 4.12 to 6.35; p < 0.001). Similarly, the intervention group reported significantly higher connection and mother's self‐perception scores at discharge (MD: 4.31; 95% CI: 3.07 to 5.56; p < 0.001), 6 weeks post‐partum (MD: 4.69; 95% CI: 3.71 to 5.68; p < 0.001) and 3 months post‐partum (MD: 4.93; 95% CI: 4.14 to 5.72; p < 0.001), compared to the control group. In contrast, the pressure from significant others scores were higher in the control group relative to the intervention group at discharge (MD: −2.09; 95% CI: −2.88 to −1.31; p < 0.001), 6 weeks post‐partum (MD: −4.35; 95% CI: −5.20 to −3.49; p < 0.001) and 3 months (MD: −4.89; 95% CI: −5.70 to −4.08; p < 0.001). Finally, the intervention group also reported higher Instrumental Needs scores at all three time points: at discharge (MD: 1.96; 95% CI: 1.35 to 2.58; p < 0.001), 6 weeks post‐partum (MD: 3.58; 95% CI: 3.05 to 4.11; p < 0.001) and 3 months post‐partum (MD: 1.18; 95% CI: 0.68 to 1.69; p < 0.001). BSE scores were significantly higher in the intervention group compared to the control group at discharge (MD: 14.29; 95% CI: 10.38 to 18.21; p < 0.001), 6 weeks post‐partum (MD: 14.04; 95% CI: 11.05 to 17.02; p < 0.001) and 3 months post‐partum (MD: 6.80; 95% CI: 4.66 to 8.94; p < 0.001). The rates of exclusive breastfeeding were higher in the intervention group than in the control group at each stage of the intervention (p < 0.01). At 6 weeks post‐partum, the intervention group's infants showed slower weight (t = −0.90, p = 0.371) and length (t = −0.69, p = 0.495) growth compared to the control group, though not significantly. By 3 months post‐partum, there was a significant difference in both weight (t = −3.46, p = 0.001) and length (t = −2.95, p = 0.004) between the groups. The findings in this study suggest that the RBF intervention programme based on SDT may be effective in improving mothers' motivation to breastfeed, building breastfeeding self‐confidence and increasing the rate of exclusive breastfeeding. The effects of the intervention on infant physical development will need to be verified with longer follow‐up in future research. Key messages: This study validated the application of responsive breastfeeding (RBF) intervention during the exclusive breastfeeding phase of Chinese infants.The RBF intervention may help to increase mothers' level of autonomous motivation for breastfeeding, enhance breastfeeding self‐efficacy and increase exclusive breastfeedingrates. The intervention had no significant effect on the weight and length of 6 week old infants but significantly impacted 3monthold infants, with slower growth observed in the intervention group compared to the control group.Future intervention programmes shouldinclude extended follow‐up periods to investigate the long‐term effects of RBF on infant growth and development. [ABSTRACT FROM AUTHOR]

The article focuses on the ongoing restrictions in U.S. hospitals regarding family presence during critical medical procedures, despite evidence supporting its benefits and ethical considerations. It emphasizes the importance of reinstating family presence as a standard of patient-centered care post-pandemic, advocating for policies that uphold patient autonomy and support family involvement in healthcare decision-making.

The article provides information on a program which aims to increase nurses' knowledge of and adherence to bedside shift report (BSR) by 50 percent within three months of implementation. Topics discussed include project site and reason for change, quality indicator with operational definitions and data collection methods, and survey responses.

Objective Students in health profession education programs were severely affected by the COVID-19 pandemic at both didactic and clinical training levels. The purpose for this American Society for Clinical Pathology Board of Certification (ASCP BOC) study was to determine the impact of the COVID-19 pandemic on graduates. This study represents the perspectives of laboratory professional graduates who sat for the BOC certification in their respective professional disciplines. Methods A survey was sent to all graduates from the National Accrediting Agency for Clinical Laboratory Science (NAACLS), Accrediting Bureau of Health Education Schools (ABHES), and Commission on Accreditation of Allied Health Education Programs (CAAHEP) accredited programs who sat for the ASCP BOC examination in 2020 and 2021 to determine the impact of COVID-19 on laboratory professional graduates during the pandemic. Results A total of 180 graduates responded to the survey. The majority of graduates indicated that at least 1 didactic program component was shifted to an online system during the pandemic and that both clinical and nonclinical student laboratories were affected. Although program completion for most graduates was not delayed, one-third of graduates delayed taking their respective BOC exam. Due to the lack of knowledge application through practical hands-on laboratory experience in their educational programs, graduates reported feeling a lack of readiness with regards to preparing for the national certification examination as well as for employment. Conclusion The study results showed the pandemic greatly impacted the education experience and readiness for the ASCP BOC examinations for graduates. Factors such as the absence of in-person learning and hands-on experience—both crucial aspects in laboratory training—and the ripple effects as a result of the pandemic, such as job loss, financial constraints, and health concerns, contributed to the decreased quality of education for graduates. [ABSTRACT FROM AUTHOR]

Eating disorders (EDs) and substance use disorders (SUDs) often co-occur. However, not all providers that treat persons with an ED provide SUD treatment. Using the National Mental Health Services Survey, this study examined 1,387 ED treatment providers in the U.S. Facilities were categorized according to whether they provided SUD treatment. Differences based on facilities' profit status, available treatment settings, payment options, and treatment services were examined. Most ED facilities in the sample offered SUD treatment services (67.2%). Differences in proportions of the facility type, availability of outpatient treatment, sliding fee scale payment option, whether the facility had a program for individuals with co-occurring mental health and SUD, couples/family therapy, dual disorders treatment, and if the facility provided telemedicine/telehealth were identified. Although most facilities in this sample offered SUD services, more should be done to increase such facilities' capacity to provide treatment for co-occurring ED and SUD nationwide. Nearly 70% of all ED treatment facilities reported offering SUD treatment. Geographic disparities in these integrated services exist. Eighty-six percent of these facilities had outpatient treatment. [ABSTRACT FROM AUTHOR]

Lack of proper eye care (EC) for mechanically ventilated patients can lead to serious ocular complications. Objective of this study is to develop and validate eyes care bundle for mechanically ventilated patients. A Delphi design study was conducted between March and May 2021. The Content Validity Index (CVI) was used to calculate the degree of agreement among the experts to analyze the bundle. Content validity was determined by 5 experts using a 4-point Likert scale. They evaluated the items in terms of the following: 1 = "irrelevant," 2 = "somewhat relevant if the phrasing is profoundly adjusted," 3 = "relevant with some adjustment," and 4 = "very relevant." The CVI was applied, and the accepted value was ≥0.50. The validation of EC bundle was conducted through 3 rounds after developed it based on the evaluated research evidence. The items were reviewed for content and face validity. The bundle was validated with 5 items with a total CVI of 0.96, a face validity of 1, and a Scale-Level Content Validity Index/Universal Agreement calculation method value of 0.8. This bundle can help critical care nurses, doctors, academics, and students assess and provide standard EC for mechanically ventilated patients. [ABSTRACT FROM AUTHOR]

Purpose: To examine behavior changes among formal caregivers in Taiwanese long-term care facilities (LTCFs) after receiving training in function-focused care for cognitive impairment (FFC-CI). Method: The current study was a clustered randomized controlled trial. Formal caregivers (i.e., RNs and nursing assistants) (N = 98) from four LTCFs were randomly assigned to experimental or control groups. Training was based on four components of FFC-CI. Data were collected four times within 9 months using five observational outcome measurements: Self-Efficacy for Restorative Care (SERCS), Outcome Expectations for Restorative Care Scale (OERCS), Restorative Care Knowledge Scale (RCKS), Restorative Care Behavior Checklist (RCBC), and Job Attitude Scale (JAS). Results: Statistically significant changes were noted in each activity of restorative care behavior among the four observational measurements. Results also indicated that job satisfaction was a statistically significant main effect for the experimental group; however, SERCS, OERCS, and RCKS scores were not statistically significant. Conclusion: To eliminate gaps between translating research outcomes to clinical practice, this study applied a theory-based caring model for caregivers to improve knowledge and skills in caring for older adults with dementia. Caregivers who received training in FFC-CI not only had higher job satisfaction but could also provide specific FFC activities for residents during their daily care. [Journal of Gerontological Nursing, 50(7), 42–50.] [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The unrelenting turmoil of the COVID-19 pandemic has been especially hard on those in the healthcare field. This chronic stress has resulted in depleted compassion towards patients served and colleagues. Researchers have suggested that empathy is a finite resource that must be replenished. For physicians in residency training and those in practice, where finding meaning and purpose in their work is already a challenge, the spark for medicine and helping others may easily become extinguished. This article explores interventions implemented in two family medicine residency programs to address concerns about burnout and compassion fatigue exacerbated by the COVID-19 pandemic. Methods: A qualitative research approach is employed here through case studies of two family medicine programs, along with a description of several interventions intended to mitigate burnout and compassion fatigue during the pandemic. Participants were 36 family medicine residents from "residency #1" and 36 family medicine residents from "residency #2." Results: The authors describe several interventions used in the two residency programs to reduce issues of compassion fatigue. These include meditation, gratitude practice, guided group support, and a focus on clinicians' physical health. Feedback from residents and program leaders suggest that these interventions were useful tools to help physicians navigate their new normal as they began to practice during a pandemic, thereby reducing burnout and challenges with compassion fatigue. A strategic plan is outlined to help other programs implement some of these strategies. Conclusions: It is imperative that training programs continue to implement interventions that emphasize resident and post-residency wellness to reduce compassion fatigue in order to navigate the new stressors that came with the COVID-19 pandemic and those that will come with pandemics in the future. [ABSTRACT FROM AUTHOR]

Improving healthcare requires appropriate community involvement supported by appropriate partner engagement methods. This research aims to develop a complex tool for evaluating the social responsibility of health facilities regarding community involvement and development. We developed areas of a new reference framework for the sustainability of healthcare organizations, which includes the area of community involvement and expansion. It is made up of nine indicators. These were designed using the most representative activities reported by hospitals around the world. Their testing was conducted in an orthopedic emergency hospital. The designed indicators are community engagement actions; the interventions' content adapted to the community; partnership and networking; the involvement of volunteers and training networks; the involvement and participation of professional associations; community-involved local opinion leaders; satisfaction with partnerships; initiatives together with the community; and educational visits. The testing and validation of health practices of the indicators highlighted their adequacy with the proposed purpose of the research and the promotion of sustainable development. We have also verified their compatibility with the requirements of national hospital accreditation legislation and the European framework for quality assurance in hospitals. [ABSTRACT FROM AUTHOR]

Background: The 24-h rooming-in policy is crucial to the Baby-Friendly Hospital Initiative (BFHI) for promoting breastfeeding. However, this policy may restrict maternal autonomy. In 2018, to integrate women's preferences into care decisions, Taiwan's Baby-Friendly certification included prenatal shared decision-making (SDM) for rooming-in. Prior to 2018, maternal knowledge, considerations, and intentions regarding rooming-in and the impact of prenatal SDM were unknown. Methods: A retrospective electronic medical record cohort study was conducted in southern Taiwan. Data on healthy postpartum women eligible for rooming-in and breastfeeding for the years 2017 and 2019, reflecting the periods before and after prenatal SDM was introduced, were gathered. Maternal and newborn characteristics, maternal knowledge, considerations, and prenatal intentions for postpartum rooming-in and breastfeeding during hospitalization were collected. Additionally, data on actual postpartum rooming-in practices during hospitalization and exclusive breastfeeding (EBF) practices from birth to hospital discharge, to 1 month, and to 2 months postpartum were collected. Descriptive and non-parametric statistics were applied to analyze the data. Results: A total of 621 women in 2017 and 311 women in 2019 were included. After prenatal SDM was introduced, the rooming-in rate during hospitalization fell from 42.2% in 2017 to 25.6% in 2019 (p < 0.001), and the EBF rate declined from 45.9% to 35.7% (p = 0.01). Additionally, the 1-month postpartum EBF rate decreased from 46.4% in 2017 (n = 571) to 44.3% in 2019 (n = 264), and the 2-month postpartum EBF rate dropped from 45.5% in 2017 (n = 591) to 40.2% (n = 308). According to the 2019 Patient Decision Aids responses (n = 236), women demonstrated limited understanding of rooming-in, with only 40.7% expressing an intention toward 24-h rooming-in. Women of older maternal age (p < 0.001), with a graduate degree (p = 0.02), full-time employment (p = 0.04), and concerns about rest disruption (p < 0.001), were more likely to prefer non-24-h rooming-in. Conclusions: Initiatives must promote prenatal SDM to enable healthcare providers to address misconceptions and tailor education, thereby increasing women's intention toward 24-h rooming-in and EBF. Future research should explore women's experiences and unmet needs at BFHI facilities to inform the construction of a baby- and mother-friendly environment. [ABSTRACT FROM AUTHOR]

The article focuses on evaluating the effectiveness of a program aimed at preventing Sudden Unexpected Postnatal Collapse (SUPC) through Proper Infant Positioning (PIP) training for mothers. Topics include the methodology involving anonymous surveys among postpartum mothers to assess their confidence and skills after receiving PIP training, revealing positive outcomes.

OBJECTIVES: To understand hospitals' approaches to spending reduction in commercial episode-based payment programs and inform incentive design. STUDY DESIGN: Qualitative arm of an explanatory sequential mixed-methods study involving semistructured interviews with hospital leaders participating in a statewide quality improvement collaborative with novel episode-based incentive payments introduced by the state's largest commercial payer. METHODS: We recruited 21 leaders from 8 purposively selected, diverse hospitals with both high and low performance. Video teleconference--based interviews followed a standardized protocol and addressed 4 domains: choice of clinical condition for evaluation, strategies for episode spending reduction, best practices for success in earning incentives, and barriers to achievement. Rapid qualitative analysis with purposeful data reduction was employed to generate a matrix of key themes within the study domains. RESULTS: Strategies were similar between high- and low-performing hospitals. When selecting conditions, some hospitals focused on areas of underperformance, aiming for improvement opportunities, whereas others chose conditions already achieving highest efficiency. Many tried to synergize with other ongoing improvement initiatives and clinical areas with established leaders and champions. Key strategies included data-driven improvement, care standardization, and protocol dissemination. Best practices for success included readmission prevention and postacute care spending containment. CONCLUSIONS: The findings highlighted hospitals' most common strategies and approaches, providing several insights into optimal design of commercial episode-based incentives: They must be lucrative enough to earn attention or consistent with larger federal programs; hospitals need opportunities to succeed through both improved performance and sustained excellence; and programs may incur malalignment between hospitals and credentialed physicians. [ABSTRACT FROM AUTHOR]

Introduction: It is still unclear whether enhanced recovery programs (ERPs) reduce postoperative morbidity after liver surgery. This study investigated the effect on liver surgery outcomes of labeling as a reference center for ERP. Materials and methods: Perioperative data from 75 consecutive patients who underwent hepatectomy in our institution after implementation and labeling of our ERP were retrospectively compared to 75 patients managed before ERP. Length of hospital stay, postoperative complications, and adherence to protocol were examined. Results: Patient demographics, comorbidities, and intraoperative data were similar in the two groups. Our ERP resulted in shorter length of stay (3 days [1–6] vs. 4 days [2–7.5], p = 0.03) and fewer postoperative complications (24% vs. 45.3%, p = 0.0067). This reduction in postoperative morbidity can be attributed exclusively to a lower rate of minor complications (Clavien-dindo grade < IIIa), and in particular to a lower rate of postoperative ileus, after labeling. (5.3% vs. 25.3%, p = 0.0019). Other medical and surgical complications were not significantly reduced. Adherence to protocol improved after labeling (17 [16–18] vs. 14 [13–16] items, p < 0.001). Conclusions: The application of a labeled enhanced recovery program for liver surgery was associated with a significant shortening of hospital stay and a halving of postoperative morbidity, mainly ileus. [ABSTRACT FROM AUTHOR]

The article discusses a 2024 study of the enhanced recovery after surgery (ERAS) approach to improve patients' surgical pathways via multimodal interventions. Topics covered include nurse managers' contribution to ERAS implementation, and results which show the themes of resource, innovation and change management, interprofessional collaboration, developing professional practice, and proximity team management. Also noted are the challenges of unclear roles and practice scope among stakeholders.

Federal and state governments mandate some health care organizations to implement antibiotic stewardship programs (ASPs). Some early adopters developed model ASPs that have helped set industry standards; other benchmarks will likely be forged in subsequent regulation, legislation, and jurisprudence. This article considers how ASP designs can affect professional autonomy, especially of frontline antibiotic stewards who are usually physicians and pharmacists. This article also considers how ASP development and implementation might influence standards of care and malpractice liability. [ABSTRACT FROM AUTHOR]

Background: Intubated preterm infants 326/7 weeks or less of gestation in a mid-Atlantic level IV neonatal intensive care unit (NICU) faced a high number of ventilator days. Based on 6 weeks of electronic health record (EHR) chart audits of extubations in this NICU in 2021, 44% of preterm infants 326/7 weeks or less of gestation were intubated for more than 28 days, with an average of 23 days on a ventilator. This NICU lacked a standardized extubation guideline providing criteria to drive extubation eligibility. Purpose: The purpose of this quality improvement (QI) project was to implement and evaluate the effectiveness of an extubation readiness guideline in preterm infants 326/7 weeks or less of gestation in a mid-Atlantic level IV NICU. Methods: This project occurred over a 17-week period in 2021. Implementation included a multidisciplinary committee formation, identification of champions, NICU staff education, completion of a guideline checklist by bedside nursing (for eligible patients), clinician reminders, and chart audits for collection of pre-/postimplementation data. Staff education completion, guideline use and compliance, demographic patient data, ventilator days, time to first extubation, and need for reintubation were tracked. Results: Postimplementation data indicated decreased need for intubation for more than 28 days, ventilator days, and days to first extubation attempt. Implications for Practice and Research: Results suggested that implementation of the evidence-based guideline was effective in decreasing average total ventilator days for preterm infants 326/7 weeks or less of gestation. [ABSTRACT FROM AUTHOR]

Copyright of Ergoscience is the property of Schulz-Kirchner Verlag Gmbh and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Healthcare-associated infections (HAIs) contribute to extended hospital stays and heightened in-hospital mortality rates. Effective infection prevention and control (IPAC) strategies are crucial for curtailing infection rates. The COVID-19 pandemic amplified disease burdens, compelling rigorous preventative measures. Mackenzie Health introduced the IPAC Safety Coaches Program to bolster adherence to IPAC guidelines and mitigate HAIs. Methods: IPAC Safety Coach training transpired over three iterative cohorts of educational sessions. Each session comprised a review of new learning material, discussion of key topics, and mandatory action items. Primary outcomes focused on hand hygiene and proper donning/doffing of personal protective equipment (PPE). Secondary outcomes focused on Clostridioides difficile (C. difficile) and central line associated bloodstream infection (CLABSI) rates. Data were collected using a standardized audit reporting form. Results: Across three training cohorts, improvements were noted in key compliance metrics: hand hygiene compliance improved by 9%, approaching statistical significance. Significant improvements were observed in PPE donning (19%), and PPE doffing (17%) compliance. Secondary outcomes demonstrated substantial reductions in C. difficile (55%) and CLABSI (57%) rates across the three cohorts. Conclusion: The novel IPAC Safety Coach Program led to improvements in hand hygiene, PPE donning and doffing compliance, and contributed to reduced C. difficile and CLABSI infection rates. [ABSTRACT FROM AUTHOR]

This research analyzes the police departments' unconventional approach to fighting heroin by offering treatment instead. Police departments implement a program, the Safe Passages, that allows an individual addicted to heroin to enter the police department without fear of arrest or questioning. A qualitative research design was used for this study that was centered on new initiatives that have been enacted by leaders in law enforcement in order to combat the heroin epidemic. This study analyzed the Safe Passages program in police departments in Will County: the overall cost of the program, information dissemination to the public, and the impact it has had on communities. Data was collected through in-depth interviews, and also available documentation that illustrated whether or not initiatives, such as the Safe Passages program, have been looked at as successful in certain communities. This qualitative study found three themes that emerged: heroin addiction was a problem in communities, the costs associated with the Safe Passages program, and the challenges, such as lack of recent participation and poor advertising, and effects the Safe Passages program has had on communities where the program was implemented. The Safe Passages program is designed for intervention to assist police departments in combating the root problem of heroin addiction. The majority of respondents felt that Safe Passages program had made a positive impact in their communities, and they would encourage other police departments to utilize this program. [ABSTRACT FROM AUTHOR]

Background: There is inconsistent utilisation of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by healthcare professionals to identify CVD risk factors early and to intervene using current recommendations. To address this issue, the Cardiovascular Assessment Screening Program (CASP) was developed, implemented, and evaluated. This manuscript reports on the second phase of an exploratory sequential mixed methods study that tested the effectiveness of the CASP with nurse practitioners (NPs) and patients in Canada. Methods: A two-armed, non-blinded, cluster randomised controlled trial (cRCT) compared the NP-led implementation of CASP with usual care by NPs in community practice clinics across one Canadian province. The NPs were the cluster variable as their screening practices could be affected by their educational training, resources, or other factors. NPs were eligible for inclusion in the study if they were located in different urban and rural community settings and could conduct follow-up visits with patients. NPs recruited and enrolled the patients from their own practices as participants if they were healthy individuals, aged 40–74 years, with no established CVD or vascular disease. Researchers randomly allocated the NPs (n = 10) to the intervention group (IG) or the control group (CG). Results: Eight (8) NPs and 167 patients participated in the cRCT study. Patient participant-level data were analysed by the originally assigned groups IG (n = 68) and CG (n = 99). Utilising GLM (generalized linear modeling) more IG patients (90%; n = 61) received comprehensive CVD screening compared to the CG patients (2%; n = 2), RR = 30.2, 95% CI [8.76, 103.9], p <.0001, controlling for the effect of NP and BP category. Conclusion: NP implementation of CASP was effective for comprehensive screening compared to usual care and led to identifying previously unknown CVD risk factors, calculated FRS, heart health priorities and personalised goal-setting. Trial registration: ClinicalTrial.gov ID#: NCT03170752, date of registration 2017/05/31. [ABSTRACT FROM AUTHOR]

Background: Diabetes self-management (DSM) helps people with diabetes to become actors in their disease. Deprived populations are particularly affected by diabetes and are less likely to have access to these programmes. DSM implementation in primary care, particularly in a multi-professional primary care practice (MPCP), is a valuable strategy to promote care access for these populations. In Rennes (Western France), a DSM programme was designed by a MPCP in a socio-economically deprived area. The study objective was to compare diabetes control in people who followed or not this DSM programme. Method: The historical cohort of patients who participated in the DSM programme at the MPCP between 2017 and 2019 (n = 69) was compared with patients who did not participate in the programme, matched on sex, age, diabetes type and place of the general practitioner's practice (n = 138). The primary outcome was glycated haemoglobin (HbA1c) change between 12 months before and 12 months after the DSM programme. Secondary outcomes included modifications in diabetes treatment, body mass index, blood pressure, dyslipidaemia, presence of microalbuminuria, and diabetes retinopathy screening participation. Results: HbA1c was significantly improved in the exposed group after the programme (p < 0.01). The analysis did not find any significant between-group difference in socio-demographic data, medical history, comorbidities, and treatment adaptation. Conclusions: These results, consistent with the international literature, promote the development of DSM programmes in primary care settings in deprived areas. The results of this real-life study need to be confirmed on the long-term and in different contexts (rural area, healthcare organisation). [ABSTRACT FROM AUTHOR]