RESUMEN
Although prehospital emergency anesthesia (PHEA), with a specific focus on intubation attempts, is frequently studied in prehospital emergency care, there is a gap in the knowledge on aspects related to adherence to PHEA guidelines. This study investigates adherence to the "Guidelines for Prehospital Emergency Anesthesia in Adults" with regard to the induction of PHEA, including the decision making, rapid sequence induction, preoxygenation, standard monitoring, intubation attempts, adverse events, and administration of appropriate medications and their side effects. This retrospective study examined PHEA interventions from 01/01/2020 to 12/31/2021 in the city of Aachen, Germany. The inclusion criteria were adult patients who met the indication criteria for the PHEA. Data were obtained from emergency medical protocols. A total of 127 patients were included in this study. All the patients met the PHEA indication criteria. Despite having a valid indication, 29 patients did not receive the PHEA. 98 patients were endotracheally intubated. For these patients, monitoring had conformed to the guidelines. The medications were used according to the guidelines. A significant increase in oxygen saturation was reported after anesthesia induction (p < 0.001). The patients were successfully intubated endotracheally on the third attempt. Guideline adherence was maintained in terms of execution of PHEA, rapid sequence induction, preoxygenation, monitoring, selection, and administration of relevant medications. Emergency physicians demonstrated the capacity to effectively respond to cardiorespiratory events. Further investigations are needed on the group of patients who did not receive PHEA despite meeting the criteria. The underlying causes of decision making in these cases need to be evaluated in the future.
Asunto(s)
Anestesia , Servicios Médicos de Urgencia , Adhesión a Directriz , Humanos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Anestesia/métodos , Adulto , Alemania , Intubación Intratraqueal , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Group B Streptococcus (GBS) infection remains a leading cause of newborn morbidity and mortality. The study aimed to determine the adherence rate to the universal screening policy a decade after its introduction. Secondly, whether the timing of antibiotics given in GBS carriers reduces the incidence of neonatal sepsis. METHODS: Delivery records at Hong Kong Baptist Hospital in 2022 were examined to retrieve antenatal and intrapartum details regarding maternal GBS carrier status, previous maternal GBS carrier status, antibiotic treatment, timing of treatment, neonatal condition at birth and whether the neonate had sepsis. Univariate statistics was used to assess the relationship between maternal GBS carrier and neonatal sepsis overall. Incidence of neonatal sepsis was stratified according to mode of delivery and timing of antibiotic. RESULTS: The adherence rate to the universal GBS screening policy was 97%. The risk of neonatal sepsis was 5.45 (95% CI 3.05 to 9.75) times higher in women who were GBS screened positive when compared to non-GBS carriers (p < 0.001). Amongst term neonates from GBS carriers delivered by Caesarean section, the risk of neonatal sepsis significantly decreased by 70% after antenatal antibiotic treatment (p = 0.041) whereas in term neonates delivered vaginally, the risk of neonatal sepsis decreased by 71% (p = 0.022) if intrapartum antibiotic prophylaxis was given 4 or more hours. CONCLUSION: Giving antenatal antibiotic treatment before Caesarean section or intrapartum antibiotic prophylaxis for 4 or more hours before vaginal delivery may decrease the risk of neonatal sepsis in term neonates delivered from GBS carriers.
Asunto(s)
Antibacterianos , Sepsis Neonatal , Complicaciones Infecciosas del Embarazo , Infecciones Estreptocócicas , Streptococcus agalactiae , Humanos , Infecciones Estreptocócicas/prevención & control , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/epidemiología , Recién Nacido , Sepsis Neonatal/prevención & control , Sepsis Neonatal/diagnóstico , Sepsis Neonatal/epidemiología , Sepsis Neonatal/microbiología , Femenino , Streptococcus agalactiae/aislamiento & purificación , Embarazo , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Hong Kong/epidemiología , Portador Sano/diagnóstico , Adulto , Profilaxis Antibiótica/métodos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Incidencia , Cesárea , Tamizaje Masivo/métodos , Adhesión a Directriz/estadística & datos numéricos , Estudios Retrospectivos , Parto ObstétricoRESUMEN
To evaluate the extent to which pharmacies in Hetauda Sub-metropolitan City, Nepal adhere to the recommended practices outlined in the good pharmacy practice guidelines formulated by International Pharmaceutical Federation and draft developed by Nepal Pharmacy Council. Good Pharmacy Practice evaluates the safety, effectiveness, availability, and accessibility of medicines, ensuring their correct usage which is essential component of community pharmacies. Data was collected by visiting community pharmacies throughout Hetauda sub-metropolitan city. The questionnaire includes 38 questions under 9 sections: premises, personnel, quality policy, services, documentation, procurement, storage, prescription handling, and dispensing. Frequencies and percentages were used to represent all categorical variables, while mean ± standard deviation (SD) was used to represent continuous variables. To determine relationships between categorical data, the Pearson Chi-square test (χ²) was utilized with a significance level set at P < .05. Using SPSS Version 23, the quantitative data were analyzed. The findings indicated an overall compliance rate of 56.21% with the GPP indicators. The lowest adherence was observed in relation to the quality policy (11.02%), whereas the highest was obtained on the procurement process (86.6%). With regard to the qualifications of the pharmacy in charge, only 16.3% of the pharmacies had a pharmacist holding a bachelor's degree, while 32.6% employed an assistant pharmacist with a diploma degree. A significant association was found between the qualification of pharmacy in charge with availability of computer (P = .010), safe and effective procurement (P = .036), keeping narcotics drugs in lock and key system (P = .002) and maintaining records of narcotics (P = .020). Our findings reveal that community pharmacists in Hetauda Sub-metropolitan city, Nepal do not meet the standards set by International Pharmaceutical Federation and the Good Pharmacy Practice guidelines formulated by the Nepal Pharmacy Council.
Asunto(s)
Servicios Comunitarios de Farmacia , Humanos , Estudios Transversales , Nepal , Servicios Comunitarios de Farmacia/normas , Adhesión a Directriz , Encuestas y Cuestionarios , Farmacias/normas , Masculino , Femenino , Farmacéuticos/estadística & datos numéricosRESUMEN
BACKGROUND: This study aimed to evaluate the approaches of pediatric surgeons and pediatric urologists in Türkiye regarding the diagnosis and treatment of testicular torsion (TT) and their adherence to the European Association of Urology (EAU) pediatric urology guideline. METHODS: A survey consisting of 19 questions, accompanied by an annotation describing the objective of the study, was emailed to pediatric surgeons and pediatric urologists in June and July 2023. RESULTS: Of the 95 respondents, 62.1% had over 10 years of experience, and 48.4% treated more than five cases of TT annually. Of the participants, 87.4% stated that scrotal Doppler ultrasonography (US) was always used, and 12.6% stated that US was used in cases of doubtful diagnosis. Concerning treatment, 14.7% reported performing manual detorsion, 70.5% never did, and 14.7% did so only if the operating room was unavailable soon. A total of 92.6% of participants opted for emergency surgery. Among participants who perform manual detorsion, 71.4% perform surgery within 24 hours after successful manual detorsion. Regarding fixation of the contralateral testicle, 14.7% never performed it, and 27.4% did so only when they performed an orchiectomy on the torsion testicle. CONCLUSION: While most participants follow EAU pediatric urology guidelines by performing emergency surgery, the rate of manual detorsion is low. Few participants stated that emergency surgery may not be performed after manual detorsion. While all of the participants performed fixation of the torsion testicle in accordance with the guidelines, the same adherence was not observed in the contralateral testicle.
Asunto(s)
Torsión del Cordón Espermático , Torsión del Cordón Espermático/cirugía , Torsión del Cordón Espermático/diagnóstico , Torsión del Cordón Espermático/terapia , Torsión del Cordón Espermático/diagnóstico por imagen , Humanos , Masculino , Turquía , Encuestas y Cuestionarios , Pautas de la Práctica en Medicina/estadística & datos numéricos , Niño , Urólogos/estadística & datos numéricos , Cirujanos , Pediatría , Adhesión a Directriz/estadística & datos numéricosAsunto(s)
Anastomosis Quirúrgica , Cirujanos , Humanos , Drenaje , Resultado del Tratamiento , Recto/cirugía , Colon/cirugía , Adhesión a Directriz , Peritoneo/cirugíaRESUMEN
Objectives: This study aimed to investigate the knowledge, attitude and experiences in sharing unpleasant health information and adherence to the SPIKES protocol among physicians at a tertiary hospital in Muscat, Oman. Methods: This cross-sectional study was conducted at the Sultan Qaboos University Hospital from August to October 2022. An electronic, self-administered questionnaire was used to gather data from physicians across various departments. Results: A total of 89 physicians completed the questionnaire (response rate = 22.3%). Most participants (n = 86, 96.6%) recognised the need for additional training in the delivery of unpleasant health information ('bad news'), with 78.7% (n = 70) expressing their willingness to undertake such training. Additionally, 32.6% (n = 29) reported negative experiences due to improper delivery of bad news, with an equal proportion admitting to disclosing bad news to patients' family without their consent. The majority (n = 77, 86.5%) demonstrated a high level of overall adherence to the SPIKES protocol, with 59.6-85.4%, 12.4-34.8% and 1.1-11.2% reported usually, sometimes and never following specific steps of the protocol, respectively. Marital status (P = 0.015) and qualifications (P = 0.032) were the only variables that were associated with adherence level, with married physicians and those with board and/or fellowship certificates reporting significantly better adherence compared to their counterparts. Conclusion: Physicians in Oman encounter challenges in delivering unpleasant health information, underscoring the interplay of cultural influences, training and adherence to protocols. To address these challenges, targeted and frequent training programmes are recommended, starting from undergraduate medical education and extending to continuous opportunities for physicians at various career levels.
Asunto(s)
Médicos , Centros de Atención Terciaria , Humanos , Omán , Estudios Transversales , Masculino , Femenino , Centros de Atención Terciaria/organización & administración , Adulto , Encuestas y Cuestionarios , Médicos/psicología , Médicos/estadística & datos numéricos , Actitud del Personal de Salud , Persona de Mediana Edad , Conocimientos, Actitudes y Práctica en Salud , Relaciones Médico-Paciente , Adhesión a Directriz/estadística & datos numéricosRESUMEN
Assessment of pressure ulcer (PU) risk remains a challenge in clinical practice. The first part of this article (Martin and Holloway, 2024) discussed the evidence base underpinning the development of clinical guidelines for PUs alongside the creation of the bundle approach regarding PU prevention. This article, part two, presents the results of a clinical audit that explores compliance against a PU prevention bundle (the aSSKINg framework) in an adult community nursing setting in the south-east of England. The clinical audit was conducted between July-December 2021 and included records of 150 patients. Overall, compliance against the aSSKINg framework was poor, with only two criterion being met: equipment provision for chair and referral to the tissue viability team. Short-term recommendations are that mandatory PU training for staff in the management of PUs should be implemented, and the tissue viability nurse network should be increased. The long-term recommendation was the introduction of the aSSKINg framework as a template into the electronic patient record.
Asunto(s)
Auditoría Clínica , Enfermería en Salud Comunitaria , Adhesión a Directriz , Úlcera por Presión , Humanos , Úlcera por Presión/prevención & control , Úlcera por Presión/enfermería , Inglaterra , Masculino , Enfermería en Salud Comunitaria/normas , Femenino , Persona de Mediana Edad , Anciano , Adulto , Guías de Práctica Clínica como Asunto , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Red blood cell (RBC) transfusion is one of the most critical and expensive lifesaving treatment modalities. A clinical audit is a valuable instrument to determine whether transfusion practices align with the guidelines and identify knowledge deficiencies. The study aimed to evaluate the RBC transfusion practices and patient outcomes at the National District Hospital in Bloemfontein, South Africa, and to determine adherence to transfusion guidelines. METHODS: A retrospective descriptive study was conducted. All blood transfusion registers in the hospital were used to identify transfusion episodes during the study period. Files were retrieved from the admissions office and information captured on a paper-based datasheet. The appropriateness of the transfusion and adherence to the South African transfusion guidelines were evaluated using specific criteria. RESULTS: Of the 118 transfusion episodes during the study period, 78 files were retrieved and 76 included in the study. The patients' median age was 47 years (interquartile range [IQR]: 32-66 years), with human immunodeficiency viruses (HIV) (n = 34; 44.7%) being the most common comorbid condition. Pre-transfusion haemoglobin was documented for all patients with a median of 4.6 g/dL (IQR: 3.95 g/dL - 5.5 g/dL). The audit revealed that in 68.4% (n = 52) of the cases, the guidelines were applied appropriately. CONCLUSION: The study described the blood transfusion practices and identified shortcomings when compared with the standard clinical guidelines.Contribution: The study highlights the importance of applying rationale, caution and consideration of the specific patient profile when performing transfusions.
Asunto(s)
Auditoría Clínica , Transfusión de Eritrocitos , Adhesión a Directriz , Hospitales de Distrito , Humanos , Sudáfrica , Transfusión de Eritrocitos/estadística & datos numéricos , Estudios Retrospectivos , Persona de Mediana Edad , Femenino , Masculino , Adulto , Anciano , Guías de Práctica Clínica como Asunto , Auditoría MédicaRESUMEN
PURPOSE: Discharge summaries are important tools for communication between health care levels and can ensure continuity of rehabilitation. This study aims to gain insight into the content of discharge summaries written by hospital physiotherapists and occupational therapists regarding patients with stroke, and their adherence to recommended criteria for discharge summaries. MATERIAL AND METHODS: 31 physiotherapy and multidisciplinary discharge summaries, for stroke patients discharged home from hospital with need of follow-up, were included in the study. We employed qualitative content analysis and descriptive statistics to explore and describe the content. RESULTS: The physiotherapists and occupational therapists adhered to the recommended criteria for content in varying degree. The main focus for physiotherapists and occupational therapists were description of ADL, sensorimotor and general cognitive functions, they rarely report tolerance to exercise, and the specific cognitive abilities to follow instruction and learn were often omitted. Less focus was put on patients' experiences and needs during acute stroke, and description of goals were omitted in the physiotherapy discharge summaries. CONCLUSION: While the physiotherapists and occupational therapists complement each other in their assessment of patients and inform the reader about both sensorimotor and cognitive functions and abilities, they omit some of the specific criteria for rehabilitation. Despite the omissions, the information provided is specific to the patients' function and needs.
Asunto(s)
Adhesión a Directriz , Terapeutas Ocupacionales , Resumen del Alta del Paciente , Fisioterapeutas , Rehabilitación de Accidente Cerebrovascular , Humanos , Femenino , Masculino , Rehabilitación de Accidente Cerebrovascular/métodos , Rehabilitación de Accidente Cerebrovascular/normas , Anciano , Persona de Mediana Edad , Resumen del Alta del Paciente/normas , Accidente Cerebrovascular/terapia , Alta del Paciente , Adulto , Anciano de 80 o más AñosRESUMEN
BACKGROUND: In Ethiopia, there were an estimated 670,906 people living with the Human Immune Virus (HIV). Implementing an HIV test and treat strategy and rapid scale-up of anti-retroviral treatment (ART) provided health facilities increased the number of the number of people living with HIV/AIDS. In the same way, the expansion of viral load monitoring in these health facilities and poor adherence to ART increase the number of high-viral load (HVL) patients. To alleviate this problem, the World Health Organization (WHO) recommended EAC intervention for HVL patients. Therefore, the aim of this research was to determine the level of healthcare providers' adherence to the EAC intervention protocol and explore barriers and facilitators of the intervention in West Amhara, Northwest Ethiopia. METHOD: Descriptive cross-sectional study design with concurrent mixed-method evaluation was employed. The adherence dimension, with its sub-dimensions of content, coverage, frequency, and duration of the EAC intervention, was used with sixteen indicators. A total of 20 high-case-load public health facilities and 173 HVL patients were included in our study. Quantitative data was entered into Epi Info and exported to SPSS version 25 for analysis. Descriptive statistics are analyzed in terms of frequencies, percentages, variances, and means and presented as narrations, frequency tables, graphs, and charts. Qualitative data were transcribed, translated, coded, and analyzed thematically using Open Code version 4.0 software. The qualitative findings were used to triangulate the quantitative findings. RESULT: The average adherence level of health care providers (HCPs) to the EAC intervention protocol was 55.3%, from which content, coverage, frequency, and duration of the intervention contributed 70.3%, 86.3%, 36.9%, and 27.7%, respectively. Most of the intervention contents were delivered during the session, but none of the providers developed a patient adherence plan at the end of the session. All HVL patients were linked and enrolled in the EAC intervention. But only 6% of them were tested for repeat VL. CONCLUSION: The average adherence level of HCPs to the EAC intervention protocol was very inadequate. The main gap identified was difficulties in completing the EAC intervention sessions based on schedules. Implementing adherence improvement strategies, assigning an adequate number of EAC providers in ART and Prevention of Mother-to-Child Transmission (PMTCT) clinics, and allowing sufficient time during EAC sessions are important.
Asunto(s)
Consejo , Infecciones por VIH , Instituciones de Salud , Personal de Salud , Cumplimiento de la Medicación , Humanos , Etiopía , Estudios Transversales , Infecciones por VIH/tratamiento farmacológico , Femenino , Masculino , Adulto , Instituciones de Salud/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Carga Viral , Adhesión a Directriz/estadística & datos numéricos , Fármacos Anti-VIH/uso terapéutico , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVE: To investigate whether referrals of general practitioners (GPs) to the memory clinic align with the regional and national dementia guidelines. DESIGN: For this single center retrospective study, data was collected from electronic patient files. METHOD: GP referrals to the memory clinic over a 1-year period were categorized and evaluated according to the regional and national guidelines. RESULTS: 310 GP referrals were included with the most common referral motivations: "Additional somatic or psychiatric factors" (77; 24,8%) and "Straightforward dementia diagnosis" (70; 22,6%). A total of 51,0% of referrals were not in line with regional guidelines: either because of non-compliant referral reasons; or limited cognitive assessment without clinical findings and/or cognitive testing. CONCLUSION: Half of GP referrals to the memory clinic were not in line with the national and regional guidelines. Referrals were often not preceded by clinical findings and/or cognitive testing. Aiming for effective care, cognitive assessments in primary care should be encouraged and with appropriate assistance.
Asunto(s)
Demencia , Atención Primaria de Salud , Derivación y Consulta , Humanos , Derivación y Consulta/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos , Demencia/diagnóstico , Femenino , Masculino , Médicos Generales/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricosRESUMEN
OBJECTIVE: To describe the adherence to the sepsis protocol by obstetric nurses in the obstetric triage of a high-risk maternity reference center. METHODS: This was a quantitative, documental, and retrospective study involving 105 pregnant women treated in obstetric triage under sepsis criteria. Data were collected through electronic medical records using structured forms and were organized into tables employing descriptive statistics. This research adhered to ethical principles concerning human studies. RESULTS: Of the checklists for initiating the SEPSIS protocol by obstetric nurses, 105 were identified. Regarding the protocol steps performed, lactate was collected in 97.1% of cases and blood cultures in 98.1%, antibiotic therapy was administered in 94.3%, and hydration was carried out in 51.4% of the cases. CONCLUSION: The initiation of the sepsis protocol for all women meeting the criteria was confirmed. However, the steps were not fully implemented as recommended by the institutional protocol, and the recommended broad-spectrum antibiotic was not administered.
Asunto(s)
Adhesión a Directriz , Sepsis , Humanos , Femenino , Estudios Retrospectivos , Embarazo , Sepsis/tratamiento farmacológico , Adulto , Adhesión a Directriz/estadística & datos numéricos , Adhesión a Directriz/normas , Triaje/métodos , Triaje/normas , Triaje/éticaRESUMEN
BACKGROUND: Negative role models can significantly impact nursing students' adherence to standard infection control precautions (SP) but there has been limited research on impacts and relevant strategies. PURPOSE: This review examined the impact of negative role models on nursing students' adherence to SP and explored strategies that nursing instructors could use to help students effectively manage the influence of negative role models. METHODS: An integrative review was conducted, guided by Whittemore and Knafl's methodology (2005). PubMed, CINAHL, and Scopus were searched for articles from 2008-2023. Research studies were critically appraised using appropriate tools. RESULTS: Fourteen articles met the inclusion criteria and were included in this review. The literature indicates that nursing students frequently encounter negative role models during their clinical placements and that such negative encounters detrimentally impact their adherence to SP. Five strategies to potentially mitigate the impact of negative role models were identified. CONCLUSION: To address the issue of negative role models, nursing instructors can help students learn specific strategies to manage encounters with negative role models, promote discussion of role modeling with students and clinical staff, and act as role models themselves. Further research is needed to inform specific strategies.
Asunto(s)
Estudiantes de Enfermería , Humanos , Control de Infecciones , Adhesión a Directriz , Bachillerato en EnfermeríaRESUMEN
BACKGROUND: Hand hygiene is known to reduce healthcare-associated infections. However, it remains suboptimal among healthcare providers. In this study, we used the Behaviour-centered Design approach to explore the facilitators and deterrents to hand hygiene among healthcare providers in the Kampala Metropolitan area, Uganda. METHODS: We conducted a formative qualitative study as part of a cluster randomised trial in 19 healthcare facilities (HCFs). The study used 19 semi-structured and 18 key informant interviews to collect data on hand hygiene status and facilitators and deterrents of hand hygiene. Research assistants transcribed verbatim and used a thematic framework aided by Nvivo 14.0. to undertake analysis. We used thick descriptions and illustrative quotes to enhance the credibility and trustworthiness of our findings. RESULTS: About 47.4% of the HCFs had sufficient hand hygiene infrastructure, and 57.9% did not report total compliance with hand hygiene during patient care. The physical facilitator for hand hygiene was the presence of constant reminders such as nudges, while the biological included the frequency of patient contact and the nature of clinical work. The only biological deterrent was the heavy workload in HCFs. The executive brain facilitators included knowledge of workplace health risks, infection prevention and control (IPC) guidelines, and a positive attitude. A negative attitude was the executive brain deterrent to hand hygiene. Recognition, rewards, and fear of infections were the only motivated brain facilitators. Behavioural setting facilitators included proximity to functional hand hygiene infrastructure, the existence of active IPC committees, good leadership, and the availability of a budget for hand hygiene supplies. Behavioural setting deterrents included the non-functionality and non-proximity to hand hygiene infrastructure and inadequate supplies. CONCLUSIONS: The study revealed low compliance with hand hygiene during the critical moments of patient care and inadequacy of hand hygiene infrastructure. The deterrents to hand hygiene included a heavy workload, negative attitude, inadequate supplies, non-functionality, and long distance to hand washing stations. Facilitators included constant reminders, fear of infections, frequency of patient contact and nature of clinical work, positive attitude, knowledge of IPC guidelines, recognition and reward, good leadership, availability of budgets for hand hygiene supplies, availability and proximity to hand hygiene supplies and infrastructure and active IPC committees. TRIAL REGISTRATION: ISRCTN Registry with number ISRCTN98148144. The trial was registered on 23/11/2020.
Asunto(s)
Adhesión a Directriz , Higiene de las Manos , Personal de Salud , Investigación Cualitativa , Humanos , Higiene de las Manos/normas , Higiene de las Manos/estadística & datos numéricos , Uganda , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Femenino , Masculino , Actitud del Personal de Salud , Entrevistas como Asunto , Infección Hospitalaria/prevención & control , AdultoRESUMEN
BACKGROUND: Pneumonia stands as a significant global contributor to mortality, particularly in South Africa, where it ranks as the second leading cause of death. The country's high prevalence of HIV infection compounds this issue, significantly increasing mortality rates associated with community-acquired pneumonia (CAP). OBJECTIVE: This study aimed to audit CAP patient management at a regional rural hospital in KwaZulu-Natal. METHOD: A retrospective review of patient files from September to December 2016 was undertaken. Data extraction from clinical files, conducted according to inclusion criteria, was transferred to a data collection sheet and analyzed using SPSS version 21. RESULTS: The review encompassed 124 patient files over four months, revealing that 117 (94.4%) patients were not managed by the Standard Treatment Guidelines and Essential Medicines List for South Africa. Of the patients admitted with CAP, 54% were HIV positive, and 49 (39.5%) patients succumbed to the illness. Notably, none of the patients underwent assessment using a severity score. CONCLUSION: The findings underscore a need for more adherence to South African guidelines for managing CAP among staff at the rural regional hospital. This leads to severe consequences, exemplified by the high mortality rate. Urgent intervention is required to incorporate severity assessment scores into pneumonia evaluations, thus enabling appropriate clinical management. CONTRIBUTION: This study sheds light on the significant impact of CAP within the South African hospital context, delineating critical gaps in clinical care and emphasizing the imperative to address clinical inertia.
Asunto(s)
Infecciones Comunitarias Adquiridas , Infecciones por VIH , Hospitales Rurales , Neumonía , Humanos , Sudáfrica/epidemiología , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/mortalidad , Infecciones Comunitarias Adquiridas/epidemiología , Masculino , Femenino , Estudios Retrospectivos , Adulto , Neumonía/mortalidad , Neumonía/tratamiento farmacológico , Neumonía/epidemiología , Neumonía/terapia , Persona de Mediana Edad , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/mortalidad , Infecciones por VIH/epidemiología , Adulto Joven , Anciano , Adhesión a Directriz , Antibacterianos/uso terapéuticoRESUMEN
The objective of this study was to determine adherence to national guidelines for aerobic and muscle-strengthening physical activity among United States (US) adults and identify factors associated with guideline nonadherence. The 2022 National Health Interview Survey data were analyzed to evaluate self-reported physical activity among 26,494 US adults. Adherence to national guidelines was defined as engaging in ≥150 minutes moderate-intensity or ≥75 minutes vigorous-intensity aerobic activity/week, and muscle-strengthening activity ≥2 days/week. A multivariable logistic regression model evaluated associations between 24 sociodemographic and health variables with nonadherence to physical activity guidelines. Shapley Additive Explanations were used to assess the relative importance of each factor in the model. The population-weighted analysis revealed that only 24.3% of US adults met both the aerobic and muscle-strengthening activity guidelines. The regression model identified 17 factors significantly associated with nonadherence. When evaluating the relative importance of these variables, older age, lower educational attainment, and lower household income emerged as the primary determinants of nonadherence. Guideline adherence was lowest among subgroups with multiple risk factors, with only 6.5% of older adults with lower income and education meeting the guidelines. In contrast, adherence was 42.7% in younger respondents with higher incomes and educational attainment. In conclusion, physical activity rates among US adults remain below public health targets, with significant disparities among sociodemographic groups. Expanded outreach efforts targeting higher-risk populations are urgently needed to address barriers, promote physical activity engagement, and achieve health equity.
Asunto(s)
Ejercicio Físico , Adhesión a Directriz , Humanos , Femenino , Masculino , Estados Unidos , Persona de Mediana Edad , Adulto , Anciano , Adhesión a Directriz/estadística & datos numéricos , Factores Socioeconómicos , Adulto Joven , Adolescente , Encuestas Epidemiológicas , Autoinforme , Factores Sociodemográficos , Factores de EdadRESUMEN
OBJECTIVE: To investigate what concerns people with acute low back pain (LBP) and explore whether demographic and clinical factors were associated with having concerns about LBP. DESIGN: Mixed-methods study. METHODS: We included participants aged ≥18 years with acute LBP (LBP≤6 weeks). We collected demographic and clinical characteristics via an online survey and asked one open-ended question to elicit participants' concerns about their LBP. We investigated concerns about LBP using inductive content analysis. Using multivariable logistic regression, we explored associations between demographic and clinical characteristics and having concerns about LBP. RESULTS: We included 2025 participants, a majority of whom (n = 1200, 59.3%) reported having at least 1 concern about their LBP. There were 34 unique concerns, which mapped to 5 themes: causes of LBP (n = 393, 19.4%), future consequences of LBP (n = 390, 19.3%), psychosocial consequences of LBP (n = 287, 14.2%), physical consequences of LBP (n = 210, 10.4%), and health consequences of LBP (n = 84, 4.2%). Demographic and clinical characteristics were associated with having concerns about LBP: participants with university education, having previously received advice for LBP, with higher LBP intensity, interference, and higher anxiety symptoms were more likely to have concerns about their LBP. CONCLUSION: Most people with acute LBP had at least 1 concern about their LBP, more commonly centered around the causes of and the future consequences of LBP. J Orthop Sports Phys Ther 2024;54(9):1-9. Epub 7 August 2024. doi:10.2519/jospt.2024.12571.
Asunto(s)
Dolor de la Región Lumbar , Humanos , Dolor de la Región Lumbar/terapia , Masculino , Femenino , Adulto , Persona de Mediana Edad , Dolor Agudo , Encuestas y Cuestionarios , Adulto Joven , Guías de Práctica Clínica como Asunto , Anciano , Adhesión a DirectrizRESUMEN
The aim of the study was to investigate radiation protection adherence among radiology personnel and associated factors. In light of the increasing integration of ionizing radiation in medical diagnostics and treatment-specifically in areas such as computed tomography, fluoroscopy, and therapeutic radiology-it is vital for radiology personnel to consistently uphold rigorous radiation protection standards. This cross-sectional study employed a self-administered questionnaire to collect demographic data and assess various aspects of radiation protection adherence among radiology personnel. The gathered data were entered into SPSS 16 for statistical analysis. Among the 119 participants, 72 (60.5%) worked in the radiology department, and 88 (77.9%) were married. Significant associations were observed between adherence levels and marital status, age groups, years of experience, and department type. Study findings showed a significant association between several demographic factors and radiation protection adherence. Furthermore, our results highlight the value of implementing radiation protection courses to enhance adherence among personnel.