Patient perception of service quality to preanesthetic oral examination: a cross-sectional study using the SERVQUAL model.

BACKGROUND: A phase-III interdisciplinary quality improvement program, the preanesthetic oral examination (PAOE), was implemented as a new program in an academic medical center to prevent perioperative dental injuries. This study was aimed at surveying the perceived service quality and satisfaction of patients who had undergone PAOE based on the SERVQUAL model. METHODS: This cross-sectional survey was conducted at the Kaohsiung Medical University Hospital using convenience sampling. Patients referred for PAOE (PAOE group) and those who had voluntarily availed dental services (control group) were recruited. A modified SERVQUAL questionnaire was used to assess the perceived service quality and patient satisfaction with dental services. Cronbach's alpha for SERVQUAL was 0.861. RESULTS: We enrolled 286 (68.8%) and 130 (31.2%) participants in the PAOE and control groups, respectively. The path analysis revealed that the PAOE group scored lower in dimensions of reliability (ß = -0.074, P = 0.003), responsiveness (ß = -0.148, P = 0.006), and empathy (ß = -0.140, P = 0.011). Furthermore, reliability (ß = 0.655, P < 0.001) and responsiveness (ß = 0.147, P = 0.008) showed a direct effect on patient satisfaction. Overall, participants were highly satisfied with the dental services. CONCLUSIONS: The PAOE group showed lower satisfaction and perceived quality of dental services compared to the control group. Although implementing an interdisciplinary program reduces the perceived service quality, its influence is limited. Employing an interdisciplinary teamwork is a win-win strategy encouraged to improve patient safety and reduce malpractice claims. Future suggestions should focus on establishing waiting times that are considered reasonable by patients. Patient-centered education related to the risk of perioperative dental injuries should be provided, and awareness of oral conditions for patient safety should be improved. Moreover, interprofessional education in continuous and undergraduate programs is necessary to improve professional quality.

[Cooperation of geriatrics and trauma surgery in certified geriatric trauma centers : Insights into different care models and the implementation of requirements resulting from certification]. / Zusammenarbeit von Geriatrie und Unfallchirurgie in zertifizierten alterstraumatologischen Zentren : Einblicke in unterschiedliche Versorgungsmodelle und in die Umsetzung von Anforderungen, die sich aus der Zertifizierung ergeben.

BACKGROUND: In Germany, different models of orthogeriatric co-management have been implemented in certified geriatric trauma centers. So far, it is not clear how the different models are implemented and what influence the certification has on the structures and processes within the centers. The present study examined the extent of cooperation between surgery and geriatrics and if the quality of care had changed since the certification of the centers. METHODS: In this study 4 guided focus group interviews (FGI) were conducted in different teams of certified geriatric trauma centers in 3 federal states with 16 participants. To specify the content of the FGI, two additional interviews were conducted with system auditors. Both types of interview were analyzed by content analysis. RESULTS: The certification supported the implementation of structures and processes in the different orthogeriatric models; however, the quality of care and cooperation between surgery and geriatrics depends on the spatial proximity and the orthogeriatric care model in the geriatric trauma centers. Simultaneously, challenges in the area of geriatric syndromes and the recruitment of skilled staff became relevant. DISCUSSION: The results can help to reflect processes in the certified geriatric trauma centers and to treat geriatric syndromes more effectively. In the future, the challenge will be to establish geriatric care under the existing shortage of skilled staff.

[Interdisciplinary surgical spectrum in cooperation of abdominal surgery and gynecology : What must the (general/abdominal) surgeon know?] / Interdisziplinär ausgerichtetes Operationsspektrum in Kooperation von Viszeralchirurgie und Gynäkologie : Was sollte der (Allgemein­/Viszeral­)Chirurg wissen?

AIM: This short overview aims to concisely outline the most important gynecological issues from a predominantly operative point of view, which could also be relevant for general and abdominal surgeons as well as important gynecological aspects of primarily visceral surgical pathologies. METHOD: Narrative review on the topic of interdisciplinary cooperation in gynecological/general and abdominal surgery through the use of PubMed® as well as the Cochrane Library with search terms, such as "operative profile of abdominal surgery and gynecology", "interdisciplinary surgery aspects of gynecology/abdominal surgery" as well as "interdisciplinary surgical approach-surgical complication". RESULTS (MAIN POINTS): As the close anatomical relationship suggests, numerous primarily gynecological pathologies can also occur in abdominal organs. Likewise, predominantly surgical pathologies can result in involvement of gynecological organs. This can make an intraoperative collaboration necessary. In addition, as a result of diagnostic uncertainty or within the context of complications, interdisciplinary collaboration can also be required preoperatively and postoperatively. Multidisciplinary knowledge as well as close cooperation of the involved specialties can improve the outcome of affected patients. CONCLUSION: Many pathologies extend not only to the boundaries of an individual discipline but can also affect physiological systems exceeding those limits. Therefore, for an optimal treatment it is necessary to be aware of such aspects of the diseases and to establish structured procedures for interdisciplinary cooperation.

Immune Thrombocytopenia Purpura Associated With COVID-19 Infection: A Challenging Diagnosis and Management.

The COVID-19 pandemic has posed unprecedented challenges in the field of medicine. Among its diverse manifestations, immune thrombocytopenia purpura (ITP) has emerged as a complication associated with COVID-19 infection. This case report presents a 90-year-old Caucasian male with a history of COVID-19 infection who developed acute hemoptysis, thrombocytopenia, and purpura. The diagnosis of ITP confirmed through exclusion criteria and clinical evaluation, occurred several weeks after the initial COVID-19 diagnosis. Differential diagnoses, including drug-induced thrombocytopenia, were carefully considered and excluded. The reported case highlights the importance of vigilance in identifying ITP as a potential complication of COVID-19 infection, even in the post-infection period. The timely initiation of appropriate treatment proved effective in managing the patient's condition. Collaboration among medical specialties facilitated comprehensive patient care, thereby reducing hospitalization periods. This case report serves as a crucial alert to physicians, underlining the need for ongoing monitoring of COVID-19 complications, especially as testing dwindles. By fostering interdisciplinary cooperation, healthcare professionals can optimize patient outcomes and effectively manage the multifaceted challenges associated with COVID-19 infection.

A Scoping Review of Educator Proficiency Interventions in Pharmacy Education Illustrated by an Interdisciplinary Model Integrating Pedagogical Theories into Practice.

Pharmacy schools recognize the need for flexibility and comprehensive curricular transformation with a competency-based focus to effectively prepare for the evolving practitioner competencies and challenges of the pharmacy profession. The curricular implementation of evidence-based teaching and learning theories and practices demands educator proficiency through skills development with indispensable faculty leadership support. Our scoping review of online databases and pharmacy education-related journals aims to identify faculty development interventions or teaching proficiency programs that integrate educational and pedagogical theories. Original studies and reviews published between 2010 and 2022 were screened based on four inclusion criteria. Thirty-four manuscripts were eligible for full-text analysis, of which seven results referenced target faculty pedagogy knowledge development. Nine key messages, as Results Statements, synthesize and provide a framework for our results analysis. An ongoing Hungarian intervention model of comprehensive faculty development with strong interdisciplinary cooperation is discussed in our study to illustrate the applicability of the Results Statements through each stage of the process. Educator motivation and relatedness to students or awareness of the educator roles are intrinsic factors, which may not be easily detectable yet significantly impact teaching proficiency and student learning outcomes. The integration of evidence-based pedagogical knowledge and training in educator proficiency development contributes to the sustainability and cost-effectiveness of faculty interventions.

Implementing an Interdisciplinary Procedure Curriculum.

INTRODUCTION: This curriculum was designed to improve access to procedures for our internal medicine residents. METHODS: We created an interdisciplinary procedure course (IDPC) composed of two simulation sessions and a one-week procedural rotation supervised by multiple specialties including nephrology, cardiology, cardiothoracic anesthesiology, general anesthesiology, and interventional radiology. After the course, residents completed two surveys documenting the number of procedures and their level of confidence on a Likert scale (1 = very unconfident to 5 = very confident) prior to and after completing the curriculum. RESULTS: Sixteen residents participated in the course from September 2021 to June 2022. The collective number of procedures performed by these 16 residents increased from 176 to 343 after a one-week rotation. For arterial lines, the proportion of residents that reported an improvement in confidence scores was 0.44 (95% confidence interval 0.23 to 1, p-value of 0.60). The proportion of residents that had an increase in their confidence performing central lines was 0.63 (95% confidence interval 0.39 to 1, p-value of 0.23). For intubations, the proportion of residents that reported an improvement in confidence was 0.94 (95% confidence interval 0.72 to 1, p-value of 0.0006). CONCLUSION: By collaborating with multiple specialties, residents almost doubled the number of procedures performed during training and reported an increased level of confidence in procedural performance for airway intubation. We learned residents want to improve their access to procedures and described a curriculum that was easily implemented.

Interdisciplinary Collaboration and Communication Among Doctors and Nurses in ICUs During the COVID-19 Pandemic and Their Importance in Professional Life Quality Improvement.

To investigate interdisciplinary cooperation and communication among doctors and nurses along with its role in improving the quality of their professional life, a cross-sectional survey was designed. The study was carried out from February to April 2021 through the application of an anonymous, structured, self-completed, closed-ended questionnaire in a convenience sample consisting of 110 healthcare professionals currently working in the intensive care units (ICUs) of three distinct hospitals (response rate: 76.4%). It was observed that medical personnel manifested a more positive stance toward interdisciplinary collaboration than nursing while women seemed to believe more than men that nurses' administrative skills are not valued enough by doctors. Nurses with limited work experience reported that doctors show scarce respect to nurses in the presence of patients' parents and companions while male nurses acknowledged more the provision of multidimensional care given to patients. Occupational stress, professional satisfaction, and burnout levels were mainly moderate across study participants.

[Profiling of patients in a specialized geriatric outpatient clinic]. / Profilanalyse ambulanter Patienten einer geriatrischen Spezialsprechstunde.

BACKGROUND: In Germany geriatric outpatient care is predominantly done by family doctors and general practitioners (GP). There are regionally different concepts for additional specialized geriatric outpatient care but they have not yet been validated and established. Still, it remains unclear whether a geriatric patient has to be diagnosed rather in a specialized outpatient or inpatient setting. The aim of the present study is the profiling of geriatric outpatients to find key distinctions from geriatric patients that have to be admitted to hospital. METHODS: Retrospective data analysis of patients sent to a specialized geriatric outpatient clinic by their GP, compared with data of geriatric inpatients sent to hospital by their GP during the same time period. Study parameters comprised elements of the comprehensive geriatric assessment as well as results of routinely applied laboratory tests. RESULTS: Patients sent to the specialized geriatric outpatient clinic showed better results of functional assessments. Regression analysis: improvement of Barthel Index, GFR and total protein increased the chance of outpatient treatment. CONCLUSION: Early identification of geriatric patients who can be treated in a specialized outpatient setting would ease the burden for GPs by interdisciplinary cooperation and prevent cost-intensive readmissions to hospital.

Palliative care on the radiation oncology ward-improvements in clinical care through interdisciplinary ward rounds.

INTRODUCTION: Palliative care is essential for patients with terminal diseases and aims at effective symptom control. This may stand in opposition to radiation treatment as an oncological treatment modality. The hereby presented work demonstrates the successful integration of a palliative care service in the radiation oncology ward. METHODS: Since 2015, 1018 patients were seen by the palliative care service on the radiation oncology ward and have been analyzed in this single center study. To assess teaching efficacy of the consultation service, a survey was conducted among 15 radiation oncology residents. RESULTS: Cooperation between the two departments proved to be efficient with rising patient numbers. Palliative care was able to guide appropriate postdischarge care with the number of patients dying on the radiation oncology ward decreasing significantly (p = 0.009). The main topics for consultation were pain medication (92.3%), organization of postdischarge care (92.3%), and psycho-oncological support (84.6%). Most residents had a positive image of the palliative care service and consented on adjectives like "enriching", "empathic", "collegial", "professionally founded", and a "low threshold for consultation". All participants agreed that cooperation deepened their knowledge on palliative care. CONCLUSION: A synergistic cooperation between a palliative care consultation service and a radiation oncology department addresses patient symptoms on an individual level. It confers advanced knowledge on palliative care which is essential for resident education and patient treatment.

The mediating effect of interdisciplinary cooperation ability on the level of hospice care practice and the degree of difficulty of medical staff / 中国实用护理杂志

Objective:To explore the mediating role of interdisciplinary cooperation ability between the level of hospice care practice and difficulty degree of hospice care for medical staff, in order to improve the quality of hospice care services for medical staff, and to provide evidence for relevant managers to formulate effective measures to reduce the implementation of hospice care difficulties.Methods:This study was a cross-sectional survey. Using convenience sampling method, the general data questionnaire, Palliative Care Difficulties Scale (PCDS), Palliative Care Self-Report Practice Scale (PCPS) and Modified Index of Interdisciplinary Collaboration (MIIC) were used to investigate 362 medical staff in all hospice care institutions of Shiyan City from July to August 2022.Results:The total score of PCDS in 362 medical staff was (40.58±13.44) points, (67.47 ± 12.50) points for PCPS and (108.36 ± 21.46) points for MIIC. There was a positive correlation between the total score of MIIC and PCDS ( r=0.500, P<0.01). The total score of PCPS was negatively correlated with the total score of MIIC ( r=-0.337, P<0.01) and the total score of PCDS ( r=-0.189, P<0.01). The interdisciplinary cooperation ability of medical staff in hospice care had a complete mediating effect between the level of practice and the degree of difficulty (Effect value=-0.190, 95% CI-0.274 to -0.126), and the mediating effect accounted for 98.5% of the total effect value. Conclusions:The practice level of hospice care can not directly affect the implementation of the difficulty degree, but by taking active measures to improve the interdisciplinary cooperation ability, so as to enhance the practice level, and then reduce the implementation of hospice care difficulty degree.

[Dermatological video consultations for German prisons : Experiences from teledermatological consultations 2020 to 2022]. / Dermatologische Videosprechstunden für deutsche Justizvollzugsanstalten : Erfahrungen aus teledermatologischen Konsilen 2020 bis 2022.

BACKGROUND: With increasing shortage of medical personnel also in the medical care in German correctional facilities, telemedicine has been used since 2016, initially in projects and then for regular medical care. Since 2019, there is the possibility of dermatological expertise in regular video consultations. OBJECTIVE: The benefits of an interdisciplinary online consultation with video and store and forward technology for dermatological issues are highlighted in terms of efficiency and feasibility. MATERIAL AND METHODS: A descriptive analysis of 450 dermatological video consultations for German correctional facilities from February 2020 to July 2022 was carried out with respect to procedures, indications and demand. RESULTS: Requests were made via a standardised form with optional photographs, which were sent via a secure cloud to the dermatology department in store and forward mode. The majority of cases could be presented live in a regular weekly video consultation and only single cases required an acute presentation within 24 h. The spectrum of skin diseases was comparable to cases presenting to a dermatology outpatient clinic. The interdisciplinary consultation management together with colleagues from general medicine enabled the transfer of the cases to the medical personnel at the correctional facility on site for follow-up and further medical procedures. Treatment could be started in all cases without delay. CONCLUSION: Teledermatology represents an important contribution to medical care in German correctional facilities and the interdisciplinary cooperation saves time and resources in the presentation and treatment of skin diseases.

[Geriatric patients in the emergency department: Development of an ANP role from the perspective of the multiprofessional team]. / Geriatrische Patient_innen in der Notfallambulanz.

Geriatric patients in the emergency department: Development of an ANP role from the perspective of the multiprofessional team Abstract. Background: Ever-increasing numbers of geriatric patients lead to challenges in emergency departments (ED). Aim: The aim of this study is to identify the need for change in emergency care and discuss the integration of an Advanced Practice Nurse (APN) based on the practical experience of nurses and physicians. The focus lies on the interdisciplinary cooperation. Methods: Within the scope of a qualitative research approach, guided interviews with five physicians and seven nurses from two Austrian emergency departments were conducted. The qualitative content analysis according to Mayring was used for data analysis. Results: Five central main categories emerged. Nurses and physicians describe growing challenges in the care of geriatric patients in emergency departments due to a high workload, time pressure and lack of resources as well as a healthcare supply that does not meet the specific needs of geriatric patients. The integration of geriatric specialised nurses was associated with an improved patient care. Based on the structure, process and outcome criteria of the Nursing Role Effectiveness Model (NREM), the core components of an ANP role are described. Conclusion: The expansion of nursing competences and the development of defined care pathways should be further accelerated. The findings integrated in the NREM form the groundwork for the role description of the Geriatric Practice Nurse (GPN) in the ED.

[Clinical procedures for intraocular lymphomas]. / Klinisches Vorgehen bei intraokulären Lymphomen.

BACKGROUND: The classification of intraocular lymphomas is based on their anatomical location. They are divided into uveal lymphomas with involvement of the choroid, ciliary body or iris and vitreoretinal lymphomas with isolated or combined involvement of the vitreous body and/or retina. Over the last decades it has become increasingly possible to work out the clinical and pathobiological features of the various subtypes, thereby reducing the diagnostic hurdles and creating improved treatment options. OBJECTIVE: A summary of the various types of intraocular lymphoma in terms of clinical features, diagnostics, treatment and prognosis is given as well as recommendations for follow-up care. METHODS: A selective literature search was carried out on the subject of intraocular lymphomas using PubMed and Google Scholar. RESULTS: Intraocular lymphomas affect different structures, so that the symptoms can also be very different. The diagnostic spectrum ranges from typical ocular examination methods to sample biopsies with subsequent cytological, histological and molecular pathological processing. The treatment pillars available are percutaneous irradiation and intravitreal drug administration as local treatment and systemic treatment or a combination of systemic and local treatment. The prognosis depends mainly on the subtype of the lymphoma and the extent of the infestation when the diagnosis is confirmed. Even though some effective treatment options are now available, it has not yet been possible to significantly reduce the mortality rate. CONCLUSION: Many different options are available for the diagnostics and treatment of intraocular lymphomas, which require close interdisciplinary cooperation. The further developments in the field of molecular pathology allow a faster and more accurate diagnosis and could open up new treatment options in the future.

The Impact of Pre-Round Meetings on the Clinical Learning of Nurses and Doctors on Hospital Wards: A Qualitative Study.

Introduction: The pre-round meeting is an interprofessional gathering conducted in conjunction with the ward round in many hospitals. Here, nurses, doctors and eventually allied health clinicians discuss clinical issues before attending to the patients. This study focused on the learning aspects of the pre-round meeting, and it is, to our knowledge, the first study to explore the impact of pre-round meetings on learning in a clinical setting. Objectives: To improve our understanding of the impact pre-round meetings has on clinical learning among the nurses and doctors who attend them. Method: A qualitative study. Focus group interviews were conducted. Participants comprised of 9 doctors and 13 nurses from two different hospitals in Norway. The participants represented both surgical and non-surgical departments. Results: This study showed that the pre-round meeting is an arena with a high learning potential. Learning takes place in the discussion that arises when different professions meet. Both nurses and doctors emphasized that the pre-round meeting is both a conscious learning arena and an arena where learning is a by-product. Several factors interfered with the utilization of its learning potential. Conclusion: The pre-round meeting is an arena with high learning potential. However various factors can influence this potential. The study highlights the importance of being aware of the learning potential in the pre-round meeting, to achieve higher-level learning objectives. A collaborative environment, continuity, competence, and availability of the staff and structured pre-round meetings are essential elements for achieving higher-level learning objectives.

Prevention and non-surgical periodontal therapy of calcium channel blockers induced severe gingival overgrowth. / A kalciumcsatorna-blokkoló gyógyszerek által indukált súlyos gingivahyperplasia konzervatív kezelése és megelozésének lehetoségei.

Összefoglaló. Bevezetés és célkituzés: A gingivahyperplasia a kalciumcsatorna-blokkoló gyógyszerek gyakori mellékhatása. Eredményeink közlésének célja, hogy bemutassuk, sebészi terápia nélkül, megfelelo egyéni szájhigiénia kialakításával és nem sebészi parodontalis terápiával milyen eredményt tudunk elérni az ínymegnagyobbodás kezelése során. Módszer: A Szegedi Tudományegyetem Fogorvostudományi Karának Parodontológiai Tanszékén 2015 és 2019 között 10 - 7 no és 3 férfi, átlagéletkoruk 56 év (50-69 év) volt -, kalciumcsatorna-blokkoló gyógyszer szedése során kialakuló, Grade III. ínyhyperplasiában szenvedo páciens kezelését végeztük konzervatív parodontalis módszerekkel, a gyógyszercsere mellozésével. A legfontosabb parodontalis értékeket rögzítettük, a tasakmélység, a vérzési index, a plakkindex és a fogmozgathatóság értékeit összegeztük vizsgálatunkban. A parodontium destrukciója mértékének megállapításához ortopantomogram és periapicalis röntgenfelvételeket értékeltünk. Eredmények: Minden parodontológiai paraméterben jelentos javulást tapasztaltunk. A nem sebészi parodontalis terápia eredményeként megszunt az elváltozás mind a 10 betegnél, és a szigorú fenntartó terápiának is köszönhetoen nem is újult ki. Következtetés: A nem sebészi terápia alkalmasnak bizonyult a súlyos gingivahyperplasia definitív kezelésére, ha az gingivitis vagy enyhe és középsúlyos parodontitis talaján alakult ki. Arra is következtethetünk az eredményeinkbol, hogy a gyógyszeres terápia megkezdése elott vagy azzal párhuzamosan parodontológiai terápiában részesülo páciensek nagy részénél a gingivahyperplasia - s ezzel a hosszú ideig tartó, drága kezelés - megelozheto lenne. Orv Hetil. 2022; 163(13): 506-512. INTRODUCTION AND OBJECTIVE: Gingival overgrowth is an adverse drug reaction in patients on long-term calcium channel blocker therapy. The aim of this study was to assess the efficacy of non-surgical pocket therapy in patients suffering from Grade III drug-related gingival overgrowth. METHOD: 10 (7 female and 3 male) patients (age between 50-69 years) diagnosed with severe, Grade III gingival overgrowth were treated in our department. Non-surgical periodontal therapy consists of improving of individual oral hygiene, scaling, polishing and subgingival mechanical debridement instrumentation. The main periodontal parameters (probing pocket depth, bleeding index, plaque index and mobility) were scored in this study. Bone loss was evaluated by orthopantomograms and periapical radiographs. Calcium channel blockers have not been replaced by any other medications during the whole course of periodontal treatment. RESULTS: Compared with baseline parameters, all scores improved after therapy. All patients showed decrease in the average probing pocket depth, deepest probing pocket depth, bleeding scores, plaque scores and tooth mobility. None of the patients needed further surgical treatment. In our followed-up patients, recurrence of gingival overgrowth has not been observed during the two-year meticulous supportive periodontal care in the patient group. CONCLUSION: Non-surgical periodontal treatment can be a potential definitive therapy in Grade III gingival overgrowth associated with gingivitis or moderate periodontitis. Periodontal screening and treatment before or simultaneously with the administration of calcium channel blockers can prevent the gingival enlargement in the majority of patient. These results outline the importance of the successful cause related periodontal therapy, started before or simultaneously with the administration of anithypertensive medications and in this way a series of further expensive therapies could be anticipated. Orv Hetil. 2022; 163(13): 506-512.

Standardized, Coordinated Care in Nursing Homes Lowers Rehospitalization After Hip Fracture.

OBJECTIVES: To assess the effect of enhanced standardized interdisciplinary cooperation between the orthogeriatric ward, municipality, and nursing home facility (NHF) on readmission rates in patients with hip fracture. DESIGN: Quasi-experimental design with a nonequivalent control group. SETTING AND PARTICIPANTS: From January 2018 to July 2020, patients with hip fracture who were admitted to the department of orthopedic surgery and traumatology at Lillebaelt Hospital, and later discharged to NHF were included. INTERVENTION: The intervention consisted of a safety program to the NHF for the first 14 days postdischarge and included assessment of vital signs, weight, pain, signs of constipation, hours of mobilization, and daily intake of fluids and high-protein beverages. Acute team nurses undertook visits (planned and unplanned) and could take blood samples and administer intravenous fluids or antibiotics at the NHF. Control participants received usual care. METHODS: The intervention was performed in 2 municipalities with an acute team; the remaining 3 municipalities comprised the control group. The primary outcome was 30-day readmission, and secondary outcomes were mortality, mobility, and quality of life. RESULTS: There were 100 patients in the intervention group and 152 in the control group. The median age was 86 years, 68% were female, and more than 60% had a low mental score; there were no statistical differences between groups in baseline variables. The 30-day readmission rate was 14% in the intervention group and 30% in the control group (P = .004). The 30-day mortality rate was 6% in the intervention group and 13% in the control group (P = .07). There was no statistically significant difference in mobility between the 2 groups but there was a higher health-related quality of life score in the intervention group (P = .045). CONCLUSIONS AND IMPLICATIONS: Enhanced standardized interdisciplinary cooperation between hospital, NHF teams, and visiting acute team nurses can lower readmissions and potentially mortality.

Clinical Features and Mortality of Endogenous Panophthalmitis in China: A Six-Year Study.

PURPOSE: To report the clinical features, treatment strategy, and mortality of patients with endogenous panophthalmitis (EP). METHODS: Fifteen patients (16 eyes) diagnosed with EP from December 2012 to December 2018 were investigated with a standard protocol at a tertiary medical center of the largest eye center in Northern China. Mortality was followed up. RESULTS: All participants were Han Chinese. The mean age was 58.3, 62.5% were male, and 93.3% were unilaterally involved. The average number of predisposing factors was 3.0. The top two predisposing factors were diabetes mellitus (DM, 93.3%) and pyogenic liver abscess (PLA, 66.7%). All patients initially presented at an ophthalmic emergency due to severe ocular symptoms. All patients were co-managed by relevant specialists and were admitted to medical or surgical wards instead of the eye center unless the systemic condition was well controlled. Only four eyes were eligible for vitrectomy. The mean follow-up duration was 12.5 months. The mortality rate was 0%. The predominant causative organism was Klebsiella pneumoniae (80.0%), and there were no positive fungal cases. CONCLUSIONS: EP is a rare, life-threatening disease. DM and PLA could predispose its development. The predominant causative organism was Klebsiella pneumoniae. The interdisciplinary cooperation system of the management of EP may reduce the mortality rate.Abbreviations :EP: endogenous panophthalmitis; EE: endogenous endophthalmitis; DM: diabetes mellitus; PLA: pyogenic liver abscess; ACI: acute cerebral infarction; UTI: urinary tract infection; ICU: intensive care unit; VA: visual acuity; LP: light perception; HM: hand motion; NLP: no light perception; K. pneumoniae: Klebsiella pneumoniae; CT: computed tomography; MRI: magnetic resonance imaging; CRP: C-reactive protein; PCT: procalcitonin; FBG: fasting blood glucose; WBC: white blood cell; NEUT: neutrophil proportion; BDG: 1,3-ß-D-glucan; GM: galactomannan; IVI: intravitreal injection; PPV: pars plana vitrectomy; ILAS: invasive liver abscess syndrome; cps: capsular polysaccharide; CSF: cerebrospinal fluid; SD: standard deviation.

Exploring Nursing Students' Learning Experiences in Improving Their Health Information Technology Competency in Interdisciplinary Cooperation: An Innovative Pilot Study.

This study aims to explore nursing students' learning experiences in improving their health information technology competency in interdisciplinary cooperation. Through the nursing student training for designing thinking focused on smart health, we revealed the profound learning experience through interdisciplinary cooperation as well as the practice of problem solving, not only strengthens the students' health information technology competency, but ignites their creative thinking and creativity, altogether enhances their competitiveness in health care industry.

[Palliative care in patients with left ventricular assist devices: systematic review]. / "Palliative care" bei Patienten mit Linksherzunterstützungssystem: systematische Übersichtsarbeit.

BACKGROUND: An increasing number of patients reach the final stage of heart failure with heart transplantation as the only curative treatment. Mechanical circulatory support, such as left ventricular assist devices (LVAD) are becoming increasingly more important at this stage of the disease. An LVAD improves the quality of life and prolongs the lifespan. The LVAD is used as a bridge to transplantation (BTT) for patients waiting for a donor heart or as a destination therapy (DT) with no transplantation intended; nevertheless, implantation is often associated with complications and the prognosis remains unfavorable in DT cases or after transition from BTT to DT. For patients the device may be a source of physical and psychological distress and can become a burden for families and caregivers. So far it remains unclear whether LVAD treatment is an indication for concurrent palliative care. OBJECTIVE: The aim of this study was to collect the current data on the influence of palliative care in LVAD patients and to identify possible formats of palliative care in clinical practice. MATERIAL AND METHODS: In May 2020, a systematic literature search was performed using the PICOS instrument in six different databases, i.e. PubMed, Cochrane library, Google scholar, Scopus, Web of Science and Journals@Ovid. We included quantitative and qualitative studies in English and German. Case reports, comments and pediatric studies were excluded. RESULTS: A total of 21 publications from an initial number of 491 were included in this review. The integration of palliative care in the context of LVAD implantation increased the number of advance directives and documented surrogate decision makers. Studies found a positive influence of palliative care on the conditions and place of death, family involvement and symptom and pain management. Involvement in the decision-making process may improve patient selection for LVAD treatment and helps patients to make the decision on informed consent. Various formats for the integration of palliative medical concepts into LVAD treatment are reported. It is not clear when palliative care involvement should start; however, most articles support an early and continuous integration in the LVAD process. We have aggregated possible topics for palliative care consultations from a number of publications. Mutual teaching of both LVAD and palliative care teams is recommended. Integration of a dedicated LVAD palliative care specialist as part of the LVAD team can support care for patients as well as clinicians. CONCLUSION: The role of palliative care in LVAD patients in clinical practice in the German-speaking area is not standardized. Early and continuous integration of palliative care into the course of LVAD treatment can improve the quality of care. Benefits for LVAD patients, caregivers and clinicians are described. For this purpose, recommendations as well as professional training for palliative care practitioners are useful. Further studies are needed to clarify the impact of palliative care in both DT and BTT patients.

Case Report of a 23-year-old first gravida presenting with breathlessness and oxygen saturation of 80.

Central principles are interdisciplinary teamwork and keeping the ratio between pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) balanced to avoid vicious circle with right heart failure and hypoxia.