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1.
Res Gerontol Nurs ; 15(4): 172-178, 2022.
Article in English | MEDLINE | ID: covidwho-1903575

ABSTRACT

Preventing acute care transfers from skilled nursing facilities (SNFs) is a challenge secondary to residents' associated debilitated status and comorbidities. Acute care transfers often result in serious complications and unnecessary health care expenditure. Literature implies that approximately two thirds of these acute care transfers could be prevented using proactive interventions. The purpose of the current study was to identify the predictors of acute care transfers for SNF residents in developing relevant prevention strategies. A retrospective chart review using multivariate logistic regression analysis showed increased odds of SNF hospitalization was significantly associated with impaired cognition, chronic obstructive pulmonary disease, and chronic kidney disease, whereas decreased odds of hospitalization was identified among non-Hispanic White residents. Study recommendations include prompt assessment of comorbid symptomatology among SNF residents for the timely management and prevention of unnecessary acute care transfers. [Research in Gerontological Nursing, 15(4), 172-178.].


Subject(s)
Hospitalization , Medical Overuse , Patient Transfer , Skilled Nursing Facilities , Aged , Cognitive Dysfunction/epidemiology , Hospitalization/statistics & numerical data , Humans , Medical Overuse/prevention & control , Medical Overuse/statistics & numerical data , Patient Discharge , Patient Transfer/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/epidemiology , Renal Insufficiency, Chronic/epidemiology , Retrospective Studies , Skilled Nursing Facilities/statistics & numerical data , United States/epidemiology
3.
Balkan Med J ; 38(3): 150-155, 2021 May.
Article in English | MEDLINE | ID: covidwho-1268391

ABSTRACT

Antibiotic consumption rates were quite high in number, although the bacterial coinfection rates were low in coronavirus disease 2019 pneumonia. Generally, empirical antibiotic treatment is not recommended for uncomplicated coronavirus disease 2019 mild to moderate pneumonia cases. On the other hand, antibiotic treatment and de-escalation are recommended for intubated intensive care unit patients or critical patients with sepsis, septic shock, or acute respiratory distress syndrome. The presentation of patients with severe coronavirus disease 2019 pneumonia can direct the clinicians to use antibiotics. We believe that wait and watch strategy can be preferred in such cases without sepsis, secondary bacterial infection findings, or procalcitonin < 0.5 ng/ mL. We think that a new wave of resistance will occur inevitably if we cannot perform the antibiotic stewardship properly.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Antimicrobial Stewardship , COVID-19 , Patient Selection , Antimicrobial Stewardship/methods , Antimicrobial Stewardship/standards , COVID-19/diagnosis , COVID-19/drug therapy , Humans , Medical Overuse/prevention & control , Severity of Illness Index
4.
BMJ Open ; 11(6): e043991, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1255594

ABSTRACT

OBJECTIVE: Promotional media coverage of early detection tests is an important driver of overdiagnosis. Following research evidence that global media coverage presents the benefits of testing healthy people far more frequently than harms, and gives little coverage to overdiagnosis, we sought to examine journalists' views on media reporting of tests, overdiagnosis, and strategies to improve critical reporting on tests. DESIGN: Qualitative study using semistructured telephone interviews. Interviews were conducted between February and March 2020 and were audiorecorded and transcribed verbatim. Framework thematic analysis was used to analyse the data. PARTICIPANTS AND SETTING: Twenty-two journalists (mainly specialising in health reporting, average 14.5 years' experience) based in Australia. RESULTS: This sample of journalists acknowledged the potential harms of medical tests but felt that knowledge of harms was low among journalists and the public at large. Most were aware of the term overdiagnosis, but commonly felt that it is challenging to both understand and communicate in light of strong beliefs in the benefits of early detection. Journalists felt that newsworthiness in the form of major public health impact was the key ingredient for stories about medical tests. The journalists acknowledged that factors, like the press release and 'click bait culture' in particular, can influence the framing of coverage about tests. Lack of knowledge and training, as well as time pressures, were perceived to be the main barriers to critical reporting on tests. Journalists felt that training and better access to information about potential harms would enable more critical reporting. CONCLUSIONS: Effectively communicating overdiagnosis is a challenge in light of common beliefs about the benefits of testing and the culture of current journalism practices. Providing journalists with training, support and better access to information about potential harms of tests could aid critical reporting of tests.


Subject(s)
Mass Media , Public Health , Australia , Humans , Medical Overuse/prevention & control , Qualitative Research
5.
Gerontology ; 66(5): 427-430, 2020.
Article in English | MEDLINE | ID: covidwho-1066968

ABSTRACT

The large scale and rapid spread of the current COVID-19 pandemic has changed the way hospitals and other health services operate. Opportunities for patient-centered decision-making at the end of life are being jeopardized by a scarcity of health system resources. In response, the traditional doctor-initiated advanced care planning (ACP) for critical illness may also need to be readjusted. We propose nurse-led and allied health-led ACP discussions to ensure patient and family inclusion and understanding of the disease prognosis, prevention of overtreatment, and potential outcomes in crisis times. We highlight known barriers and list enablers, long-term and short-term opportunities to assist in the culture change.


Subject(s)
Advance Care Planning , Betacoronavirus , Communication , Coronavirus Infections/epidemiology , Medical Overuse/prevention & control , Nurse's Role , Pneumonia, Viral/epidemiology , Social Workers , COVID-19 , Decision Making , Humans , Pandemics , SARS-CoV-2 , Terminal Care
6.
BMJ Open ; 10(10): e038390, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-810653

ABSTRACT

INTRODUCTION: In order to avoid unnecessary hospital admission and associated complications, there is an urgent need to improve the early detection of infection in nursing home residents. Monitoring signs and symptoms with checklists or aids called decision support tools may help nursing home staff to detect infection in residents, particularly during the current COVID-19 pandemic.We plan to conduct a survey exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes in England and Sweden. METHODS AND ANALYSIS: An international cross-sectional descriptive survey, using a pretested questionnaire, will be used to explore nurses, care workers and managers views and experiences of how infections are detected and managed in practice in nursing homes. Data will be analysed descriptively and univariate associations between personal and organisational factors explored. This will help identify important factors related to awareness, knowledge, attitudes, belief and skills likely to affect future implementation of a decision support tool for the early detection of infection in nursing home residents. ETHICS AND DISSEMINATION: This study was approved using the self-certification process at the University of Surrey and Linköping University ethics committee (Approval 2018/514-32) in 2018. Study findings will be disseminated through community/stakeholder/service user engagement events in each country, publication in academic peer-reviewed journals and conference presentations. A LAY summary will be provided to participants who indicate they would like to receive this information.This is the first stage of a plan of work to revise and evaluate the Early Detection of Infection Scale (EDIS) tool and its effect on managing infections and reducing unplanned hospital admissions in nursing home residents. Implementation of the EDIS tool may have important implications for the healthcare economy; this will be explored in cost-benefit analyses as the work progresses.


Subject(s)
Communicable Disease Control , Coronavirus Infections , Medical Overuse/prevention & control , Nursing Homes/statistics & numerical data , Pandemics , Patient Care Management , Pneumonia, Viral , Skilled Nursing Facilities/statistics & numerical data , Betacoronavirus/isolation & purification , COVID-19 , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Cost-Benefit Analysis , Cross-Sectional Studies , England/epidemiology , Health Knowledge, Attitudes, Practice , Health Personnel/standards , Hospitalization , Humans , Patient Care Management/economics , Patient Care Management/methods , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Practice Management/economics , Research Design , SARS-CoV-2 , Sweden/epidemiology
8.
J Gen Intern Med ; 35(7): 2186-2188, 2020 07.
Article in English | MEDLINE | ID: covidwho-197385

ABSTRACT

The COVID-19 outbreak is putting tremendous strain on the US healthcare system, with a direct impact on medical professionals, hospital systems, and physical resources. While comprehensive public health and regulatory efforts are essential to overcome this crisis, it is important to recognize this moment as an opportunity to provide more intelligent and more efficient care in spite of increasing patient volumes and fewer resources. Specifically, we must limit unnecessary and wasteful medical practices and improve the delivery of those services which enhance the quality of patient care. In doing so, we will increase availability of the critical resources required for the provision of high-quality care to those in greatest need both now and in the future.


Subject(s)
Coronavirus Infections/epidemiology , Critical Pathways , Delivery of Health Care , Efficiency, Organizational , Medical Overuse/prevention & control , Pneumonia, Viral/epidemiology , Betacoronavirus , COVID-19 , Critical Pathways/organization & administration , Critical Pathways/standards , Critical Pathways/trends , Delivery of Health Care/economics , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Efficiency, Organizational/standards , Efficiency, Organizational/trends , Health Services Accessibility/trends , Health Services Needs and Demand , Humans , Organizational Innovation , Pandemics , Patient Acceptance of Health Care , SARS-CoV-2
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