Conectar
Hospital falls persist as a major threat to patient safety. This study aimed to develop an interprofessional reference standard to prevent, manage and report hospital falls.
A Delphi consensus methodology, informed by the Conducting and Reporting Delphi Studies guideline, was used to design the reference standard. An interprofessional expert panel (n=47) of health professionals, researchers, policymakers and consumers participated in three Delphi rounds. Following the review of clinical guidelines, an e-Delphi survey was developed and piloted to derive 60 initial items for the standard. Two iterative rounds of e-Delphi surveys were distributed via Research Electronic Data Capture and included free-text questions and 9-point Likert scales. An online consensus meeting followed, to ratify the final standard.
In the first Delphi round, there was over 80% agreement for 44/60 items to be included in the reference standard. This increased to 48/60 items in Round 2. At the final consensus meeting, 12 items still did not reach consensus for inclusion and one was added, yielding 49 items. Items that replicated text according to falls with injury/without injury were combined, resulting in 42 items in the final reference standard. Agreed items included: (1) brief screening of falls risk on hospital admission; (2) comprehensive falls assessment for inpatients who are older, frailer or have complex conditions; (3) single interventions (such as environmental adaptations and exercise); (4) multifactorial interventions; (5) education of patients, families and staff; (6) optimising local falls hospital policies, procedures and leadership capability; (7) optimising documentation and reporting; (8) improving accreditation processes; (9) workforce redesign to augment falls education. Items that did not reach agreement (n=12) pertained to alarms, bed rails, grip socks, artificial intelligence, volunteers and care bundles.
This new reference standard provides a checklist for staff, patients, managers and policymakers to reduce unwanted variations in prevention, management and reporting of hospital falls.
ANZCTR 386960
Carbapenem-resistant Pseudomonas aeruginosa exacerbates the healing of chronic leg ulcer among patients. Further, production and dissemination of the carbapenemase genes are associated with P. aeruginosa high-risk sequence types. Hence, understanding the population structure of these organisms is essential for healthcare personnel to establish effective leg ulcers care management, prevention interventions and control strategies particularly in regions with poor diagnosis. A cross-sectional study included inpatients and outpatients with chronic leg ulcers was conducted from August 2022 to April 2023 in 2 hospitals in Kilimanjaro region. Antimicrobial susceptibility testing was done by using the disc diffusion method. Further, whole genome sequencing was performed to study the genotypic characteristics of the isolates. Ten of 92 participants were positive for genus Pseudomonas isolates upon culture during the study period. Ambler class D carbapenemase genes were carried in all 8 isolates, and class B (blaVIM−2$$ {\mathrm{bla}}_{\mathrm{VIM}-2} $$, blaDIM−1$$ {\mathrm{bla}}_{\mathrm{DIM}-1} $$) in 2 isolates. The tree topology showed that all 8 P. aeruginosa isolates that carried any of the Ambler carbapenemase genes were in one clade with the reference strain PAO1. This study sheds light on different carbapenemase gene types (VIM-2, DIM-1, and OXA-types) harboured in the denominated global high-risk and endemic sequence types in 2 tertiary hospitals in northern Tanzania, alarming the possibility of a prolonged healing process and a high risk of treatment failure among patients because of the increased spread of antimicrobial resistance. Further, the findings underscore the need for antimicrobial surveillance to guide healthcare personnel in managing chronic leg ulcers for better patient outcomes and the implementation of antimicrobial stewardship programs.
by Dima Alhomsi, Mhd Khaled Tello, Dania Abdalsalam, Majd Barmo, Hamzeh Al Asadi, Hasan Najjar, Bayan Alsaid
IntroductionBasic medical sciences form the cornerstone of any medical knowledge and are essential for understanding various diseases. This study aims to shed light on students’ viewpoints toward those sciences while delving into their motivations and hindrances and investigating individual subjects.
MethodsThis cross-sectional study was carried out at Damascus University in Syria, targeting final-year medical students. Data collection occurred on a designated clerkship day, during which students were invited to complete an anonymous, self-administered questionnaire. The questionnaire evaluated students’ overall perception and academic interest in studying basic medical sciences in pre-clinical years and their willingness to pursue these sciences as a prospective career.
ResultsThe study surveyed 350 medical students, with 40% rating their interest as good/very good. The extensive content was perceived as a major hindrance by 76.9%. Anatomy was perceived as the easiest subject while pharmacology and biochemistry were considered the hardest. The majority acknowledged the value of basic sciences for further medical education (75.1%) and good physician (77.4%), but only 20.9% indicated their relevance for practical training. Furthermore, 68.6% of students were not interested in pursuing these sciences as a career, primarily due to their preference for clinical fields (55.8%) and concerns about low-income potential (41.3%).
ConclusionThis study highlighted students’ positive views on Basic Medical Sciences, emphasizing their essential role in understanding disease pathophysiology for medical education and practice. Nonetheless, it pointed out a lack of practical training. The findings underscore the importance of decreasing content intensity and enhancing retention through practical approaches aligned with clinical practice.
by Eugénie M. Kamabu, Justin L. Paluku, William P. Howlett, Abid M. Sadiq, Eliada B. Nziku, Doreen T. Eliah, Ibrahim Ali Ibrahim Muhina, Fuad H. Said, Tumaini E. Mirai, Elifuraha W. Mkwizu, Furaha S. Lyamuya, Elichilia R. Shao, Kajiru G. Kilonzo, Venance P. Maro, Sarah J. Urasa, Nyasatu G. Chamba
BackgroundAmong acute stroke patients (ASPs), diabetes mellitus (DM) is associated with a higher risk of death, functional dependency, and recurrence. This study aimed to determine the impact of DM on the 30-day mortality among admitted ASPs in northern Tanzania.
Materials and methodsThis was a hospital-based prospective cohort study performed among ASPs with and without DM who were admitted to Kilimanjaro Christian Medical Centre from November 2022 to May2023. ASPs were followed for 30 days after the onset of an acute stroke to identify the primary outcome, which was all-cause mortality. Descriptive statistics, logistic regression, and survival analysis were conducted,
ResultsOut of 213 ASP, 82 (38.5%) had DM. The overall crude mortality rate was 46.9%. ASPs with DM had a higher mortality rate of 53.7% compared with those without DM (42.7%). A higher proportion of acute stroke patients with DM (84.1%) had a poor outcome (mRS 3-6) (p = 0.038). DM was statistically non-significant for 30-day mortality (aHR 1.56; 95% CI: 0.73–3.32; p = 0.252). However, fever (p = 0.005), severe admission Glasgow coma scale (p = 0.005), severe stroke (p = 0.008), elevated serum creatinine (p = 0.008), and an abnormal respiratory pattern (p = 0.042), were predictors of 30-day mortality,
ConclusionThis study demonstrated a high mortality in ASPs. Although DM did not have a significant impact on 30-day mortality, other factors, such as altered mental state, stroke severity, fever, elevated creatinine, and abnormal respiration, need to be accounted for that may have a significant impact on the mortality in ASPs. These findings highlight the significant burden of DM in stroke patients and underscore the importance of early diagnosis and treatment of ASPs, in the hopes of improving clinical practice and guidelines and reducing morbidity and mortality in Tanzania.
FreshRSS