Project description:BackgroundInadvertent perioperative hypothermia is an unintentional drop in core body temperature to less than 36 °C perioperatively and is associated with many negative outcomes such as infection, a prolonged stay in a recovery room, and decreased patient comfort.ObjectiveTo determine the incidence of postoperative hypothermia and to identify the associated factors with postoperative hypothermia in patients undergoing head, neck, breast, general, urology, and vascular surgery. The incidences of pre- and intraoperative hypothermia were examined as the intermediate outcomes.Materials and methodsA retrospective chart review was conducted in adult patients undergoing surgery at a university hospital in a developing country for two months (October to November 2019). Temperatures below 36 °C were defined as hypothermia. Univariate and multivariate analyses were used to identify factors associated with postoperative hypothermia.ResultsA total of 742 patients were analyzed, the incidence of postoperative hypothermia was 11.9% (95% CI 9.7%-14.3%), and preoperative hypothermia was 0.4% (95% CI 0.08%-1.2%). Of the 117 patients with intraoperative core temperature monitoring, the incidence of intraoperative hypothermia was 73.5% (95% CI 58.8-90.8%), and hypothermia occurred most commonly after anesthesia induction. Associated factors of postoperative hypothermia were ASA physical status III-IV (OR = 1.78, 95%CI 1.08-2.93, p = 0.023) and preoperative hypothermia (OR = 17.99, 95%CI = 1.57-206.89, p = 0.020). Patients with postoperative hypothermia had a significantly longer stay in the PACU (100 min vs. 90 min, p = 0.047) and a lower temperature when discharged from PACU (36.2 °C vs. 36.5 °C, p < 0.001) than those without hypothermia.ConclusionThis study confirms that perioperative hypothermia remains a common problem, especially in the intraoperative and postoperative periods. High ASA physical status and preoperative hypothermia were associated factors of postoperative hypothermia. In order to minimize the incidence of perioperative hypothermia and enhance patient outcomes, appropriate temperature management should be emphasized in patients at high risk.RegistrationClinical Trials.gov (NCT04307095) (13/03/2020).

Project description:ObjectivesUnplanned readmissions to the intensive care unit (ICU) are highly undesirable, increasing variance in care, making resource planning difficult and potentially increasing length of stay and mortality in some settings. Identifying patients who are likely to suffer unplanned ICU readmission could reduce the frequency of this adverse event.SettingA single academic, tertiary care hospital in the UK.ParticipantsA set of 3326 ICU episodes collected between October 2014 and August 2016. All records were of patients who visited an ICU at some point during their stay. We excluded patients who were ≤16 years of age; visited ICUs other than the general and neurosciences ICU; were missing crucial electronic patient record measurements; or had indeterminate ICU discharge outcomes or very early or extremely late discharge times. After exclusion, 2018 outcome-labelled episodes remained.Primary and secondary outcome measuresArea under the receiver operating characteristic curve (AUROC) for prediction of unplanned ICU readmission or in-hospital death within 48 hours of first ICU discharge.ResultsIn 10-fold cross-validation, an ensemble predictor was trained on data from both the target hospital and the Medical Information Mart for Intensive Care (MIMIC-III) database and tested on the target hospital's data. This predictor discriminated between patients with the unplanned ICU readmission or death outcome and those without this outcome, attaining mean AUROC of 0.7095 (SE 0.0260), superior to the purpose-built Stability and Workload Index for Transfer (SWIFT) score (AUROC=0.6082, SE 0.0249; p=0.014, pairwise t-test).ConclusionsDespite the inherent difficulties, we demonstrate that a novel machine learning algorithm based on transfer learning could achieve good discrimination, over and above that of the treating clinicians or the value added by the SWIFT score. Accurate prediction of unplanned readmission could be used to target resources more efficiently.

Project description:ObjectiveAlthough numerous studies have assessed patient satisfaction in diverse settings, in the realm of nursing surgical care, standardization of measurement for patient experience and satisfaction is lacking. Therefore, the aim of this study was to assess the satisfaction of surgical patients with perioperative nursing care.MethodA descriptive cross-sectional survey was conducted. Sociodemographic characteristics and clinical data were recorded. Patient satisfaction was measured with a modified version of the La Monica-Oberst Patient Satisfaction Scale (LOPSS-12).Results150 patients (73 women, 49% and 77 men; 51%) completed the survey. The mean age was 63 years (standard deviation, 16 years). The mean overall satisfaction score on the La Monica-Oberst Patient Satisfaction Scale was 3.17 (standard deviation, 0.21). The scale showed adequate content validity (Lawshe's Content Validity Index was 0.76) and moderate reliability (Cronbach's alpha = 0.70). Two variables-patient sex and the presence of comorbidities-were significantly associated with overall satisfaction: men and patients with comorbidities were more satisfied with the care received. Patients with university studies were significantly more likely than patients with less education to consider nurses "impatient," but also considered the nurses' advice to be "useful." Patients with hospital-acquired complications were more likely to perceive nurses to be "more interested in completing tasks than in listening," although they also felt that nurses worked "conscientiously."ConclusionOverall, patient satisfaction with perioperative nursing care was good. This study identified several areas of nursing care in need of improvement, particularly the need to spend more time with patients and to keep them better informed about the perioperative process. The modified La Monica-Oberst Patient Satisfaction Scale is suitable for measuring surgical patient satisfaction with perioperative nursing care. The findings presented here may be of value to nursing administrators, educators, and nursing care providers to improve patient satisfaction and to develop strategies to prevent patient dissatisfaction.

Project description:IntroductionEarly antibiotic administration is one of the core treatments of sepsis which associated with reduced mortality rate. However, the appropriate timing of antibiotics remains a controversial issue, especially in patients without septic shock. Here, we reported the outcomes of early antibiotic administration within one hour from the time of infection suspicion in a tertiary care hospital.MethodsWe reviewed the medical records and sepsis protocols in Chulabhorn Hospital, Bangkok, Thailand, from January 2021 to December 2023 for patients presenting with sepsis. We had our own sepsis protocol which we used for early detection and treatment of sepsis patients. We compared the 28-day mortality, 90-day mortality, and the length of stay between patients with time-to-antibiotics (TTA) within one hour and patients with TTA more than one hour.ResultsWe recruited 1,506 patients into our study. The mean age is 68 years and 49.40% of patients is female. 90.97% of the patients have comorbidities. The most common comorbidities were cancer (68.66%), and hypertension (33.40%). The 28-day mortality rate and the 90-day mortality rate were significantly lower in the patients with TTA within one hour compared to those with TTA more than one hour (P = 0.009 and P = 0.042, respectively). Nonetheless, adjusted mortality rate was significantly lower in only 28-day mortality rate but not 90-day mortality rate. Subgroup analysis showed that the mortality rate was significantly lower in patients with ICD-10 diagnosis of infections (15.35% vs. 21.51%, P = 0.029), patients with cancer (17.29% vs. 24.11%, P = 0.016), and patients with solid cancer (20.86% vs. 28.18%, P = 0.036). However, subgroup analysis for the mortality rate at 90 days were not statistically significant.ConclusionAntibiotic administration within one hour from the time of infection suspicion is associated with lower mortality rates at 28 days but not at 90 days after adjusted analysis. Cancer patients, especially patients with solid cancer, will benefit more with time-to-antibiotics less than one hour.

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Incidence of Cancer in Sarcoidosis Patients in a Tertiary Care Hospital in the UK.

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Incidence of Cancer in Sarcoidosis Patients in a Tertiary Care Hospital in the UK.

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