Faculty Opinions recommendation of Preoperative electrocardiograms: patient factors predictive of abnormalities.

AbstractObjectives:Antibiotics are commonly used in intensive care units (ICUs), yet differences in antibiotic use across ICUs are unknown. Herein, we studied antibiotic use across ICUs and examined factors that contributed to variation.Methods:We conducted a retrospective cohort study using data from Ontario’s Critical Care Information System (CCIS), which included 201 adult ICUs and 2,013,397 patient days from January 2012 to June 2016. Antibiotic use was measured in days of therapy (DOT) per 1,000 patient days. ICU factors included ability to provide ventilator support (level 3) or not (level 2), ICU type (medical-surgical or other), and academic status. Patient factors included severity of illness using multiple-organ dysfunction score (MODS), ventilatory support, and central venous catheter (CVC) use. We analyzed the effect of these factors on variation in antibiotic use.Results:Overall, 269,351 patients (56%) received antibiotics during their ICU stay. The mean antibiotic use was 624 (range 3–1460) DOT per 1,000 patient days. Antibiotic use was significantly higher in medical-surgical ICUs compared to other ICUs (697 vs 410 DOT per 1,000 patient days; P < .0001) and in level 3 ICUs compared to level 2 ICUs (751 vs 513 DOT per 1,000 patient days; P < .0001). Higher antibiotic use was associated with higher severity of illness and intensity of treatment. ICU and patient factors explained 47% of the variation in antibiotic use across ICUs.Conclusions:Antibiotic use varies widely across ICUs, which is partially associated with ICUs and patient characteristics. These differences highlight the importance of antimicrobial stewardship to ensure appropriate use of antibiotics in ICU patients.

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Predictors of Caregiver Burden in Delirium: Patient and Caregiver Factors

Innovation in Aging ◽

10.1093/geroni/igaa057.818 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 254-255

Author(s):

Patricia Tabloski ◽

Franchesca Arias ◽

Nina Flanagan ◽

Tamara Fong ◽

Eva Schmitt ◽

...

Keyword(s):

Caregiver Burden ◽

Living Arrangements ◽

Living Arrangement ◽

Patient Characteristics ◽

Confusion Assessment Method ◽

Assessment Method ◽

Functional Domain ◽

Medical Patients ◽

Patient Factors ◽

Caregiver Relationship

Abstract Delirium — an acute disorder of attention and cognition — is a common, life-threatening and costly syndrome occurring frequently in older hospitalized persons. The unexpected, rapid, and volatile nature of delirium can be difficult for family caregivers to experience and may contribute to subjective feelings of distress (i.e. “delirium burden”). The aim of this study was to examine whether pre-admission patient characteristics or patient-caregiver relationship and living arrangements were associated with caregiver burden as measured by the delirium burden scale for caregivers (DEL-B-C; score 0-40, higher score is more burden). Our sample consisted of 208 older adults and their caregivers from the Better Assessment of Illness (BASIL) study, an ongoing prospective, observational study of surgical and medical patients ≥70 years old; 22% of patients experienced delirium by the Confusion Assessment Method (CAM) and the average DEL-B-C score was 7.9, 95% CI(6.95-8.88). Results indicated that neither patient-caregiver relationship and living arrangement or patient factors including pre-admission pain, sleep disturbance, or new onset incontinence were significantly correlated with delirium-related caregiver burden. However, DEL-B-C scores were significantly higher in caregivers of patients with any ADL impairment (mean 8.5 vs. 5.2, p = .016) during hospitalization although none of the individual functional deficits alone were statistically significant. This finding suggests that the association of ADL impairment and DEL-B-C scores is not driven by a single functional domain. Future studies are needed to further understand how caregiver characteristics and patient factors occurring before and during hospitalization contribute to caregiver burden after the occurrence of delirium.

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Causes of discharge delays from the acute medical unit (AMU) in a tertiary level teaching hospital, Brunei Darussalam

Proceedings of Singapore Healthcare ◽

10.1177/20101058211006143 ◽

2021 ◽

pp. 201010582110061

Author(s):

Dayang Nur Hilmiyah binti Awang Husaini ◽

Justin Fook Siong Keasberry ◽

Khadizah Haji Abdul Mumin ◽

Hanif Abdul Rahman

Keyword(s):

Observational Study ◽

Discharge Planning ◽

Patient Factors ◽

Medical Unit ◽

Prolonged Length ◽

Acute Medical Unit ◽

Brunei Darussalam ◽

Medical Issues ◽

Hospital Factors ◽

Prolonged Hospital

Background: Many patients admitted to the acute medical unit experience a prolonged length of stay in hospital due to discharge delays. Consequently, this may impact the patients, healthcare institution and national economy in terms of patient safety, decreased hospital capacity, lost patient workdays and financial performance. Objectives: The main aim of this observational study was to identify the causes of discharge delays among acute medical unit patients admitted in the Raja Isteri Pengiran Anak Saleha Hospital, Brunei. Methods: A retrospective observational study, with data of patients admitted to the acute medical unit collected from Brunei Health Information Systems between September and December 2018. Statistical analyses were performed to obtain relevant results and any statistically significant associations. Results: A total of 357 patients were admitted to the acute medical unit over the 4-month period; 218 patients (61.1%) experienced discharge delays. Of these 218 patients, 158 patients (72.5%) encountered discharge delays mainly due to intrinsic patient factors, while the discharge delays in 88 patients (40.4%) were attributed to hospital factors. The main reason for discharge delays for patient factors was slow recovery among 67 patients (30.7%), whereas for hospital factors it was the weekend limitation of services available in 23 patients (10.6%). Conclusions: There were various causes of discharge delays identified among the 218 acute medical unit patients who experienced discharge delays. Older patients with frailty, polypharmacy and complex medical issues were more likely to have a prolonged hospital stay in the acute medical unit. Stringent inclusion criteria, increasing discharge planning as well as an effective multidisciplinary approach will aid in reducing discharge delays from the acute medical unit.

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Surgical Techniques for Tonsillectomy and Perioperative Respiratory Complications in Children

Otolaryngology ◽

10.1177/01945998211015176 ◽

2021 ◽

pp. 019459982110151

Author(s):

Rahul G. Baijal ◽

Karla E. Wyatt ◽

Teniola Shittu ◽

Eugenia Y. Chen ◽

Eric Z. Wei ◽

...

Keyword(s):

Surgical Technique ◽

Chart Review ◽

Surgical Techniques ◽

Retrospective Chart Review ◽

Airway Disease ◽

Respiratory Complications ◽

Patient Factors ◽

Children's Hospital ◽

Reactive Airway Disease ◽

Children’S Hospital

Objectives The aim of this study was to determine the incidence of perioperative respiratory complications in children following tonsillectomy with cold and hot dissection surgical techniques. Study Design The study was a retrospective cohort study. Setting Retrospective chart review was performed for all children presenting for a tonsillectomy at Texas Children’s Hospital from November 2015 to December 2017. Methods Pre- and intraoperative patient factors, including surgical technique with cold or hot dissection (electrocautery or radiofrequency ablation), and perioperative anesthetic factors were collected to determine the incidence of perioperative respiratory complications. Results A total of 2437 patients underwent a tonsillectomy at Texas Children’s Hospital from November 2015 to December 2017. The incidence of perioperative respiratory complications was 20.0% (n = 487). Sickle cell disease, cardiac disease, reactive airway disease, pulmonary disease, age >2 and <3 years, and obesity, defined as a body mass index >95th percentile for age, were significant for overall perioperative respiratory complications. There was no difference in the incidence of perioperative respiratory complications in children undergoing tonsillectomy by cold or hot dissection. Conclusion Perioperative respiratory complications following tonsillectomy are more affected by patient factors than surgical technique.

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Nurse and patient factors: Predicting seclusion in adolescent psychiatric units

Journal of Child and Adolescent Psychiatric Nursing ◽

10.1111/jcap.12306 ◽

2021 ◽

Author(s):

Miriam K. Yurtbasi ◽

Glenn Melvin ◽

Christine Pavlou ◽

Michael Gordon

Keyword(s):

Patient Factors ◽

Psychiatric Units

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Diminished autonomy and justice in liver transplantation – The price of scarcity?

Clinical Ethics ◽

10.1177/14777509211016286 ◽

2021 ◽

pp. 147775092110162

Author(s):

Philip Berry ◽

Sreelakshmi Kotha

Keyword(s):

Patient Autonomy ◽

Patient Involvement ◽

Organ Allocation ◽

Self Determination ◽

Wait List ◽

Medical Assessment ◽

Patient Factors ◽

Future Directions ◽

Allocation Criteria ◽

Qualitative Nature

Patient autonomy and distributive justice are fundamental ethical principles that may be at risk in liver transplant units where decisions are dictated by the need to maximise the utility of scarce donor organs. The processes of patient selection, organ allocation and prioritisation on the wait list have evolved in a constrained environment, leading to high levels of complexity and low transparency. Regarding paternalism, opaque listing and allocation criteria, patient factors such as passivity, guilt, chronic illness and sub-clinical encephalopathy are cited as factors that may inhibit patient engagement. Regarding justice, established regional, gender and race based inequities are described. The paradox whereby hepatologists both advocate for individual patients and discharge their duty of stewardship to apportion organs according to larger utilitarian principles is explored. Competing subjective factors such as physicians’ perception of moral responsibility, the qualitative nature of expert medical assessment and institutional or personal loyalty to re-transplantation candidates are described. Realistic limits of self-determination and justice are discussed, and possible future directions in terms of patient involvement proposed.

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