Improvement of the nutritional support management system for patients in intensive care units

BACKGROUND Nutritional support for patients hospitalized in the intensive care unit(ICU)is an important part of clinical treatment and care,but there are significant implementation difficulties.AIM To introduce a modified nutritional support management system for ICU patients based on closed-loop information management and psychological counseling.METHODS The division of functions,personnel training,system construction,development of an intelligent decision-making software system,quality control,and improvement of the whole process were carried out to systematically manage nutritional support for ICU patients.RESULTS Following the implementation of the whole process management system,the scores of ICU medical staff’s knowledge,attitudes/beliefs,and practices regarding nutritional support were comprehensively enhanced.The proportion of hospital bed-days of total enteral nutrition(EN)in ICU patients increased from 5.58%to 11.46%,and the proportion of EN plus parenteral nutrition increased from 42.71%to 47.07%.The rate of EN initiation within 48 h of ICU admission increased from 37.50%to 48.28%,and the EN compliance rate within 72 h elevated from 20.59%to 31.72%.After the implementation of the project,the Self-rating Anxiety Scale score decreased from 61.07±9.91 points to 52.03±9.02 points,the Self-rating Depression Scale score reduced from 62.47±10.50 points to 56.34±9.83 points,and the ICU stay decreased from 5.76±2.77 d to 5.10±2.12 d.CONCLUSION The nutritional support management system based on closed-loop information management and psychological counseling achieved remarkable results in clinical applications in ICU patients.

Wearable Healthcare and Continuous Vital Sign Monitoring with IoT Integration

Technical and accessibility issues in hospitals often prevent patients from receiving optimal mental and physical health care,which is essential for independent living,especially as societies age and chronic diseases like diabetes and cardiovascular disease become more common.Recent advances in the Internet of Things(IoT)-enabled wearable devices offer potential solutions for remote health monitoring and everyday activity recognition,gaining significant attention in personalized healthcare.This paper comprehensively reviews wearable healthcare technology integrated with the IoT for continuous vital sign monitoring.Relevant papers were extracted and analyzed using a systematic numerical review method,covering various aspects such as sports monitoring,disease detection,patient monitoring,and medical diagnosis.The review highlights the transformative impact of IoTenabled wearable devices in healthcare,facilitating real-time monitoring of vital signs,including blood pressure,temperature,oxygen levels,and heart rate.Results from the reviewed papers demonstrate high accuracy and efficiency in predicting health conditions,improving sports performance,enhancing patient care,and diagnosing diseases.The integration of IoT in wearable healthcare devices enables remote patient monitoring,personalized care,and efficient data transmission,ultimately transcending traditional boundaries of healthcare and leading to better patient outcomes.

Revolutionizing Healthcare—The Integration of Virtual Worlds, AR, and Metaverse Technology

This paper explores the transformative impact of virtual worlds, augmented reality (AR), and the metaverse in the healthcare sector. It delves into the ways these technologies are reshaping patient care, medical education, and research, while also addressing the challenges and opportunities they present. The paper highlights the potential benefits of these technologies and emphasizes the need for comprehensive regulatory frameworks and ethical guidelines to ensure responsible integration. Finally it outlines their transformative impact and discusses the challenges and opportunities they present for the future of healthcare provision.

Perceptions of nurses in Japan toward their patients' expectations of care: A qualitative study

Objectives: This study aimed to investigate ideal nurse involvement based on the expectations of patients.Data on conflicts between nurses and patients were obtained.The patient situation involved standard nursing treatment,rather than acute phase or palliative care.Methods: Questionnaires were distributed among senior nurses attending a series of trainings in 2012 and 2013.The nurses were requested to return their completed questionnaires within two weeks.We ensured the effectiveness of the interview process to obtain accurate answers.The sample comprised 240 head nurses and assistant head nurses who were asked to respond anonymously to 57 questions about non-acute (stable) psychiatric or physical nurse-patient scenarios.Qualitative data analysis was conducted using these responses.Results: We received 41 completed responses (response rate =17.1%).The expectations of patients and their families were reflected in five categories,namely,inference,empathic understanding,listening attitude,individual treatment,and reliable skills and explanations.Inference was independently categorized as a particularly strong characteristic of Japanese patients' expectations.Conclusions: Nursing care in situations where conflicts or misunderstandings may arise can be improved by encouraging nurses to be attentive to the moods,feelings,and expectations of patients and their families.The findings from this study can improve the quality of Japanese nursing care with regard to sensing (inferring) and reacting to the expectations of patients.

Transitional care interventions to reduce readmission in patients with chronic obstructive pulmonary disease:A meta-analysis of randomized controlled trials

Objective：To objectively assess the effect of transitional care on readmission for patients with chronic obstructive pulmonary disease.Methods：The PubMed,Science Direct,Web of Science,Cochrane Library,CNKI,and Wanfang databases were searched for relevant randomized controlled trials（RCTs） published from January 1990 through April 2016.The quality of eligible studies was assessed by two investigators.The primary outcome assessed was readmission for COPD and all-cause readmission.The pooled effect sizes were expressed as the relative risk and standard mean difference with 95%confidence intervals.Heterogeneity among studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions（Version5.1.0） and determined with an I^2 statistic.Results：A total of seven RCTs that included 1879 participants who met the inclusion criteria were analyzed.The results of subgroup analysis showed significant differences in readmission for COPD at the6 month and 18 month time points and all-cause readmission at the 18 month follow-up.Transitional care could reduce readmission for COPD at the 6 month[RR = 0.51,95%CI（0.38,0.68）,P 〈 0.00001]and18 month time points[RR = 0.56,95%CI（0.45,0.69）,P 〈 0.00001,and also reduce all-cause readmission after 18 months[RR = 0.72,95%CI（0.62,0.84）,P 〈 0.0001].The reduction of all-cause readmission between the intervention and control groups in the 2nd year,however,was less than that in the 1st year.Conclusions：Transitional care is beneficial to reducing readmission for patients with COPD.Duration of≥ 6 and ≤ 18 months are more effective,and the effect weakens over intervention time,especially after the end of intervention.Both durations point to the importance of ongoing intervention and reinforcement after the end of intervention.

Logistic Regression Analysis and Nursing Interventions for High-risk Factors for Pressure Sores in Patients in a Surgical Intensive Care Unit

Objective： To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods： A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam- ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results： According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were statistically greater in the pressure sore group than in the control group （P〈0.05）. The multivariate logistic regression analysis revealed that the number of days of norepinephrine use and the level of lactic acid in the arterial blood were high risk-factors for pressure sores （P〈0.05）. Conclusions： The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of decompression measures during the treatment of the patients, are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.

Knowledge levels and attitudes of health care professionals toward patients with hepatitis C infection

AIM:To study knowledge levels and attitudes of health care providers toward patients with hepatitis C virus infection in Guilan,a northern province of Iran.METHODS:This cross-sectional study was performed on 239 health care professionals from the Razi Hospital,including doctors,nurses,and operating room technicians.The questionnaires consisted of questions on demographic characteristics,knowledge levels,and attitudes toward hepatitis C patients.The questionnaire was tested in a pilot study and validated by Cronbach' s alpha coefficient.Data were analyzed using SPSS16 software.RESULTS:The mean ± SD knowledge score was 17.43 ± 2.65(from a total of 22).51.9% of the participants achieved scores higher than the mean.There was a significant relationship between knowledge score and age(P = 0.001),gender(P = 0.0001),occupational history(P = 0.0001),and educational history(P = 0.027).There was also a significant relationship between attitude level and age(P = 0.002),gender(P = 0.0001),occupational history(P = 0.0001),and educational history(P = 0.035).Physicians were significantly more knowledgeable and showed more positive attitudes.There was a positive correlation between knowledge and attitude scores(P = 0.02).CONCLUSION:Discriminatory attitudes are common among health care providers toward hepatitis C patients.It is therefore necessary to improve their knowledge level and attitude toward this disease.

A qualitative study of nurses’experiences of self-care counseling in migrant patients with heart failure

Objectives:This study aims to enhance researchers’and nurses’understanding of how to best support migrant patients with heart failure in self-care management.Previous research on self-care in heart failure patients has highlighted its importance,particularly among migrant populations.Nurses play an important role in informing and engaging patients with chronic conditions like heart failure to support their active participation in self-care.However,nurses’experiences of providing self-care counseling to migrant populations with heart failure have not been studied.Methods:A qualitative study was conducted.Nurses working with migrant patients with HF(n?13)from different types of facility in Western Sweden were interviewed between October and December 2020.Data were collected using semi-structured interviews and analyzed using inductive thematic analysis.Results:The main theme that emerged from the interviews was the difficulty for nurses“to find balance”in self-care counseling.The nurses during self-care counseling had:“to accept challenges,”“to use creative strategies,”faced“problems related to health literacy,”and“to work according to their(the nurses’)obligations.”It was evident that nurses faced several challenges in counseling migrants in self-care,including language and cultural barriers,time resource constraints,low levels of health literacy,and experienced disharmony between the law and their professional norms.They perceived building caring relationships with their patients to be crucial to fostering health-promoting self-care processes.Conclusions:To increase self-care adherence,nurses must become more sensitive to cultural differences and adapt self-care counseling to patients’health literacy.The findings of this research support and challenge nurses in providing the best counsel to migrant patients with heart failure living in Sweden’s multi-ethnic society.Policymakers in the health care organization should act to facilitate mutual cultural understanding between all involved partners for patient-safe self-care counseling.

The Introduction of Pharmaceutical Care in Psychiatric Outpatients in Community Pharmacy of the Northeast Region of Argentina

The purpose of this paper is to implement a pharmaceutical care program in psychiatric outpatients in a community pharmacy. Outpatients （536） with psychiatric treatment requiring the dispensing of medication prescribed by a psychiatrist were followed up in a community pharmacy, where different medicines were prescribed as PS （pharmaceutical specialties）, PC （pharmaceutical compounding） or both PS and PC. Each prescription was registered with details on a patient level. Also, three reporting sheets were designed： patients profile, patients monitoring and patients counseling. The total study population in the community pharmacy consisted of 536 outpatients： 357 （66.6%） females and 179 （33.4%） males. Most of the outpatients （78.5%） have health insurance, 50% correspond to public and 28.5% to private institution. The other patients （21.5%） do not have medical insurance. We also observed that the education level of these patients was： primary school 19.1%; high school 45.9%; college 15.3% and university 20.7%. Many patients had more than one psychiatric diagnosis, to whom were prescribed different medicines. All the medication studies on the charts were screened for prescriptions with antidepressants and other psychotropic drugs, starting on the date of first diagnosis made by a psychiatrist. The counseling to the patients was also registered. The possibility of the follow-up of these outpatients in the community pharmacy promoted the development of the psychiatric pharmacy and all advances in care for patients with mental health needs, working in closer collaboration with psychiatrists.

Study on Related Factors of Acute Kidney Injury in Patients under Intensive Care

Objectives:To study the related factors of acute kidney injury(AKI)in intensive care unit(ICU)patients.Methods:The clinical data of 879 patients in the intensive care unit were retrospectively analyzed.AKI patients were selected according to the AKI clinical diagnostic criteria,the causal analysis was performed,the indicators of AKI patients were tested,and the urine volume and the time of admission to the ICU were recorded.Finally,logistic regression analysis was used to analyze the risk factors that affect the prognosis.Results:Among the 879 patients in the intensive care unit,96 patients(10.9%)met the KDIGO-AKI diagnostic criteria,of which 29(30.31%)died and 49(51.04%)required renal replacement therapy.As the age and stage of AKI patients increase,the mortality rate also increases.The pathology constituted 46 septic patients(47.92%)and 50 non-septic patients(52.08%).Patients with septic AKI have longer ICU and hospital stay than patients with non-septic AKI(t=2.291,0.023;t=2.082,0.041),and the rate of renal replacement therapy is higher(χ2=4.091,P=0.042).Logistic regression analysis shows that old age,low urine volume,shock,acidosis,stage 3 of AKI,intake of blood pressure drugs,infections,and the need for renal replacement therapy are relevant factors that affect AKI.Conclusions:In the intensive care unit,the incidence and mortality of AKI are very high;the treatment of AKI is related to many factors;early detection and treatment is very crucial to reduce the mortality of AKI.

Effect of patient COVID-19 vaccine hesitancy on hospital care team perceptions

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic posed new challenges in patient care worldwide.Vaccinations,which have proven efficacious in lowering the COVID-19 hospital burden,are still avoided by large populations.We,therefore,hypothesized that hospital care teams would have worse perceptions regarding the characteristics and care of patients with vaccine hesitancy.AIM To evaluate whether patient vaccine hesitancy affected the hospital care team(HCT)perceptions.METHODS We performed a prospective clinical study using structured questionnaires.We approached physicians and nurses with previous experience caring for COVID-19patients from 11 medical centers across Israel during the fourth COVID-19 surge(September and October 2021).The participants completed a questionnaire with the following parts:(1)Sociodemographic characteristics;(2)Assessment of anger(STAXI instrument)and chronic workplace stress(Shirom-Melamed burnout measure);and(3)Three tools to assess the effect of patient vaccine hesitancy on the HCT perceptions(the difficult doctor-patient relation questionnaire,the medical staff perception of patient’s responsibility questionnaire and the characterological derogation questionnaire).Results were evaluated according to each part of the questionnaire and the questionnaire as a whole.Associations between HCT perceptions and their baseline characteristics,anger or chronic workplace stress were assessed.RESULTS The HCT experienced their relationship with unvaccinated patients as more difficult(P<0.001,Cohen’s d=0.85),perceived unvaccinated patients as responsible for their medical condition(P<0.001,d=1.39)and perceived vaccinated patients as having a higher character value(P<0.001,d=1.03).Unvaccinated patients were considered selfish(P<0.001),less mature(P<0.001)and less satisfying to care for(P<0.001).The relationship with unvaccinated patients was more difficult among HCT with higher burnout(r=0.37,n=66,P=0.002).No correlations with baseline characteristics were found.All three study tools showed high internal consistency(αbetween 0.72 and 0.845).CONCLUSION Our results should raise awareness of the possible effects of vaccine hesitancy on HCT perceptions regarding unvaccinated patients.In order to minimize the potential negative impact on patient care,designated departments should promote specific patient-centered preparations.Further investigations should assess whether vaccine hesitancy directly affects patient quality of care.

Sleeping Conditions of Older Adults with Delirium Receiving Home Care

We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their bedding, after ruling out insomnia and dementia. The incidence of delirium was 28.6%;delirium onset occurred within an average of 2.7 (SD = 12) days after the start of home care among those whose care environment was changed due to hospital discharge or moving. Increased interrupted sleep and activity during sleep indicated that sleep fragmentation occurred before delirium onset. In conclusion, individuals aged ≥65 years and those whose care environment has changed should be screened for delirium because the time to delirium onset is short. Further, interventions to monitor the sleep status and prevent delirium onset should be implemented from the day home care begins.

Predictive risk factors for prolonged stay in intensive care unit in patients undergoing coronary artery bypass grafting surgery

Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses

Predictive risk factors associated with prolonged stay in the intensive care unit for patients undergoing coronary artery bypass grafting surgery

Objective The rate of post-operative complications has been increased with the changes in patients’age,prolonged duration,more severe and diffused lesions,and more patients with complications in recent years. We try to identify the risk factors associated with prolonged stay in the intensive care unit (ICU) after coronary artery bypass graft surgery (CABG) . Methods 1623 patients who received CABG surgery in Beijing Anzhen Hospital

Unveiling the challenges encountered by newly graduated nurses during night shifts:A descriptive qualitative study

Objectives:Newly graduated nurses commence night shifts during a phase of heightened vulnerability to reality shock,exacerbating the challenges faced by these graduates.Therefore,this study aimed to identify the challenges experienced by newly graduated nurses when undertaking night shifts in order to help identify a strategy for supporting their adaptation to these shifts.Methods:Semi-structured personal interviews were used to collect data.Fifteen newly graduated nurses were selected to participate in the study by purposive sampling method from November 2021 to March 2022 in one of four general hospitals situated in the southwestern region of Japan.Semi-structured interviews were analyzed by using thematic analysis.Results:The analysis revealedfive central themes and nine subthemes:challenges in task efficiency(task organization challenges,challenges in time-constrained task performance),challenges in responding to patients’changing conditions(challenges in responding to patients’irregular conditions,challenges in responding to nighttime changes in patients’behaviors),challenges in independent practice(challenges in engaging in independent nursing practice,challenges in dealing with unexpected events),challenges in establishing collaborative relationships(challenges in working closely with other staff,challenges in establishing collaborative relationships during night shifts with limited resources),challenges in adapting to shift work(challenges in managing physical conditions for shift work).Conclusions:Newly graduated nurses often encounter challenges in performing their tasks during the transition period.When working night shifts,they face additional hurdles unique to nocturnal duties.Thefindings underscore the necessity for these graduates to develop night shift-specific readiness to effectively navigate the demands inherent in such work schedules.

Interdepartmental miscommunication regarding radiology:Addressing chronic challenges and exploring solutions

Effective communication and collaboration among healthcare professionals are crucial for delivering high-quality patient care.Interdepartmental miscommunication poses a significant challenge to healthcare systems,potentially undermining the quality of healthcare services provided.In the same manner,communication barriers between referring physicians and radiologists can specifically affect radiology services and patient outcomes.This article attempts to put the spotlight on the ever-present chronic challenges of this issue and prompt readers to recognize the relevant potential pitfalls in their daily clinical practice.Practical solutions are explored and proposed,which should be tailored to the specific needs and issues that each individual institution may face.

Practical Exploration of Strengthening Team Communication and Cooperation in Head Nurse Nursing Management

This study explores the practical application of nursing management led by head nurses to enhance team communication and collaboration within clinical settings.By integrating leadership theories with nursing practice,this research adopts a qualitative methodology to examine the effects of strategic communication and teamwork enhancement initiatives.Through interviews,observations,and the analysis of case studies in various hospital departments,the study identifies key barriers to effective team communication and collaboration,including hierarchical structures,lack of standardized communication protocols,and insufficient training.Solutions implemented involve targeted communication skills training,the establishment of interdisciplinary teamwork protocols,and leadership workshops for head nurses.The outcomes indicate significant improvements in team efficiency,patient care quality,and staff satisfaction.This research underscores the importance of head nurses in fostering an environment conducive to open communication and collaborative practice,thereby advancing patient care and team performance.

Awareness of Radiologists and Radiographers toward Patient Care in the Interventional Radiology Department

Background: The hospitals and health care centres are organized around the patient, a model in which healthcare providers partner with patients and families to identify and satisfy patients’ needs and preferences. Providers respect patients’ values and preferences, address their emotional and social needs, and involve them and their families in decision making. According to the best of our knowledge, there is no evidence to prove, radiologists and radiographers are aware enough about the patient safety, care, and code of conduct with their patients in the interventional radiology department. Objective: This article aims to measure the awareness of radiologists and radiographers toward care and safety in an interventional radiology department. Material and Method: This study was carried in period from 15 February to 20 April 2022. One hundred sixty-four radiographers and radiologists participating in this study completed the questionnaire, which equals a response rate of approximately 82%. The questionnaire was fully completed by almost all responders;only a few of them gave partial answers. Results: The first question for radiographers and radiologists was “the sufficient awareness about the patient safety and care during the interventional radiology procedure. Also, the majority of the radiographers and radiologists are providing the patients with sufficient information when he/she ask for help or queries. A large number of radiographers and radiologists were participating in this study explaining the procedures to patients before starting the examinations in a structured way. Finally, the result shows both radiographers and radiologists respect the patient’s rights, privacy, and dignity and also kept the radiation protection during the interventional radiology procedures. Conclusion: This article summarizes the key categories of awareness of patient care issues in the provision of interventional radiology services, from the joint perspectives of radiographers and radiologists, and provides references for further reading in all major relevant areas.

Clinical and cost impact of intravenous proton pump inhibitor use in non-ICU patients

AIM:To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS:Data collection was performed prospec-tively during a 6-mo period on 340 patients who re-ceived omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration. RESULTS:Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which,only 17% met the guideline criteria for SUP indication,14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis,while the remaining 69% were identifi ed as having an unjustified indication for PPI use. Theinitiation of IV PPIs was appropriate in 55% of pa-tients. Half of these patients were candidates for switching to the oral dosage form during their hos-pitalization,while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%,P = 0.003). The cost analysis associated with the appro-priateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17 732.5 and $14 571,respectively. CONCLUSION:This study highlights the over-utili-zation of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.

Big Data Analytics in Healthcare——A Systematic Literature Review and Roadmap for Practical Implementation

The advent of healthcare information management systems(HIMSs)continues to produce large volumes of healthcare data for patient care and compliance and regulatory requirements at a global scale.Analysis of this big data allows for boundless potential outcomes for discovering knowledge.Big data analytics(BDA)in healthcare can,for instance,help determine causes of diseases,generate effective diagnoses,enhance Qo S guarantees by increasing efficiency of the healthcare delivery and effectiveness and viability of treatments,generate accurate predictions of readmissions,enhance clinical care,and pinpoint opportunities for cost savings.However,BDA implementations in any domain are generally complicated and resource-intensive with a high failure rate and no roadmap or success strategies to guide the practitioners.In this paper,we present a comprehensive roadmap to derive insights from BDA in the healthcare(patient care)domain,based on the results of a systematic literature review.We initially determine big data characteristics for healthcare and then review BDA applications to healthcare in academic research focusing particularly on No SQL databases.We also identify the limitations and challenges of these applications and justify the potential of No SQL databases to address these challenges and further enhance BDA healthcare research.We then propose and describe a state-of-the-art BDA architecture called Med-BDA for healthcare domain which solves all current BDA challenges and is based on the latest zeta big data paradigm.We also present success strategies to ensure the working of Med-BDA along with outlining the major benefits of BDA applications to healthcare.Finally,we compare our work with other related literature reviews across twelve hallmark features to justify the novelty and importance of our work.The aforementioned contributions of our work are collectively unique and clearly present a roadmap for clinical administrators,practitioners and professionals to successfully implement BDA initiatives in their organizations.