scholarly journals Real World Patterns of Antimicrobial Use and Microbiology Investigations in Patients with Sepsis outside the Critical Care Unit: Secondary Analysis of Three Nation-Wide Point Prevalence Studies

2019 ◽  
Vol 8 (9) ◽  
pp. 1337 ◽  
Author(s):  
Maja Kopczynska ◽  
Ben Sharif ◽  
Harry Unwin ◽  
John Lynch ◽  
Andrew Forrester ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Significant Proportion ◽  
Secondary Analysis ◽  
Real Life ◽  
Point Prevalence ◽  
Screening Tools ◽  
Antibiotic Administration ◽  
Prevalence Studies ◽  
Acute Hospitals ◽  
Sepsis Screening

Recent description of the microbiology of sepsis on the wards or information on the real-life antibiotic choices used in sepsis is lacking. There is growing concern of the indiscriminate use of antibiotics and omission of microbiological investigations in the management of septic patients. We performed a secondary analysis of three annual 24-h point-prevalence studies on the general wards across all Welsh acute hospitals in years 2016–2018. Data were collected on patient demographics, as well as radiological, laboratory and microbiological data within 48-h of the study. We screened 19,453 patients over the three 24 h study periods and recruited 1252 patients who fulfilled the entry criteria. 775 (64.9%) patients were treated with intravenous antibiotics. Only in 33.65% (421/1252) of all recruited patients did healthcare providers obtain blood cultures; in 25.64% (321/1252) urine cultures; in 8.63% (108/1252) sputum cultures; in 6.79% (85/1252) wound cultures; in 15.25% (191/1252) other cultures. Out of the recruited patients, 59.1% (740/1252) fulfilled SEPSIS-3 criteria. Patients with SEPSIS-3 criteria were significantly more likely to receive antibiotics than the non-septic cohort (p < 0.0001). In a multivariable regression analysis increase in SOFA score, increased number of SIRS criteria and the use of the official sepsis screening tool were associated with antibiotic administration, however obtaining microbiology cultures was not. Our study shows that antibiotics prescription practice is not accompanied by microbiological investigations. A significant proportion of sepsis patients are still at risk of not receiving appropriate antibiotics treatment and microbiological investigations; this may be improved by a more thorough implementation of sepsis screening tools.

Cognitive screening tools for identification of dementia in illiterate and low-educated older adults, a systematic review and meta-analysis

2017 ◽  
Vol 29 (6) ◽  
pp. 897-929 ◽  
Author(s):  
Stella-Maria Paddick ◽  
William K. Gray ◽  
Jackie McGuire ◽  
Jenny Richardson ◽  
Catherine Dotchin ◽  
...  
Keyword(s):  
Older Adults ◽  
Validation Studies ◽  
Meta Analysis ◽  
Significant Proportion ◽  
Educational Background ◽  
Screening Tools ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Low Literacy ◽  
Prevalence Studies

ABSTRACTBackground:The majority of older adults with dementia live in low- and middle-income countries (LMICs). Illiteracy and low educational background are common in older LMIC populations, particularly in rural areas, and cognitive screening tools developed for this setting must reflect this. This study aimed to review published validation studies of cognitive screening tools for dementia in low-literacy settings in order to determine the most appropriate tools for use.Method:A systematic search of major databases was conducted according to PRISMA guidelines. Validation studies of brief cognitive screening tests including illiterate participants or those with elementary education were eligible. Studies were quality assessed using the QUADAS-2 tool. Good or fair quality studies were included in a bivariate random-effects meta-analysis and a hierarchical summary receiver operating characteristic (HSROC) curve constructed.Results:Forty-five eligible studies were quality assessed. A significant proportion utilized a case–control design, resulting in spectrum bias. The area under the ROC (AUROC) curve was 0.937 for community/low prevalence studies, 0.881 for clinic based/higher prevalence studies, and 0.869 for illiterate populations. For the Mini-Mental State Examination (MMSE) (and adaptations), the AUROC curve was 0.853.Conclusion:Numerous tools for assessment of cognitive impairment in low-literacy settings have been developed, and tools developed for use in high-income countries have also been validated in low-literacy settings. Most tools have been inadequately validated, with only MMSE, cognitive abilities screening instrument (CASI), Eurotest, and Fototest having more than one published good or fair quality study in an illiterate or low-literate setting. At present no screening test can be recommended.

scholarly journals Health literacy level in a various nephrology population from Québec: predialysis clinic, in-centre hemodialysis and home dialysis; a transversal monocentric observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Annabel Boyer ◽  
Yannick Begin ◽  
Julie Dupont ◽  
Mathieu Rousseau-Gagnon ◽  
Nicolas Fernandez ◽  
...  
Keyword(s):  
Health Literacy ◽  
Observational Study ◽  
Health Information ◽  
Healthcare Providers ◽  
Significant Proportion ◽  
Good Health ◽  
Sufficient Information ◽  
Home Dialysis ◽  
Limited Health Literacy ◽  
Limited Health

Abstract Background Health literacy refers to the ability of individuals to gain access to, use, and understand health information and services in order to maintain a good health. It is especially important in nephrology due to the complexity of chronic kidney disease (CKD). The present study sought to define health literacy levels in patients followed in predialysis clinic, in-center dialysis (ICHD), peritoneal dialysis (PD) and home hemodialysis (HHD). Methods This transversal monocentric observational study analysed 363 patients between October 2016 and April 2017. The Brief Health Literacy Screen (BHLS) and the Health Literacy Questionnaire (HLQ) were used to measure health literacy. Multivariate linear regressions were used to compare the mean scores on the BHLS and HLQ, across the four groups. Results Patients on PD had a significantly higher BHLS’score than patients on ICHD (p = 0.04). HLQ’s scores differed across the groups: patients on HHD (p = 0.01) and PD (p = 0.002) were more likely to feel understood by their healthcare providers. Compared to ICHD, patients on HHD were more likely to have sufficient information to manage their health (p = 0.02), and patients in the predialysis clinic were more likely to report high abilities for health information appraisal (p < 0.001). Conclusion In a monocentric study, there is a significant proportion of CKD patients, especially in predialysis clinic and in-centre hemodialysis, with limited health literacy. Patients on home dialysis (HHD and PD) had a higher level of health literacy compared to the other groups.

Implications for the Physical Design of the Postnatal Care Unit from a Targeted Analysis of Issues With Accessing the Bathroom at Night in the Acute Setting: A Secondary Analysis

2021 ◽  
Vol 10 (1) ◽  
pp. 309-312
Author(s):  
Varshita Chirumamilla ◽  
Joseph M. Gerard ◽  
Alison E. Sweeney ◽  
Kristin P. Tully ◽  
Alison M. Stuebe ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Secondary Analysis ◽  
Hospital Environment ◽  
Patient Room ◽  
Hospital Visit ◽  
Acute Setting ◽  
Targeted Analysis ◽  
Standard Patient ◽  
Clinical Environments ◽  
Visual Privacy

Assessing hospital environment conditions is necessary for healthcare providers and patients to coordinate safe care. The aims of this research included: a) identifying patterns in hospital visit feedback transcripts regarding bathroom doors and lights in the hospital room and b) interpreting the results to make recommendations for more enabling clinical environments. The methods used by the research team included organizing transcript data, assigning codes, and conducting an interrater reliability test to assess codebook efficacy. Finally, working with maternal and infant mortality experts, recommendations for the hospital were developed. We identified four possible interventions to address barriers: a) implement low-height, dimmable lighting along the base of the patient room, b) provide personal lights, such as penlights, to staff for nighttime assessments, c) install and improve on existing grab bars in patient room bathrooms and d) replace the standard patient room bathroom door with a different kind of auditory/visual privacy barrier.

To err is system; a comparison of methodologies for the investigation of adverse outcomes in healthcare

2021 ◽  
pp. 251604352199026
Author(s):  
Peter Isherwood ◽  
Patrick Waterson
Keyword(s):  
Patient Safety ◽  
System Performance ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Real Life ◽  
Adverse Outcomes ◽  
System Level ◽  
Future Performance ◽  
System A ◽  
Regulatory Bodies

Patient safety, staff moral and system performance are at the heart of healthcare delivery. Investigation of adverse outcomes is one strategy that enables organisations to learn and improve. Healthcare is now understood as a complex, possibly the most complex, socio-technological system. Despite this the use of a 20th century linear investigation model is still recommended for the investigation of adverse outcomes. In this review the authors use data gathered from the investigation of a real life healthcare near incident and apply three different methodologies to the analysis of this data. They compare both the methodologies themselves and the outputs generated. This illustrates how different methodologies generate different system level recommendations. The authors conclude that system based models generate the strongest barriers to improve future performance. Healthcare providers and their regulatory bodies need to embrace system based methodologies if they are to effectively learn from, and reduce future, adverse outcomes.

scholarly journals ‘Not just a piece of skin in front of you’—a qualitative exploration of the experiences of adolescents with eczema and psoriasis with healthcare professionals

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041108
Author(s):  
Isabella Joy de Vere Hunt ◽  
Abigail McNiven ◽  
Amanda Roberts ◽  
Himesh Parmar ◽  
Tess McPherson
Keyword(s):  
Young People ◽  
Skin Disease ◽  
Healthcare Professionals ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Secondary Analysis ◽  
Emotional Impact ◽  
Skin Conditions ◽  
The Uk ◽  
Qualitative Exploration

BackgroundThere is little qualitative research in the UK focussing on adolescents’ experience of their healthcare providers, and inflammatory skin conditions are a common heath problem in adolescence.AimTo explore the experiences of adolescents with eczema and psoriasis with healthcare professionals, and to distil the participants’ key messages for their healthcare providers.DesignThis is a secondary thematic analysis of interviews with adolescents with eczema or psoriasis.ParticipantsThere were a total of 41 text transcripts of interviews with young people with eczema or psoriasis who had given permission for secondary analysis; 23 of the participants had eczema, and 18 psoriasis. Participants were living in the UK at time of interview, and aged 15–24 years old.ResultsWe have distilled the following key messages from young people with eczema and psoriasis for healthcare providers: (1) address the emotional impact; (2) give more information, with the subtheme and (3) appreciate patient research. We identified the following eczema-specific themes: (ECZ-4) ‘It’s not taken seriously’; (ECZ-5) offer choice in treatment and (ECZ-6) lack of structure/conflicting advice. Two psoriasis-specific themes were identified: (PSO-4) feeling dehumanised/treat me as a person; and (PSO-5) think about how treatments will affect daily life.ConclusionThis qualitative data analysis highlights the need for greater recognition of the emotional impact of skin disease in adolescence, and for more comprehensive provision of information about the conditions. We call for greater sensitivity and flexibility in our approach to adolescents with skin disease, with important implications for healthcare delivery to this group.

Observance gap between users: Lessons from a trial of a smartphone application for parental empowerment in Autism Spectrum Disorders (Preprint)

2021 ◽  
Author(s):  
Olivier Bonnot ◽  
Vladimir Adrien ◽  
Veronique Venelle ◽  
Dominique Bonneau ◽  
Fanny Gollier-Briant ◽  
...  
Keyword(s):  
Autism Spectrum Disorders ◽  
Secondary Analysis ◽  
Real Life ◽  
Smartphone Application ◽  
Autism Spectrum ◽  
Filling Rate ◽  
Actual Use ◽  
Intent To Use ◽  
Spectrum Disorders ◽  
Prospective Longitudinal

BACKGROUND Conflicting data emerge from literature regarding actual use of smartphone application in medicine, some authors considering it as a breakthrough while other suggesting that real-life use is disappointing. However, digital tools are everyday more present in medicine. We developed SMARTAUTISM, a smartphone application focused on empowerment in a day to day-based help for parents having a child with Autism Spectrum Disorders (ASD) asking questions and providing a feed-back screen with simple curves. OBJECTIVE To evaluate the qualitative and quantitative usage of a smartphone application by caregivers of ASD individuals. METHODS This is a prospective, longitudinal, exploratory, open study with a 6-month follow-up period of family having one child with ASD. Data are recorded longitudinally, and outcome criteria were: (i) overall filling rate, (ii) filling rate by degree of completion and by interest of users for our feed-back screen and qualitative questionnaire based on attrition. RESULTS Participants have a very high intent to use our app during the six months period (95%). However, secondary analysis shows that only 46 of subjects had constant filling rate over 50%. Interestingly, those high-profile users are characterized by higher use and satisfaction with the feed-back screen when compared to low (p<0.001) and moderate (p=0.007) users. CONCLUSIONS Real or perceived utility is an important incentive in the use of empowerment smartphone apps. CLINICALTRIAL Clinical Trial : NCT03020277 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2016-012135

Correlates of e-cigarette use among active duty US military personnel: implications for cessation policy

2021 ◽  
pp. e001700
Author(s):  
Sarah Godby ◽  
R Dierst-Davies ◽  
D Kogut ◽  
L Degiorgi Winslow ◽  
M M Truslow ◽  
...  
Keyword(s):  
Military Personnel ◽  
Healthcare Providers ◽  
Secondary Analysis ◽  
Health Agency ◽  
Active Duty ◽  
Tobacco Prevention ◽  
Cigarette Use ◽  
Us Military ◽  
Active Duty Military ◽  
Health Related

BackgroundElectronic cigarette (or e-cigarette) use has grown substantially since its US market introduction in 2007. Although marketed as a safer alternative to traditional cigarettes, studies have shown they can also be a gateway to their use. The purpose of this investigation is to identify factors associated with different patterns of tobacco use among active duty military personnel.MethodsA secondary analysis was conducted using the 2014 Defense Health Agency Health Related Behaviors survey data. Results are based on 45 986 US military respondents, weighted to 1 251 606. Both univariate and regression analyses were conducted to identify correlates.ResultsIn 2014, approximately 7.8% of respondents reported using e-cigarettes at least once in the past year. Among e-cigarette users, 49% reported exclusive e-cigarette use. Prevalence of exclusive use is highest among white people (58%), Navy (33%), men (83%) and persons with income ≤$45 000 (65%). Regression comparing exclusive cigarette with exclusive e-cigarette users revealed higher odds of being Air Force (OR=2.19; CI 1.18 to 4.06) or Navy (OR=2.25; CI 1.14 to 4.41) personnel and being male (OR=1.72; CI 1.12 to 2.64), and more likely to not receive smoking cessation messaging from healthcare providers in the last 12 months (OR=2.88; CI 1.80 to 4.62). When comparing exclusive e-cigarette users with poly-tobacco users, e-cigarette users had higher odds of being Hispanic (OR=2.20; CI 1.02 to 4.78), college educated (OR=4.25; CI 1.22 to 14.84) and not receiving tobacco prevention/cessation messaging (OR=4.80; CI 2.79 to 8.27).ConclusionThe results demonstrate that exclusive e-cigarette users in the military have unique characteristics when compared with groups of other/mixed tobacco users. Findings can inform cessation and prevention efforts to improve both the overall health and combat readiness of active duty military personnel.

scholarly journals Incidence of early-onset sepsis in infants born to women with clinical chorioamnionitis

2018 ◽  
Vol 46 (8) ◽  
pp. 926-933 ◽  
Author(s):  
Tara M. Randis ◽  
Madeline Murguia Rice ◽  
Leslie Myatt ◽  
Alan T.N. Tita ◽  
Kenneth J. Leveno ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Apgar Score ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Antibiotic Administration ◽  
Nulliparous Women ◽  
Early Onset Sepsis ◽  
Adverse Neonatal Outcomes

Abstract Objective To determine the frequency of sepsis and other adverse neonatal outcomes in women with a clinical diagnosis of chorioamnionitis. Methods We performed a secondary analysis of a multi-center placebo-controlled trial of vitamins C/E to prevent preeclampsia in low risk nulliparous women. Clinical chorioamnionitis was defined as either the “clinical diagnosis” of chorioamnionitis or antibiotic administration during labor because of an elevated temperature or uterine tenderness in the absence of another cause. Early-onset neonatal sepsis was categorized as “suspected” or “confirmed” based on a clinical diagnosis with negative or positive blood, urine or cerebral spinal fluid cultures, respectively, within 72 h of birth. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by logistic regression. Results Data from 9391 mother-infant pairs were analyzed. The frequency of chorioamnionitis was 10.3%. Overall, 6.6% of the neonates were diagnosed with confirmed (0.2%) or suspected (6.4%) early-onset sepsis. Only 0.7% of infants born in the setting of chorioamnionitis had culture-proven early-onset sepsis versus 0.1% if chorioamnionitis was not present. Clinical chorioamnionitis was associated with both suspected [OR 4.01 (3.16–5.08)] and confirmed [OR 4.93 (1.65–14.74)] early-onset neonatal sepsis, a need for resuscitation within the first 30 min after birth [OR 2.10 (1.70–2.61)], respiratory distress [OR 3.14 (2.16–4.56)], 1 min Apgar score of ≤3 [OR 2.69 (2.01–3.60)] and 4–7 [OR 1.71 (1.43–2.04)] and 5 min Apgar score of 4–7 [OR 1.67 (1.17–2.37)] (vs. 8–10). Conclusion Clinical chorioamnionitis is common and is associated with neonatal morbidities. However, the vast majority of exposed infants (99.3%) do not have confirmed early-onset sepsis.

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