Prevalence, Severity, and Predictors of Poststroke Depression in a Prospective Cohort of Jordanian Patients

Poststroke depression (PSD) is common and remains a significant risk factor for poor outcomes. This prospective study is aimed at assessing the prevalence, severity, and predictors of PSD among Jordanian stroke survivors. A total of 151 patients who were consequently admitted to a tertiary teaching hospital with ischemic or hemorrhagic strokes were enrolled. Participants were screened on admission for premorbid depression using the PHQ-9 questionnaire; then, screening for PSD was repeated one and three months after stroke using the same tool. Depression prevalence at each screening was reported, and logistic regression analysis was conducted to evaluate for significant predictors. PHQ-9 scores suggestive of depression were reported by 15%, 24.83%, and 17.39% of respondents on admission and after one and three months, respectively. Scores suggesting severe depression were reported by 0.71%, 2.13%, and 6.52% of respondents, respectively. Significant predictors of PSD were having chronic kidney disease, current smoking status, moderate or severe disability (mRS score) at stroke onset, and severe dependence (BI) after one month ( p values 0.007, 0,002, 0.014, and 0.031, respectively). Patients with secondary and high school education levels were less likely to get depression compared with illiterate patients ( p 0.042). This study showed that nearly one in four Jordanian stroke survivors experienced PSD after one month. In contrast, while the overall PSD prevalence declined towards the end of follow-up period, patients who remained depressed showed a tendency towards higher PSD severity.

Evaluating the Inappropriate Prescribing and Utilization of Caspofungin, a Four-Year Analysis at a Teaching Hospital in Saudi Arabia

The appropriate use of antimicrobial agents improves clinical outcomes and reduces antimicrobial resistance. Nevertheless, data on inappropriate prescription and negative outcomes are inconsistent. The objective of this study was to assess the prescription appropriateness of Caspofungin at a tertiary teaching hospital in Saudi Arabia and the impact on mortality at 30 days. A retrospective chart review was performed for patients who received Caspofungin from May 2015 to December 2019 to obtain prescription information and culture and susceptibility tests. The appropriateness of the dosage (ApD), initiation time (ApI), agent selection (ApS), and duration of therapy (ApDUR) was evaluated based on recommendations of the infectious diseases society of America. 355 eligible patients who received 3458 Caspofungin doses were identified. Their median age was 54 years (range 18–96). Overall, 270 (76.1%) patients received empirical prescriptions, of which 74.4% had the appropriate dose, and 56.3% had received it for more than five days, despite no proven Candida infection. This was not influenced by past medical history (p = 0.394). Only 39% of patients who received definitive prescriptions met all four study criteria for appropriate prescription. Therefore, antimicrobial stewardship programs can improve the appropriate utilization of antifungal therapies.

A survey on current practice of informed consent process in surgical specialties of a tertiary teaching hospital center: What is the state of play?

Background Informed consent is essential in current medical practice and should be a global standard to be sought at all instances when doctors interact with patients. The aim of this study was to evaluate compliance to the guidelines of the Portuguese health entity regarding the correct filling process of informed consent. Methods A prospective observational survey was conducted upon arrival of the patient at the operating room of a tertiary teaching hospital center in Portugal, in march 2021, to verify the presence of informed consent in the clinical process. A sample of 202 clinical files was randomly collected. Results Only 47% of the patients had the informed consent document in the clinic process and only 45% of the total clinical files had the informed consent signed by the patient. Merely 21.8% of the informed consents respected all the items recommended by the guidelines of the Portugal health entity. Most of the surgical informed consent (SIC) had only basic information and only a lower percentage had reports about the surgical procedure, information regarding the treatment, possible consequences of a missed treatment or complications and possible treatment alternatives. Those results didn’t conform to the standard regulations of the Portuguese health guidelines regarding SIC. Conclusion Even though improvements in SIC were attained in recent years, our study suggests that the implementation of SIC is still suboptimal in surgical practice. It is important to raise awareness for the obtention of SIC by the healthcare team, because complete information before an invasive procedure is an ethical requirement.

COVID-19–induced acute kidney injury in critically ill patients: epidemiology, risk factors, and outcome

Background: The kidney represents a potential target for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Acute kidney injury (AKI) can occur through several mechanisms and includes intrinsic tissue injury by direct viral invasion. Clinical data about the clinical course of AKI are lacking. We aimed to investigate the proportion, risk factors, and prognosis of AKI in critical patients affected with coronavirus disease 2019 (COVID-19).Methods: A case/control study conducted in two intensive care units of a tertiary teaching hospital from September to December 2020.Results: Among 109 patients, 75 were male (69%), and the median age was 64 years (interquartile range [IQR], 57–71 years); 48 (44%) developed AKI within 4 days (IQR, 1–9). Of these 48 patients, 11 (23%), 9 (19%), and 28 (58%) were classified as stage 1, 2, and 3, respectively. Eight patients received renal replacement therapy. AKI patients were older and had more frequent sepsis, acute respiratory distress syndrome, and rhabdomyolysis; higher initial urea and creatinine; more marked inflammatory syndrome and hematological disorders; and required more frequent mechanical ventilation and vasopressors. An elevated level of D-dimers (odds ratio [OR], 12.83; 95% confidence interval [CI], 1.9–85) was an independent factor of AKI. Sepsis was near to significance (OR, 5.22; 95% CI, 0.94–28; P=0.058). Renal recovery was identified in three patients. AKI, hypoxemia with the ratio of the arterial partial pressure of oxygen and the inspiratory concentration of oxygen <70, and vasopressors were identified as mortality factors.Conclusions: AKI occurred in almost half the patients with critical COVID-19. A high level of D-dimers and sepsis contributed significantly to its development. AKI significantly worsened the prognosis in these patients.

Comparison of OPD-Referral and Self-Referral Patients In The Emergency Department

Background: To compare outpatient department (OPD) referral patients and self-referral patients in the emergency department (ED) in terms of hospitalization, mortality, and length of stay.Methods: We collected ED patients of a tertiary teaching hospital over a 3-month period. We excluded pediatric patients and patients with certain inconsistent characteristics, such as trauma and out-of-hospital cardiac arrest, or referral from other facilities. After propensity score matching, we compared the hospitalization, mortality, and length of stay in the ED of the OPD-referral patents and self-referral patients. We categorized the patients as “emergency” or “urgency” according to their triage information and then analyzed the effects of different severity levels.Results: The OPD-referral ED patients, compared with the self-referral patients, had a higher admission rate (49.8% vs. 28.9%, p < 0.001; odds ratio [OR] = 2.44, 95% confidence intervals [CIs]: 1.91 - 3.12). Among the emergency patients, there was no significant difference regarding the admission rate (62.6% vs. 55.8%, p = 0.257) or the mortality rate (4.6% vs. 8%, p = 0.253). Among the urgent patients, the admission rate was significantly different between the OPD-referral and self-referral groups (46% vs. 20.2%, p < 0.001; OR = 3.36, 95% CIs: 2.48 - 4.55). The urgent patients who were referred from OPD tended to have a higher mortality rate (2.1% vs. 0.5%, p = 0.064). Regarding the length of ED stay, only the discharge and urgent subgroups differed according to OPD- and self-referral status (p < 0.001), with a median of 5.8 hours versus 2.3 hours.Conclusions: The OPD-referral ED patients have a higher admission rate and a longer length of stay than self-referral patients in urgent triage. The OPD-referral ED patients might have more severe and complex conditions. We should be more alert to OPD-referred patients even when they initially appear not severely ill.

Physiological Observations and Nursing Interventions in the Pre-Arrest Patient: A Descriptive Study

<p>Aim: To identify how nurses respond to abnormal physiological observations in the 12 hours prior to a patient having a cardiac arrest. Methods: A descriptive observational design was used to retrospectively review the observation charts and nursing notes of 28 patients who had an in-hospital cardiac arrest, during a 20 month period. This study was performed in a large, tertiary teaching hospital in New Zealand. Key Findings Only one patient met the hospitals minimum standard of four hourly observations and a full set of vital signs were performed on only three patients. The nursing responses were limited to increasing the frequency of observations or informing the doctor. There were few other interventions to treat the abnormality. Eight (32%) patients who had either no response or a partial response to their abnormal physiology did not survive. The nursing documentation demonstrated that abnormal neurological observations were tolerated for significant periods of time and were not acted upon in 62% of these patients. The nursing documentation revealed that the delivery of oxygen was often insufficient to meet the patient's requirements and the medical staff were aware of less than half the patients with abnormal physiology. Discussion removed statement re pt survival: This research identified major deficiencies with recording patient vital signs. If these are not recorded regularly, patient deterioration will be missed and treatment cannot be initiated. Nurses need to respond to abnormal physiology beyond repeating vital signs and informing the medical staff. They are accountable for initiating interventions to prevent further deterioration. Conclusion: The early recognition of patient deterioration and treatment are essential to prevent cardiac arrest. Education strategies are required to improve compliance with recording patient vital signs, communication between nursing and medical staff and how to respond to patient deterioration. The barriers to these must be addressed and solutions sought if patient mortality is to be improved.</p>

Physiological Observations and Nursing Interventions in the Pre-Arrest Patient: A Descriptive Study

<p>Aim: To identify how nurses respond to abnormal physiological observations in the 12 hours prior to a patient having a cardiac arrest. Methods: A descriptive observational design was used to retrospectively review the observation charts and nursing notes of 28 patients who had an in-hospital cardiac arrest, during a 20 month period. This study was performed in a large, tertiary teaching hospital in New Zealand. Key Findings Only one patient met the hospitals minimum standard of four hourly observations and a full set of vital signs were performed on only three patients. The nursing responses were limited to increasing the frequency of observations or informing the doctor. There were few other interventions to treat the abnormality. Eight (32%) patients who had either no response or a partial response to their abnormal physiology did not survive. The nursing documentation demonstrated that abnormal neurological observations were tolerated for significant periods of time and were not acted upon in 62% of these patients. The nursing documentation revealed that the delivery of oxygen was often insufficient to meet the patient's requirements and the medical staff were aware of less than half the patients with abnormal physiology. Discussion removed statement re pt survival: This research identified major deficiencies with recording patient vital signs. If these are not recorded regularly, patient deterioration will be missed and treatment cannot be initiated. Nurses need to respond to abnormal physiology beyond repeating vital signs and informing the medical staff. They are accountable for initiating interventions to prevent further deterioration. Conclusion: The early recognition of patient deterioration and treatment are essential to prevent cardiac arrest. Education strategies are required to improve compliance with recording patient vital signs, communication between nursing and medical staff and how to respond to patient deterioration. The barriers to these must be addressed and solutions sought if patient mortality is to be improved.</p>