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Patients with opioid use disorder (OUD) seek care in primary care settings where nurses support the provision of medication-assisted treatment. Office-based opioid treatment (OBOT) that includes buprenorphine hydrochloride administration under the supervision of a nurse for stabilization and maintenance therapy has the potential to improve outcomes for patients with OUD in primary care settings. However, the first step is to determine if OBOT nurses provide nurse-sensitive care, which consists of activities that have been shown to make a difference in patient outcomes. Content analysis of 368 nursing notes from 100 patients enrolled in an OBOT program in an urban hospital-based primary care clinic was conducted. Data were analyzed descriptively according to quantity and qualitatively according to the content. Entries indicative of care coordination and transition management were extracted. Seven content categories within care coordination were identified, including harm reduction, medication management, symptom management, communication between providers, promoting adherence, self-management goal setting, and patient education. Four areas within transition management were identified including supporting connections to resources, referrals for care, medication reconciliation, and communication with other facilities. Care coordination was documented more frequently than transition management. The presence of nurse-sensitive indicators provides evidence for and distinguishes the role of the nurse in OUD care.

Objective Recent World Health Organization (WHO) recommendations regarding uterotonics for the prevention of postpartum hemorrhage (PPH) state that carbetocin should be considered a first-line prophylactic agent for all births where its cost is comparable to other effective uterotonics. This study evaluated whether a room temperature stable formulation of carbetocin met this recommendation in a Canadian urban hospital setting. Methods A decision tree model was developed to assess the financial implications of replacing oxytocin with carbetocin as a first-line prophylactic agent for PPH prevention in a Greater Toronto Area (GTA) hospital. The analysis accounted for the mode of delivery, efficacies of carbetocin and oxytocin in PPH prevention, occurrence of PPH-related health outcomes, and health care resource costs for PPH interventions. Results This study found that a GTA hospital, with 3242 deliveries per year, could save over CAD $349 000 annually by switching to room temperature stable carbetocin for PPH prevention. Carbetocin was able to lower institution costs by reducing the use of health care resources for PPH management in low-risk and high-risk PPH patients. The cost-saving potential of carbetocin relative to oxytocin was largely attributed to its greater efficacy in preventing the consequences of PPH. Conclusion The use of room temperature stable carbetocin as a first-line prophylactic agent for PPH prevention meets WHO recommendations regarding uterotonics for PPH in a GTA hospital. The model from this study can be used to determine the financial impact of switching from oxytocin to carbetocin in other jurisdictions while diversifying a hospital's pool of PPH prophylactic agents.

Background Falls are the leading cause of traumatic injury in older adults. Multidisciplinary approaches between trauma surgeons and primary care providers can powerfully advocate for fall prevention. This study explores current fall prevention practices and barriers to falls screening and prevention in the primary care setting and proposes pertinent recommendations to address the deficiencies. Methods A questionnaire was adapted from a previous survey study to explore the beliefs, knowledge, attitudes, and clinical practice regarding falls by primary care providers. The questionnaire was distributed by e-mail to primary care providers at a tertiary urban medical center. Results The survey achieved a response rate of 58%. All respondents agreed that older adult patients should be assessed for fall risks and that evidence-based fall prevention programs can reduce the risk of falls. However, 43% of respondents did not agree that they had the expertise to perform fall risk assessments, and similarly 43% did not agree they have the time to perform fall risk assessments in the office. Furthermore, although 52% of respondents were aware of the Medicare reimbursement for fall risk screening, only 24% had billed for fall risk screening and only 5% agreed that they were adequately reimbursed. Conclusion Several barriers to performing fall prevention care in the primary care setting were identified: unfamiliarity with resources, perceived lack of time, and perceived insufficient reimbursement. We implemented a set of interventions which include an educational series and workflow optimization to overcome barriers identified.

Standard manual cleaning and disinfection practices are often inadequate. Persistent contamination in the environment poses an infection risk that may be mitigated by no-touch disinfection systems. This study evaluates the efficacy of dry hydrogen peroxide (DHP) on microbial air and surface contamination as an adjunct to routine cleaning and disinfection in a large urban hospital.Surface samples were collected in five different hospital units, two pediatric and three adult, after manual cleaning on multiple days before and after DHP implementation. Air samples were also collected in each unit pre- and post-DHP use. Data outcomes were reported as colony forming units (CFU) with species identification.The overall mean surface microbial burden was reduced by 96.5 percent for all units post-DHP compared to baseline (P0.001), with the greatest reductions achieved on privacy curtains (99.5 %). Mean microbial air sample counts were also reduced post-DHP compared to pre-DHP.This study demonstrates that DHP was effective in reducing both air and surface microbial contamination in a variety of settings within a large, tertiary care hospital.

We investigated the secular trends of the incidence and hospitalization cost of hip fracture in Tangshan, China. The incidence of hip fracture and the hospitalization cost were both increasing during the observation period. The present study aimed to determine sex-, age-, and fracture type-specific incidence and annual changes in hip fractures in Tangshan, China, between 2007 and 2018. We analyzed annual hip fracture incidence using urban hospital data during 2007–2018 and calculated incidence rate/100,000 person years in each age group and sex. We assessed annual changes in incidence among people aged >60 years using linear-by-linear association tests and evaluated hospitalization costs with the Kruskal–Wallis test. During the study period, we observed an increasing proportion of hip fractures in people >60 years old from 14.2 to 22.79%. Crude hip fracture incidence increased markedly from 140.87 to 306.56/100,000 in women (p 60 years. Type-specific analysis indicated significantly increased trends in incidence of cervical and trochanteric fractures among women and cervical fracture among men (p < 0.01). In people aged 36–60 years, the trend of hip fracture increased significantly in both sexes. The total and cervical-to-trochanteric ratio in men increased, with significant upward trends (p < 0.01). The proportion of cervical fracture was higher than that for trochanteric fracture in women, with stable levels from 2007 to 2018. Hospitalization costs for cervical and trochanteric fractures increased by 51.91% and 53.20%, respectively, during 2011–2018. Tangshan will have an increasing burden on health care resources attributable to a considerable rise in hip fracture incidence and the older population. Further investigation of risk factors and subsequent implementation of effective measures to prevent hip fracture are needed.

There is conflicting literature suggesting that intra-articular corticosteroid injections before total knee arthroplasty (TKA) may lead to an increase in the rate of postoperative complications, specifically periprosthetic joint infection (PJI). Thus, this retrospective review of all TKAs performed at a large, urban hospital will add valuable evidence to help guide future patient care. After exclusion criteria, we retrospectively reviewed 417 patients who received a TKA from a group of fellowship-trained orthopaedic surgeons between 2009 and 2016 at a single academic medical center. Minimum follow-up time was 1 year. Patients were separated into two groups: those who received a preoperative intra-articular corticosteroid injection and those who did not receive an injection. Subgroups were created based on the timing of their most recent preoperative injection: 0 to 3 months, 3 to 6 months, 6 to 12 months, 12+ months, and an unknown time period. Postoperative outcomes for PJI, revision TKA, and manipulation under anesthesia (MUA) were analyzed via a Chi-square test. No statistically significant postoperative differences were observed between groups: PJI (p = 0.904), revision TKA (p = 0.206), and MUA (p = 0.163). The temporal subgroups also failed to demonstrate a statistically significant result: PJI (p = 0.348), revision TKA (p = 0.701), and MUA (p = 0.512). This study revealed no absolute or temporal association between preoperative, intra-articular corticosteroid injections, and complications after TKA. Because these injections are a commonly used treatment modality prior to TKA, further studies should be conducted on a nationwide basis to draw more concrete conclusions.

Revisit intention is a very important topic in a marketing context. However, previous literature is still rarely linked together with trust, satisfaction and two types of service, namely medical and non-medical with the hospital as the subject. Hospitals have the task of providing complete individual health services. This study aims to analyze the relationship between the quality of medical services and the quality of non-medical services on satisfaction, trust and revisit intention on the sub-urban hospitals. This research is a quantitative study using primary data from distributing questionnaires to 250 patients of the sub-urban hospitals. The data in this study were analyzed using the SEM (Structural Equation Model) method with AMOS 24 software. The results of this study indicate that the quality of medical services and the quality of non-medical services have a positive and significant effect on satisfaction. Meanwhile, patient satisfaction has a positive and significant effect on trust and revisit intention. However, trust was found to have a positive but insignificant effect on revisit intention. This research recommends several implications to the management of sub-urban hospitals. The managers of the sub-urban hospital are advised to pay more attention to and emphasize medical services, non-medical services, and patient satisfaction because it has been empirically proven to increase Revisit Intention

Peripheral artery disease (PAD) potentially affects health-related Quality of Life, Disability Adjusted Life Years (DALYs) and is a strong prognostic marker for future cardiovascular events in elderly population. PAD commonly affects the elderly but may go undiagnosed in them, probably due to the presence of other morbidities like osteoarthritis and associated muscle spasm. Aim. The aim of this study was to determine the predictors of PAD in elderly by evaluating the socio-demographic and clinical characteristics in elderly patients. Methods. A cross sectional hospital based study was carried out among 370 patients aged 60 years and above attending a Tertiary Hospital from September to November 2017. A systematic random sampling technique was utilized. A structured questionnaire was administered to collect data on socio-demographic characteristics, lifestyle variables, and medical history. The Ankle Brachial Index (ABI) was used to assess for PAD. Analysis was done using Chi-square test and logistic regression. Results. The mean age was 69.3±7 years comprising of 76.5% females, 50% of the respondents were married while 47% were widowed. After adjusting for other variables, the result of the multi-logistic regression indicated that only patients with abnormal pedal pulse were more likely to present with PAD than those with normal pedal pulse (OR=10.634, 95% CI=2.4-47.121, p=0.002). Conclusion. The study reveals that abnormal pedal pulses were significant predictors of PAD, therefore it is recommended that regular screening (clinical foot examination and ABI) should be done for elderly to achieve early detection of PAD and facilitate prompt treatment.

Medically underserved patients experience significant barriers to affordable acute care. This brief report describes an innovative urban hospital-affiliated federally qualified health center urgent care clinic that successfully meets a medically underserved population's need for accessible, appropriate, and affordable acute care.

Background This study investigates the impact of standing electric scooter-related injuries within an entire integrated hospital system. Methods We performed a retrospective review of patients involved in standing electric scooter incidents presenting throughout an urban hospital network over a 10 month period. Rates of Google searches of scooter-related terms performed locally were used as a surrogate for ride frequency. Injury, mechanism, and cost data were analyzed. Results Data on 248 patients were reviewed. Twenty-three (9%) were under 18 years old. Loss of balance was the most common cause of injury accounting for nearly half, while tripping over a scooter 14 (6%) affected the elderly disproportionately. Eight (3%) riders wore helmets. All TBI and closed head injuries occurred in unhelmeted patients. Most incidents occurred in the street, only one in a bicycle lane. Facilities costs were greater for patients under the influence of alcohol and marijuana. Conclusion Policies related to the use of mandated safety equipment, dedicated bicycle lanes, and the proper storage of empty vehicles should be further investigated.

Background: Children Emergency Room (CHER) is a vital health care services point in many hospitals and can contribute beneficially in the evaluation of many hospitals ncluding tertiary ones. It enables many paediatric cases to be managed in the hospitals without being admitted into the paediatric wards with good outcomes. Material and Methods: This was a retrospective study involving review of records of all the children seen in the CHER between January 2012 and June 2012. The objectives were to look at the pattern and outcome of paediatric conditions in CHER with the aim of providing data for further evaluation and improvement. A proforma developed by the authors was used in collecting the relevant information from the patients’ records. The data collected was simply analyzed. Results: The total of 486 paediatric patients who satisfied the inclusion and exclusion criteria were seen in the CHER. Those less then one year of age constituted 58.6% of the patients. Majority (56.8%) of the patients were males. Also 52.9% of the patients lived in the rural areas. There was preponderance (96.7%) of medical conditions. Majority of both the males (78.6%) and females (72.4%) were discharged. Only 6.17% of the patients died while 15.6% were admitted into the wards. Conclusion: There was a preponderance of varieties of medical conditions in our environment with infections constituting the majority with resultant relative high mortality. Thus improvement in the uptake of the different childhood survival strategies including immunization and breast feeding will help in minimizing these problems.

The influence of patient-level factors on palliative and hospice care is unclear. We conducted a retrospective review of 2321 patients aged ≥18 that died within 6 months of admission to our institution between 2012 and 2017. Patients were included for analysis if their chart was complete, their length of stay was ≥48 hours, and if based on their diagnoses, they would have benefited from palliative care consultation (PCC). Bayesian regression with a weakly informative prior was used to find the odds ratio (OR) and 99% credible interval (CrI) of receiving PCC based on race/ethnicity, education, language, insurance status, and income. 730 patients fit our inclusion criteria and 30% (n = 211) received PCC. The OR of receiving PCC was 1.26 (99% CrI, 0.73-2.12) for Blacks, 0.81 (99% CrI, 0.31-1.86) for Hispanics, and 0.69 (99% CrI, 0.19-2.46) for other minorities. Less than high school education was associated with greater odds of PCC (OR 2.28, 99% CrI, 1.09-4.93) compared to no schooling. Compared to English speakers, non-English speakers had higher odds of receiving PCC when cared for by medical services (OR 3.01 [99% CrI, 1.44-5.32]) but lower odds of PCC when cared for by surgical services (0.22 [99% CrI

Les sujets en état de pré-diabète sont exposés à un risque élevé de diabète et de dyslipidémies. La présente étude avait eu pour but de mesurer la prévalence du pré-diabète et du diabète chez des sujets reçus à l’hôpital, puis de déterminer le profil lipidique des pré-diabétiques. Il s’est agi d’une étude rétrospective à visée descriptive, portant sur 3538 patients âgés de 3 à 120 ans, reçus en 2013 au Centre Hospitalier Universitaire nommé Campus. La glycémie, la cholestérolémie totale, la HDL-Cholestérolémie, et la triglycéridémie ont été dosées sur l’automate SELECTRA PRO M. La non-HDL- Cholestérolémie a été calculée. La prévalence du pré-diabète a été déterminée suivant les critères de l’Organisation Mondiale de la Santé (OMS) et du « American Diabetes Association » (ADA). La prévalence du pré-diabète suivant les critères de l’OMS était de 8,1% contre 21,5% selon les critères de l’ADA. La prévalence du diabète était de 12,9%. Elle était de 15,3% chez les sujets âgés de 45 à 59 ans. Au sein de la population pré-diabétique 42,3 à 45,6% avaient des dyslipidémies. La prévalence du pré-diabète à l’hôpital était importante. Une prise en charge de ce dernier permettrait de prévenir le diabète de type 2 et réduire les risques de dyslipidémies. Mots clés : Glycémie, dyslipidémies, pré-diabétiques, Togo. English Title: Prevalence of pre-diabetes and diabetes with evaluated lipid profile, in urban hospital: retrospective study on 3538 patients seen at the Lomé campus university hospital. People with pre-diabetes are at high risk for diabetes and dyslipidemia. The aim of the present study was to measure the prevalence of pre-diabetes and diabetes in hospital patients, and then to determine the lipid profile of pre-diabetics. It was a retrospective descriptive study, involving 3538 patients aged 3 to 120 years, received in 2013 at the University Hospital Center called Campus. Blood glucose, total cholesterol, HDL-Cholesterolemia, and triglyceridemia were measured on the SELECTRA PRO M automatic analyzer. Non-HDL-Cholesterolemia was calculated. The prevalence of pre-diabetes was determined according to the criteria of the World Health Organization (WHO) and the "American Diabetes Association" (ADA). The prevalence of pre-diabetes according to WHO criteria was 8.1% compared to 21.5% according to ADA criteria. The prevalence of diabetes was 12.9%. It was 15.3% in subjects aged 45 to 59 years. In the pre-diabetic population 42.3 to 45.6% had dyslipidemia. The prevalence of pre-diabetes in hospital was high. Management of the latter would prevent type 2 diabetes and reduce the risk of dyslipidemia. Keywords: Glycemia, dyslipidemia, pre-diabetics, Togo.

Introduction The Centers for Disease Control and Prevention recommend considering screening asymptomatic women for trichomonas in high-prevalence settings. Whether urban abortion clinics constitute such a setting is unknown. Material and Methods We offered trichomonas screening to patients presenting for abortion from October 2018 to February 2019 as a practice improvement and conducted a chart review. Results Ninety-two percent (593/644) of patients underwent testing. Trichomonas prevalence was 10.0% (95% CI 7.7−12.6). Ninety five percent of patients diagnosed were treated. Testing only symptomatic patients would have missed 98% of infections. Conclusions Trichomonas was highly prevalent, and universal testing and treatment was feasible in an urban abortion clinic.

Background: Patients hospitalized with Parkinson’s disease (PD) require timely delivery of carbidopa-levodopa (C/L) medication. Ill-timed administration of C/L doses is associated with greater morbidity and longer lengths of stay. Objective: To understand the barriers to timely C/L administration, and implement strategies to improve the administration of the drug to hospitalized PD patients. Methods: Several key strategies were employed in 2015 to improve the timely delivery of C/L doses: 1. three kinds of nursing alert in the electronic medical record (EMR); 2. staff in-service education; 3. stocking immediate-release C/L into automated medication dispensing machines on key hospital units; 4. reports to nurse unit managers on timeliness of C/L administration; and 5. reconciliation of inpatient and outpatient levodopa orders by the hospital pharmacist upon admission. The primary outcome was the percent of C/L doses administered within 60, 30, and 15 minutes of scheduled time. Results: Our urban hospital, affiliated with a Parkinson’s Foundation Center of Excellence, had 5,939 C/L administrations in 2018. There was sustained improvement in timely delivery of doses, from 89.3% in 2012 to 96.5% in 2018 (within 60 minutes of the scheduled time), 65.5% to 86.4% (30 minutes), and 42.3% to 71.1% (15 minutes) (all p

Among the global Indigenous population, concepts of health and healthy living are wholistically intertwined within social, physical, natural, and spiritual systems. On-going processes of colonization and experiences of environmental dispossession have had the effect of removing Indigenous peoples from the lands, people and knowledge systems that have traditionally promoted their health. In 2014, Big-Canoe and Richmond introduced the idea of environmental repossession. This concept refers to the social, economic, and cultural processes Indigenous people are engaging in to reconnect with their traditional lands and territories, the wider goal being to assert their rights as Indigenous people and to improve their health and well-being. As Indigenous mothers, both who live in urban centres “away” from our families and traditional lands and knowledge systems, we engage with this conceptual model as a hopeful way to reimagine relationships to land, family, and knowledge. We embrace the concept of environmental repossession, and its key elements – land, social relationships, Indigenous knowledge – as a framework for promoting health and healing spaces among those who live “away” from their traditional territory. Drawing on three examples, an urban hospital, a university food and medicine garden, and a men’s prison, we suggest that these spaces do indeed offer important structural proxies for land, social relationships, and Indigenous knowledge, and can be important healing spaces. With increasingly urbanizing Indigenous populations in Canada, and around the world, these findings are important for the development of healing places for Indigenous peoples, regardless of where they live.

BACKGROUND As the rate of opioid use in pregnancy escalates, there are a growing number of women diagnosed with opioid use disorder (OUD) and their newborns being cared for in inpatient settings. PURPOSE In this study, we sought to better understand the experiences of nurses and nursing assistants working with women diagnosed with OUD and their newborns. By identifying the needs of nurses and nursing assistants, the findings from this study may contribute to reductions in stigma and improved patient care. METHODS Nurses and nursing assistants were recruited from a postpartum unit at a large urban hospital in Utah. Participants (n = 30) attended up to 4 semistructured focus groups. We utilized Braun and Clarke's 6-phase approach to thematic analysis to analyze transcribed interviews. FINDINGS/RESULTS Themes identified during the data analysis process included negative feelings and reactions toward patients; preferential concern for the newborn over maternal well-being; and identification of organizational and training needs to overcome these challenges. IMPLICATIONS FOR PRACTICE These findings identify strategies for addressing challenges faced by nurses and nursing assistants in caring for women diagnosed with OUD and their newborns. IMPLICATIONS FOR RESEARCH Future research should examine the effectiveness of approaches to reduce behaviors influenced by stigma among nurses and nursing assistants working with women diagnosed with OUD and their newborns, as well as employee and patient satisfaction, and long-term health outcomes.

We administered a questionnaire survey to assess the available clinical resources for the diagnosis and treatment of breast cancer and identify the issues faced by rural hospitals in the Tohoku region in Japan. The term rural hospital was defined by the following three criteria: the facility is a certified regional cancer center and hospital, no breast specialist is on staff, and ≥ 10 breast surgeries per year have been performed. Thirty-eight rural hospitals were eligible, and each was sent a self-administered questionnaire consisting of 26 questions by mail. Responses were received from 29 of the 38 hospitals. Most of the hospitals had adequate facilities for diagnosis and treatment, but they needed specialists’ support for ≥ 2 days per month. Approximately half of the hospitals indicated that applying resources for diagnosis and treatment of breast cancer, especially during planning of treatment and management of advanced breast cancer patients, was a burden. Interestingly, the hospitals felt that being able to provide treatment to their patients was more ideal rather than referring them to urban hospital like the prefectural cancer center and hospital providing specialized cancer treatment. The surveyed rural hospitals needed practical and knowledge-based support from specialists. Unfortunately, the number of specialists is currently insufficient in Tohoku. Increased number of certified physicians, clinical pathways for sharing patient’s information and updated knowledge, and information and communication technology for treatment with specialists’ intervention in rural hospitals may solve issues in Tohoku.

OBJECTIVES The aims of this study were to determine and improve accuracy of the Broselow Tape (BT) in estimating children's weight by adding body habitus parameters. METHODS This cross-sectional study was conducted in an urban hospital pediatric clinic. Children up to 8 years old coming in for well-child visit were included. Children with acute illness or presence of any chronic condition potentially resulting in growth disturbance and out of BT height range were excluded. The following body habitus parameters were measured using the Centers for Disease Control and Prevention guidelines: actual weight, predicted weight using BT (BTW), mid-thigh circumference (MTC), body mass index, mid-arm circumference, and waist-to-hip ratio. RESULTS A total of 301 children were enrolled. Of these, 151 were male (50%). Hispanics constituted 160 (53.2%). There was a positive linear association between BTW and actual weight in the overall cohort (adjusted R = 0.9164, P < 0.001). However, there was a difference in this association among children younger than 2 years and children older than 2 years (adjusted R = 0.89 vs 0.4841). Incorporating MTC and/or waist circumference along with BTW in the model increased the accuracy, providing a better estimate of actual weight (adjusted R = 0.94, P < 0.001). CONCLUSIONS We conclude that there might be inaccuracies in the weight predicted by BT in our patient population, especially those weighing more than 15 kg and older than 2 years. Our study also demonstrates that MTC correlates closely with the actual weight and could be used in addition to BT for more accurate weight estimation.

Knowing the distinctive features of patients with the highest utilization of the emergency department (ED) is paramount to finding adequate alternatives to ED care for selected patients and improving health care quality and efficiency.This study aimed to identify ED high-frequency users and compare their clinical and utilization characteristics with other ED users.Secondary data analysis of ED visits and patients database from a Portuguese public urban hospital. Retrospective study of adults visiting the ED in 2016 (61,403 patients; 95,643 visits), comparing demographic and clinical characteristics of patients and clinical and temporal characteristics of ED visits between high-frequency users (10 ED visits in 2016) and frequent (4-10 ED visits) and nonfrequent (1-3 ED visits) users.We identified 169 high-frequency users (0.3% of patients and 3.0% of ED visits) with an average number of 16.9 visits in 2016. Patients in this group were older (61.8 years; frequent users: 61.2 years; nonfrequent users: 53.4 years; p 0.01) and required immediate and mental health care more frequently (18.6% of high-frequency users, 17.4% of frequent users, 13.5% of nonfrequent users, and 6.6%; 3.3%, 2.3%; p 0.01). High-frequency users also used the ED for nonurgent reasons more than remaining groups (6.1%, 3.5%, 3.1%; p 0.01).High-frequency users are an aged and heterogeneous group, requiring tailored interventions to improve care.

The current quality improvement study aimed to determine hearing loss (HL) prevalence in older adult patients in a large urban hospital, and the success of current processes to identify its presence during routine admission procedures. Predictors of HL were also evaluated, with the goal of identifying risk factors that might help staff anticipate patient communication challenges. A sample of 162 newly admitted patients, age 70 and older, participated in a hearing/communication assessment that included audiometry and an informal self-report measure about hearing difficulty. Chart review was conducted to assess whether patients with confirmed hearing/communication deficits had been identified as such during the admission or nursing assessments. Results revealed a high prevalence of HL (72.8%) and relatively low sensitivity of routine admission procedures in identifying this communication deficit (14.4% to 43.2%). Age and male gender were found to be predictors of HL. The invisibility of HL poses a challenge to nurses in recognizing when older adult patients are at risk for communication breakdowns. Communication breakdowns associated with HL can potentially impact patients' adherence to treatment plans. [ Journal of Gerontological Nursing, 46 (6), 34–42.]

Background Vital signs are routinely measured from patients presenting to the emergency department (ED), but how they predict clinical outcomes like hospitalization is unclear. Objectives To evaluate how pulse, respiratory rate, temperature, and mean arterial pressure (MAP) at ED presentation predicted probability of hospitalization, transfer to another center, or death in the ED (as a composite outcome) vs. other ED dispositions (discharged, eloped, and sent to observation or labor and delivery), and to assess the performance of different modeling strategies, specifically, models including flexible forms of vital signs (as restricted cubic splines) vs. linear forms (untransformed numeric variables) vs. binary transformations (vital signs values categorized simply as normal or abnormal). Methods We analyzed the data of 12,660 adults presenting for medical illnesses to the ED at the University of California, San Francisco Medical Center, San Francisco, California, throughout 2014. We used flexible forms of vital signs data at presentation (pulse, temperature, respiratory rate, and MAP) to predict ED disposition (admitted, transferred, or died, vs. other ED dispositions) and to guide binary transformation of vital signs. We compared performance of models including vital signs as flexible terms, binary transformations, or linear terms. Results A model including flexible forms of vital signs and age to predict the outcome had good calibration and moderate discrimination (C-statistic = 71.2, 95% confidence interval [CI] 70.0–72.4). Binary transformation of vital signs had minimal impact on performance (C-statistic = 71.3, 95% CI 70.2–72.5). A model with linear forms was less calibrated and had slightly reduced discrimination (C-statistic = 70.3, 95% CI 69.1–71.5). Conclusions Findings suggest that flexible modeling of vital signs may better reflect their association with clinical outcomes. Future studies to evaluate how vital signs could assist clinical decision-making in acute care settings are suggested.

Objective Pregnant African American women living in low-income urban communities have high rates of trauma exposure and elevated risk for the development of trauma-related disorders, including posttraumatic stress disorder (PTSD) and depression. Yet, engagement in behavioral health services is lower for African American women than Caucasian women. Limited attention has been given to identifying trauma exposure and PTSD, especially within at-risk communities. The present study examined rates of trauma exposure, PTSD, depression, and behavioral health treatment engagement in an obstetrics/gynecology (OB/GYN) clinic within an urban hospital. Method The study included 633 pregnant African American women screened within the OB/GYN clinic waiting room; 55 of the women also participated in a subsequent detailed clinical assessment based on eligibility for a separate study of intergenerational risk for trauma and PTSD in African American mother-child dyads. Results Overall, 98% reported trauma exposure, approximately one third met criteria for probable current PTSD, and one third endorsed moderate-or-severe depression based on self-report measures. Similar levels were found based on clinical assessments in the subsample. While 18% endorsed depression treatment, only 6% received treatment for PTSD. In a subsample of women with whom chart reviews were conducted (n = 358), 15% endorsed a past psychiatric diagnosis but none shared their PTSD diagnosis with their OB/GYN provider. Conclusion Results of the current study highlight elevated levels of trauma exposure, PTSD, and depression in low-income, African American pregnant women served by this urban clinic, and demonstrate the need for better identification of trauma-related disorders and appropriate linkage to culturally responsive care especially for PTSD. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

espanolObjetivo. Analizar la adecuacion de las prescripciones de antibioticos de categoria especial (ATB de CE) en el Servicio de Urgencias Hospitalario (SUH) de un centro urbano de tercer nivel. Material y metodos. Se selecciono una muestra aleatoria de 100 pacientes diferentes a los que se les inicio un ATB de CE en Urgencias durante el ano 2018. El equipo investigador reviso la historia clinica del episodio de urgencias y de ingreso. Se determino mediante regresion logistica los factores independientes asociados con el grado de adecuacion del tratamiento. Resultados. Se analizaron 97 prescripciones de las cuales 66 (68%) cumplian los criterios de prescripcion adecuada. El grado de adecuacion fue del 70% si la infeccion estaba relacionada con la asistencia sanitaria y del 75% si el paciente tenia factores de riesgo de infeccion por microorganismos multirresistentes (MMR). El porcentaje de adecuacion fue mayor en los casos en los que se especifico el foco de la infeccion (72%) y la gravedad del episodio (73%). Las variables independientes que se asociaron a una prescripcion adecuada fueron: la presencia de factores de riesgo de infeccion por MMR (OR: 2,35 IC 95%: 1,65 – 3,17 p: 0,01), el especificar el foco de la infeccion (OR: 3,79 IC 95%: 1,72 – 4,22 p: 0,02) y senalar la gravedad del episodio (OR: 3,09 IC 95%: 1,12 – 3,09 p: 0,03). Conclusiones. La prescripcion de los ATB de CE en el SUH es adecuada en la medida que se tenga en cuenta el ambito de adquisicion de la infeccion, los factores de riesgo de MMR, el foco de infeccion y la gravedad del cuadro clinico. EnglishObjective. The aim of the study was to analyze the adequacy of the special category antibiotics prescriptions in the Emergency Department (ED) of a third level urban Hospital. Material and methods. A random sample of 100 different patients who were started with a special category antibiotic along 2018 in the ED was selected. The research team reviewed the medical history of the emergency and admission episode. The independent factors associated with the degree of adequacy of the treatment were determined by logistic regression. Results. A total of 97 prescriptions were analyzed of which 66 (68%) met the criteria of adequate prescription, 23 (24%) adequate prescription, but with equally recommended alternatives and 8 (8%) were inappropriate prescriptions. The degree of adequacy was 70% if the infection was related to healthcare and 75% if the patient had risk factors for multiresistant (MR) microorganisms’ infection. The percentage of adequacy was higher in the cases in which the focus of the infection (72%) and the severity of the episode (73%) were specified. The independent variables that were associated with an adequate prescription were: the presence of risk factors for MR microorganisms’ infection (OR: 2.35 95% CI: 1.65 - 3.17 p: 0.01), if the focus of the infection (OR: 3.79 95% CI: 1.72 - 4.22 p: 0.02) and the severity of the episode (OR: 3.09 95% CI: 1.12 - 3.09 p: 0.03) were specified. Conclusions. The prescription of special category antibiotics in ED is appropriate if the clinical guidelines are followed and if the setting of infection acquisition, the risk factors of MR microorganisms, the focus and the severity of infection are taken into account in clinical picture.

Background In urbanized, low-income cities with high rates of congestion, delivery of antiepileptic drugs (AEDs) by unmanned aerial vehicles (drones) to people with epilepsy for both emergency and non-urgent distribution may prove beneficial. Methods Conakry is the capital of the Republic of Guinea, a low-income sub-Saharan African country (2018 per capita gross national income US$830). We computed the number of drones and delivery times to distribute AEDs from a main urban hospital to 27 pre-identified gas stations, mosques and pharmacies and compared these to the delivery times of a personal vehicle. Results We predict that a single drone could serve all pre-identified delivery locations in Conakry within a 20.4-h period. In an emergency case of status epilepticus, 8, 20 and 24 of the 27 pre-identified destinations can be reached from the hub within 5, 10 and 15 min, respectively. Compared with the use of a personal vehicle, the response time for a drone is reduced by an average of 78.8% across all times of the day. Conclusions Drones can dramatically reduce the response time for both emergency and routine delivery of lifesaving medicines. We discuss the advantages and disadvantages of such a drone delivery model with relevance to epilepsy. However, the commissioning of a trial of drones for drug delivery in related diseases and geographies is justified.

Absztrakt: Bevezetés: A gyógynövények alkalmazása egyre szélesebb körben terjed világszerte, használatuk során azonban számos gyógyszer-interakcióval, mellékhatással kell számolni. Magyarországon még nem végeztek vegyes műtéti profilú beteganyagon gyógynövények alkalmazásával kapcsolatos vizsgálatot. Célkitűzés: Vizsgálatunk célja az volt, hogy felmérjük egy városi kórház és egy egyetemi klinika betegei között a leggyakrabban használt gyógynövények fajtáit, alkalmazási gyakoriságukat és ennek hajlamosító tényezőit. Módszer: Anonim, kérdőíves felmérést végeztünk két helyen: a Jávorszky Ödön Kórházban és a Semmelweis Egyetem I. Sz. Sebészeti Klinikáján. Összesen ezer kérdőívet osztottunk ki, melyből 612 kérdőív került feldolgozásra leíró statisztikai elemzéssel, χ2-próbával és Fisher-féle egzakt teszttel. Eredmények: A válaszadók 34,3%-a használt már valaha gyógynövényt, 19,6%-uk a műtét előtti két hétben. A legnépszerűbb gyógynövény az élettartam-prevalenciát tekintve a fokhagyma, a kamilla és a citromfű volt, míg a műtét előtti kéthetes időintervallumban a fokhagyma, a gyömbér és a csipkebogyó. A felmérésben szereplők 58,5%-a szenvedett valamilyen társbetegségben, melyek közül a daganatos betegségek, gastrooesophagealis reflux és endokrin betegség esetén a gyógynövény-felhasználás szignifikánsan gyakoribb volt. A betegek 64,4%-a általános sebészeti beavatkozásra várt, köztük a gyógynövény-felhasználás népszerűbb. A szociodemográfiai tényezőket vizsgálva elmondható, hogy a gyógynövények alkalmazására hajlamosít a női nem, a magas iskolázottság, a 60 év feletti életkor és a fővárosi környezet. Következtetés: Vizsgálatunk alapján az elektív műtétre váró betegek harmada használt gyógynövénykészítményeket, ötödük a műtétet megelőző két hétben. Alkalmazásuk gyakoribb a női nem, magas iskolázottság, daganatos vagy endokrin betegség és 60 év feletti életkor esetén. A gyógynövények fogyasztásáról az alkalmazók alig ötöde számolt be a kezelőorvosának. Orv Hetil. 2020; 161(1): 17–25.

This study aimed to evaluate the association between the quantity of subcutaneous fat (assessed by skinfold thickness) and the inter-device agreement of 2 tissue oximeters.This is a prospective cohort study.This study was conducted in a tertiary care academic urban hospital.Healthy volunteers were recruited.All patients recruited had their tissue saturations and skinfold thickness measured at 4 different sites (shoulder, forearm, knee, and calf) on both sides of the body using 2 tissue oximeters, the INVOS 5100C and the EQUANOX 7600.Higher skinfold measures were associated with an increase in the difference between measures provided by both oximeters (slope = -0.59, Pearson correlation coefficient = -0.51, p0.001). This observed association persisted in a linear mixed model (-0.48 [95% confidence interval [CI] -0.61 to -0.36], p0.001). The sex of the volunteers also influenced the inter-oximeter agreement (women: -5.77 [95% CI -8.43 to -3.11], p0.001), as well as the forearm sites (left forearm: -7.16 [95% CI -9.85 to -4.47], p0.001; right forearm:-7.01 [95% CI -9.61 to -4.40], p0.001).The inter-device agreement of the 2 studied oximeters is correlated to the quantity of subcutaneous fat. Monitoring using tissue oximetry should be interpreted with great care when sensors are placed on sites with a significant quantity of subcutaneous fat. In addition to the monitoring of cerebral oximetry, following the variations of saturations at the same peripheral site seems to remain the most secure way to use that technology for the monitoring of critically ill patients.

Objectives: Frailty and diabetes are on the rise due to the aging population. This study was conducted to examine frailty conditions among patients with Type 2 diabetes (T2DM) in Hanoi, Vietnam, as well as determine its associated factors. Methods: A cross-sectional study on T2DM patients at an urban hospital. This study assessed the frailty status using the FRAIL questionnaire. Socio-demographic, clinical, and paraclinical characteristics were obtained. Multivariate regression models were performed to detect factors associated with frailty. Results: Of 379 patients, the FRAIL scale results showed that 8/379 patients were at the frailty level (2.1%), and 33/379 patients were at the pre-frailty level (8.7%). Patients who had above high school education and were retired were at lower risk of pre-frailty/frailty than those with high school education or below, and self-employed, respectively. Conversely, patients with a higher number of comorbidities were more likely to develop pre-frailty and frailty. Conclusion: This study showed a low prevalence of pre-frailty and frailty among T2DM patients. It is necessary to manage diabetes carefully and strictly control the comorbidities in this population. Interventions should focus on higher risk populations, such as those with low education levels and self-employment.

This study examined a sample of incarcerated patients who received health care at an urban safety-net hospital in Massachusetts. Sociodemographic, clinical, and utilization data were obtained from patients' charts and administrative data. Our sample was 87% male and 36% Black and included a large proportion of patients with substance-related use. Incarcerated patients receiving outside care had a wide range of acute and chronic medical and surgical conditions, necessitating both emergent and scheduled care. The most frequent outpatient encounters included surgery (neurosurgery and oral/maxillofacial surgery), ophthalmology, medicine, and radiation oncology. Our findings provide a better understanding of the health care services that incarcerated patients may require outside their facilities and the kinds of interventions and policies that are needed to increase access to more timely care.

To identify points for improvements within the health system where Aboriginal and Torres Strait Islander cancer patients may experience a lack of continuity in their cancer care. The optimal care pathway for Aboriginal and Torres Strait Islander people with cancer (OCP) framework was utilised as a tool in this work.Semi-structured interviews were conducted with health professionals at the primary health care (PHC) and hospital setting. Data were categorised into six steps using the OCP framework.This study identified multiple time-points in the cancer pathways that could be strengthened to increase the continuity of cancer care for these patients. In addition, the provision of person-centred care and adequate education tailored to patients' and health professionals' needs can help minimise the likelihood of patients experiencing a lack of continuity in their cancer care. Participants were recruited from an urban hospital (n = 9) and from six Aboriginal Community Controlled Health Services (n = 17) across geographical locations in Queensland. The provision of culturally competent care, effective communication, coordination and collaboration between services along the cancer pathway from prevention and early diagnosis through to end-of-life care were highlighted as important to enhance care continuity for Indigenous Australians.The implementation of recommendations outlined in the OCP framework may help with improving cancer care continuity for Indigenous patients with cancer.Aboriginal and Torres Strait Islander people can sometimes find cancer care pathways complex and difficult to navigate. This study identified points in the cancer pathways that could be strengthened to increase the continuity of cancer care for these patients which could potentially lead to improved outcomes.

Study objective A better understanding of differences in traumatic brain injury incidence by geography may help inform resource needs for local communities. This paper presents estimates on traumatic brain injury–related hospitalizations and deaths by urban and rural county of residence. Methods To estimate the incidence of traumatic brain injury–related hospitalizations, data from the 2017 Healthcare Cost and Utilization Project’s National Inpatient Sample were analyzed (n=295,760). To estimate the incidence of traumatic brain injury–related deaths, the Centers for Disease Control and Prevention’s National Vital Statistics System multiple-cause-of-death files were analyzed (n=61,134). Datasets were stratified by residence, sex, principal mechanism of injury, and age group. Traumatic brain injury–related hospitalizations were also stratified by insurance status and hospital location. Results The rate of traumatic brain injury–related hospitalizations was significantly higher among urban (70.1 per 100,000 population) than rural residents (61.0), whereas the rate of traumatic brain injury–related deaths was significantly higher among rural (27.5) than urban residents (17.4). These patterns held for both sexes, individuals age 55 and older, and within the leading mechanisms of injury (ie, suicide, unintentional falls). Among patients with Medicare or Medicaid, the rate of traumatic brain injury–related hospitalizations was higher among urban residents; there was no urban/rural difference with other types of insurance. Nearly all (99.6%) urban residents who were hospitalized for a traumatic brain injury received care in an urban hospital. Additionally, approximately 80.3% of rural residents were hospitalized in an urban hospital. Conclusion Urban residents had a higher rate of traumatic brain injury–related hospitalizations, whereas rural residents had a higher rate of traumatic brain injury–related deaths. This disparity deserves further study using additional databases that assess differences in mechanisms of injury and strategies to improve access to emergency care among rural residents.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a pandemic which has infected more than 128 million people and led to over 2.8 million deaths worldwide. Although the introduction of efficacious vaccines has led to overall declines in the incidence of SARS-CoV-2 infection, there has been a recent increase in infections once more due to the appearance of mutant strains with higher virulence. It therefore remains vital to identify predictors of poor outcomes in this patient population. Purpose The objective of our study was to identify predictors of prolonged hospitalization, intensive care unit (ICU) admission, intubation, and death in patients infected with SARS-CoV-2. Methods We conducted a retrospective analysis of all patients hospitalized with SARS-CoV-2 at our health system that includes one tertiary care center and two community hospitals located in the Chicago metropolitan area. The main outcome was a composite endpoint of hospitalization >28 days, ICU admission, intubation, and death. Explanatory variables associated with the primary outcome in the bivariate analysis (p Results Between March 1, 2020 and May 31, 2020, 1029 patients hospitalized with SARS-CoV-2 were included in our analysis. Of these patients, 379 met the composite endpoint. Baseline demographics are described in Table 1. Of note, our cohort consisted of a predominantly minority patient population including 47% Hispanic, 17% African American, 16% Caucasian, and 16% other. In bivariate analysis, age, hypertension, tobacco and alcohol abuse, obesity, coronary artery disease, arrhythmias, valvular heart disease, dyslipidemia, hypertension, stroke, diabetes, documented thrombosis, troponin, CRP, ESR, ferritin, LDH, BNP, D-dimer >5x the upper limit of normal, lactate, and right ventricular outflow tract velocity time integral After multivariable adjustment, explanatory variables associated with the composite endpoint included troponin (OR 2.36; 95% CI 1.08–5.17, p 0.03), D-dimer (OR 1.5; 95% CI 1.23–1.98, p Conclusions In a large urban cohort with a predominantly minority population, we identified several clinical predictors of poor outcomes. Of note, race was not a predictor of the primary endpoint in this study. While recent literature has demonstrated worse outcomes among racial minorities infected with SARS-CoV-2, our data suggests these variations are related to social determinants of health rather than biologic causes. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Loyola University Medical Center

OBJECTIVE To explore factors influencing the implementation of patient navigator programs within a hospital for seniors with complex care needs. METHODS A qualitative descriptive design using in-depth interviews was conducted. Participant interviews were conducted in Toronto, Ontario between September 2020 and February 2021. Data were analysed using thematic analysis. RESULTS Thirty-five semi-structured interviews were conducted with 38 participants from a large urban hospital (n = 21) and community healthcare organizations (n = 17), including organizational leaders, and acute care and rehabilitation providers. Follow-up interviews occurred with 16 participants (7 from the community and nine from the hospital). This study identified five key factors influencing organizational readiness for successful implementation of a patient navigator program for seniors with complex conditions, which included: (a) vision from senior leadership, (b) technological infrastructure, (c) existing hospital-community partnerships, (d) well-established process for referrals, and (e) staff capacity. The overarching theme of communication was also identified. CONCLUSIONS The findings of this study provide a better understanding of hospital and community professionals' needs and challenges when implementing patient navigator programs for seniors with complex care conditions. There are a number of factors that influence an organization's readiness for program uptake and delivery, with the need for clear communication being paramount. Further research to test the effects of readiness on successful implementation outcomes is warranted.

There is very limited literature on the experiences of fathers during Obstetric prenatal care (PNC), especially hearing from fathers’ voices directly. The MGH Fatherhood Project conducted two annual surveys—data combined for analysis—of all fathers who accompanied their partners to prenatal care visits over 2-week periods at a large, tertiary-care urban hospital in Boston, MA. The anonymous, voluntary close-ended survey was offered in multiple languages and self-administered on iPads.Results: Nine hundred fifty nine fathers participated, 86% of attending fathers, possibly making the study the largest research sample of fathers in PNC. Fathers are actively and deeply engaged with the impending birth; they have substantial physical health needs (obesity, family planning and lack of primary care), and mental health needs (stress, depressive symptoms, and personal isolation). Fathers perceived they were well treated during the PNC visit, but were desirous of more reproductive, relational, and infant health information and skills, which they preferred to receive from publications, social media, or health professionals; and they were very supportive of PNC fatherhood initiatives.Discussion: The results suggest five sets of practical recommendations to create a more father-friendly environment in Obstetric care-Staff Training; Father-Friendly Clinic Environment; Explicit Affirmation of Father Inclusion; Development of Educational Materials; and Specialized Father-Focused Health Initiatives, all with the goal of improving reproductive health outcomes for families.

The purpose of this study was to assess the appropriate utilization of peripherally inserted central venous catheter (PICC) placement in patients in an urban hospital setting. We performed a retrospective review of a prospective database created for quality assurance purposes of all patients who had a PICC request placed on Friday afternoon–Sunday between January and June 2019. Data collected included demographic information, pertinent medical history, and procedural details (incidence of PICC placement and the reason for PICC cancellation). The most common reasons for PICC consultation was “long-term intravenous (IV) antibiotics” (51.3%) and “poor IV access” (39.5%). On retrospective chart review, only 51/76 (67%) patients underwent subsequent PICC placement in the days following request placement. Of the 1/3 patients in whom a PICC was not subsequently placed, 64% were deemed nonindicated, and an additional 28% were contraindicated. In these patients, the reason for PICC consultation was most commonly “poor IV access.” There appears to be an overutilization of PICCs in our hospital setting; indications for PICCs should be carefully reviewed as these lines pose a risk of morbidity to patients who may not need them.