The Quality in Psychiatric Care-Forensic In-Patient Staff (QPC-FIPS) instrument: Psychometric properties and staff views of the quality of forensic psychiatric services in Sweden

The aim of the present study was to evaluate the psychometric properties and dimensionality of the instrument Quality in Psychiatric Care-Forensic In-Patient Staff (QPC-FIPS) and to describe the perceived quality of psychiatric care among forensic inpatient service staff. A sample of 348 forensic inpatient staff from 18 forensic wards in Sweden participated in the study. A confirmatory factor analysis revealed a seven-factor structure with item loadings > 0.50 on expected factors, indicating adequate psychometric properties. The staff’s ratings of quality of care were high, 94% being positive. The highest ratings were found for the secluded-environment dimension and the lowest for the secure-environment dimension. Several factors influenced the ratings of quality of care, for instance, staff’s time to perform their duties and staff’s age. It is concluded that the QPC-FIPS can give valuable information about staff’s perceptions of the quality of care provided at inpatient forensic psychiatric care services, which can be used to identify areas for quality improvement. Use of the QPC-FIPS is an easy and inexpensive way to evaluate quality in forensic inpatient care, preferably in conjunction with the QPC-FIP instrument developed for forensic inpatients and covering the same items and dimensions.

Factor Structure and Psychometric Properties of the Danish Adaptation of the Instrument Quality in Psychiatric Care-Forensic In-Patient Staff (QPC-FIPS)

There is a need for an internationally standardized and psychometrically tested instrument to measure the perceptions of staff members on the quality of forensic inpatient care provided. The aim of the present study was to adapt the Swedish instrument Quality of Psychiatric Care-Forensic In-Patient Staff (QPC-FIPS) to the Danish context and to evaluate its psychometric properties and factor structure in this context. All permanently employed staff members at all 27 forensic inpatient wards in Denmark were invited to answer the Danish version of the QPC-FIPS. In total, 641 staff members participated, resulting in a response rate of 80%. The Danish version of the QPC-FIPS showed adequate psychometric properties and excellent goodness of fit of the hypothesised factor structure. Hence, the Danish QPC-FIPS is an excellent instrument for evaluating quality of forensic inpatient care both in clinical practice and in cross-cultural research. The members of staff generally reported that the care provided to patients was of high quality. The quality of the forensic-specific dimension was rated the highest, followed by the support, secluded environment, encounter, discharge and participation. The quality of the secure environment dimension was perceived to be the worst. The QPC-FIPS includes important aspects of staff members’ assessments of quality of care and offers a simple and inexpensive way to evaluate psychiatric forensic inpatient care. The QPC-FIPS can be used together with the Quality of Psychiatric Care-Forensic In-Patient (QPC-FIP) instrument, which covers the same items and dimensions as the QPC-FIPS, to identify patients’ and staff members’ views on quality of care and to improve the quality of forensic psychiatric care and benchmarking.

Outcomes in patients with COVID-19 and new onset heart blocks: Insight from the National Inpatient Sample database

BACKGROUND Coronavirus disease 2019(COVID-19)caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has resulted in a worldwide health crisis since it first appeared.Numerous studies demonstrated the virus’s predilection to cardiomyocytes;however,the effects that COVID-19 has on the cardiac conduc-tion system still need to be fully understood.AIM To analyze the impact that COVID-19 has on the odds of major cardiovascular complications in patients with new onset heart blocks or bundle branch blocks(BBB).METHODS The 2020 National Inpatient Sample(NIS)database was used to identify patients admitted for COVID-19 pneumonia with and without high-degree atrioven-tricular blocks(HDAVB)and right or left BBB utilizing ICD-10 codes.The patients with pre-existing pacemakers,suggestive of a prior diagnosis of HDAVB or BBB,were excluded from the study.The primary outcome was inpatient mortality.Secondary outcomes included total hospital charges(THC),the length of hospital stay(LOS),and other major cardiac outcomes detailed in the Results section.Univariate and multivariate regression analyses were used to adjust for confounders with Stata version 17.RESULTS A total of 1058815 COVID-19 hospitalizations were identified within the 2020 NIS database,of which 3210(0.4%)and 17365(1.6%)patients were newly diagnosed with HDAVB and BBB,respectively.We observed a significantly higher odds of in-hospital mortality,cardiac arrest,cardiogenic shock,sepsis,arrythmias,and acute kidney injury in the COVID-19 and HDAVB group.There was no statistically significant difference in the odds of cerebral infarction or pulmonary embolism.Encounters with COVID-19 pneumonia and newly diagnosed BBB had a higher odds of arrythmias,acute kidney injury,sepsis,need for mechanical ventilation,and cardiogenic shock than those without BBB.However,unlike HDAVB,COVID-19 pneumonia and BBB had no significant impact on mortality compared to patients without BBB.CONCLUSION In conclusion,there is a significantly higher odds of inpatient mortality,cardiac arrest,cardiogenic shock,sepsis,acute kidney injury,supraventricular tachycardia,ventricular tachycardia,THC,and LOS in patients with COVID-19 pneumonia and HDAVB as compared to patients without HDAVB.Likewise,patients with COVID-19 pneumonia in the BBB group similarly have a higher odds of supraventricular tachycardia,atrial fibrillation,atrial flutter,ventricular tachycardia,acute kidney injury,sepsis,need for mechanical ventilation,and cardiogenic shock as compared to those without BBB.Therefore,it is essential for healthcare providers to be aware of the possible worse predicted outcomes that patients with new-onset HDAVB or BBB may experience following SARS-CoV-2 infection.

心境稳定剂联合喹硫平或奥氮平治疗双相情感障碍躁狂发作疗效分析

目的研究心境稳定剂锂盐、丙戊酸盐联合喹硫平、奥氮平治疗双相情感障碍躁狂发作的疗效差异,为双相情感障碍躁狂发作患者选择合适的治疗方案提供参考。方法采用回顾性分析方法,收集某医院2015年1月—2022年7月收治的120例双相情感障碍躁狂发作患者的病历信息,按治疗方案不同分为4组,碳酸锂联合喹硫平组(21例)、碳酸锂联合奥氮平组(21例)、丙戊酸钠联合喹硫平组(50例)、丙戊酸钠联合奥氮平组(28例)。在治疗前、住院2周后、出院时采用倍克-拉范森躁狂量表评估患者躁狂症状,比较各组临床疗效、不良反应发生率,分析影响2周后躁狂症状缓解率的因素。结果4种联合方案入院时评分与2周后评分、出院时评分差异具有统计学意义(P<0.001);碳酸锂联合喹硫平组2周后缓解率优于碳酸锂联合奥氮平组,差异有统计学意义(P<0.01);多因素Logistic回归分析发现,家族史、药物不良反应、治疗方案、发病年龄与患者治疗2周后躁狂症状缓解率相关。结论4种联合方案均能有效改善双相情感障碍躁狂发作患者的躁狂症状;药物治疗方案推荐依次选用丙戊酸钠联合喹硫平、碳酸锂联合喹硫平、丙戊酸钠联合奥氮平、碳酸锂联合奥氮平;患者治疗2周后的躁狂症状缓解率与家族史、药物不良反应、药物治疗方案、发病年龄相关。

Impact of IPMOE on nursing tasks in the medical ward: A time-motion study

Introduction:The In-patient Medication Order Entry System (IPMOE) was first implemented in the medical ward of Princess Margaret Hospital,Hong Kong.It was a local developed close-loop system including prescription,dispensing and administration modules.Evaluation on its impact on nursing tasks would be important for practice improvement and subsequent system enhancement.Objective:The study was conducted to quantify the nursing times across medication-associated tasks for paper-based MAR and computer-based IPMOE,including change in the tasks and time patterns before and after IPMOE implementation.Methods:This was a prospective observation study in medical wards before (Jan 2014-Jun 2014) and after (Mar 2015-Jun 2015) the implementation of IPMOE.We conducted 8-hr observation studies of individual nurses with a customized application to time various pre-categorized nursing tasks.Statistical inferences and interrupted time series analysis was performed to identify the change in the intercept and trends over time after implementation.Result:The average number of medication-related tasks was significantly reduced from 61.07 to 29.81,a reduction of 31.26 episodes per duty (P < 0.001,95% CI 22.9-39.63).The time for the medication-related tasks was reduced from 32 min (SD =21.57) to 26.57 min (SD =11.35) and the medication administration time increased from 37.93 min (SD-14.78) to 44.37 min (SD 19.45),but there was no overall significant difference in the time spent on each duty (P =0.315) between the two groups.An improving trend in the delayed effect was observed (P =0.03),which indicated a run-in period for new application was needed in clinical setting.Conclusion:Our study had shown the time motion observation could be applied to measure the impact of the IPMOE in a busy clinical setting.Through classification of activities,validation,objective measurement and longitudinal evaluation,the method could be applied in various systems as well as different clinical settings in measure efficiency.

Proposed Libyan Guidelines for the Management of Inpatient Hyperglycemia with Corona Virus-19 (COVID-19) Infection

Serious hyperglycemia is one of the manifestations of COVID-19 infection which increase patient morbidity and mortality especially in patient requiring hospitalization. Consequently, many protocols and algorithms for hospitalized patients with COVID-19 induced hyperglycemia based mainly on recent studies and previous evidence on non-COVID-19 patients were published. Of note nearly all guidelines released by the different COVID-19 committees in Libya don’t include a clear focus on management of in-patient hyperglycemia and maybe this plays a pivotal role in increase our COVID-19 in-hospital mortality. I proposed a simplified approach depending on the released international guidelines to be easily implemented by Libyan health care staff caring about COVID-19 patients and hoping to be accepted by our National Diabetes Committee.

运用失效模式及效应分析改善临床给药流程的探讨

目的对临床给药流程进行改造，以减少用药流程的风险。方法运用失效模式及效应分析的基本步骤，成立流程改进工作小组，列出临床给药的流程，指出子流程下可能导致差错的环节及原因。提出优先解决的问题及流程整改方案，设计新型的临床给药流程。结果新旧给药流程优先风险数值比较差异有显著性（P〈0．01）；改造后用药相关缺陷从4例下降至2例。结论将失效模式及效应分析对临床护理给药流程进行分析，能前瞻性地发现工作流程中潜在的缺陷，使管理者发现流程中应该优先解决的问题，为护理工作流程改造提供科学的方法，确保病人用药安全。