Impact of Nursing Interventions on Hospital Readmissions in Patients With Pulmonary Tuberculosis: A Quasi-Experimental Study.

PURPOSE: Our study aimed to evaluate the effectiveness of the nursing care program on the incidence and rate of 28-day hospital readmissions among pulmonary tuberculosis (TB) patients. METHODS: We conducted a quasi-experimental study using a historical control (usual care) group. Patients diagnosed with pulmonary TB who received nursing interventions between January 28, 2021, and May 31, 2021, were categorized as an intervention group, whereas historical controls were selected from January 1, 2020, to December 31, 2020. The primary outcomes were the incidence and rates of hospital readmissions within 28 days due to TB-related complications. The secondary outcome was the change in knowledge and self-care behavior scores at discharge and 28 days postdischarge. Cox models were used to assess the intervention's impact on the incidence of hospital readmission. Rates of readmission were compared by the Poisson model. Both Cox and Poisson models were adjusted for age, sex, sputum smears at diagnosis, serum albumin level, and diabetes mellitus at baseline. RESULTS: Among 104 pulmonary TB patients included in the analysis (68 were in a historical control group and 36 were in an intervention group), 20 patients were readmitted due to TB-related complications. We found that our nursing care program resulted in a significant reduction in the incidence (adjusted hazard ratio was 0.16 [95% CI 0.03, 0.87]) and the rate of hospital readmissions (adjusted incidence rate ratio was 0.22 [95% CI 0.06, 0.85]). Furthermore, nursing interventions significantly improved knowledge and self-care behavior scores with significant score retention at 28 days postdischarge. CONCLUSIONS: The nursing care program can significantly decrease the incidence and rate of 28-day hospital readmission and improve knowledge and self-care behavior scores in pulmonary TB patients.

Use of Andrographis paniculata (Burm.f.) Wall. ex Nees and risk of pneumonia in hospitalised patients with mild coronavirus disease 2019: A retrospective cohort study.

Background: Andrographis paniculata (Burm.f.) Wall. ex Nees (AP) has been widely used in Thailand to treat mild COVID-19 infections since early 2020; however, supporting evidence is scarce and ambiguous. Thus, this study aimed to examine whether the use of AP is associated with a decreased risk of pneumonia in hospitalised mild COVID-19 patients. Materials and methods: We collected data between March 2020 and August 2021 from COVID-19 patients admitted to one hospital in Thailand. Patients whose infection was confirmed by real-time polymerase chain reaction, had normal chest radiography and did not receive favipiravir at admission were included and categorised as either AP (deriving from a dried and ground aerial part of the plant), given as capsules with a total daily dose of 180 mg andrographolide for 5 days or standard of care. They were followed for pneumonia confirmed by chest radiography. Multiple logistic regression was used for the analysis controlling for age, sex, diabetes, hypertension, statin use, and antihypertensive drug use. Results: A total of 605 out of 1,054 patients (mostly unvaccinated) were included in the analysis. Of these, 59 patients (9.8%) developed pneumonia during the median follow-up of 7 days. The incidence rates of pneumonia were 13.93 (95% CI 10.09, 19.23) and 12.47 (95% CI 8.21, 18.94) per 1,000 person-days in the AP and standard of care groups, respectively. Compared to the standard of care group, the odds ratios of having pneumonia in the AP group were 1.24 (95% CI 0.71, 2.16; unadjusted model) and 1.42 (95% CI 0.79, 2.55; fully adjusted model). All sensitivity analyses were consistent with the main results. Conclusion: The use of AP was not significantly associated with a decreased risk of pneumonia in mild COVID-19 patients. While waiting for insights from ongoing trials, AP's use in COVID-19 should be done with caution.