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Rocky Mountain spotted fever (RMSF), a tickbome disease caused by Rickettsia rickettsii, is the leading cause of death from rickettsial infections in the Western Hemisphere (1). The disease can progress [...]

The rapid spread of the COVID-19 virus and the massive influx of patients exceeded the intensive care units capacity limit. Hospitals have engaged community partners to request resources or transfer patients to facilities with available resources. This setting fosters the need for rationing decisions to allocate scarce resources consistently, rather than basing decisions on clinicians' intuition in the heat of the moment. In this paper, we identify the inter-hospital COVID-19 patients' transfer criteria, and we apply a multi-criteria decision-making methodology to classify and rank these criteria in order to determine the transfer priority scores between hospitals. We then develop an optimisation model for patient systematic referral from saturated to recipient hospitals with contingency capacity expansion and a ventilator donation scheme. To deal with the uncertainty related to the number of ill patients requesting beds in hospitals, a two-stage stochastic model is presented and solved using the sample average approximation. A case with real data related to the COVID-19 French context is presented, which allows us to assess the resilience of the hospital network under the proposed solutions. The results show how local and regional coalitions can avert the saturation of the hospital system and reduce the number of rejected patients. [ABSTRACT FROM AUTHOR]

Probiotics have emerged as agents that improve a wide range of conditions and provide essential ingredients for potential health benefits. Probiotics exhibit a diverse array of effects by engaging in [...]

Pain is a major factor expressed by hospital patients and is the main reason they seek medical help. Evidence suggests that children experiencing pain often do not receive optimal pain assessment and relief. This article refers to a literature review discussing tools and management strategies for assessing children's pain. It concludes that implementing an educational program for medical professionals could enhance their awareness of best practices in pain assessment and management guidelines. [ABSTRACT FROM AUTHOR]

ABSTRACT Most domestic and family violence (DFV) research has focused on establishing prevalence and screening rates in public health and community samples. This study sought to address a gap in the literature by evaluating DFV screening and response practices in a private mental healthcare inpatient service and determining if clients of the service had unmet DFV needs. A prospective, convenience sample, mixed methods, cross‐sectional survey of adult inpatient mental health consumers was employed. Sixty‐two participants completed the Royal Melbourne Hospital Patient Family Violence Survey. Quantitative Likert‐type and categorical responses were collated and analysed descriptively (count and percentage). Free‐text responses were analysed using qualitative description within a content analysis framework. Sixty‐five percent of participants had been screened for at least one DFV issue, on at least one occasion, with 35% not being screened, to their recall. Twenty‐three percent reported disclosing DFV concerns, 82% felt very supported by the clinician's response to their disclosure, and 86% were provided with information they found helpful. Unmet needs were identified in 13% of participants, who had wanted to disclose DFV concerns but not feel comfortable to do so. No unscreened respondents disclosed DFV concerns, highlighting the need to uphold best practice guidelines for direct enquiry. Most disclosing clients were positive about the support they received. Indicated areas for improvement were screening rates, active follow‐up, increasing psychology support levels and safety planning. [ABSTRACT FROM AUTHOR]

We investigate the factors that influence the variance in hospital charges and inpatient care for kidney transplant cases in the US. Using the AHRQ's (Agency for Healthcare Research and Quality) HCUP's (Hospital Cost and Utilization Project) NIS (National Inpatient Sample) database, we find that variance in hospital charges and inpatient care is driven by patient demographics and hospital variables. We find that variance in hospital charges and inpatient care is determined by patient-specific factors including age, gender, race, and income, and hospital factors such as size, type, and location. Our results provide a deeper understanding of the non-clinical factors that impact hospital charges and inpatient care for kidney transplant patients. [ABSTRACT FROM AUTHOR]

Purpose: Recent innovations in radiological imaging have enabled the detection of micro-remnant niduses of arteriovenous malformations (AVMs) after gamma knife radiosurgery (GKS), which have not been previously perceptible. Herein, we focus on the difficulty of evaluating micro-remnant AVMs after GKS that are hardly perceptible on conventional examinations and propose integrating follow-up three-dimensional rotational angiography (3D-RA) in the previous gamma plan as a solution. Methods: We retrospectively searched NTT Medical Center Tokyo hospital database for patients with AVMs who underwent both two-dimensional digital subtraction angiography (2D-DSA) and 3D-RA as follow-up for GKS from February 2021 to January 2024. Patients with suspected nidus occlusion on the latest non-contrast-enhanced magnetic resonance angiography (NC-MRA) were included, and contrast-enhanced magnetic resonance angiography (CE-MRA), 2D-DSA, and 3D-RA were evaluated. Results: Twelve patients with 13 AVM sites were defined as having complete nidus occlusion on upfront NC-MRA. On 2D-DSA, seven AVM sites showed the presence of slight remaining AVMs based on the detection of remnant drainage veins, however the nidus was not detected in three cases. Nevertheless, 3D-RA detected micro-remnant niduses in all seven AVM sites, and four patients underwent re-GKS. Nine patients with ten AVM sites also underwent CE-MRA, and six AVM sites were diagnosed with radiation-induced parenchymal injury. Conclusion: Importing the 3D-RA image into the treatment planning has the potential to be more helpful than NC-MRA or CE-MRA to detect micro-remnant AVMs and evaluate the true remnant volume, and may contribute to a more detailed treatment planning, thereby improving the results of GKS retreatment. [ABSTRACT FROM AUTHOR]

Introduction: Recently, a method was developed to predict the motor Functional Independence Measure (FIM) score at discharge in patients with stroke by stratifying the effects of factors such as age and cognitive function and multiplying those by the influence coefficients of these factors. However, an evaluation of the predictive performance of the method is required for clinical application. The present study aimed to evaluate the predictive performance of this prediction method. Methods: Patients with stroke discharged from a rehabilitation ward between April 2021 and September 2022 were included. Predicted values of the motor FIM score at discharge were calculated after data collection from the hospital's patient database. The concordance between predicted and actual values was evaluated using the interclass correlation coefficient; moreover, the residual values were calculated. Results: In total, 207 patients were included in the analysis. The median age was 79 (69-85) years, and 112 (54.1%) patients were male. The interclass correlation coefficient between predicted and actual values was 0.84 (95% confidence interval 0.75-0.89) for the motor FIM score at discharge. Meanwhile, the median residual value was 5.3 (-2.0-10.3) for the motor FIM score at discharge. Discussion: The prediction method was validated with good performance. However, the residual values indicated that some cases deviated from the prediction. In future studies, it will be necessary to improve the predictive performance of the method by clarifying the characteristics of cases that deviate from the prediction. [ABSTRACT FROM AUTHOR]

Background: Midregional‐proAdrenomedullin (MR‐proADM) has been recently proposed as a tool in patients with sepsis and septic shock. Our aim was to evaluate the prognostic role of MR‐proADM in hospitalized patients with sepsis and septic shock. Methods: PRISMA guideline was followed. MEDLINE and EMBASE were searched up to June 2023. Primary outcome was mean difference in MR‐proADM among survivors and nonsurvivors, secondary outcome mean difference in MR‐proADM according to infection severity and type. Risk of bias was evaluated using Newcastle–Ottawa scale for observational studies and Cochrane tool for randomized trials. Pooled mean differences (MD) with corresponding 95% confidence intervals (CIs) were calculated in a random‐effects model. Results: Twenty‐four studies included 6730 adult patients (1208 nonsurvivors and 5522 survivors) and three studies included 195 paediatric patients (30 nonsurvivors and 165 survivors). A total of 10, 4 and 13 studies included, respectively, patients with sepsis (3602 patients), septic shock (386 patients) and a mixed population (2937 patients). Twenty‐one studies included patients with different source of infection, three with pneumonia and one with a catheter‐related infection. Most studies (n = 12) had a follow‐up of 28 days. In adult cohort, pooled mean difference between nonsurvivors and survivors of MR‐proADM was 2.55 mmol/L (95% CI: 1.95–3.15) with higher values in patients with septic shock (4.25 mmol/L; 95% CI, 2.23–6.26 mmol/L) than in patients with sepsis (1.77 mmol/L; 95% CI: 1.11–2.44 mmol/L). In paediatric cohort, pooled mean difference was 3.11 mmol/L (95% CI: −0.02‐6.24 mmol/L). Conclusions: Higher values of MR‐proADM are detectable in nonsurvivors adult and paediatric‐hospitalized patients with sepsis or septic shock. [ABSTRACT FROM AUTHOR]

BackgroundObjectiveMethodResultsConclusionNigeria remains one of the countries with a high hepatitis B virus (HBV) burden in Africa. Reports have indicated the presence of mixed HBV genotypes in Nigeria; however, there is still paucity of data regarding mixed genotype infections particularly in the Southern part of the country.Our aim is to determine the HBV genotype distribution among HBsAg-positive gastroenterology patients at the University College Hospital Ibadan, Nigeria.Serum samples were screened for HBsAg by ELISA, and positive samples were genotyped by semi-nested multiplex PCR for HBV genotypes A, B, C, D, E and F.Data generated were analyzed in R-studio. A total of 81/90 (90%) of HBsAg-positive samples were successfully genotyped, and genotype A was most prevalent with 15.7%, while genotypes B and E were the least with 1.2% each. Genotypes A/C infection was the highest among mixed infections with 40% prevalence, while genotypes A/D were the least prevalent mixed infection with 4.8%.We advocate for a comprehensive genotype analysis in larger cohorts across Nigeria, to give a more comprehensive understanding of the distribution and prevalence of different HBV genotypes population wide. [ABSTRACT FROM AUTHOR]

Background: Few studies have evaluated the use of laparoscopic staplers in robotic procedures (bedside stapling, BS). This study aims to evaluate the effectiveness of BS compared with robotic staplers (RS) in bariatric robotic procedures. Methods: Patients who underwent robotic sleeve gastrectomy or gastric bypass elective procedures between 1/1/2021 and 12/31/2021 were extracted from PINC AI™ Healthcare Data. The following clinical outcomes were compared: blood transfusion, bleeding, anastomotic leak, intensive care unit (ICU) visit, and 30-day readmission, operating room (OR) time, inpatient costs, and length of stay. We evaluated baseline balance in BS and RS and bivariate association between covariates and outcomes using Chi-square or Fisher exact test and t-test or ANOVA. Multivariable general linear mixed models (GLMMs) with respective gamma or binomial distribution and log-link function were used to obtain adjusted outcomes variations between BS and RS. Results: Total of 7268 discharges were included with 1603 (22.1%) BS and 5665 (77.9%) RS cases. RS cases consisted of a higher number of patients who were Hispanic (17.0% vs. 9.4%), had Medicaid (26.9% vs. 19.4%) and underwent sleeve gastrectomy (68.4% vs. 53.5%). Higher proportions of RS cases were done by providers in Northeast region (35.5% vs. 24.3%), smaller size (< 500 beds; 71.1% vs. 52.3%), and teaching hospitals (59.4% vs. 39%). The adjusted outcomes variations demonstrated that patients that had RS were significantly more likely to have blood transfusions, ICU stays, increased ORT (19 min) and costs ($1273). Sensitivity analysis showed similar results, except no significant differences in blood transfusion rates in both groups. Conclusions: Bedside staplers significantly reduce healthcare resource utilization with equivalent effectiveness and fewer ICU stays compared to robotic staplers. [ABSTRACT FROM AUTHOR]

Objectives: To investigate temporal changes in the association between SARS‐CoV2 viral load (VL) and markers of inflammation during hospitalization, as well as the ability of these markers alone or in combination to predict severe outcomes. Methods: Serial oropharyngeal and blood samples were obtained from hospitalized COVID‐19 patients (n = 160). Levels of inflammatory markers and oropharyngeal VL were measured during hospitalization (admission, days 3–5, and days 7–10) and related to severe outcomes (respiratory failure/intensive care unit admission). Results: Elevated admission levels of IL (interleukin)‐6, IL‐33, IL‐8, monocyte chemoattractant protein‐1 (MCP‐1), interferon‐γ‐induced protein 10 (IP‐10), IL‐1β, and IL‐1Ra were associated with severe outcomes during hospitalization. Although no inflammatory markers correlated with VL at baseline, there was a significant correlation between VL and levels of IP‐10 and MCP‐1 at days 3–5, accompanied by IL‐8 and IL‐6 at days 7–10. Finally, there was a seemingly additive effect of IP‐10, MCP‐1, and IL‐6 in predicting severe outcomes when combined with high VL at baseline. Conclusions: An increasing number of inflammatory markers were associated with VL during the first 10 days of hospitalization, and several of these markers were associated with severe outcomes, in particular when combined with elevated VL. Future studies should assess the potential for combining antiviral and immunomodulatory treatment, preferably guided by viral and inflammatory biomarkers, for the selection of high‐risk patients. [ABSTRACT FROM AUTHOR]

Background: Physical restraint is used to prevent agitation, to continue treatments and to ensure safety in intensive care patients. Physical restraint has negative effects on physical and psychological health, and physical restraint should not be used unless necessary. Aims: The purpose of this study was to evaluate the development of vascular complications in extremities of physically restrained patients hospitalized in the intensive care unit (ICU) and the associated factors. Study Design: A prospective, observational study. The study was conducted between September 1, 2022, and March 31, 2023 in eight ICUs of a hospital located in the inner regions of Türkiye. The development of vascular complications (discolouration, distemperature, variations in capillary refill time, fluctuations in peripheral pulse, skin ulceration and oedema in the area of physical restraint) rate in patients hospitalized in the ICUs who were physically restrained. Independent sample t test, Mann–Whitney U test and Pearson‐χ2 test were used to analyse the data. Results: During the study, 2409 patients were admitted to ICUs. Physical restraint was applied to 209 of these patients. Of the 209 patients, 112 patients who met the inclusion criteria were included in the study. The physical restraint site of the patients was evaluated an average of 230.12 times and physical restraint was terminated in 9.8% of the patients (n = 112) because of vascular complications that developed in the physical restraint site. The rate of vascular complications at the site of physical restraint was higher in patients with endotracheal tubes (p <.05), lower GCS scores (p <.05) and higher INR values (p <.05). Patients with skin ulceration at the restraint site received more massages and cream applications (%95CL = 1. 1.692–34.734, OR = 7.667, p =.032). It was determined that more massage was applied to patients with changes in skin temperature at the restraint site (%95Cl = 1.062–11.599, OR = 3.510, p =.032). Conclusions: Vascular complications may develop at the restraint site in patients hospitalized in the ICU. This may be more common in ICU patients with endotracheal tube, lower GCS score and higher INR values. Relevance to Clinical Practice: Nurses should closely monitor ICUs patients with endotracheal tube, lower GCS score and higher INR values, and implement care interventions to prevent the development of vascular complications. [ABSTRACT FROM AUTHOR]

Aim: To construct a nursing assessment framework for patients in anaesthesia recovery period. Design: A three‐round modified Delphi method was employed to capture the consensus of 22 panellists. Methods: The initial items in the nursing assessment framework for patients in anaesthesia recovery period were developed based on the mini‐clinical evaluation exercise (mini‐CEX). A panel of 22 experts participated in this study. The panellists have more than 10 years of experience in either clinical anaesthesia, or post‐anesthesia nursing, or operating room nursing, or surgical intensive nursing. Between March and April 2023, the panellists evaluated and recommended revisions to the initial framework. Results: This study resulted in the development of a nursing assessment framework for patients in anaesthesia recovery period. The initial version of the framework consisted of six dimensions with 27 items. Six items were modified after the first round of consultation. After the second round, five modifications and four deletions were made based on expert opinion. The third round resulted in a convergence of expert opinion. The framework, which consists of 24 items across five dimensions, was refined. The five dimensions are as follows: History‐taking, Physical assessment, Clinical judgement, Organizational efficiency and Humanistic concern. Conclusion: The nursing assessment framework for patients in anaesthesia recovery period was reached consensus between the 22 experts' opinions. Implications for the profession and patient care: The assessment framework constructed in this study could be used for the process evaluation of post‐anesthesia nursing. The framework may guide perianesthesia nurses in the timely and effective assessment of patients during this critical phase of care. It may be used for perianesthesia nursing education or to evaluate nurses' assessment skills. Reporting method: The study is reported in accordance with the Guidance on Conducting and Reporting DElphi Studies (CREDES) recommendations. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Introduction: Pathway innovation using smartphone otoscopy and tablet‐based audiometry technologies to deliver ear and hearing services via trained audiologists may improve efficiency of the service. An ENT‐integrated‐community‐ear service (ENTICES—combining community audiology management, remote ENT review and novel technologies) was piloted. We aimed to assess the efficiency and safety of ENTICES. Method: ENTICES was a community‐based and audiologist‐led pathway. Patients with otological symptoms were self‐referred to this service. Smartphone otoscopy and tablet‐based audiograms were performed. Two otologists reviewed all decisions made in the community by audiologists based on video‐otoscopy, hearing tests and chart reviews. Data on the first 50 consecutive new patients attending either consultant‐led hospital otology clinics (HOC), audiologist‐led hospital advanced audiology diagnostics (AAD) or ENTICES clinics were collected between 1 August 2021 and 31 December 2021. Data were collected through chart reviews and questionnaires to compare the three pathways with respect to efficiency, patient satisfaction, technology utility and safety. Results: No audiology‐led ENTICES decisions were amended by hospital otologists following remote review. Remote review of video‐otoscopy with history was sufficient for a diagnosis in 80% of cases. Adding hearing tests and standardised history increased the diagnostic yield to 98%. Patient satisfaction scores showed 100% service recommendation. The cost per patient, per visit, was £83.36, £99.07 and £69.72 for AAD, HOC or ENTICES, respectively. Conclusion: ENTICES provides a safe ear and hearing service that patients rated highly. Thirty‐two per cent of hospital otology patients were eligible for this service. For those patients, ENTICES is 20% more cost‐effective and can reduce the number of clinic visits by up to 60% compared with HOC. [ABSTRACT FROM AUTHOR]

Introduction: Anorexia nervosa (AN) is characterised by limited remission rates and emotional dimensions are often neglected. Cognitive remediation and emotional skills training (CREST) protocol aims to address cognitive and emotional factors. This study evaluates the feasibility and effectiveness of a modified rolling‐group CREST protocol in an inpatient setting. Methods: Quasi‐experimental design evaluated CREST protocol in a rehabilitation programme. A total of 116 females diagnosed with AN were included, of whom 63 were included in the CREST protocol and 53 in the standard rehabilitation treatment. Various standardized measures were employed to assess psychopathology. Data collection occurred longitudinally, before and after CREST implementation. Results: No significant differences emerged between groups regarding changes in specific eating psychopathology. CREST group exhibited significant improvements in emotion regulation (p = 0.002) and social skills (p = 0.014), besides a reduction in alexithymia (p < 0.001) and cognitive rigidity (p = 0.013). Empathic features remained stable. Participants reported positive perceptions of the CREST intervention. Discussion: The study highlights the potential benefits of integrating emotional training within multidisciplinary intensive treatment for AN. Results emphasise the importance of treatment protocol with more affective and hot‐cognition‐related interventions, beyond weight‐related psychopathology. Implementing a rolling‐group CREST protocol in an inpatient setting showed promise in enhancing the emotional abilities of AN patients. Highlights: The Cognitive remediation and emotional skills training (CREST) group exhibited exceptional adherence, with no dropouts observed, indicating strong engagement and acceptability of the programme among participants.Participants in the CREST group experienced significant reductions in Difficulties in Emotion Regulation Scale (DERS) scores, suggesting enhanced emotional regulation skills compared to the treatment as usual ,TAU group.The CREST intervention led to a notable decrease in alexithymia scores, indicating improved emotional awareness and expression among participants. [ABSTRACT FROM AUTHOR]

Purpose: This study investigates the motivations for orthognathic surgery and assesses the quality of life (QoL) and satisfaction among patients treated at a hospital over 12 months. Methods: We employed an Arabic version of the Orthognathic Quality of Life Questionnaire (OQLQ), used pre-surgery and at 2 weeks, 3 months, and 6 months post-surgery. This included demographic data, the OQLQ, and visual analogue scales (VAS). The OQLQ, originally by Cunningham et al., was translated and adapted by Al-Asfour et al. Additional validated questions were added to both pre- and post-operative surveys. Results: Of 136 participants (51 males, 85 females, average age 25.1), most underwent surgery for facial aesthetics (85.2%) and bite correction (57.3%). Treatments included various osteotomies. OQLQ scores significantly dropped from 63.3% pre-surgery to 23% at 6 months, showing QoL improvement. 97.8% reported better psychological status post-surgery (p = 0.0001), with 94.1% satisfaction at 6 months (p = 0.0001). Conclusion: The orthognathic surgery yielded positive outcomes in functional and psychological aspects, leading to high satisfaction and improved QoL in patients with dentofacial deformity. [ABSTRACT FROM AUTHOR]

Background: Medical text, as part of an electronic health record, is an essential information source in healthcare. Although natural language processing (NLP) techniques for medical text are developing fast, successful transfer into clinical practice has been rare. Especially the hospital domain offers great potential while facing several challenges including many documents per patient, multiple departments and complex interrelated processes. Methods: In this work, we survey relevant literature to identify and classify approaches which exploit NLP in the clinical context. Our contribution involves a systematic mapping of related research onto a prototypical patient journey in the hospital, along which medical documents are created, processed and consumed by hospital staff and patients themselves. Specifically, we reviewed which dataset types, dataset languages, model architectures and tasks are researched in current clinical NLP research. Additionally, we extract and analyze major obstacles during development and implementation. We discuss options to address them and argue for a focus on bias mitigation and model explainability. Results: While a patient's hospital journey produces a significant amount of structured and unstructured documents, certain steps and documents receive more research attention than others. Diagnosis, Admission and Discharge are clinical patient steps that are researched often across the surveyed paper. In contrast, our findings reveal significant under-researched areas such as Treatment, Billing, After Care, and Smart Home. Leveraging NLP in these stages can greatly enhance clinical decision-making and patient outcomes. Additionally, clinical NLP models are mostly based on radiology reports, discharge letters and admission notes, even though we have shown that many other documents are produced throughout the patient journey. There is a significant opportunity in analyzing a wider range of medical documents produced throughout the patient journey to improve the applicability and impact of NLP in healthcare. Conclusions: Our findings suggest that there is a significant opportunity to leverage NLP approaches to advance clinical decision-making systems, as there remains a considerable understudied potential for the analysis of patient journey data. [ABSTRACT FROM AUTHOR]

Can Electronic Health Records (EHR) predict opioid misuse in general patient populations? This research trained three backpropagation neural networks to explore EHR predictors using existing patient data. Model 1 used patient diagnosis codes and was 75.5% accurate. Model 2 used patient prescriptions and was 64.9% accurate. Model 3 used both patient diagnosis codes and patient prescriptions and was 74.5% accurate. This suggests patient diagnosis codes are best able to predict opioid misuse. Opioid misusers have higher rates of drug abuse/mental health disorders than the general population, which could explain the performance of diagnosis predictors. In additional testing, Model 1 misclassified only 1.9% of negative cases (non-abusers), demonstrating a low type II error rate. This suggests further clinical implementation is viable. We hope to motivate future research to explore additional methods for universal opioid misuse screening. [ABSTRACT FROM AUTHOR]

Background: Accurate assessment of relative intravascular volume is one of the cornerstones for the proper management of hospitalized patients requiring hemodialysis. Currently, the use of dynamic parameters such as bedside ultrasonography is recommended to support the assessment of the intravascular volume profile. This study aimed to prospectively evaluate findings of sonographic assessment of intravascular volume estimate (SAFE-A) protocol among hemodialysis inpatients with end-stage renal disease, before and after the hemodialysis sessions, and correlate these findings with the net ultrafiltrate (UFNET). Results: A positive correlation was found between the negative variation of 1 point in the score of the SAFE-A protocol with the withdrawal of 426.73 mL of net ultrafiltrate. Conclusions: There was a strong correlation between the score of the SAFE-A protocol and the net ultrafiltrate. Therefore, this study concludes that the application of the SAFE-A protocol in dialysis patients demonstrates a correlation between the suggested score and volume status, consistent with findings from the original study conducted in a distinct population. [ABSTRACT FROM AUTHOR]

Background: Stroke is rapidly developing clinical signs of focal/ global disturbance of cerebral function, with symptoms lasting more than 24 h and leading to death. Data showed that stroke deaths in Ethiopia reached nearly seven percent of total deaths. Despite this report, there is a paucity of investigations about the problem. Objective: To determine in-hospital mortality and its associated factors among hospitalized stroke patients in Hiwot Fana Comprehensive Specialized University Hospital and Jugal General Hospital, eastern Ethiopia from September 2016–August 2022 G.C. Methods: A retrospective cohort study was conducted among hospitalized stroke patients. A sample size of 395 medical records was selected from a total of 564 stroke patients by a simple random sampling technique. The data was analyzed by SPSS version 26 using bivariable and multivariable cox-regression models. A p-value of 0.05 and less at a 95% confidence interval was used to establish a statistically significant association. Results: Of the total, 109 (27.6%) died in the hospital while 57.2% and 15.2% of them were discharged with improvement and against medical advice, respectively. Age greater than 65 (AHR = 4.71, 95% CI = 1.11–19.96), creatinine level > 1.2 mg/dl (AHR = 1.54, 95% CI = 1.0-2.39), and co-morbidity with atrial fibrillation (AHR = 1.48, 95% CI = 1.0-2.21) were significantly associated with in-hospital mortality. Conclusion: In-hospital mortality was found in more than a quarter of stroke patients. Mortality was more likely increased among the patients with age > 65, serum creatinine level > 1.2 mg/dl, and atrial fibrillation. Hence, these high-risk patients need to be monitored. [ABSTRACT FROM AUTHOR]

Anemia is a common but often underdiagnosed and undertreated geriatric syndrome in hospitalized older patients. In this retrospective multicenter study, we aimed at characterizing the prevalence, risk factors, diagnostic and treatment approach to anemia in older patients admitted to acute care hospitals, focusing on differences between nephrology and geriatrics units. Prevalence and risk factors for anemia, diagnostic inertia (lack of iron, vitamin B12, and folate status assessment), replacement inertia (omitted treatment with iron, vitamin B12 or folic acid), and erythropoiesis-stimulating agents (ESA) inertia were explored. 1963 patients aged 82.7 (6.8) years were included in the study; 66.7% of the study population had anemia; among anemic patients, diagnostic inertia and replacement inertia were common with rates of 22–31% and 50–87%, respectively; omitted treatment with ESA affected 67.2% of patients and was more prevalent in geriatric units. In most cases, patients with ESA inertia were not routinely screened for iron tests. COPD, cancer, eGFR 45–60 ml/min were associated with increased tendency to ESA inertia. In conclusion, anemia had a high prevalence in older patients discharged from acute care units, but it is often underdiagnosed and undertreated. [ABSTRACT FROM AUTHOR]

Background: The growing geriatric population has specific medical characteristics that should be taken into account especially in trauma setting. There is little evidence on management of abdominal trauma in the elderly and this article compares the management and outcomes of younger and older patients in order to highlight fields of improvement. Method: We conducted a retrospective database analysis from two European university hospitals selecting patients admitted for abdominal injury and extracted the following data: epidemiological data, mechanisms of the trauma, vital signs, blood tests, injuries, applied treatments, trauma scores and outcomes. We compared to different age group (16–64 and 65+ years old) using uni- and multivariable analysis. Results: 1181 patients were included for statistical analysis. The main mechanisms of injury in both group were traffic accidents and in the elderly group, falls were more frequent. Both had similar Abbreviated Injury Score except for the thoracic injuries, which was higher in the elderly group. We reported a death rate of 13% in the elderly group and 7% in the younger group. However, multivariable analysis did not report age as an independent predictor of mortality. The management including surgery, blood transfusion and need for intensive care were similar in both groups. Conclusion: Although elderly patients suffering abdominal trauma have an almost two fold higher mortality, their management is quite similar leading to an important point of improvement in regards to triage and lower threshold for more aggressive management and surveillance. Age itself does not seem to be a reliable predictor of mortality. Introducing a frailty score when taking care of elderly trauma patients could improve the outcomes. [ABSTRACT FROM AUTHOR]

Background: There is a growing demand for colonoscopy, worldwide, resulting in increased rate of inappropriate referrals. This "overuse" of colonoscopies has become a major burden for health care. Objectives: to assess the appropriateness of colonoscopies performed at the endoscopy unit of the university hospital of Sousse and to compare these results of appropriateness according to the European Panel of Appropriateness of Gastrointestinal Endoscopy (EPAGE) I and EPAGE II criteria. Patients and methods: this cross-sectional study included all consecutive patients referred for a diagnostic colonoscopy, between January 2017 and December 2018. Patients referred for exclusively therapeutic indications, those with incomplete colonoscopies were not included. Patients with poor bowel preparation or missing data were also excluded. Indications were assessed using the EPAGE I and EPAGE II criteria. Results: From 1972 consecutive patients, 1307 were included. Overall, 986 (75.4%) of all referrals were for out-patients. The majority of patients were referred by gastroenterologists (n = 1026 patients; 78.5%), followed by general surgeons (n = 85; 6.5%). The commonest indications were lower abdominal symptoms (275; 21%) followed by uncomplicated diarrhea (152; 11.6%). Relevant findings were present in 363 patients (27.7%). Neoplastic lesions were the dominant finding in 221 patients (16.9%). EPAGE I and EPAGE II criteria were applicable for 1237 (88.8%) and 1276 (97.7%) patients respectively. Hematochezia and abdominal pain recorded the highest inappropriate rates with both sets of criteria. Appropriate colonoscopies increased to 76.4% when EPAGE II criteria were applied; whereas uncertain and inappropriate procedures decreased to 10.3% and 10.9% respectively Appropriateness of indication was significantly higher in hospitalized patients. For the EPAGE II criteria, the specialty of the referring physician was also significantly associated to the appropriate use. The agreement between EPAGE I and EPAGE II criteria was slight using the weighted version of k (k = 0.153). Conclusions: The updated and improved EPAGE II guidelines are a simple and valid tool for assessing the appropriateness of colonoscopies. They decreased the inappropriate rate and the possibility of missing potentially severe diagnoses. [ABSTRACT FROM AUTHOR]

Background: Clonorchiasis has significant socioeconomic importance in endemic areas; however, studies investigating the disease burden in specific sub-regions are lacking. This study aims to address the gap by quantifying the current disease burden caused by clonorchiasis in Guangdong province and assessing its distribution characteristics. Methods: Comprehensive measures, including prevalence rates, disability-adjusted life years (DALYs), and direct medical costs, were used to assess the disease burden of clonorchiasis. To estimate the prevalence rate, the number of infections was divided by the examined population, based on the annual surveillance data on clonorchiasis cases during 2016–2021. The calculation of DALYs was based on the epidemiological parameters according to the definition issued by the World Health Organization. Cost data of clonorchiasis were utilized to quantify the direct medical costs. The distribution characteristics of disease burden were assessed through comparisons of groups of population defined by geographic area, time, and characteristics of people. Results: In 2021, clonorchiasis posed a significant disease burden in Guangdong Province. The prevalence rate was found to be 4.25% [95% CI (4.02%, 4.49%)], with an associated burden of DALYs of 406,802.29 [95% CI (329,275.33, 49,215,163.78)] person-years. The per-case direct medical costs of patients with clonorchiasis were estimated to be CNY 7907.2 (SD = 5154.4). Notably, while the prevalence rate and DALYs showed a steady decrease from 2016 to 2020, there was a rising trend in 2021. Spatial clustering of clonorchiasis cases and DALYs was also observed, particularly along the Pearl River and Han River. This suggests a concentration of the disease in these regions. Furthermore, significant differences in prevalence rates were found among various demographic groups, including sex, age, occupation, and education level. Additionally, patients with longer hospital stays were more likely to incur higher direct medical costs. Conclusions: The burden of clonorchiasis in Guangdong Province remains high, despite significant progress achieved through the implementation of the prevention and control programs. It is suggested that measures should be taken based on the distribution characteristics to maximize the effectiveness of prevention and control, with a primary focus on key populations and areas. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Pro‐resolving molecules may curb disease caused by viruses without altering the capacity of the host to deal with infection. AP1189 is a melanocortin receptor‐biased agonist endowed with pro‐resolving and anti‐inflammatory activity. We evaluated the preclinical and early clinical effects of treatment with AP1189 in the context of COVID‐19.C57BL/6j mice were infected intranasally with MHV‐A59 or hK18‐ACE2 mice with SARS‐CoV‐2. AP1189 (10 mg·kg−1, BID, s.c.) was given to the animals from day 2 and parameters evaluated at day 5. Human PBMCs from health donors were infected with SARS‐CoV‐2 in presence or absence of AP1189 and production of cytokines quantified. In the clinical study, 6 patients were initially given AP1189 (100 mg daily for 14 days) and this was followed by a randomized (2:1), placebo‐controlled, double‐blind trial that enrolled 54 hospitalized COVID‐19 patients needing oxygen support. The primary outcome was the time in days until respiratory recovery, defined as a SpO2 ≥ 93% in ambient air.Treatment with AP1189 attenuated pulmonary inflammation in mice infected with MHV‐A59 or SARS‐CoV‐2 and decreased the release of CXCL10, TNF‐α and IL‐1β by human PBMCs. Hospitalized COVID‐19 patients already taking glucocorticoids took a median time of 6 days until respiratory recovery when given placebo versus 4 days when taking AP1189 (P = 0.017).Treatment with AP1189 was associated with less disease caused by beta‐coronavirus infection both in mice and in humans. This is the first demonstration of the effects of a pro‐resolving molecule in the context of severe infection in humans. [ABSTRACT FROM AUTHOR]

Objective: Frailty and hypoproteinaemia are common in older individuals. Although there is evidence of a correlation between frailty and hypoproteinaemia, the relationship between frailty and hypoproteinaemia in hospitalized/critically ill and older community residents has not been clarified. Therefore, the aim of our meta-analysis was to evaluate the associations between frailty and hypoproteinaemia in different types of patients. Methods: A systematic retrieval of articles published in the PubMed, Embase, Medline, Web of Science, Cochrane, Wanfang, and CNKI databases from their establishment to April 2024 was performed to search for studies on the associations between severity of frailty or prefrailty and hypoproteinaemia in older adults. The Newcastle‒Ottawa Scale and the Agency for Healthcare Research and Quality Scale were used to assess study quality. Results: Twenty-two studies were included including 90,351 frail older people were included. Meta-analysis revealed an association between frailty or prefrailty and hypoproteinaemia (OR = 2.37, 95% CI: 1.47, 3.83; OR = 1.62, 95% CI: 1.23, 2.15), there was no significant difference in the risk of hypoproteinaemia between patients with severe frailty and those with low or moderate frailty (OR = 0.62, 95% CI:0.44, 0.87). The effect of frailty on the occurrence of hypoproteinaemia was more obvious in hospitalized patients/critically ill patients than in surgical patients (OR = 3.75, 95% CI: 2.36, 5.96), followed by older community residents (OR = 2.30, 95% CI: 1.18, 4.49). Conclusion: Frailty is associated with hypoproteinaemia in surgical patients, hospitalized older patients and older community residents. Future studies should focus on the benefits of albumin supplementation in preventing or alleviating frailty and related outcomes in the future. [ABSTRACT FROM AUTHOR]

Objective: Serum lipoprotein(a) [Lp(a)] is a risk factor of cardiovascular diseases. However, the relationship between the serum Lp(a) and clinical outcomes has been seldom studied in Chinese hospitalized patients with cardiovascular diseases. Methods: We retrospectively collected the clinical data of hospitalized patients with cardiovascular diseases in the Cardiovascular Department of Dongguan People's Hospital from 2016 to 2021 through the electronic case system. Patients were divided into 4 groups based on Lp(a) quartiles: Quartile1 (≤ 80.00 mg/L), Quartile 2 (80.01 ~ 160.90 mg/L), Quartile 3 (160.91 ~ 336.41 mg/L), Quartile 4 (> 336.41 mg/L). Cox proportional hazard regression models were constructed to examine the relationship between Lp(a) and cardiovascular events. Results: A total of 8382 patients were included in this study. After an average follow-up of 619 (320 to 1061) days, 1361 (16.2%) patients developed major adverse cardiovascular events, and 125 (1.5%) all-cause death were collected. The incidence of MACEs was 7.65, 8.24, 9.73 and 10.75 per 100 person-years in each Lp(a) quartile, respectively; the all-cause mortality was 0.48, 0.69, 0.64 and 1.18 per 100 person-years in each Lp(a) quartile, respectively. The multivariate Cox regression analysis suggested that high Lp(a) level was an independent risk factor for MACEs (HR: 1.189, [95% CI: 1.045 to 1.353], P = 0.030) and all-cause death (HR: 1.573, [95% CI: 1.009 to 2.452], P = 0.046). Conclusion: In addition to traditional lipid indicators, higher Lp(a) exhibited higher risks of adverse cardiovascular events and death, indicated worse prognosis. Lp(a) may be a new target for the prevention of atherosclerotic diseases. [ABSTRACT FROM AUTHOR]

Background: Individuals with substance use disorders (SUDs) are hospitalized in growing numbers. Stigma is pervasive among their hospital providers, and SUD management during medical admissions is often inadequate. However, little is known about how these patients perceive their care quality. In particular, few studies have explored their positive care perceptions or recommendations for improvement. Objective: To explore perspectives on positive aspects, negative aspects, and consequences of care, as well as recommendations for improvement among hospitalized patients with SUDs. Design and participants: We conducted semi-structured, in-depth bedside interviews (n = 15) with patients who have been diagnosed with a SUD and were admitted to medical or surgical floors of an urban academic medical center. Approach: Interviews explored patients' hospital experiences and recommendations for improvement. The interviews were audio-recorded, transcribed verbatim, and imported into NVivo software. Two reviewers independently coded the transcripts using interpretative phenomenological analysis and inductive thematic analysis according to grounded theory, and recurring themes were identified from the data. Patients' demographic and clinical data were analyzed with descriptive statistics. Key Results: Perceived clinical and emotional proficiency were the most important components of positive experiences, whereas perceived bias and stigmatized attitudes, clinical improficiency, and inhumane treatment were characteristic of negative experiences. Such care components were most consequential for patients' emotional well-being, trust, and care quality. Recommendations for improving care included specific suggestions for initiating and promoting continued recovery, educating, and partnering in compassionate care. Conclusions: Hospitalized patients with SUDs often experience lower quality and less compassionate care linked to pervasive stigma and poor outcomes. Our study highlights under-recognized perspectives from this patient population, including socioemotional consequences of care and recommendations grounded in lived experiences. By striving to advance our care in accordance with patients' viewpoints, we can turn hospitalizations into opportunities for engagement and promoting recovery. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Patient or Public Contribution Implications for Clinical practice Developing a severity assessment scale for critically ill patients' thirst and conducting reliability and validity tests, aiming to provide healthcare professionals with a scientific and objective tool for assessing the level of thirst.Based on literature review and qualitative interviews, a pool of items was generated, and a preliminary scale was formed through two rounds of Delphi expert consultation. Convenience sampling was employed to select 178 ICU patients in a top‐three hospital from May 2023 to October 2023 as the study subjects to examine the reliability and validity of the severity assessment scale for critically ill patients' thirst.The developed severity assessment scale for critically ill patients' thirst consists of 8 evaluation items and 26 evaluation indicators. The agreement coefficients for two rounds of expert consultation were 100% and 92.6% for the positive coefficient, and the authority coefficients were .900 and .906. Kendall's concordance coefficients were .101 and .120 (all p < .001). The overall Cronbach's α coefficient for the scale was .827. The inter‐rater reliability coefficient was .910. The Item‐Content Validity Index (I‐CVI) ranged from .800 to 1.000, and the Scale‐Content Validity Index/Average (S‐CVI/Ave) was .950.The critically ill patients' thirst assessment scale is reliable and valid and can be widely used in clinical practice.The AiMi Academic Services (www.aimieditor.com) for English language editing and review services.The scale developed in this study is a simple and ICU‐specific scale that can be used to assess the severity of thirst in critically ill patients. As such, the severity of thirst in critically ill patients can be evaluated quickly so that targeted interventions can be implemented according to the patient's specific disease and treatment conditions. Therefore, patient comfort can be improved, and thirst‐related health problems can be prevented. [ABSTRACT FROM AUTHOR]

Background: The Safewards model aims to reduce conflict and use of containment on psychiatric wards. To evaluate the implementation of Safewards and understand why it is effective in some settings but not in others, it is important to assess the level of implementation fidelity. To do this, the Safewards Fidelity Checklist (SFC) is often used, which focuses on objective visual observations of interventions but does not include patient responsiveness. The latter is a key indicator of implementation fidelity and includes engagement, relevance, acceptability and usefulness. The aim of the present study was to investigate the fidelity of Safewards implementation on an acute psychiatric ward from the perspective of patient responsiveness. Method: The study was conducted on a ward for patients with mainly affective disorders. To assess the general level of fidelity the SFC was used together with a detailed ward walkthrough. Ten patients were interviewed with a focus on patient responsiveness to each of the seven interventions implemented on the ward. Data were analysed using qualitative descriptive analysis. Results: The findings indicate high implementation fidelity, which was reflected in the SFC assessment, walkthrough and patient responsiveness. Patients gave examples of improvements that had happened over time or of the ward being better than other wards. They felt respected, less alone, hopeful and safe. They also described supporting fellow patients and taking responsibility for the ward climate. However, some patients were unfamiliar with a ward where so much communication was expected. Several suggestions were made about improving Safewards. Conclusions: This study confirms previous research that patient responsiveness is an important factor for achieving fidelity in a prevention programme. The patients' descriptions of the acceptability, relevance and usefulness of the specific interventions reflected to a high degree the objective visual observations made by means of the SFC and ward walkthrough. Patient engagement was demonstrated by several suggestions about how to adapt the interventions. There is potential to obtain valuable input from patients when adapting Safewards in practice. This study also presents many examples of practical work with these interventions and the effects it can have on patients' experiences of care. [ABSTRACT FROM AUTHOR]

Background: The association between rurality of patients' residence and hospital experience is incompletely described. The objective of the study was to compare hospital experience by rurality of patients' residence. Methods: From a US Midwest institution's 17 hospitals, we included 56,685 patients who returned a post-hospital Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. We defined rurality using rural-urban commuting area codes (metropolitan, micropolitan, small town, rural). We evaluated the association of patient characteristics with top-box score (favorable response) for 10 HCAHPS items (six composite, two individual, two global). We obtained adjusted odds ratios (aOR [95% CI]) from logistic regression models including patient characteristics. We used key driver analysis to identify associations between HCAHPS items and global rating (combined overall rating of hospital and recommend hospital). Results: Of all items, overall rating of hospital had lower odds of favorable response for patients from metropolitan (0.88 [0.81–0.94]), micropolitan (0.86 [0.79–0.94]), and small towns (0.90 [0.82–0.98]) compared with rural areas (global test, P =.003). For five items, lower odds of favorable response was observed for select areas compared with rural; for example, recommend hospital for patients from micropolitan (0.88 [0.81–0.97]) but not metropolitan (0.97 [0.89–1.05]) or small towns (0.93 [0.85–1.02]). For four items, rurality showed no association. In metropolitan, micropolitan, and small towns, men vs. women had higher odds of favorable response to most items, whereas in rural areas, sex-based differences were largely absent. Key driver analysis identified care transition, communication about medicines and environment as drivers of global rating, independent of rurality. Conclusions: Rural patients reported similar or modestly more favorable hospital experience. Determinants of favorable experience across rurality categories may inform system-wide and targeted improvement. [ABSTRACT FROM AUTHOR]

Background: Nosocomial infections (NIs) frequently occur and adversely impact prognosis for hospitalized patients with cirrhosis. This study aims to develop and validate two machine learning models for NIs and in-hospital mortality risk prediction. Methods: The Prediction of Nosocomial Infection and Prognosis in Cirrhotic patients (PIPC) study included hospitalized patients with cirrhosis at the Qingchun Campus of the First Affiliated Hospital of Zhejiang University. We then assessed several machine learning algorithms to construct predictive models for NIs and prognosis. We validated the best-performing models with bootstrapping techniques and an external validation dataset. The accuracy of the predictions was evaluated through sensitivity, specificity, predictive values, and likelihood ratios, while predictive robustness was examined through subgroup analyses and comparisons between models. Results: We enrolled 1,297 patients into derivation cohort and 496 patients into external validation cohort. Among the six algorithms assessed, the Random Forest algorithm performed best. For NIs, the PIPC-NI model achieved an area under the curve (AUC) of 0.784 (95% confidence interval [CI] 0.741–0.826), a sensitivity of 0.712, and a specificity of 0.702. For in-hospital mortality, the PIPC- mortality model achieved an AUC of 0.793 (95% CI 0.749–0.836), a sensitivity of 0.769, and a specificity of 0.701. Moreover, our PIPC models demonstrated superior predictive performance compared to the existing MELD, MELD-Na, and Child-Pugh scores. Conclusions: The PIPC models showed good predictive power and may facilitate healthcare providers in easily assessing the risk of NIs and prognosis among hospitalized patients with cirrhosis. [ABSTRACT FROM AUTHOR]

Background: Complicated mild traumatic brain injury (cmTBI) is a common neurosurgical disorder that consumes a significant amount of healthcare resources without a clearly established benefit. Best practices for the management of cmTBI regarding triage, hospital admission, and the necessity for repeat imaging are controversial. Our objective is to describe the rate of radiographic progression and neurologic decline for isolated traumatic subarachnoid hemorrhage (itSAH) patients admitted to the hospital. We hypothesized that only a minority of itSAH patients suffer radiographic progression and that radiographic progression is not necessarily associated with neurologic decline. Methods: Database queries and direct patient chart reviews were used to gather patient data. T-tests and Fisher's exact tests were performed. Results: A total of 340 patients with cmTBI associated with itSAH were included for analysis. The radiographic progression rate was 5.6%. There was no statistically significant association between age, gender, GCS at presentation, anticoagulation status, and risk of radiographic progression. However, subgroup analysis on anticoagulated patients did show those on warfarin had a statistically significant risk of radiographic progression (p = 0.003). No patient developed neurologic decline, irrespective of whether they developed radiographic progression. Conclusion: Secondary triaging, hospital admission, ICU stay, and repeat HCT might not be necessary for awake, GCS 13–15 patients with itSAH without any other significant injuries. In the case of anticoagulant use, but not necessarily antiplatelet use, the medication should be reversed, and admission should be considered. [ABSTRACT FROM AUTHOR]

Background: The clinical presentation of Community-acquired pneumonia (CAP) in hospitalized patients exhibits heterogeneity. Inflammation and immune responses play significant roles in CAP development. However, research on immunophenotypes in CAP patients is limited, with few machine learning (ML) models analyzing immune indicators. Methods: A retrospective cohort study was conducted at Xinhua Hospital, affiliated with Shanghai Jiaotong University. Patients meeting predefined criteria were included and unsupervised clustering was used to identify phenotypes. Patients with distinct phenotypes were also compared in different outcomes. By machine learning methods, we comprehensively assess the disease severity of CAP patients. Results: A total of 1156 CAP patients were included in this research. In the training cohort (n=809), we identified three immune phenotypes among patients: Phenotype A (42.0%), Phenotype B (40.2%), and Phenotype C (17.8%), with Phenotype C corresponding to more severe disease. Similar results can be observed in the validation cohort. The optimal prognostic model, SuperPC, achieved the highest average C-index of 0.859. For predicting CAP severity, the random forest model was highly accurate, with C-index of 0.998 and 0.794 in training and validation cohorts, respectively. Conclusion: CAP patients can be categorized into three distinct immune phenotypes, each with prognostic relevance. Machine learning exhibits potential in predicting mortality and disease severity in CAP patients by leveraging clinical immunological data. Further external validation studies are crucial to confirm applicability. [ABSTRACT FROM AUTHOR]

The article presents developments on acupuncture practice-based research in the age of artificial intelligence (AI). It introduces projects that illustrate the possibilities for a structured approach to collecting practice data, including a mixed-model for integrating qualitative and quantitative analyses from real-world date sets, the Acuaware study on electronic health record, surveys on common outcome measures in traditional Chinese medicine, and inpatient acupuncture quorum sensing.

Bedside teaching (BST) is a core element of medical education. In light of a reported decrease in BST, evidence on how to use BST time most efficiently should be developed. Given that little research into the tangible quality characteristics of good BST has been reported, we investigated the influence of various teacher and structural characteristics on the perceived quality of BST. We filmed and coded 36 BSTs involving 24 lecturers and 259 students. Structural characteristics of interest were: number of students and patients, overall duration, and the proportion of clinical examination. Lecturer questionnaires provided insight into teaching experience and intrinsic motivation, and student evaluations assessed the quality of BSTs in three dimensions. Correlations are reported using the Pearson r and a linear mixed model (LMM). The intrinsic motivation of lecturers was significantly positively correlated with perceived quality, but their experience was only weakly so correlated. In the LMM, a significant association was observed for the quality dimension of clinical teaching with the number of patients and the proportion of time spent on clinical examination. Based on our findings, we recommend including multiple patients in BSTs, and providing substantial opportunities for clinical examination. Regarding lecturers, motivation matters more than experience. [ABSTRACT FROM AUTHOR]

Objective: To compare the risk of surgical site infections in patients undergoing laparoscopic cholecystectomy with or without prior ERCP. Study Design: Prospective Comparative study. Setting: Surgical Unit-I of Holy Family Hospital, Rawalpindi. Period: December 2021 to May 2022. Methods: Total 140 patients were included. Group A had ERCP before their laparoscopic cholecystectomy. Those, who had laparoscopic cholecystectomy without first undergoing ERCP included in Group B. For this study, we used SPSS to analyze the data we gathered (version 23.0). Two groups were compared for surgical site infection using the Chi-square test. The level of significance was set at P 0.05. Results: Total 140 patients with biliary tract disease (choledocholithiasis, cholangitis and cholelithiasis) were enrolled in this study. In group-A, there were 16(22.9%) males and 54(77.1%) females, while in Group-B, there were 14(20.0%) males and 56(80.0%) females. In patients with prior ERCP group, 28(40.0%) developed surgical site infections, while in patients without ERCP group, 13(18.6%) developed surgical site infections with a p-value of 0.005, which is statistically significant. Conclusion: An increase in the incidence of SSI following laparoscopic cholecystectomy by two- fold is connected with pre-operative (ERCP) so we plan to assess if this technique is linked to a higher risk of wound infection after surgery. we suggest that long term use of antibiotics can reduce the rate of SSI and longer stay of patients in hospital. [ABSTRACT FROM AUTHOR]

Access to palliative care (PC) holds significance for hospital-admitted patients grappling with the symptoms of life limiting illnesses. Nonetheless, numerous such patients who could gain from PC fail to receive it promptly or even at all. We can leverage the prior year's historical data extracted from electronic health records of hospitalized patients to train a machine learning (ML) model. This model's purpose would be to prognosticate the requirement for PC consultation using real-time data. The model, operating as a semi-supervised system, will be integrated into institutional data pipelines, and utilized by a downstream display application overseen by the PC team. In cases where the PC team deems it suitable, a team member will communicate with the respective care team of the patient. The ML model's training efficacy will be assessed using the area under the curve (AUC) metric, employing a 20% reserved validation set. The threshold for PC consultations will be grounded in historical data. To enhance the ML model's precision, the pivotal variables within the model will be pinpointed, and any sources of biases or errors in the model will be identified for meticulous refinement. The AUC values of successive ML models will be juxtaposed with cross-validation data. Automatizing the referral procedure through electronic health record systems has the potential to usher in a more effective and streamlined approach to healthcare delivery. [ABSTRACT FROM AUTHOR]

Purpose: Clinical decision support systems (CDSS) are used to identify drugs with potential need for dose modification in patients with renal impairment. ChatGPT holds the potential to be integrated in the electronic health record (EHR) system to give such dosing advices. In this study, we aim to evaluate the performance of ChatGPT in clinical rule-guided dose interventions in hospitalized patients with renal impairment. Methods: This cross-sectional study was performed at Tergooi Medical Center, the Netherlands. CDSS alerts regarding renal dysfunction were collected from the electronic health record (EHR) during a 2-week period and were presented to ChatGPT and an expert panel. Alerts were presented with and without patient variables. To evaluate the performance, suggested medication interventions were compared. Results: In total, 172 CDDS alerts were generated for 80 patients. Indecisive responses by ChatGPT to alerts were excluded. For alerts presented without patient variables, ChatGPT provided "correct and identical" responses to 19.9%, "correct and different" responses to 26.7%, and "incorrect responses to 53.4% of the alerts. For alerts including patient variables, ChatGPT provided "correct and identical" responses to 16.7%, "correct and different" responses to 16.0%, and "incorrect responses to 67.3% of the alerts. Accuracy was better for newer drugs such as direct oral anticoagulants. Conclusion: The performance of ChatGPT in clinical rule-guided dose interventions in hospitalized patients with renal dysfunction was poor. Based on these results, we conclude that ChatGPT, in its current state, is not appropriate for automatic integration into our EHR to handle CDSS alerts related to renal dysfunction. [ABSTRACT FROM AUTHOR]

To explore the influencing factors of urinary tract infection (UTI) in hospitalized patients with spinal cord injury and to construct and verify the nomogram prediction model. This study is a retrospective cohort study. From January 2017 to March 2022, 558 patients with spinal cord injury admitted to the Department of Rehabilitation Medicine of a tertiary hospital in Anhui Province, China, were selected as the research objects, and they were randomly divided into training group (n = 390) and verification group (n = 168) according to the ratio of 7:3, and clinical data including socio-demographic characteristics, disease-related data, and laboratory examination data were collected. Univariate analysis and multivariate logistic regression were used to analyze the influencing factors of UTI in hospitalized patients with spinal cord injuries. Based on this, a nomogram prediction model was constructed with the use of R software, and the risk prediction efficiency of the nomogram model was verified by the receiver operating characteristic curve and calibration curve. Logistic regression analysis showed that the American Spinal Cord Injury Association (ASIA)-E grade (compared with ASIA-A grade) was an independent protective factor for UTI in hospitalized patients with spinal cord injury (odds ratio < 1, P < 0.05), while white blood cell count and indwelling catheter were independent risk factors for UTI in hospitalized patients with spinal cord injury (odds ratio > 1, P < 0.05). Based on this, a nomogram risk predictive model for predicting UTI in hospitalized rehabilitation patients with spinal cord injury was constructed, which proved to have good predictive efficiency. In the training group and the verification group, the area under the receiver operating characteristic curve of the nomogram model is 0.808 and 0.767, and the 95% confidence interval of the area under the receiver operating characteristic curve of the nomogram in the training group and the verification group is 0.760∼0.856 and 0.688∼0.845, respectively, indicating the nomogram model has good discrimination. According to the calibration curve, the prediction probability of the nomogram model and the actual frequency of UTI in the training group and the verification group are in good consistency, and the results of the Hosmer-Lemeshow bias test also suggest that the nomogram model has a good calibration degree in both the training group and the verification group (P = 0.329, 0.067). ASIA classification level, white blood cell count, and indwelling catheter are independent influencing factors of UTI in hospitalized patients with spinal cord injury. The nomogram prediction model based on the above factors can simply and effectively predict the risk of UTI in hospitalized patients with spinal cord injury, which is helpful for clinical medical staff to identify high-risk groups early and implement prevention, treatment, and nursing strategies in time. [ABSTRACT FROM AUTHOR]

Background: The ability to classify patients' goals of care (GOC) from clinical documentation would facilitate serious illness communication quality improvement efforts and pragmatic measurement of goal-concordant care. Feasibility of this approach remains unknown. Objective: To evaluate the feasibility of classifying patients' GOC from clinical documentation in the electronic health record (EHR), describe the frequency and patterns of changes in patients' goals over time, and identify barriers to reliable goal classification. Design: Retrospective, mixed-methods chart review study. Participants: Adults with high (50–74%) and very high (≥ 75%) 6-month mortality risk admitted to three urban hospitals. Main Measures: Two physician coders independently reviewed EHR notes from 6 months before through 6 months after admission to identify documented GOC discussions and classify GOC. GOC were classified into one of four prespecified categories: (1) comfort-focused, (2) maintain or improve function, (3) life extension, or (4) unclear. Coder interrater reliability was assessed using kappa statistics. Barriers to classifying GOC were assessed using qualitative content analysis. Key Results: Among 85 of 109 (78%) patients, 338 GOC discussions were documented. Inter-rater reliability was substantial (75% interrater agreement; Cohen's kappa = 0.67; 95% CI, 0.60–0.73). Patients' initial documented goal was most frequently "life extension" (N = 37, 44%), followed by "maintain or improve function" (N = 28, 33%), "unclear" (N = 17, 20%), and "comfort-focused" (N = 3, 4%). Among the 66 patients whose goals' classification changed over time, most changed to "comfort-focused" goals (N = 49, 74%). Primary reasons for unclear goals were the observation of concurrently held or conditional goals, patient and family uncertainty, and limited documentation. Conclusions: Clinical notes in the EHR can be used to reliably classify patients' GOC into discrete, clinically germane categories. This work motivates future research to use natural language models to promote scalability of the approach in clinical care and serious illness research. [ABSTRACT FROM AUTHOR]

Service providers find it difficult to implement Physical Exercise (PE) strategies in routine care within inpatient mental health settings even though they perceive it to be an effective therapy, with a robust evidence base. Identifying barriers that exist can assist with the development of future interventions and support PE services being introduced into mental health inpatient settings. The aim of this systematic review was to synthesise the evidence on the barriers or perceived barriers that exist amongst service users and providers when incorporating PE as an intervention within inpatient mental health settings. Using a narrative synthesis approach, four main themes were identified: (i) Barriers relating to service users' mental and physical health, (ii) Factors relating to service providers, (iii) Environmental factors and (iv) Cultural factors. Both service users and providers need more knowledge on implementing PE in inpatient mental health settings. Tailored programmes for service users are warranted, with specialist roles for staff developed. [ABSTRACT FROM AUTHOR]

Medically compromised people with anorexia nervosa are cared for in inpatient settings where clinicians closely monitor health and safety. Clinicians are in a position of power, with the capacity to impose mandated weight gain to achieve medical stabilisation. Consumers are in a vulnerable position, compelled to temporarily relinquish autonomy and to accept coercive practices that often diminish the quality of the therapeutic relationship. Clinicians' position of power in mental healthcare has a dual potential for both healing and harm, and limited attention has been given to consumers' views of clinicians' power. The aim of this qualitative descriptive study was to investigate the consumer perspective of clinicians' power in the inpatient care of anorexia nervosa, establishing insight into the beneficence and maleficence of the power asymmetry. Ten women with anorexia nervosa in the community participated in semi‐structured interviews online. The COREQ checklist was used to ensure accuracy and completeness of reporting. Thematic analysis revealed that abuses of power were common in the course of inpatient AN care, however life‐saving measures were regarded as defensible. The perception of clinicians' power was determined by the strength of interpersonal relationships and clinicians' clinical competence. To mitigate the potential for harmful experiences, clinicians' use of power must be exercised with close consideration for consumer perspectives, with the integration of person‐centred care and trauma‐informed care principles. [ABSTRACT FROM AUTHOR]

Patients with Coronavirus Disease 2019 (COVID-19) who required mechanical ventilation and had prolonged hospital stay present with medical instability and functional impairments after the acute hospitalization. To present the rehabilitation outcome of three patients with COVID-19 admitted to an inpatient rehabilitation unit using a case series method. Subjects included three consecutive male patients admitted to the rehabilitation unit with a diagnosis of deconditioning and critical illness myopathy. On admission, patients were evaluated by a multidisciplinary team using outcome measures such as 6-min walk test (6 MWT), 10-m walk test (10 MWT), berg balance scale (BBS), and dynamometry. Each patient received daily therapy with a minimum of 900 min per week during their rehabilitation stay. Treatment strategies included fatigue management, training of mobility and activities for daily living tasks, muscle strengthening, and cognitive retraining. All patients showed significant improvements across all the outcome measures, specifically, the 6MWT (minimal clinically identifiable difference (MCID) range: 14–30.5 m) and the 10MWT (MCID range: 0.10–0.20 m/s) which exceeded the MCID for all three patients. The BBS also demonstrated significant improvement, surpassing the minimum detectable change of 5–7 points. Of the three patients, two were able to be discharged at an independent level, while one required supervision for safety. Patients with COVID-19, who experienced prolonged hospital stay present with severe impairments in muscle strength, functional mobility, and participation in daily living tasks. Inpatient rehabilitation may have the potential to reduce impairments and accelerate the recovery process while managing ongoing medical issues. [ABSTRACT FROM AUTHOR]

Transport of biopharmaceuticals from a hospital to a patient's home is scarcely researched but it is essential to investigate the effects of such transport on the stability of the drug, before home-based care can take place. In this study, transport of biopharmaceuticals in vials that are marketed as ready-to-administer from a hospital pharmacy to patients' homes was investigated. Immunoglobulin packages were tracked with 10 G and 25 G shock indicators and temperature data loggers. In the control group, immunoglobulins were transported from the hospital pharmacy to the outpatient daycare unit. During the transport process to patients' homes (n = 39), almost half of the packages were shocked with 25 G and more than half of all packages exceeded the required temperature range. Fortunately, the results found do not affect the stability of the ready-to-administer vials with immunoglobulins. However, these results indicate that the transport of biopharmaceuticals should be better controlled as not all biopharmaceuticals or formulations are so stable. Therefore, results of this pilot study provide a basis for recommendations for home-based therapy. [ABSTRACT FROM AUTHOR]