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Mistriage is important because of its potential for serious consequences, notwithstanding the beneficial effects of the emergency patient classification system employed to alleviate overcrowding in emergency departments (EDs). This study aimed to assess mistriage using the Korean Triage and Acuity Scale (KTAS) and identify factors influencing it.
Retrospective cross-sectional study.
We examined the factors influencing mistriage in the KTAS and rates of under- and over-triage. Participants were obtained by combining electronic health records with registry data from the National Emergency Department Information System. We assessed the eligibility of patients aged ≥ 15 years who visited the ED between July 1, 2022, and June 30, 2023. Using the KTAS classification criterion, two experienced experts determined the final acuity level. We employed multivariate logistic regression analysis to evaluate the factors that predict under- and over-triage.
Of 53,947 ED encounters, 1110 participants were enrolled in this study. Mistriage occurred in 207 (18.6%) patients: 88 (7.9%) had under-triage, and 119 (10.7%) had over-triage. In adjusted analyses, under-triage was associated with lower mean arterial pressure (odds ratio [OR], 5.42; 95% confidence interval [CI], 1.45–20.32) and presenting complaints of immunity or fever (OR, 3.41; 95% CI, 1.38–8.45), while over-triage was associated with advanced age (OR, 0.52; 95% CI, 0.28–0.98), pain (OR, 1.96; 95% CI, 1.18–3.25), lower KTAS experience (OR, 1.95; 95% CI, 1.08–3.51), and several specific present complaints.
By improving mistriage, the quality of emergency medical services may be enhanced through reduced costs, increased operational efficiency, and improved patient safety and satisfaction. Implementation of standardized criteria, validated triage tools, and enhanced provider training is crucial for achieving more accurate emergency triage. Additionally, establishing regulatory and financial incentives and developing realistic standards for mistriage management will optimize triage processes and ensure prompt, prioritized care.
Menopause is associated with significant physical, psychosocial, and emotional changes that can negatively affect women's quality of life (QoL). In response to this, psychological interventions like mindfulness-based interventions have shown promise in alleviating menopausal symptoms and improving psychological well-being.
A comprehensive randomized controlled trial was conducted from May to August 2024 at Damanhour University, Egypt. One hundred and twenty menopausal women were randomly assigned to either the intervention group (n = 60), which participated in seven mindfulness sessions, or the control group (n = 60), which received general health education. Pre and postintervention data were collected using the Menopause-Specific QoL questionnaire, the Depression Anxiety Stress Scale-21, and the Mindful Attention Awareness Scale. Independent samples t-tests were performed to compare groups, while paired t-tests assessed within-group changes post-intervention. Effect sizes were calculated using Cohen's d, ensuring a robust and reliable data analysis.
The intervention group showed significant improvements across all domains of menopause-specific QoL, including vasomotor (d = 0.788, p < 0.01), psychosocial (d = 1.042, p < 0.01), physical (d = 0.809, p < 0.01), and sexual (d = 0.794, p < 0.01). Additionally, significant reductions were observed in anxiety (d = 1.221, p < 0.01), stress (d = 1.030, p < 0.01), and depression (d = 0.880, p < 0.01), along with a significant increase in mindfulness (d = 1.335, p < 0.01) postintervention.
The MBIS significantly improved menopause-specific QoL and reduced anxiety, stress, and depression while enhancing mindfulness in menopausal women. These findings suggest that mindfulness-based interventions could be game changers in managing menopausal symptoms and improving overall psychological well-being, offering hope for a better QoL for menopausal women.
The research will primarily impact healthcare providers working with menopausal women, particularly those offering psychological support or nonpharmacological treatments. It also impacts menopausal women themselves by providing evidence-based intervention options that could alleviate menopausal symptoms. Furthermore, researchers and policymakers focusing on women's health and mental well-being may use these findings to inform future studies and healthcare strategies.
Women from Damanhur University.
This trial was registered with the ClinicalTrials.gov database under the registration number NCT06421909
Depressive symptoms are common, worsening heart failure (HF) progression and reducing quality of life. While supervised structured exercise training is effective for managing depressive symptoms, it often demands a substantial time commitment or intensive activity that may discourage participation.
Evaluate the impacts of reducing sedentary time with short bouts of light physical activities or greater intensity levels on depressive symptoms after HF patients' enrollment in a home-based intervention.
A total of 127 HF patients participated in an experimental two-group design, randomly allocated to either delayed or immediate decreasing sedentary time intervention. The immediate group started the intervention immediately, while the delayed group began after the first group finished their intervention. The 8-week intervention, guided by the Theory of Planned Behavior, focused on interrupting 30 min of sedentary behavior with short bouts of light- or greater intensity physical activities. Demographic and clinical variables were collected at baseline. Depressive symptoms were assessed at baseline, pre-intervention, and post-intervention. Physical activity (daily steps) was monitored daily during the study period using the Samsung mobile health app.
Both groups demonstrated reduced sedentary time during the intervention, with improvements in HF symptom burden. Repeated measures analysis of variance revealed a significant reduction in depressive symptoms in both groups post-intervention, with a greater reduction seen in the immediate group before the delayed group began the intervention.
The study highlights the effectiveness of interrupting sedentary behavior with light- or greater intensity activities in managing depressive symptoms among HF patients. The home-based intervention, facilitated by mobile technology, provides a feasible and accessible approach to improving mental well-being.
The findings support the broader implementation of home-based interventions addressing sedentary time reduction as a valuable strategy for enhancing the mental health of HF patients, particularly those facing challenges with traditional rehabilitation programs or intense exercise.
Attention-deficit hyperactivity disorder (ADHD), affecting 5% of global children, presents inattention, hyperactivity, and impulsivity. Sleep problems, prevalent in 70% of cases, exacerbate long-term psychosocial challenges.
This study aimed to assess the efficacy of behavioral sleep intervention in alleviating sleep problems, enhancing quality of life (QoL), and reducing ADHD symptom severity among children diagnosed with ADHD.
A randomized controlled trial was conducted from June 2022 to April 2023. The intervention group (n = 47) engaged in a hybrid approach, participating in both face-to-face and Zoom sessions, while the control group (n = 45) received standard care. Data collection involved administering the Children's Sleep Habits Questionnaire (CSHQ), Pediatric Quality of Life Inventory (PedsQL), and ADHD Rating Scale IV (ADHD-RS-IV).
Significant enhancements were observed in CSHQ (p ≤ 0.001, effect size = 1.913), PedsQL (p ≤ 0.001, effect size = 1.862), and a notable reduction in ADHD-RS-IV (p ≤ 0.001, effect size = 1.548). These findings highlight the intervention's efficacy in improving sleep quality, QoL, and reducing ADHD symptomatology.
This trial contributes substantially to understanding behavioral sleep interventions' impact on ADHD-affected children, enhancing quality of life and ADHD symptomatology. The study highlights the importance of individualized care for optimal outcomes in children with ADHD.
The study's findings underscore the potential for integrating behavioral sleep interventions into routine nursing practices, offering a valuable approach to address sleep-related challenges in children with ADHD. By focusing on sleep improvement, nurses can contribute to enhancing overall well-being and emotional regulation in these children within the context of comprehensive healthcare.
Accurate and rapid triage can reduce undertriage and overtriage, which may improve emergency department flow. This study aimed to identify the effects of a prospective study applying artificial intelligence-based triage in the clinical field.
Systematic review of prospective studies.
CINAHL, Cochrane, Embase, PubMed, ProQuest, KISS, and RISS were searched from March 9 to April 18, 2023. All the data were screened independently by three researchers. The review included prospective studies that measured outcomes related to AI-based triage. Three researchers extracted data and independently assessed the study's quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) protocol.
Of 1633 studies, seven met the inclusion criteria for this review. Most studies applied machine learning to triage, and only one was based on fuzzy logic. All studies, except one, utilized a five-level triage classification system. Regarding model performance, the feed-forward neural network achieved a precision of 33% in the level 1 classification, whereas the fuzzy clip model achieved a specificity and sensitivity of 99%. The accuracy of the model's triage prediction ranged from 80.5% to 99.1%. Other outcomes included time reduction, overtriage and undertriage checks, mistriage factors, and patient care and prognosis outcomes.
Triage nurses in the emergency department can use artificial intelligence as a supportive means for triage. Ultimately, we hope to be a resource that can reduce undertriage and positively affect patient health.
We have registered our review in PROSPERO (registration number: CRD 42023415232).
Nurses are identified as having higher work stress and poor mental health risk among health care workforce globally. It remains unclear which modifiable stress factors pose the greatest risk for poor psychological health among nursing workforce and needed to inform targeted practice and policy change.
To determine which occupation-related or personal stress factors precipitate higher risk for burnout, depression, anxiety, job satisfaction or intention to leave one's position among nurses globally.
A cross-sectional anonymous survey was administered via email using a snowball recruitment strategy.
Academic researchers and clinical industry leaders across 3 global regions collaborated to generate an email listserv of professional nursing contacts for survey distribution. The survey included valid and reliable measures to scale stress factors (Work Stress Questionnaire), and screen for burnout (single item), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2), resilience (Brief Resilience Scale) and intention to leave one's job (single item). We used logistic regression, first unadjusted and then adjusted for personal and professional characteristics, to determine associations between stress factors and psychological health risk.
The final sample consisted of responses from 2864 nurses working across 13 countries. Most respondents reported working as a clinical nurse in the Philippines (n = 2275), United States (n = 424) and Saudi Arabia (n = 104). One third of nursing respondents endorsed high burnout and intention to leave their job. Those reporting work conflict had significantly higher odds of burnout (odds ratio 3.18; 95% CI 2.22–4.54) and three times more likely to screen positive for depression (odds ratio 3.02; 95% CI 1.36–6.72) and anxiety (odds ratio 2.92; 95% CI 1.57–5.43). Those endorsing difficulty sleeping were 15 times more likely to screen positive for depression (odds ratio 15.63; 95% CI 2.09–117.06). Lack of social support was significantly associated to higher risk for burnout, job dissatisfaction, depression, anxiety, and intention to leave one's position.
Nurses remain at risk for burnout and poor psychological health stemming from work stress. Factors such as clear workplace goals and assignments, increased engagement, good sleep health and social support may serve as protective factors against suboptimal psychological health, and in-turn poor workforce retention.
Nurses reporting conflict in the workplace are three times more likely to screen positive for burnout, depression, and anxiety. Nurses reporting difficulty sleeping are 15 times more likely to screen positive for depression. Several modifiable factors can be targeted to reduce poor psychological health and high workforce turnover among nurses across countries.
Existing literature suggests that transgender women (TW) may be at high risk for adverse mental health due to stress attributed to combined experiences of stigma and complex social and structural vulnerabilities. Little research has examined how these co-occurring experiences relate to mental health. We aimed to test a theoretically driven conceptual model of relationships between stigma, social and structural vulnerabilities, and mental health to inform future intervention tailoring.
Partial least square path modeling followed by response-based unit segmentation was used to identify homogenous clusters in a diverse community sample of United States (US)-based TW (N = 1418; 46.2% White non-Hispanic). This approach examined associations between latent constructs of stigma (polyvictimization and discrimination), social and structural vulnerabilities (housing and food insecurity, unemployment, sex work, social support, and substance use), and mental health (post-traumatic stress and psychological distress).
The final conceptual model defined the structural relationship between the variables of interest within stigma, vulnerability, and mental health. Six clusters were identified within this structural framework which suggests that racism, ethnicism, and geography may be related to mental health inequities among TW.
Our findings around the impact of racism, ethnicism, and geography reflect the existing literature, which unfortunately shows us that little change has occurred in the last decade for TW of color in the Southern US; however, the strength of our evidence (related to sampling structure and sample size) and type of analyses (accounting for co-occurring predictors of health, i.e., stigma and complex vulnerabilities, reflecting that of real-world patients) is a novel and necessary addition to the literature. Findings suggest that health interventions designed to offset the negative effects of stigma must include anti-racist approaches with components to reduce or eliminate barriers to resources that contribute to social and structural vulnerabilities among TW. Herein we provide detailed recommendations to guide primary, secondary, and tertiary prevention efforts.
This study demonstrated the importance of considering stigma and complex social and structural vulnerabilities during clinical care and design of mental health interventions for transgender women who are experiencing post-traumatic stress disorder and psychological distress. Specifically, interventions should take an anti-racist approach and would benefit from incorporating social support-building activities.
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