Characteristics and outcome of COVID-19 patients admitted to the ICU: a nationwide cohort study on the comparison between the first and the consecutive upsurges of the second wave of the COVID-19 pandemic in the Netherlands

Background To assess trends in the quality of care for COVID-19 patients at the ICU over the course of time in the Netherlands. Methods Data from the National Intensive Care Evaluation (NICE)-registry of all COVID-19 patients admitted to an ICU in the Netherlands were used. Patient characteristics and indicators of quality of care during the first two upsurges (N = 4215: October 5, 2020–January 31, 2021) and the final upsurge of the second wave, called the ‘third wave’ (N = 4602: February 1, 2021–June 30, 2021) were compared with those during the first wave (N = 2733, February–May 24, 2020). Results During the second and third wave, there were less patients treated with mechanical ventilation (58.1 and 58.2%) and vasoactive drugs (48.0 and 44.7%) compared to the first wave (79.1% and 67.2%, respectively). The occupancy rates as fraction of occupancy in 2019 (1.68 and 1.55 vs. 1.83), the numbers of ICU relocations (23.8 and 27.6 vs. 32.3%) and the mean length of stay at the ICU (HRs of ICU discharge = 1.26 and 1.42) were lower during the second and third wave. No difference in adjusted hospital mortality between the second wave and the first wave was found, whereas the mortality during the third wave was considerably lower (OR = 0.80, 95% CI [0.71–0.90]). Conclusions These data show favorable shifts in the treatment of COVID-19 patients at the ICU over time. The adjusted mortality decreased in the third wave. The high ICU occupancy rate early in the pandemic does probably not explain the high mortality associated with COVID-19.

The Influence of Checklist Model Documentation on the Completeness of Nursing Care Documentation at Arosuka Hospitals 2017

Background: The nursing care documentation technique that applied at Arosuka Hospital was narrative recording technique. Based on documentation evaluation of nursing care, nursing documentation at Arosuka Hospital was still not equal to documentation of nursing care. Methods: This research intends to analyze the effect of checklist documenting model to the documentation of nursing care in Arosuka Hospital. This research had been conducted since January to June 2017 and the data were collected from May to June 2017. The method of this research was quasi-experiment, pre-test and post-test group research. There were forty-five nurses taken as the samples with total sampling techniques applied. The instruments that used in this research were the forms of checklist documenting model and nursing care evaluation sheet. Result: The result of the research has shown that there is difference of the completeness of nursing care documentation before and after using the checklist model documenting format. The average number of nursing care documentation is higher with the checklist model compared to narrative model mean (40,533). This checklist documenting model is recommended to be applied in Arosuka Distric Hospital to improve the completeness of nursing care documentation in Arosuka Distric Hospital. Keywords:Checklist model, documentation, nursing care.

Comparing Sources of Disruptions to Telemedicine-Enabled Stroke Care in an Ambulance

Objective: The purpose of this study is to understand the nature and source of disruptions in an ambulance during the telemedicine-based caregiving process for stroke patients to enhance the ambulance design for supporting telemedicine-based care. Background: Telemedicine is emerging as an efficient approach to provide timely remote assessment of patients experiencing acute stroke in an ambulance. These consults are facilitated by connecting the patient and paramedic with a remotely located neurologist and nurse using cameras, audio systems, and computers. However, ambulances are typically retrofitted to support telemedicine-enabled care, and the placement of these systems inside the ambulance might lead to spatial challenges and disruptions during patient evaluation. Method: Video recordings of 13 simulated telemedicine-based stroke consults were coded and analyzed using an existing systems-based flow disruption (FD) taxonomy. For each observed disruption—the type, severity or impact, location in the ambulance, and equipment involved in the disruption were recorded. Results: Seat size, arrangement of assessment equipment, location of telemedicine equipment (computer workstation), and design of telemedicine camera were among the factors that impacted telemedicine-related disruptions. The left ambulance seat zone and head of the patient bed were more involved in environmental hazard–related disruptions, while the right zone of the ambulance was more prone to interruptions and communication-related disruptions. Conclusion: Adequate evaluation space for the paramedic, proper placement of evaluation equipment, and telemedicine computer location could facilitate the stroke care evaluation process and reduce FDs in the ambulance.

Development and validation of a mobile application for point of care evaluation of growth failure

Objectives Lack of systematic evaluation of short stature results in unnecessary work-up on one hand while missing pathology on the other. We have developed a mobile application that guides work-up based on age, auxology (height, BMI, and corrected standard deviation score), and skeletal maturation with an aim of reducing the diagnostic errors. Aim of this study is to develop and validate a mobile application for point of care evaluation of short stature. Methods The application was developed (n=400) and validated (n=412) on children and adolescents (2–18 years of age) presenting to our Pediatric Endocrinology Clinic with short stature. Height standard deviation score thresholds determining the need for workup were derived from Receiver Operating Characteristics (ROC) curve. Student’s t-test and ROC curves were used to identify the most appropriate parameter differentiating constitutional delay of growth and puberty (CDGP) from pathological and nutritional from endocrine causes. The validation of the application involved comparing the application predicted and clinical diagnosis at each step of the algorithm. Results The mobile application diagnosis was concordant with clinical diagnosis in 408 (99.0%) with discordance in four (two with CDGP labeled as growth hormone deficiency [GHD] and two with GHD labeled as CDGP). Conclusions Mobile application guided short stature assessment has a high concordance with the clinical diagnosis and is expected to help point of care short stature evaluation.

Information Technology in the Dissemination of Results of the Primary Health Care Evaluation in Brazil: A Qualitative Study

Background: Considering advancements in information technology for disseminating results of evaluations, it is essential to demonstrate the functionalities and performance of these practices in order to achieve the objectives established by the evaluation proponents. This study aimed to evaluate the use of information technology for disseminating results obtained from the Primary Health Care evaluation in Brazil. Methods: A qualitative single-case study was performed with triangulation of techniques and key informants. Analyses of public documents and field research were conducted. Convenience sample of 54 participants (seven from the Department of Primary Care/Ministry of Health and 47 from teaching and research institutions) was selected from the external evaluation team. Content analysis was performed, and the Atlas ti.8.4.24 software organized, managed, and categorized textual data. Codification was performed by peers (three researchers) while experts validated codes (two researchers). Right after, codes were extracted and categorized.Results: Dissemination of results is complex due to multiple components. Incorporation also favored advances in data observation and implementation of data openness, becoming available for professionals, policymakers, and universities. Challenges regarding delivery time of reports, access restriction, lack of interest, and digital skills influenced reaching expected goals of the proponent.Conclusion: Information technology for disseminating results of evaluations may improve performance of health teams and managers and redefine priorities of work processes to strengthen Primary Health Care. Emphasis in planning, technological infrastructure, digital inclusion, and policy decision making is recommended to disseminate data effectively to the population.

Translation and validation of the Arabic version of the barrier to access to care evaluation (BACE) scale

Purpose This paper aims to translate and validate an Arabic version of the Barriers to Access to Care Evaluation (BACE) BACE scale to make it appropriate for the targeted socio-cultural and linguistic context. Design/methodology/approach This psychometric study has two main compounds: translating the BACE into Arabic and validating it. Using the back-translation method, the authors involved seven professional individuals to maximize the efficacy of the translated version. The authors began with the process of translating the scale from English into Arabic and vice versa followed by evaluation, compression and matching. Later, a pilot study with a sample size of 35 participants was conducted to receive feedback on the Arabic version of the scale. Finally, an online survey was generated and distributed among Arabic-speaking countries; a total of 630 participants were voluntarily involved in this study. Findings A total of 630 participants completed the survey with a mean age of 31.4 ± 12.9, and 402 (63.8%) were females. Cronbach’s alpha coefficient and McDonald's Omega coefficient were both greater than 0.9. The confirmatory factor analysis was found to fit highly satisfactory with the stigma-related barriers. Research limitations/implications The BACE was validated in Arabic and its psychometric properties were examined in-depth and found to be strong. Originality/value This paper fulfils an identified need to translate tools to make mental health more accessible to patients in need.

Validation of the Chinese version of the Care Evaluation Scale for measuring the quality of structure and process of end-of-life care from the perspective of bereaved family

Background Assessing the quality of structure and process of end-of-life care can help improve outcomes. There was currently no valid tool for this purpose in Mainland China. The aim of this study is to validate the Chinese version of the Care Evaluation Scale (CES). Methods From January to December 2017, a cross-sectional online survey was conducted among bereaved family members of cancer patients from 10 medical institutes. The reliability of the CES was assessed with Cronbach’s α, and structural validity was evaluated by confirmatory factor analysis. Concurrent validity was tested by examining the correlation between the CES total score and overall satisfaction with end-of-life care, quality of dying and death, and quality of life. Results A total of 305 valid responses were analyzed. The average CES score was 70.7 ± 16.4, and the Cronbach’s α of the CES was 0.967 (range: 0.802–0.927 for the 10 domains). The fit indices for the 10-factor model of CES were good(root-mean-square error of approximation, 0.047; comparative fit index, 0.952; Tucker–Lewis index, 0.946; standardized root mean square residual, 0.053). The CES total score was highly correlated with overall satisfaction with medical care (r = 0.775, P < 0.01), and moderately correlated with patients’ quality of life (r = 0.579, P < 0.01) and quality of dying and death (r = 0.570, P < 0.01). In addition, few associations between CES total score and demographic characteristics, except for the family members’ age. Conclusions The Chinese version of the CES is a reliable and valid tool to evaluate the quality of structure and process of end-of-life care for patients with cancer from the perspective of bereaved family in Mainland China.