Work Place Violence in the Health Care Facility

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Fast-track hospital end-of-life discharge pathway: is it actually fast? National clinical audit

ObjectivesTo determine adherence to Department of Health and Social Care target of fast-track pathway discharge for end-of-life care within 48 hours.MethodsMulticentre audit in England using retrospective analysis of patient records for fast-track pathway tools submitted between 1 March 2019 and 31 March 2019.ResultsMost patients (72%) were not discharged within the 48-hour target. There was significant variability in success between hospital sites. Delays in discharge were most frequently considered to be secondary to delays in sourcing packages of care and 24-hour care facility placements. Involvement of specialist discharge nurses in paperwork submission improved rates by Commissioning Care Groups. Patients who died in hospital had significantly longer admissions than those who were discharged (discharged 19 days (IQR 11–28) vs died 28 days (IQR 18–42); p=0.039). This was entirely accounted for by increased numbers of days between admission and first suggestion of fast-track pathway discharge in those who died in hospital (discharged 9 days (IQR 5–19), died 15 days (IQR 9–33); p=0.003).ConclusionsWe demonstrated a delay in the fast-track pathway discharge process with significant variation in success of the discharge process at different geographical locations.

Pre-hospital transdermal glyceryl trinitrate in patients with stroke mimics: data from the RIGHT-2 randomised-controlled ambulance trial

Background Prehospital stroke trials will inevitably recruit patients with non-stroke conditions, so called stroke mimics. We undertook a pre-specified analysis to determine outcomes in patients with mimics in the second Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial (RIGHT-2). Methods RIGHT-2 was a prospective, multicentre, paramedic-delivered, ambulance-based, sham-controlled, participant-and outcome-blinded, randomised-controlled trial of transdermal glyceryl trinitrate (GTN) in adults with ultra-acute presumed stroke in the UK. Final diagnosis (intracerebral haemorrhage, ischaemic stroke, transient ischaemic attack, mimic) was determined by the hospital investigator. This pre-specified subgroup analysis assessed the safety and efficacy of transdermal GTN (5 mg daily for 4 days) versus sham patch among stroke mimic patients. The primary outcome was the 7-level modified Rankin Scale (mRS) at 90 days. Results Among 1149 participants in RIGHT-2, 297 (26%) had a final diagnosis of mimic (GTN 134, sham 163). The mimic group were younger, mean age 67 (SD: 18) vs 75 (SD: 13) years, had a longer interval from symptom onset to randomisation, median 75 [95% CI: 47,126] vs 70 [95% CI:45,108] minutes, less atrial fibrillation and a lower systolic blood pressure and Face-Arm-Speech-Time tool score than the stroke group. The three most common mimic diagnoses were seizure (17%), migraine or primary headache disorder (17%) and functional disorders (14%). At 90 days, the GTN group had a better mRS score as compared to the sham group (adjusted common odds ratio 0.54; 95% confidence intervals 0.34, 0.85; p = 0.008), a difference that persisted at 365 days. There was no difference in the proportion of patients who died in hospital, were discharged to a residential care facility, or suffered a serious adverse event. Conclusions One-quarter of patients suspected by paramedics to have an ultra-acute stroke were subsequently diagnosed with a non-stroke condition. GTN was associated with unexplained improved functional outcome observed at 90 days and one year, a finding that may represent an undetected baseline imbalance, chance, or real efficacy. GTN was not associated with harm. Trial registration This trial is registered with International Standard Randomised Controlled Trials Number ISRCTN 26986053.

The impact of polymerase chain reaction (PCR) on diagnosis and management of infectious uveitis at a tertiary care facility

Background Polymerase Chain Reaction (PCR) is a well-accepted adjunct in the management of infectious uveitis. In turn, few reports in the literature have evaluated how PCR then impacts patient care. This study aims to evaluate the impact of PCR sampling on diagnosis and treatment of infectious uveitidies at a large tertiary care facility. Main body This is a retrospective, observational study of patients with aqueous and vitreous PCR samples obtained from 2014 to 2019. The study was undertaken at a single institution. At least one follow up visit following results of PCR testing was required for inclusion. If a patient had multiple PCR samples taken, only the first sample was included. The patients were divided into three categories based on pre-sampling diagnosis. A chi-square test was used to analyze the data. 108 cases were available for analysis. PCR did not change diagnosis or management in any of the cases where pre-sampling diagnosis carried a high clinical suspicion for negative PCR. Overall, the results of PCR testing had a more significant impact on diagnosis in those cases where pre-sampling diagnosis was unknown versus those where it was confirmatory in nature, thus presumed to be related to an infectious entity tested by PCR (74% vs. 29%, p = 0.00006). The rate of treatment change based on PCR was similar between those cases where there was a high clinical suspicion for positive PCR and those where pre-sampling diagnosis was unknown (32% vs. 33%, p = 0.95). Further analyzing specimens separately depending on source of sample, this pattern persisted for aqueous samples, with PCR showing a more significant impact on diagnosis in those cases where the diagnosis was unknown versus those where sampling was confirmatory (86% vs. 31%, p = 0.00004). The rate of change in treatment between the two groups was similar (35% vs. 31%, p = 0.79). Vitreous samples followed a similar pattern with a higher rate of diagnosis change for those cases where pre-sampling diagnosis was unknown and a similar rate in treatment change between the two groups, however this did not reach statistical signifigance (44% vs. 25%, p = 0.28; 27% vs. 33%, p = 0.74). Conclusion There is no well-defined algorithm as to when to employ PCR testing in uveitis. As expected, in our experience, it has the largest impact on diagnosis when the diagnosis is unknown, however even when confirmatory in nature, it continues to impact patient management.

Covid-19 Vaccine Hesitancy in Nursing Home Staff and the Need for Ongoing Education and Vaccine Access

Objective: To study vaccine hesitancy among health care workers who provide direct care in nursing homes and long term care facilities which cater to the most vulnerable population of the community. Design: This is a cross sectional cohort study Setting and participants: The study was conducted on the front line healthcare workers who work in long term care facilities. Methods: A nationwide survey was conducted on the certified nurse assistants on November 16th 2020 which reached 7000 survey recipients. Results: Out of 7000 survey recipients, 3119 responded (45% response rate). There was 71.6% (2,233) negative response about taking the covid19 vaccine due to lack of trust and education of information Conclusions and implications: Our study concluded that the vaccine hesitancy is high among the health care workers of long-term care facility and that ongoing education and interactive dialogue with certified nurse assistants and ongoing access to vaccine is critical as the willingness improves.

Persistence of Anti-SARS-CoV-2 Antibodies in Long Term Care Residents Over Seven Months After Two COVID-19 Outbreaks

BackgroundAs part of the public health outbreak investigations, serological surveys were carried out following two COVID-19 outbreaks in April 2020 and October 2020 in one long term care facility (LTCF) in British Columbia, Canada. This study describes the serostatus of the LTCF residents and monitors changes in their humoral response to SARS-CoV-2 and other human coronaviruses (HCoV) over seven months.MethodsA total of 132 serum samples were collected from all 106 consenting residents (aged 54-102) post-first outbreak (N=87) and post-second outbreak (N=45) in one LTCF; 26/106 participants provided their serum following both COVID-19 outbreaks, permitting longitudinal comparisons between surveys. Health-Canada approved commercial serologic tests and a pan-coronavirus multiplexed immunoassay were used to evaluate antibody levels against the spike protein, nucleocapsid, and receptor binding domain (RBD) of SARS-CoV-2, as well as the spike proteins of HCoV-229E, HCoV-HKU1, HCoV-NL63, and HCoV-OC43. Statistical analyses were performed to describe the humoral response to SARS-CoV-2 among residents longitudinally.FindingsSurvey findings demonstrated that among the 26 individuals that participated in both surveys, all 10 individuals seropositive after the first outbreak continued to be seropositive following the second outbreak, with no reinfections identified among them. SARS-CoV-2 attack rate in the second outbreak was lower (28.6%) than in the first outbreak (40.2%), though not statistically significant (P>0.05). Gradual waning of anti-nucleocapsid antibodies to SARS-CoV-2 was observed on commercial (median Δ=-3.7, P=0.0098) and multiplexed immunoassay (median Δ=-169579, P=0.014) platforms; however, anti-spike and anti-receptor binding domain (RBD) antibodies did not exhibit a statistically significant decline over 7 months. Elevated antibody levels for beta-HCoVs OC43 (P<0.0001) and HKU1 (P=0.0027) were observed among individuals seropositive for SARS-CoV-2 compared to seronegative individuals.ConclusionOur study utilized well-validated serological platforms to demonstrate that humoral responses to SARS-CoV-2 persisted for at least 7 months. Elevated OC43 and HKU1 antibodies among SARS-CoV-2 seropositive individuals may be attributed to cross reaction and/or boosting of humoral response.

The predictive utility of functional status at discharge: a population-level cohort analysis

Background Functional status is a patient-important, patient-centered measurement. The utility of functional status measures to inform post-discharge patient needs is unknown. We sought to examine the utility of routinely collected functional status measures gathered from older hospitalized patients to predict a panel of post-discharge outcomes. Methods In this population-based retrospective cohort study, Adults 65+ discharged from an acute hospitalization between 4 November 2008 and 18 March 2016 in Ontario, Canada and received an assessment of functional status at discharge using the Health Outcomes for Better Information and Care tool were included. Multivariable regression analysis was used to determine the relationship between functional status and emergency department (ED) re-presentation, hospital readmission, long term care facility (LTCF) admission or wait listing (‘LTCF readiness’), and death at 180 days from discharge. Results A total of 80 020 discharges were included. 38 928 (48.6%) re-presented to the ED, 24 222 (30.3%) were re-admitted, 5 037 (6.3%) were LTCF ready, and 9 047 (11.3%) died at 180 days. Beyond age, diminished functional status at discharge was the factor most associated with LTCF readiness (adjusted Odds Ratio [OR] 4.11 for those who are completely dependent for activities of daily living compared to those who are independent; 95% Confidence Interval [CI]: 3.70-4.57) and death (OR 3.99; 95% CI: 3.67-4.35). Functional status also had a graded relationship with each outcome and improved the discriminability of the models predicting death and LTCF readiness (p<0.01) but not ED re-presentation or hospital re-admission. Conclusion Routinely collected functional status at discharge meaningfully improves the prediction of long term care home readiness and death. The routine assessment of functional status can inform post-discharge care and planning for older adults.

Kegiatan Pemantauan Kasus Covid 19

ABSTRAKCOVID-19 adalah penyakit yang disebabkan Novel Coronavirus 2019. Gejalanya bergejala mirip dengan flu biasa, namun COVID-19 sampai saat ini memiliki fatalitas lebih tinggi dan virus ini juga menyebar dengan sangat cepat karena bisa pindah dari orang ke orang bahkan sebelum orang tersebut menunjukkan gejala. Cara isolasi mandiri dirumah yaitu selalu memakai masker dan membuang masker bekas ditempat yang ditentukan, jika sakit (ada gejala demam, flu dan batuk) maka tetap di rumah. Jangan pergi bekerja, sekolah, ke pasar atau ke ruang publik untuk mencegah penularan masyarakat, manfaatkan fasilitas telemedicine atau sosial media kesehatan dan hindari transportasi publik. Beritahu dokter dan perawat tentang keluhan dan gejala, serta riwayat bekerja ke daerah terjangkit atau kontak dengan pasien COVID-19, selama dirumah, bisa bekerja di rumah. Gunakan kamar terpisah dari anggota keluarga lainya, dan jaga jarak 1 meter dari anggota keluarga, tentukan pengecekan suhu harian, amati batuk dan sesak nafas. Hindari pemakaian bersama peralatan makan dan mandi dan tempat tidur, terapkan perilaku hidup sehat dan bersih, serta konsumsi makanan bergizi, mencuci tangan dengan sabun dan air mengalir dan lakukan etika batuk dan bersin, jaga kebersihan dan kesehatan rumah dengan cairan desinfektan. Selalu berada di ruang terbuka dan berjemur di bawah sinar matahari setiap pagi (±15-30 menit), Hubungi segera fasilitas pelayanan kesehatan jika sakit berlanjut seperti sesak nafas dan demam tinggi, untuk mendapatkan perawatan lebih lanjut. Tujuan pengabdian masyarakat ini adalah untuk melakukan pemantauan kasus covid 19 di Kota Bandung. Kegiatan pengabdian masyarakat ini memberikan pelayanan dengan melakukan pemantauan agar mengetahui keadaan, kondisi dan perkembangan yang dialami oleh warga yang terpapar covid 19 di Kota Bandung. Hasil pengabdian masyarakat diperoleh seluruh warga yang terpapar covid 19 sudah dalam keadaan sehat dan pulih seperti sedia kala. Kata Kunci: Pemantauan kasus covid 19. ABSTRACT COVID-19 is a disease caused by the 2019 Novel Coronavirus. The symptoms are similar to the common cold, but COVID-19 has so far had a higher fatality and this virus also spreads very quickly because it can move from person to person even before the person shows symptoms. . The way to self-isolate at home is to always wear a mask and throw away used masks in the designated place, if you are sick (symptoms of fever, flu and cough) then stay at home. Do not go to work, school, to the market or to public spaces to prevent community transmission, take advantage of telemedicine facilities or health social media and avoid public transportation. Tell doctors and nurses about complaints and symptoms, as well as a history of working in infected areas or in contact with COVID-19 patients, while at home, you can work at home. Use a separate room from other family members, and keep a distance of 1 meter from family members, determine daily temperature checks, observe coughs and shortness of breath. Avoid sharing eating and bathing utensils and bedding, apply healthy and clean living habits, and consume nutritious food, wash hands with soap and running water and practice coughing and sneezing etiquette, keep your home clean and healthy with disinfectant liquid. Always be in an open space and bask in the sun every morning (±15-30 minutes), Contact the health care facility immediately if the illness persists such as shortness of breath and high fever, to get further treatment. The purpose of this community service is to monitor COVID-19 cases in the city of Bandung. This community service activity provides services by monitoring to find out the conditions, conditions, and developments experienced by residents exposed to COVID-19 in the city of Bandung. The results of community service were obtained that all residents who were exposed to COVID-19 were in good health and recovered as usual. Keywords: Monitoring cases of covid 19.