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To deal with the upcoming challenges and complexity of the nursing profession, it is deemed important to reflect on our current organization of care. However, before starting to rethink the organization of nursing care, an overview of important elements concerning nursing care organization, more specifically nursing models, is necessary. The aim of this study was to conduct a mapping review, accompanied by an evidence map to map the existing literature, to map the field of knowledge on a meta‐level and to identify current research gaps concerning nursing models in a hospital setting. Next to nursing models, two other organizational correlates seem to be of importance when looking at the organization of nursing care: nurse staffing and skill mix. Although it seems that in recent research, the theoretical focus on the organization of nursing care has been left behind, the increasingly complex healthcare environment might gain from the use of nursing theory, or in this case, care delivery models. As almost no fundamental studies have been done toward the combination of care delivery models, nurse staffing, and skill mix, those elements should be taken into account to fully capture the organization of nursing care in future research. [ABSTRACT FROM AUTHOR]

Aim Design Methods Results Conclusion Impact Reporting method Patient or public contribution To synthesize and assess the effectiveness of different care delivery models in a hospital setting, taking into account patient‐ and nurse‐related outcomes.A systematic review with narrative synthesis in which a comparison was made between different care delivery models.The search string consisted of four clusters: ‘nursing’, ‘care delivery models’, ‘hospital setting’ and ‘quantitative research designs’. Four electronic databases were searched from the inception of the databases to January 2023: Medline, Embase, CINAHL and Web of Science.In total, 19 studies were included in the systematic review. The most commonly compared care delivery models were functional nursing to primary nursing (n = 6), patient allocation to team nursing (n = 4), team nursing to primary nursing (n = 3) and functional nursing to modular nursing (n = 3). Only one randomized crossover trial was found, other included studies were pretest–posttest designs or quasi‐experimental designs. The implementation of a nursing care delivery model was the study intervention. The following aspects of the intervention were not reported or inadequately described by the majority of the authors; tailoring of an intervention, modifications to an intervention and the adherence or fidelity to the intervention. Job satisfaction and quality of nursing care were the most commonly reported nursing outcomes, while patient satisfaction was the most commonly reported patient outcome. Due to a high heterogeneity in outcome measures between the studies, a meta‐analysis of the included studies was not possible. All included studies had a high risk of overall bias.This systematic review found mixed evidence, inconsistent reporting of certain elements of the interventions, high heterogeneity in outcome measures and low methodological quality. Although this systematic review could not answer which nursing care delivery model is the most effective or most promising, other important findings from this review may inform future research. There are differences in care delivery model descriptions and a lack of agreement on the strengths and weaknesses of the care delivery models. No clear‐cut answer can be given about the effect of different care delivery models in a hospital setting on patient‐ and nurse‐related outcomes. Job satisfaction and quality of nursing care were the most commonly reported nursing outcomes, while patient satisfaction was the most commonly reported patient outcome. This review can support the development of future care delivery redesign strategies. The systematic review was reported according to the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA).No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aims: In‐hospital prescribing errors may result in patient harm, such as prolonged hospitalisation and hospital (re)admission, and may be an emotional burden for the prescribers and healthcare professionals involved. Despite efforts, in‐hospital prescribing errors and related harm still occur, necessitating an innovative approach. We therefore propose a novel approach, in‐hospital pharmacotherapeutic stewardship (IPS). The aim of this study was to reach consensus on a set of quality indicators (QIs) as a basis for IPS. Methods: A three‐round modified Delphi procedure was performed. Potential QIs were retrieved from two systematic searches of the literature, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) statement. In two written questionnaires and a focus meeting (held between the written questionnaire rounds), potential QIs were appraised by an international, multidisciplinary expert panel composed of members of the European Association for Clinical Pharmacology and Therapeutics (EACPT). Results: The expert panel rated 59 QIs and four general statements, of which 35 QIs were accepted with consensus rates ranging between 79% and 97%. These QIs describe the activities of an IPS programme, the team delivering IPS, the patients eligible for the programme and the outcome measures that should be used to evaluate the care delivered. Conclusions: A framework of 35 QIs for an IPS programme was systematically developed. These QIs can guide hospitals in setting up a pharmacotherapeutic stewardship programme to reduce in‐hospital prescribing errors and improve in‐hospital medication safety. [ABSTRACT FROM AUTHOR]

Background: In geriatrics, explicit criteria for potentially inappropriate prescriptions (PIPs) are useful for optimizing drug use. Objective: To produce an expert consensus on explicit definitions of antibiotic-PIPs for hospitalized older patients. Methods: We conducted a Delphi survey involving French experts on antibiotic stewardship in hospital settings. During the survey's rounds, the experts gave their opinion on each explicit definition, and could suggest new definitions. Definitions with a 1-to-9 Likert score of between 7 and 9 from at least 75% of the participants were adopted. The results were discussed during consensus meetings after each round. Results: Of the 155 invited experts, 128 (82.6%) participated in the whole survey: 59 (46%) infectious diseases specialists, 45 (35%) geriatricians, and 24 (19%) other specialists. In Round 1, 65 explicit definitions were adopted and 21 new definitions were suggested. In Round 2, 35 other explicit definitions were adopted. The results were validated during consensus meetings (with 44 participants after Round 1, and 54 after Round 2). Conclusions: The present study is the first to have provided a list of explicit definitions of potentially inappropriate antibiotic prescriptions for hospitalized older patients. It might help to disseminate key messages to prescribers and reduce inappropriate prescriptions of antibiotics. [ABSTRACT FROM AUTHOR]

Background: The global rise in antibiotic resistance necessitates an understanding of antibiotic usage patterns and the corresponding development of resistance within hospitals. This study explores these patterns within the General Medicine department of a tertiary care hospital. Objective: To determine the relationship between antibiotic prescription patterns and the emergence of resistance in a General Medicine department, and to identify potential areas of improvement for antibiotic stewardship. Methods: A cross-sectional study was undertaken, reviewing 500 antibiotic prescriptions and the associated patient records over a six-month period. Pathogen susceptibility to antibiotics was ascertained using standard microbiological techniques. Results: Of the 500 prescriptions assessed, 68% involved antibiotics. The most commonly prescribed antibiotics were cephalosporins (29%), followed by fluoroquinolones (24%). It was found that 28% of the prescriptions potentially represented antibiotic misuse, often in cases with a primary viral diagnosis. Antibiotic resistance testing revealed that 38% of bacterial isolates exhibited resistance to the routinely prescribed antibiotics, with fluoroquinolones showing the highest resistance rates. Conclusions: The study indicates that there is a notable divergence from recommended antibiotic prescription guidelines within the General Medicine department. The observed resistance patterns underscore the urgency of implementing comprehensive antibiotic stewardship programs to promote optimal antibiotic use. [ABSTRACT FROM AUTHOR]

At the start of the 20th century, cesarean section (CS) was uncommon in obstetrics. By the end of the century, CS rates had increased dramatically worldwide. Although the explanation for the increase is multifactorial, a major driver in the ongoing escalation is the increase in women who are delivered by repeat CS. This is due, in part, to the fact that there has been a sharp fall in vaginal birth after CS (VBAC) rates as fewer women are offered a trial of labor after CS (TOLAC), due principally to fears of a catastrophic intrapartum uterine rupture. This paper reviewed international VBAC policies and trends. A number of themes emerged. The risk of intrapartum rupture and its associated complications is low and may sometimes be overestimated. Individual maternity hospitals in both developed and developing countries are inadequately resourced to safely supervise a TOLAC. Efforts to mitigate the risks of TOLAC by careful patient selection and good clinical practices may be underutilized. Given the serious short‐term and long‐term consequences of rising CS rates for women and for maternity services generally, a review of TOLAC policies worldwide should be prioritized and consideration given to convening a Global Consensus Development Conference on Delivery after CS. Synopsis: The dramatic fall in trial of labor after cesarean section rates globally may reflect overestimation of risks and underestimation of benefits associated with vaginal birth. [ABSTRACT FROM AUTHOR]

Background: Clinical pharmacists have a pivotal role in the management of the patient's medication. However, it is necessary to know how pharmacist‐mediated deprescribing could be implemented in a hospital setting according to hospital physicians. Objective: To explore physicians' views on the involvement of hospital pharmacists in the deprescribing process using the example of PPIs. Methods: A qualitative study using two focus groups with hospital physicians was conducted to determine their attitudes regarding deprescribing initiated by the hospital pharmacist. The interviews were recorded and transcribed using the NVivo analysis software. A thematic analysis led to a categorization of all the verbatims. Results: Hospital doctors are reluctant to deprescribe drugs initiated by a colleague and feel that it is the responsibility of the general practitioner (GP), who fails to do so due to lack of time. In this situation, the hospital pharmacist is in the best position to deprescribe because of his/her expertise in drug therapy. This should be a discussion between the hospital pharmacist, the hospital doctor, the GP and the patient. Deprescribing should always be adapted to the patient's context. Conclusion: Hospital physicians are open to a pharmacist‐mediated, patient‐centred approach to deprescribing as long as the GP is involved. [ABSTRACT FROM AUTHOR]

Prior studies of associations between hospital location and outcomes for pediatric appendectomy have not adjusted for significant differences in patient and treatment patterns between settings. This was a cross-sectional analysis of pediatric appendectomies in the 2016 Kids' Inpatient Database (KID). Weighted multiple linear and logistic regression models compared hospital location (urban or rural) and academic status against total admission cost (TAC), length of stay (LOS), and postoperative complications. Patients were stratified by laparoscopic (LA) or open (OA) appendectomy. Among 54,836 patients, 39,454 (73%) were performed at an urban academic center, 11,642 (21%) were performed at an urban non-academic center, and 3740 (7%) were performed at a rural center. LA was utilized for 49,011 (89%) of all 54,386 patients: 36,049 (91%) of 39,454 patients at urban academic hospitals, 10,191 (87%) of 11,642 patients at urban non-academic centers, and 2771 (74%) of 3740 patients at rural centers (p < 0.001). On adjusted analysis, urban academic centers were associated with an 18% decreased TAC (95% CI −0.193–−0.165; p < 0.001) despite an 11% increased LOS (95% CI 0.087–0.134; p < 0.001) compared to rural centers. Urban academic centers were associated with a decreased odds of complication among patients who underwent LA (OR 0.787, 95% CI 0.650–0.952) but not after OA. After adjusting for relevant patient and disease-related factors, urban academic centers were associated with lower costs despite longer lengths of stay compared to rural centers. Urban academic centers utilized LA more frequently and were associated with decreased odds of postoperative complications after LA. [ABSTRACT FROM AUTHOR]

Abstract Introduction Patients' and companions' participation in healthcare could help prevent adverse events, which are a significant cause of disease and disability. Before designing interventions to increase participation, it is first necessary to identify attitudes to patient safety. This study aimed to explore patients' and companions' perceptions, attitudes and experiences of patient safety, taking into account contextual factors, such as cultural background, which are not usually captured in the literature. Methods We conducted a qualitative study with a theoretical sampling of 13 inpatients and 3 companions in a university hospital in Barcelona, Spain. Information was obtained from individual and triangular interviews. A descriptive thematic content analysis was conducted by four analysts and a consensus was reached within the research team on the key categories that were identified. We also conducted a card‐sorting exercise. Results All informants emphasized the role of good communication with health professionals, a calm environment and the need for patient education. Discursive positions differed by cultural background. Informants from a Pakistani–Bangladeshi background emphasized language barriers, while those from European and Latin‐American backgrounds stressed health professionals' lack of time and the need for more interdisciplinary teamwork. The card‐sorting exercise identified several opportunities to enhance participation: checking patient identification and medication dispensation, and maintaining personal and environmental hygiene. Conclusion This exploration of informants' discourse on patient safety identified a wide variety of categories not usually considered from institutional perspectives. The findings of this study could enrich interventions in areas with diverse cultural backgrounds, as well as current frameworks based exclusively on institutional perspectives. Patient or Public Contribution The results of the study were communicated to patients and accompanying persons via telephone or email. Similarly, a focus group was held with a patient forum to comment on the results. In the design of subsequent interventions to improve patient safety at the hospital, the proposals of patients and companions for their participation will be included together with healthcare professionals' opinions.

Abstract Aim Nurse‐led care aims to optimize the discharge preparation with a focus on increasing patients' independency and self‐care abilities. This study compared patients' improvements of self‐care abilities and frequency of readmission rate between nurse‐led care and regular nursing care within the acute hospital setting. Design A quasi‐experimental design within a real‐world setting was used for this work. Methods We included a pool of 2501 patients from a control group (medically stable in usual care) and 420 patients from an intervention group (nurse‐led care). After propensity score matching, the study cohort consisted of 612 patients. Results From admission to discharge, nurse‐led care patients showed superior improvements of total self‐care abilities compared to usual care patients. In particular, we found improvements in the following categories: mobility, grooming and excretion. Patients with nurse‐led care were furthermore less frequently readmitted to hospital compared with the control group patients. Patient or public contribution No patient or public contribution.

Hospital-acquired infections pose an ongoing threat to patient safety due to the presence of multi-drug-resistant organisms (MDROs) and other pathogens such as Clostridioides difficile which are dependent on thorough and effective cleaning and disinfection by personnel. This study evaluated the influence of UV-C air treatment: the air in the room was sanitized by UV-C and redirected into the room. In addition, ozone was released into the room to treat actual surfaces in low-risk areas such as hospital gyms, and high- to medium-risk areas such as hospital rooms. To this aim, a portable device designed for treating the environment air was tested against nine bacterial strains including Aspergillus spp. and Clostridioides spp. The use of UV-C air treatment during daily operations and ozone treatment achieved at least a 2-log 10 pathogen reduction except for Clostridioides spp. Effective prevention of C. difficile normally requires the use of combined approaches that include chemical compounds and disinfection agents whose toxicity can be harmful not only to patients but also to healthcare personnel. Thus, the proposed no-touch device may be evaluated in future research to assess the needed requirements for its possible and full implementation in hospitals. [ABSTRACT FROM AUTHOR]

Introduction: Patients' and companions' participation in healthcare could help prevent adverse events, which are a significant cause of disease and disability. Before designing interventions to increase participation, it is first necessary to identify attitudes to patient safety. This study aimed to explore patients' and companions' perceptions, attitudes and experiences of patient safety, taking into account contextual factors, such as cultural background, which are not usually captured in the literature. Methods: We conducted a qualitative study with a theoretical sampling of 13 inpatients and 3 companions in a university hospital in Barcelona, Spain. Information was obtained from individual and triangular interviews. A descriptive thematic content analysis was conducted by four analysts and a consensus was reached within the research team on the key categories that were identified. We also conducted a card‐sorting exercise. Results: All informants emphasized the role of good communication with health professionals, a calm environment and the need for patient education. Discursive positions differed by cultural background. Informants from a Pakistani–Bangladeshi background emphasized language barriers, while those from European and Latin‐American backgrounds stressed health professionals' lack of time and the need for more interdisciplinary teamwork. The card‐sorting exercise identified several opportunities to enhance participation: checking patient identification and medication dispensation, and maintaining personal and environmental hygiene. Conclusion: This exploration of informants' discourse on patient safety identified a wide variety of categories not usually considered from institutional perspectives. The findings of this study could enrich interventions in areas with diverse cultural backgrounds, as well as current frameworks based exclusively on institutional perspectives. Patient or Public Contribution: The results of the study were communicated to patients and accompanying persons via telephone or email. Similarly, a focus group was held with a patient forum to comment on the results. In the design of subsequent interventions to improve patient safety at the hospital, the proposals of patients and companions for their participation will be included together with healthcare professionals' opinions. [ABSTRACT FROM AUTHOR]

Allied health clinical placements take place within an increasingly overstretched health care system where demand for services often exceeds availability of resources. Within this environment, student placements are often perceived as an additional burden to an already overwhelmed workforce. This study explored whether the quality of patient care was enhanced when services were re-designed using a collaborative partnership approach to more purposefully integrate students into delivery of care. Using an embedded multiple case study design, data were collected through focus groups and interviews, patient experience surveys, and secondary administrative data sources. Cases were across physiotherapy and occupational therapy in six different hospital settings. Perception of care provided by students was viewed positively by all stakeholders, including patients. Perceived health outcomes of faster improvement of health condition, improved mobility and function identified through our qualitative findings were supported by quantitative service delivery markers such as increased therapy sessions, more patients being discharged home instead of to other care facilities and reduced length of stay. Health care providers and students alike perceived improvements in service efficiencies whilst maintaining high quality care. This study has provided preliminary evidence towards improved patient care when a partnering approach is adopted whereby students are intentionally integrated into services that otherwise might not have been delivered. Furthermore, it has shifted the associated narrative from students as additional burden to students as benefit. [ABSTRACT FROM AUTHOR]

In hospitals, older patients are at increased risk of falling multiple times. This study incorporated an epidemiologic cross-sectional design consisting of 4,348 older patients (≥65-year-old). Eight hundred eighty five (20.4%) in-patients experienced multiple falls while remaining participants had one fall incident. A patient fall event was recorded with age, sex, incident date, type of fall, and location. Logistic regression assessed risk factors found in patients with multiple falls compared to those with one fall. Significant differences were observed in the proportion of multiple falls: in a bed with no rails, standing, walking, and using a wheel/Geri chair (p <.05). Overall, sex, type of fall, and location were significant in predicting multiple falls (p <.05). Male patients were at 16.1% greater risk of multiple falls, when compared to females (p <.05). A fall in complex care, mental health, or respirology were more likely to experience multiple falls (OR = 2.659, 3.620, 1.593 respectively), while season had no impact. [ABSTRACT FROM AUTHOR]

Recognition and escalation of the deteriorating patient is multifaceted and relevant to all clinicians involved. However, little evidence exists exploring how clinicians from different professions make decisions about early signs of clinical deterioration and how this affects their actions. The aim of this study was to explore interprofessional clinicians' and students' experiences of responding to and escalating care of deteriorating patients. A convenience sample of clinicians and students from acute hospital settings in regional Australia participated in focus groups. Participants were able to identify barriers, facilitators, and strategies for improvement during the recognition and escalation of the deteriorating patient. Four themes were detected throughout the 38 focus group discussions: a Standardized Approach, Workplace Culture and Teamwork, Confidence and Experience, and Communication. Although standardization of systems and processes supported clinician's recognition and escalation of the deteriorating patient, use and misuse of the systems by some participants were identified as barriers to seeking assistance. Positive workplace culture and teamwork were important to promoting the escalation of care. Participants identified that experience in recognizing and responding to deteriorating patients increased their confidence. [ABSTRACT FROM AUTHOR]

Background: This project aimed to implement a quality improvement initiative to reduce the utilization of non-indicated intravenous (IV) antihypertensive medications in the hospital setting and evaluate its impact on hospital length of stay. Methods: A quality improvement initiative was conducted at a 500-bed regional hospital to improve management of inpatients with asymptomatic severe hypertension. An algorithm was developed to guide management to minimize the inappropriate use of IV antihypertensives. Educational sessions were conducted with medical providers and nursing staff to promote adherence to the algorithm. Pharmacy records were reviewed to assess the utilization of IV antihypertensive medications. Aggregated length of hospital stay before and after the intervention were compared. Statistical analysis was performed using paired t-tests. Results: The utilization of IV antihypertensive medications was reduced by 47.6% after the intervention, as measured by days of therapy per 1000 patient days (p Conclusions: The implementation of a quality improvement initiative, including an algorithm and education for healthcare staff, successfully reduced the utilization of non-indicated IV antihypertensive medications in the hospital setting. This approach has the potential to improve patient safety and reduce healthcare costs. Further research is needed to explore the long-term effectiveness of this intervention and its impact on patient outcomes.

Background: In geriatrics, explicit criteria for potentially inappropriate prescriptions (PIPs) are useful for optimizing drug use. Objective: To produce an expert consensus on explicit definitions of antibiotic-PIPs for hospitalized older patients. Methods: We conducted a Delphi survey involving French experts on antibiotic stewardship in hospital settings. During the survey’s rounds, the experts gave their opinion on each explicit definition, and could suggest new definitions. Definitions with a 1-to-9 Likert score of between 7 and 9 from at least 75% of the participants were adopted. The results were discussed during consensus meetings after each round. Results: Of the 155 invited experts, 128 (82.6%) participated in the whole survey: 59 (46%) infectious diseases specialists, 45 (35%) geriatricians, and 24 (19%) other specialists. In Round 1, 65 explicit definitions were adopted and 21 new definitions were suggested. In Round 2, 35 other explicit definitions were adopted. The results were validated during consensus meetings (with 44 participants after Round 1, and 54 after Round 2). Conclusions: The present study is the first to have provided a list of explicit definitions of potentially inappropriate antibiotic prescriptions for hospitalized older patients. It might help to disseminate key messages to prescribers and reduce inappropriate prescriptions of antibiotics.

Abstract Since diagnostic laboratories handle large COVID-19 samples, researchers have established laboratory-based assays and developed biosensor prototypes. Both share the same purpose; to ascertain the occurrence of air and surface contaminations by the SARS-CoV-2 virus. However, the biosensors further utilize internet-of-things (IoT) technology to monitor COVID-19 virus contamination, specifically in the diagnostic laboratory setting. The IoT-capable biosensors have great potential to monitor for possible virus contamination. Numerous studies have been done on COVID-19 virus air and surface contamination in the hospital setting. Through reviews, there are abundant reports on the viral transmission of SARS-CoV-2 through droplet infections, person-to-person close contact and fecal-oral transmission. However, studies on environmental conditions need to be better reported. Therefore, this review covers the detection of SARS-CoV-2 in airborne and wastewater samples using biosensors with comprehensive studies in methods and techniques of sampling and sensing (2020 until 2023). Furthermore, the review exposes sensing cases in public health settings. Then, the integration of data management together with biosensors is well explained. Last, the review ended with challenges to having a practical COVID-19 biosensor applied for environmental surveillance samples. [ABSTRACT FROM AUTHOR]

Aims and objectives: To investigate the consistency in the prevalence and associated factors of frailty determined by the physical‐originated Fatigue, Resistance, Ambulation, Illnesses and Loss of weight (FRAIL) scale and the multidimensional Tilburg Frailty Indicators (TFI) scale. Background: Accurate assessment of frailty and the identification of its associated factors could guide the development and implementation of holistic and individualised treatment plan. However, recommendations regarding the selection of frailty assessment tools are inconclusive. Design: This is a cross‐sectional study, the reporting of which followed the STROBE guidelines. Methods: A total of 1220 older adults were recruited from a university affiliated tertiary hospital in Xi'an City, Northwest China, and administrated with a social‐demographic and health‐related information sheet, the FRAIL, the TFI, the Short‐Form Mini‐Nutritional Assessment, the Pittsburgh Sleep Quality Index and the 5‐level EuroQol 5 dimensions questionnaire. Descriptive statistics and binary logistic regression analysis were used to investigate the prevalence of frailty and its associated factors. Results: The prevalence of physical‐originated and multidimensional frailty was 55.2% and 77.6%, respectively. The consistency between the two scales was low. Taking the combined use of the two instruments as the reference, the TFI and FRAIL could identify 89.99% and 64.02% of the participants with frailty. Polypharmacy, health‐related quality of life and sleep quality were found to be associated with both physical‐originated and multidimensional frailty. Nutritional status and level of physical activity were additionally identified as the independent associated factors of multidimensional frailty. Conclusions: The prevalence of frailty among hospitalised older adults is high. There is low consistency between the FRAIL and TFI in detecting frailty. The TFI exhibited higher sensitivity in detecting individuals with frailty and its associated factors. Relevance to clinical practice: The findings of this study supported a single use of the TFI for the assessment of frailty in the hospital setting. [ABSTRACT FROM AUTHOR]

Aim: Nurse‐led care aims to optimize the discharge preparation with a focus on increasing patients' independency and self‐care abilities. This study compared patients' improvements of self‐care abilities and frequency of readmission rate between nurse‐led care and regular nursing care within the acute hospital setting. Design: A quasi‐experimental design within a real‐world setting was used for this work. Methods: We included a pool of 2501 patients from a control group (medically stable in usual care) and 420 patients from an intervention group (nurse‐led care). After propensity score matching, the study cohort consisted of 612 patients. Results: From admission to discharge, nurse‐led care patients showed superior improvements of total self‐care abilities compared to usual care patients. In particular, we found improvements in the following categories: mobility, grooming and excretion. Patients with nurse‐led care were furthermore less frequently readmitted to hospital compared with the control group patients. Patient or public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Low levels of physical activity (PA) and sleep disruption are commonly seen in older adult inpatients and are associated with poor health outcomes. Wearable sensors allow for objective continuous monitoring; however, there is no consensus as to how wearable sensors should be implemented. This review aimed to provide an overview of the use of wearable sensors in older adult inpatient populations, including models used, body placement and outcome measures. Five databases were searched; 89 articles met inclusion criteria. We found that studies used heterogenous methods, including a variety of sensor models, placement and outcome measures. Most studies reported the use of only one sensor, with either the wrist or thigh being the preferred location in PA studies and the wrist for sleep outcomes. The reported PA measures can be mostly characterised as the frequency and duration of PA (Volume) with fewer measures relating to intensity (rate of magnitude) and pattern of activity (distribution per day/week). Sleep and circadian rhythm measures were reported less frequently with a limited number of studies providing both physical activity and sleep/circadian rhythm outcomes concurrently. This review provides recommendations for future research in older adult inpatient populations. With protocols of best practice, wearable sensors could facilitate the monitoring of inpatient recovery and provide measures to inform participant stratification and establish common objective endpoints across clinical trials. [ABSTRACT FROM AUTHOR]

Neuropsychology applied in a hospital context, an emerging expertise of Psychology has been extremely relevant in recent studies, since the possibilities of action permeate from early stages of surgical procedures, from functional cognitive assessments, to later stages, reaching the neuropsychological rehabilitation process. Despite this, there is a lack of more detailed data on the particularities of this work with the interprofessional staff. In this sense, this study aimed to describe the perception of neuropsychologists and healthcare professionals who work in hospital teams about hospital neuropsychology. This is an exploratory study with a qualitative approach, according to the analysis criteria of semiotic phenomenology. Twenty-one professionals from hospitals in the southeast region of Brazil participated (nine neuropsychologists and twelve professionals from different specialties in the healthcare area), who responded to a semi - structured interview via video conference. The results revealed nine different themes: "Hospital scenario entrance", "Ignorance of the area versus Appreciation", "Attributions of the neuropsychology in the hospital", "Financial obstacles", "Training processes", "Divergence of functions", "Relevance versus Costs", "Interaction between professionals from different specialties" and "Knowledge about the neuropsychologist's attributions". The discussion of the results points out the lack of knowledge from healthcare professionals, of the possibilities of the contribution of hospital neuropsychology as a limiting factor for the insertion of professionals in this field, as well as fragility in interprofessionality, evidenced by the deficient communication between team members. It is concluded that these findings expose the need to rethink training processes in the field of healthcare and psychology, in addition to indicate the need for further studies to explore neuropsychology fields that go beyond the traditional clinical context. [ABSTRACT FROM AUTHOR]

Background: Dignity therapy is a psychotherapy intervention whose main goal is to improve the quality of life, promote spiritual and psychological health, and reduce suffering in people with life-threatening diseases. Deteriorating health status is associated with low perceived dignity. The COVID-19 pandemic has been associated with growing concerns about the quality of health care. Therefore, the present study aimed to examine the perception of patients with COVID-19 about respecting their dignity in hospital settings and related variables. Patients and methods: A cross-sectional study was conducted in 2021, on 206 patients with COVID-19 in hospitals. Patient Dignity Questionnaire (PDI) was used to collect data and descriptive and inferential statistics were used to analyse the data. Results: The mean age of the participants was 54.83 ± 14.98 years and most of them were male (67.5%). The mean score of overall perceived dignity was 69.76 ± 10.62 out of 125. Participants rated 7 out of 25 items as 3 or higher, indicating the importance of these items in the clinical setting. The highest and lowest mean scores were in the dependence (3.28 ± 0.55) and social support (1.49 ± 0.59) subscales, respectively. The mean dignity score was associated with the patients' educational level and gender (p = 0.012) (p = 0.065). Conclusions: Patients with COVID-19 were concerned about respecting their dignity. The study patients were more concerned about the dimensions of symptom distress, existential distress, and dependence. Conducting training workshops on respecting human dignity in patients with COVID-19 can improve nurses' knowledge and skills in this area and promote respect for patient dignity. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore in a hospital setting the relationships between work motivation and stress among psychologists working in hospitals. The second aim was to identify the respective roles of threat appraisal and challenge appraisal in this population. We expected work stress to have a motivational impact in the workplace, with primary cognitive appraisal (e.g., threat or challenge) playing a crucial role. The study included a large sample of 430 French psychologists recruited in French hospitals with a mean age of 33.68 ± 8.73 years. We assessed perceived work stress, work motivation, and primary cognitive appraisal. Analysis showed two main outcomes. First, perceived stress in the workplace impacts work motivation; specifically, the higher the perceived stress, the less motivation is self-determined. Second, threat cognitive appraisal has a direct and negative motivational impact, but also an indirect impact via perceived stress. However, appraisal of work as a cognitive challenge also directly and positively impacts motivation in the workplace, without indirect effects. Finally, work stress, work motivation and primary cognitive appraisals are significantly related with the workplace. These relationships support complementarity with the Transactional Model of Stress and SDT motivational approach in a theoretical and practical perspective in the workplace. [ABSTRACT FROM AUTHOR]

Despite a long history of the adoption of a peer workforce in alcohol and other drug treatment service provision, there is limited peer reviewed literature on the benefits of peer worker role integration in the hospital setting. Our qualitative study explored the perceptions of people with lived experience of problematic alcohol and other drugs use and their experiences of peer worker roles in the hospital setting. Twenty semi-structured interviews with people who experienced problematic alcohol and other drug use. Transcripts were thematically analyzed and guided by a broad interest in a therapeutic alliance. We identified four themes related to how lived experience expertise within a peer worker role strengthened therapeutic alliances: (i) by building trust and credibility; (i) by building hope; (iii) the ability to approach informally; and (iv) in continuing to be accessible long term. The results partly echo earlier literature, however highlight two innovative aspects that relate to lived experience expertise that maintain therapeutic alliances in the hospital setting being, firstly, the ability to approach informally, and secondly, an opportunity for longer-term engagement. In Australia at present there is a window of opportunity to better integrate peer workers into clinical care models, and as such our results have implications for how policy makers might better approach peer worker integration and configuration to improve treatment-seeking intentions both within and beyond the hospital setting. [ABSTRACT FROM AUTHOR]

Purpose – This research aimed to explore the prevalence of musculoskeletal disorders (MSDs) and related factors among subcontracted cleaners in a teaching hospital in Thailand. Design/methodology/approach – A cross-sectional study was conducted of 393 subcontracted cleaners in a teaching hospital, from May to June 2020. Face-to-face interviews were carried out using a standard questionnaire, consisting of four parts: (1) participant characteristics, (2) stress test, (3) work characteristics and (4) standardized Nordic questionnaire, Thai version, for MSDs outcome. Multiple logistic regression analyses were performed to determine the association between MSDs and related factors. Findings – The prevalence of MSDs was 81.9%, involving mostly the lower back (57.7%), followed by the shoulder (52.6%). Factors significantly associated with MSDs were as follows: male gender (OR = 3.06, 95% CI [1.19, 7.87]), severe stress (OR = 2.72, 95% CI [1.13, 6.54]), history of injuries (OR = 4.37, 95% CI [1.27, 15.11]), mopping posture (OR = 2.81, 95% CI [1.43, 5.50]) and task duration (OR = 1.90, 95% CI [1.01, 3.57] for 2–4 h and OR = 3.39, 95% CI [1.17, 9.86] for more than 4 h). Sick leave due to MSDs was associated with history of injuries, Thai nationality and having another part-time job. Originality/value – The study findings about MSDs in terms of prevalence and related factors contributed to limited pool of the knowledge among subcontracted hospital cleaners in Thailand and middle-income country settings. With growing popularity in outsourcing cleaning services among hospitals in these countries, the study findings could raise a concern and inform policymakers and hospital administrators the importance of the magnitude and risk factors for MSDs necessitating design of preventive strategies.

Private insurance is designed to provide more timely and cost-effective medical care. With the increase in healthcare deductibles, however, patients are delaying operative management of a variety of pathologies toward the end of the fiscal year with the hopes of having met their deductible. In this retrospective review, the authors assess the operative timing of common orthopedic upper extremity surgeries between publicly and privately insured patients at both university and physician-owned medical institutions. Objectives: Patients with private healthcare plans often defer nonemergent or elective procedures toward the end of the year once they have met their deductible. No previous studies have evaluated how insurance status and hospital setting may affect surgical timing for upper extremity procedures. Our study aimed to evaluate the influence of insurance and hospital setting on end-of-the-year surgical cases for elective carpometacarpal (CMC) arthroplasty, carpal tunnel, cubital tunnel, and trigger finger release, and nonelective distal radius fixation. Methods: Insurance provider and surgical dates were gathered from two institutions' electronic medical records (one university, one physician-owned hospital) for those undergoing CMC arthroplasty, carpal tunnel release, cubital tunnel release, trigger finger release, and distal radius fixation from January 2010 to December 2019. Dates were converted into corresponding fiscal quarters (Q1–Q4). Using the Poisson exact test, comparisons were made between the case volume rate of Q1–Q3 and Q4 for private insurance and then for public insurance. Results: Overall, case counts were greater in Q4 than the rest of the year at both institutions. There was a significantly greater proportion of privately insured patients undergoing hand and upper extremity surgery at the physician-owned hospital than the university center (physician owned: 69.7%, university: 50.3%; P < 0.001). Privately insured patients underwent CMC arthroplasty and carpal tunnel release at a significantly greater rate in Q4 compared with Q1–Q3 for both institutions. Publicly insured patients did not experience an increase in carpal tunnel releases during the same period at both institutions. Conclusions: Privately insured patients underwent elective CMC arthroplasty and carpal tunnel release procedures in Q4 at a significantly greater rate than publicly insured patients. This finding suggests private insurance status, and potentially deductibles, influence surgical decision making and timing. Further work is needed to evaluate the impact of deductibles on surgical planning and the financial and medical impact of delaying elective surgeries. [ABSTRACT FROM AUTHOR]

The Government of India has committed to educate 90,000 midwives functioning in midwifery-led care units (MLCUs) to care for women during labour and birth. There is a need to consider local circumstances in India, as there is no 'one size fits all' prescription for MLCUs. To explore contextual factors influencing the implementation of MLCUs across India. Data were collected through six focus group interviews with 16 nurses, midwives, public health experts and physicians, representing six national and international organisations supporting the Indian Government in its midwifery initiative. Transcribed interviews were analysed using content analysis. Four generic categories describe the contextual factors which influence the implementation of MLCUs in India: (i) Perceptions of the Nurse Practitioner in Midwifery and MLCUs and their acceptance, (ii) Reversing the medicalization of childbirth, (iii) Engagement with the community, and (iv) The need for legal frameworks and standards. Based on the identified contextual factors in this study, we recommend that in India and other similar contexts the following should be in place when designing and implementing MLCUs: legal frameworks to enable midwives to provide full scope of practice in line with the midwifery philosophy and informed by global standards; pre- and in-service training to optimize interdisciplinary teamwork and the knowledge and skills required for the implementation of the midwifery philosophy; midwifery leadership acknowledged as key to the planning and implementation of midwifery-led care at the MLCUs; and a demand among women created through effective midwifery-led care and advocacy messages. [ABSTRACT FROM AUTHOR]

Prior studies of associations between hospital location and outcomes for pediatric appendectomy have not adjusted for significant differences in patient and treatment patterns between settings. This was a cross-sectional analysis of pediatric appendectomies in the 2016 Kids’ Inpatient Database (KID). Weighted multiple linear and logistic regression models compared hospital location (urban or rural) and academic status against total admission cost (TAC), length of stay (LOS), and postoperative complications. Patients were stratified by laparoscopic (LA) or open (OA) appendectomy. Among 54,836 patients, 39,454 (73%) were performed at an urban academic center, 11,642 (21%) were performed at an urban non-academic center, and 3740 (7%) were performed at a rural center. LA was utilized for 49,011 (89%) of all 54,386 patients: 36,049 (91%) of 39,454 patients at urban academic hospitals, 10,191 (87%) of 11,642 patients at urban non-academic centers, and 2771 (74%) of 3740 patients at rural centers (p < 0.001). On adjusted analysis, urban academic centers were associated with an 18% decreased TAC (95% CI −0.193–−0.165; p < 0.001) despite an 11% increased LOS (95% CI 0.087–0.134; p < 0.001) compared to rural centers. Urban academic centers were associated with a decreased odds of complication among patients who underwent LA (OR 0.787, 95% CI 0.650–0.952) but not after OA. After adjusting for relevant patient and disease-related factors, urban academic centers were associated with lower costs despite longer lengths of stay compared to rural centers. Urban academic centers utilized LA more frequently and were associated with decreased odds of postoperative complications after LA.

Abstract Clinical pharmacists have been increasing their participation mainly through actions aimed at patient care, with international studies demonstrating favorable cost-benefit ratio from pharmacists interventions. However, there are few studies carried out in Brazil about the subject. This study aims to assess the economic impact of pharmaceutical interventions (PIs) in a hospital setting performed in October 2018. Each performed PI was registered and associated with the direct cost of drugs for economic impact analysis. A total of 185 PIs were evaluated, comprising 106 patients. The most intervened drugs were antibiotics, presenting the greatest economic impact, R$2,370. The total economic impact was R$2,578, mainly in the Pediatric Intensive Care Unit that represented R$1,701. Regarding the economic impact by PI as the “Suspension of drug without indication” saved R$1,360 while the “Inclusion of required drugs” cost R$807. It was estimated that the savings would be R$30,936 and, if PIs were performed at day zero, the savings would be R$79,728 per year. An average of 1.75 PI per patient was performed with an economic impact of R$14 per PI. Our results showed that clinical pharmacist’s role in the evaluation of pharmacotherapy is important for patients’ health and represents a positive economic impact.

Featured Application: Facilitating activity during the evening shift and reducing reliance on sitting as the major means of performing out-of-bed activity are possible avenues to increase overall physical activity among patients post-stroke in acute hospital settings. Early activity post-stroke reduces secondary complications and improves rehabilitation outcomes. This study aimed to describe the physical activities of stroke patients in an acute hospital setting, compare activity patterns between working shifts, and assess associations between activity and clinical status. Twenty-one patients (mean age 69.4 ± 33.4 years,13 men) admitted due to acute ischemic stroke wore activity monitors for two weeks or until discharge. During the morning and evening shifts, the activity monitor collected daily data on walking and body position. The study discovered that patients' overall activity levels were low and that activity was higher during morning shifts than evening shifts (sitting time: 185.31 ± 109.31 min and 91.8 ± 98.46 min, p = 0.002; number of steps: 58.3 ± 32.73 and 30.4 ± 17.6 steps, p < 0.001). Upright and sitting time increased in morning shifts (p = 0.002), while the number of steps increased in both morning and evening shifts (p = 0.002). In the evening shift, there was a fair (r = 0.28, p = 0.02) positive correlation between grip strength and the number of steps, such that patients with higher grip strength took more steps. In addition, there were poor (r = −0.2, p = 0.02) correlations between motor function (Trunk Control Test and Functional Ambulation Category) and time in an upright position, such that patients with lower functional ability sat longer. Clinical characteristics and level of activity did not show any other correlations. To conclude, the main out-of-bed activity of patients was sitting during morning shifts. The findings highlight the temporal differences in activity throughout the day, as well as the disconnect between clinical characteristics and activity levels. [ABSTRACT FROM AUTHOR]

Aim: To evaluate nurses' documented practice when communicating about pain for people with dementia in hospital. Design: Retrospective medical record review. Method: Medical records were retrieved from four inpatient units in a district and a tertiary teaching hospital of people aged 65 years and over with documented dementia. Data were extracted on nurses' documented pain assessment and management. Pain frequency and association between patient self‐report, pain scores, cognition levels and analgesics used during hospitalization were analysed using descriptive and inferential statistics. Multivariate regression examined patient characteristics, pain characteristics and length of hospital stay. Results: One‐hundred patient records met the inclusion criteria between 1 January and 31 August 2017. Sixty‐six percent of patients with dementia had pain documented at least once during hospitalization with 58% reported as moderate to severe pain intensity. Patients' pain severity during admission was associated with their length of hospital stay. Ninety‐three percent of nurses used a self‐reporting pain tool and 7% used an observational pain tool. Pain scores were not associated with patients' cognition level, nurses' pain reports or analgesic management. Conclusion: Pain frequently occurs in people with dementia during hospitalization. Fragmented pain reporting influences the translation of pain messages. Disproportionate pain tool application and non‐association between pain scores and analgesic management suggest a potential knowledge gap among nurses about the practical use of pain tools and practice gap between pain assessment and management in dementia care. Impact Pain was regularly assessed by nurses and implemented as a fifth vital sign for people with dementia in hospitals. However, the high frequency of pain affects care outcomes. Areas for improvement include nursing practice of pain assessment and management in dementia care in hospitals. Further understanding of the usefulness of pain tools and the efficacy of pain scores when communicating about pain in dementia care in hospitals is required. [ABSTRACT FROM AUTHOR]

[Display omitted] Compounded medicines are widely used, especially for pediatric patients. The aim of this study was to evaluate children's acceptability of compounded preparations and to provide information regarding compounding practices' characteristics in a Romanian hospital setting. An observational, cross-sectional, and retrospective study was conducted in three Clinical Pediatric Departments (Emergency Clinical Hospital for Children, Cluj-Napoca). The study population comprised patients under 18 years old taking at least one compounded medication. Study data was collected mainly through an interviewer-administered questionnaire and medicine acceptability was assessed based on the children's first reaction to the preparations using a 3-point facial hedonic scale. A total of 162 compounded medications were evaluated. A positive/negative reaction was reported for 20.83%/58.33%, 20.63%/49.21%, and 66.67%/7.41% of oral, oromucosal and cutaneous dosage forms. Although patient disapproval was recorded for various reasons, medication administration was successful in over 75% of cases. Factors such as fewer steps required for intake of a dose, capsule dosage form, no additional food/drink immediately after drug intake, medication perceived as "easy/very easy" to swallow, were correlated with a better acceptability of oral preparations. This study highlights the importance of identifying factors that can improve the acceptability of compounded preparations and, subsequently, treatment outcomes in pediatric patients. [ABSTRACT FROM AUTHOR]

• Studies show that terror events do not impact on the psychiatric emergency department. • It is unknown if larger events have a different effect on psychiatric visits. • After the 2023 attack on Israel, emergency department visits rose by 46 % from 2022. • In 2023, fewer patients had psychiatric history. • Major terror events significantly affect psychiatric emergency department utilization. In October 2023, Israel sustained a massive terror attack, with 1,300 people murdered, over 240 kidnapped, and millions exposed to the horrors. This study's aim is to examine the profile of patients arriving to the emergency department (ED) for psychiatric services during the month following the attack, compared to a similar period the year prior. In this cohort study, we compared patients arriving to the ED of a large general hospital in the center of Tel Aviv for psychiatric services during the month post-attack with the previous year using t -tests and chi-square exams. In 2023, 256 patients arrived in the ED for psychiatric evaluation and/or treatment, 46 % more than in 2022. Of these, 64 % were examined due to symptoms related to the terror attack. In 2023, significantly fewer patients had a prior psychiatric diagnosis (68% vs. 89 %). Significantly more patients were diagnosed with acute stress reaction or acute stress disorder in the ED, compared to almost no such diagnoses in 2022 (14 % and 43% vs. 0 % and 1 %). Major terror incidents profoundly influence psychiatric ED visits. Planning efforts for major emergencies should be adapted accordingly. [ABSTRACT FROM AUTHOR]

Indicating how community participation transfers to application within the nursing learning and working context. Preparing nurses to drive advances in health care requires the integration of working and learning. Learning communities are therefore recommended to connect students, educational programs and health care organizations. A multiple case study with three hospital learning communities was conducted during the 2019–2020 academic year, partly during the COVID-19 pandemic. The main data were collected by conducting three group interviews and 21 individual interviews with members. A hybrid thematic analysis approach was used. Seven themes originated from the analysis: learning community features, learning community preconditions, learning community needs, impetus, application, research context and meaningfulness. Individual members applied acquired knowledge, skills and attitudes later or in other situations. Depending on the case, collective application manifested as inventing, consulting or reusing, but this seemed less sustainable in the research context at the time. Application within the nursing learning and working context occurs and is sustained at the individual level even when there are no organized learning community sessions in times of crisis. Framing and facilitators' support can be used to encourage collective application. • Learning communities contribute to integrating learning and working. • Community involvement can prompt application in other moments or situations. • Acquired knowledge, skills, and attitudes are individually applied by members. • Collective application is reflected in inventing, consulting or reusing. • Transfer to application also occurred during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The aim of this study was to understand through Healthcare professionals' (HCPs) opinions the barriers and facilitators to implement MI in older hospitalized patients. A qualitative study with semi-structured interviews was performed among 23 HCPs involved in the medication management of older hospitalized patients (geriatricians, nurses, psychologists and pharmacists). A thematic analysis was conducted using a deductive approach through the Theoretical Domain Framework (TDF), and an inductive approach. The thematic analysis reported 25 factors influencing MI implementation, mapped into 8 TDF themes, and including 13 facilitators, 8 barriers, and 4 both. The main factors identified were: 'cognitive and sensory disorders' (barrier), 'having dedicated time and HCPs' (facilitator and barrier), and the 'HCP's awareness about MI' (facilitator). Ten factors were identified as specific to the older population. Implementing MI in a hospital setting with older patients presented both barriers and facilitators. To ensure successful MI implementation, it is important to take into account the older patients' context, the hospital environment, and the HCPs-related factors. • Barriers and facilitators for implementing motivational interviewing (MI) in older hospitalized patients were identified. • Healthcare professionals identified 25 factors influencing MI implementation, including 10 factors specific to older population. • This study provided recommendations for the MI implementation in the hospital setting and with an older population. • To enrich our findings about MI implementation, a complementary qualitative study should be conducted involving older hospitalized patients. • Factors influencing older patients motivation to take their medications were also identified. [ABSTRACT FROM AUTHOR]

Introduction: Interventions designed to improve safety culture in hospitals foster organisational environments that prevent patient safety events and support organisational and staff learning when events do occur. A safety culture supports the required health workforce behaviours and norms that enable safe patient care, and the well-being of patients and staff. The impact of safety culture interventions on staff perceptions of safety culture and patient outcomes has been established. To-date, however, there is no common understanding of what staff outcomes are associated with interventions to improve safety culture and what staff outcomes should be measured. Objectives: The study seeks to examine the effect of safety culture interventions on staff in hospital settings, globally. Methods and Analysis: A mixed methods systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches will be conducted using the electronic databases of MEDLINE, EMBASE, CINAHL, Health Business Elite, and Scopus. Returns will be screened in Covidence according to inclusion and exclusion criteria. The mixed-methods appraisal tool (MMAT) will be used as a quality assessment tool. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials and non-randomised studies of interventions will be employed to verify bias. Synthesis will follow the Joanna Briggs Institute methodological guidance for mixed methods reviews, which recommends a convergent approach to synthesis and integration. Discussion: This systematic review will contribute to the international evidence on how interventions to improve safety culture may support staff outcomes and how such interventions may be appropriately designed and implemented.

Older hospitalized patients with chronic kidney disease (CKD) are part of the geriatric population with a substantial risk of potentially inappropriate medication (PIM) use. The high rates of multimorbidity and polypharmacy, along with the progressive decline of eGFR, contribute to increasing the risk of drug–drug and drug–disease interactions, overdosing, and adverse drug reactions (ADRs). In this multicenter cross-sectional study, we aimed to evaluate the prevalence of CKD under-reporting and PIMs among older patients discharged from acute geriatric and nephrology units throughout Italy. Renal function was determined by estimated glomerular filtration rate (eGFR) through the Berlin Initiative Study (BIS) equation; the prevalence of PIMs was calculated by revising drug prescriptions at discharge according to STOPP criteria, Beers criteria, and summaries of product characteristics (smPCs). A descriptive analysis was performed to compare the clinical and pharmacological characteristics of patients in the two distinct settings; univariate and multivariate logistic regression models were performed to explore factors associated with CKD under-reporting in the discharge report forms and PIM prevalence. Overall, the study population consisted of 2,057 patients, aged 83 (77–89) years, more commonly women, with a median of seven (5–10) drugs prescribed at discharge. CKD under-reporting was present in 50.8% of the study population, with higher rates in geriatric vs. nephrology units (71.1% vs. 10.2%, p < 0.001). 18.5% of the study population was discharged with at least one renally inappropriate medication; factors associated with at least one contraindicated drug at discharge were the number of drugs (PR 1.09, 95% CI 1.14–1.19); atrial fibrillation (PR 1.35, 95% CI 1.01–1.81); diabetes (PR 1.61, 95% CI 1.21–2.13); being hospitalized in nephrology units (PR 1.62, 95% CI 1.14–2.31), CKD stage 3b (PR 2.35, 95% CI 1.34–4.13), and stage 4–5 (PR 14.01, 95% CI 7.36–26.72). Conversely, CKD under-reporting was not associated with the outcome. In summary, CKD under-reporting and inappropriate medication use were common in older patients discharged from hospital; the relatively high number of PIMs in both nephrology and geriatric settings underlines the need to improve appropriate prescribing during hospital stay and to decrease the risk of ADRs and side effects in this highly vulnerable population.

• The COVID-19 pandemic did not increase healthcare workers' hand hygiene compliance. • The automated hand hygiene system captured over 100,000 hand hygiene opportunities. • Studies are warranted to curb the challenges limiting hand hygiene compliance. Healthcare workers' (HCWs) adherence to hand hygiene is vital in combatting COVID-19 in hospitals. We aimed to investigate HCWs hand hygiene compliance before and during the COVID-19 pandemic and hypothesised that hand hygiene compliance would increase during the pandemic. We conducted a prospective observational study in three medical departments at the Regional Hospital of West Jutland, Denmark from April 2019 to August 2020. A total of 150 HCWs participated before the COVID-19 pandemic and 136 during the pandemic. Hand hygiene observations were assessed using an automated hand hygiene monitoring system. Students unpaired t-test was used to assess differences in hand hygiene compliance rates in each department. Comparison analyses showed, that hand hygiene compliance in department A and B was significantly higher before the COVID-19 pandemic than during the pandemic; a 7% difference in department A and a 5% difference in department B. For department C, the total hand hygiene compliance was unchanged during the pandemic compared to before. The COVID-19 pandemic did not raise hand hygiene compliance. Further studies are needed to verify these findings and further identify barriers to hand hygiene compliance among HCWs. [ABSTRACT FROM AUTHOR]

Abstract Background It is known that drug shortages represent a major challenge for all stakeholders involved in the process, but there is little evidence regarding insights into patients′ awareness and perspectives. This study aimed to investigate the patients-perceived drug shortages experience and their view on outcomes in different European hospital settings. Furthermore, we wanted to explore information preferences on drug shortages. Methods A retrospective, cross sectional, a mixed method study was conducted in six European hospital settings. One hospital (H) from each of this country agreed to participate: Bosnia and Herzegovina (H-BiH), Croatia (H-CR), Germany (H-GE), Greece (H-GR), Serbia (H-SE) and Poland (H-PO). Recruitment and data collection was conducted over 27 months from November 2017 until January 2020. Overall, we surveyed 607 patients which completed paper-based questionnaire. Questions related to: general information (demographic data), basic knowledge on drug shortages, drug shortages experienced during hospitalization and information preferences on drug shortage. Differences between hospital settings were analyzed using Chi-squared test or Fisher’s exact test. For more complex contingency tables, Monte Carlo simulations (N = 2000) were applied for Fisher’s test. Post-hoc hospital-wise analyses were performed using Fisher’s exact tests. False discovery rate was controlled using the Bonferroni method. Analyses were performed using R: a language and environment for statistical computing (v 3.6.3). Results 6 % of patients reported experiences with drug shortages while hospitalized which led to a deterioration of their health. The majority of affected patients were hospitalized at hematology and/or oncology wards in H-BiH, H-PO and H-GE. H-BiH had the highest number of affected patients (18.1 %, N = 19/105, p

Low levels of physical activity (PA) and sleep disruption are commonly seen in older adult inpatients and are associated with poor health outcomes. Wearable sensors allow for objective continuous monitoring; however, there is no consensus as to how wearable sensors should be implemented. This review aimed to provide an overview of the use of wearable sensors in older adult inpatient populations, including models used, body placement and outcome measures. Five databases were searched; 89 articles met inclusion criteria. We found that studies used heterogenous methods, including a variety of sensor models, placement and outcome measures. Most studies reported the use of only one sensor, with either the wrist or thigh being the preferred location in PA studies and the wrist for sleep outcomes. The reported PA measures can be mostly characterised as the frequency and duration of PA (Volume) with fewer measures relating to intensity (rate of magnitude) and pattern of activity (distribution per day/week). Sleep and circadian rhythm measures were reported less frequently with a limited number of studies providing both physical activity and sleep/circadian rhythm outcomes concurrently. This review provides recommendations for future research in older adult inpatient populations. With protocols of best practice, wearable sensors could facilitate the monitoring of inpatient recovery and provide measures to inform participant stratification and establish common objective endpoints across clinical trials.

Background The protected or restricted supply of certain antimicrobials such as linezolid, caspofungin, aztreonam, in the acute hospital setting is an important element of Antimicrobial Stewardship (AMS) programmes to address the growing problem of antimicrobial resistance. This process involves submitting an application for use to be reviewed typically by a Consultant Microbiologist, Infectious Disease Consultant or Antimicrobial Pharmacist. Aim To investigate healthcare professionals' knowledge, experiences, and attitudes towards the protected/restricted antimicrobials process in order to identify possible methods of optimisation and improvement. Method Semi-structured interviews with stakeholders involved in the protected/restricted antimicrobial prescribing, dispensing and administration process were conducted in September–October 2019 in a 350-bed voluntary, general, acute hospital in Ireland. Interviews were analysed by the Framework method and mapped to the Theoretical Domains Framework (TDF). Results Interviews were conducted with 8 Doctors, 4 Pharmacists and 3 Nurses. TDF domains identified included: 'Knowledge'; 'Social/professional role and identity'; 'Social influences'; 'Memory, attention and decision processes'; 'Beliefs about consequences'; 'Environmental contexts and resources'. The relationship between prescribers and the AMS Team was reported as a facilitator of the process, whereas the inconsistency of the filing and versions of forms on the wards were seen as challenges. Conclusion The results of this study have shown that the existing protected/restricted antimicrobial process is a multi-disciplinary effort with barriers that require attention in order to make future improvements. Standardization of the form across all wards, an electronic version of the form, and structured education around AMS were suggested to optimize the process. [ABSTRACT FROM AUTHOR]

Objectives: Severe cases of COVID-19 have overwhelmed hospital systems across the nation. This study aimed to describe the healthcare resource utilization of patients with COVID-19 from hospital visit to 30 days after discharge for inpatients and hospital-based outpatients in the United States.Methods: A retrospective cohort study was conducted using Premier Healthcare Database COVID-19 Special Release, a large geographically diverse all-payer hospital administrative database. Adult patients (age ≥ 18 years) were identified by their first, or "index," visit between April 1, 2020, and February 28, 2021, with a principal or secondary discharge diagnosis of COVID-19.Results: Of 1 454 780 adult patients with COVID-19, 33% (n = 481 216) were inpatients and 67% (n = 973 564) were outpatients. Among inpatients, mean age was 64.4 years and comorbidities were common. Most patients (80%) originated from home, 10% from another acute care facility, and 95% were admitted through the emergency department. Of these patients, 23% (n = 108 120) were admitted to intensive care unit and 14% (n = 66 706) died during index hospitalization; 44% were discharged home, 15% to nursing or rehabilitation facility, and 12% to home health. Among outpatients, mean age was 48.8 years, 44% were male, and 60% were emergency department outpatients (n = 586 537). During index outpatient visit, 79% were sent home but 10% had another outpatient visit and 4% were hospitalized within 30 days.Conclusions: COVID-19 is associated with high level of healthcare resource utilization and in-hospital mortality. More than one-third of inpatients required post hospital healthcare services. Such information may help healthcare providers better allocate resources for patients with COVID-19 during the pandemic. [ABSTRACT FROM AUTHOR]

Abstract Background Failure to thrive is a common reason for referral to paediatric services. Malnutrition or inadequate caloric intake is the most common cause, while organic form is unlikely in children who are asymptomatic and healthy on examination. By this study we evaluate the application of a cost-effective flow chart that helps the clinician in a hospital setting discern accurately organic and non-organic failure to thrive. Methods Conduct a prospective single-center study in children up to 2 years of age with growth faltering. The pediatricians used a practical flow chart, took the medical history, created a growth chart, performed clinical examinations, and requested blood test and consultations in a step by step approach. Results Among the 74 subjects included in the study, the diagnosis of organic failure to thrive was reached by 42%. Gastrointestinal and genetic diagnoses were the most frequent. Patients with organic failure to thrive had significantly lower gestational age and birth weight. Age at diagnosis and Z-score weight were lower in organic than in non-organic forms. Most patients with non-organic forms (88%) did not undergo in-depth blood test or specialist advice. Conclusion The flow chart we presented was accurate for diagnosing children with failure to thrive in a hospital setting and distinct organic and non-organic forms. It was cost-effective to avoid unnecessary blood test or consultations in most non-organic diagnoses.

Introduction: Malnutrition is considered to be a severe complication in hospitalized patients, which increases the length of hospital stay, treatment costs, and mortality. The present study aimed to evaluate neck circumference as a possible predictor of metabolic disorders in the hospital settings. Methods: This study was conducted on 300 hospitalized patients selected from the internal disease ward of Imam Reza Hospital in Tabriz, Iran. Data were recorded on their demographic characteristics, medical history, medication use, and anthropometric and biochemical parameters. Dietary supplementation use, nutritional support, and physical activity (PA) were also measured using the subjective global assessment tool, and neck circumference (NC) was measured by the researcher. Data analysis was performed in SPSS version 16.0. Results: In total, 61.8% of the male and 65.9% of the female patients had an NC of equal to or higher than normal. Chi-square was applied to assess the categorical variables, and one-way ANOVA was used for the continuous variables, indicating significant correlations between the NC and gender, body mass index, marital status, occupation status, PA, current nutritional status, and medical history such as diabetes mellitus (DM), hypertension (HTN), and renal disorders, as well as the use of some medications (p

Vegetarian diets can satisfy nutritional requirements and have lower environmental impacts than those containing meat. However, fruits and vegetables are wasted at higher rates than meat. Reducing both food waste (FW) and the environmental impacts associated with food production is an important sustainability goal. Therefore, the aim of this study was to examine potential tradeoffs between vegetarian meals' lower impacts but potentially higher FW compared to meat-containing meals. To examine this, seven consecutive days of plate FW data from Loma Linda University Medical Center (LLUMC) patients were collected and recorded from 471 meals. Mean total FW and associated greenhouse gas emissions (GHGE) were higher among meat-containing meals (293 g/plate, 604 g CO2-eq/plate) than vegetarian meals (259 g/plate, 357 g CO2-eq/plate) by 34 g (p = 0.05) and 240 g CO2-eq (p < 0.001), respectively. Statistically significant differences were observed in both FW and associated GHGE across major food categories, except fruit, when comparing vegetarian and meat-containing meals. Overall, vegetarian meals were preferable to meat-containing meals served at LLUMC both in terms of minimizing FW and lowering environmental impacts. Other institutions serving vegetarian meal options could expect similar advantages, especially in reduced GHGE due to the high CO2 embodied in meat. [ABSTRACT FROM AUTHOR]