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Objective: To assess whether conditional bedside alarm triggers can reduce the frequency of nonactionable alarms without compromising patient safety and enhance nursing and family satisfaction., Study Design: Single-center, quality improvement initiative in an acute care cardiac unit and pediatric intensive care unit. Following the 4-week preintervention baseline period, bedside monitors were programmed with hierarchical time delay and conditional alarm triggers. Bedside alarms were tallied for 4 weeks each in the immediate postintervention period and 2-year follow-up. The primary outcome was alarms per monitored patient day. Nurses and families were surveyed preintervention and postintervention., Results: A total of 1509 patients contributed to 2034, 1968, and 2043 monitored patient days which were evaluated in the baseline, follow-up, and 2-year follow-up periods, respectively. The median number of alarms per monitored patient day decreased by 75% in the pediatric intensive care unit (P < .001) and 82% in the acute care cardiac unit (P < .001) with sustained effect at the 2-year follow-up. No increase of rapid response calls, emergent transfers, or code events occurred in either unit. Nursing surveys reported an improved capacity to respond to alarms and fewer perceived nonactionable alarms. Family surveys, however, did not demonstrate improved sleep quality., Conclusions: Implemented changes to bedside monitor alarms decreased total alarm frequency in both the acute care cardiac unit and pediatric intensive care unit, improving the care provider experience without compromising safety., Competing Interests: Declaration of Competing Interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have no conflicts to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Malnutrition and poor functional reserves place patients at risk for negative surgical outcomes. In this prospective study we aimed to measure preoperative nutritional and sarcopenia risk and evaluate their impact on postoperative outcomes., Methods: Adults scheduled to undergo elective general and gastrointestinal surgery were screened for nutrition risk using the Malnutrition Universal Screening Tool screening tool. Sarcopenia risk was measured using the SARC-F tool and hand-grip strength. Patients were followed postoperatively. Incidence of complications, length of stay (LOS), readmission rates, and need for step-down care were recorded., Results: One hundred and twenty-two patients were included. Mean age was 53.8 years (standard deviation [SD] 16.44). Sixty-six (54%) were scheduled for day-case procedures, and 56 (46%) for nonday-case procedures. About 18.9% (n = 23) were at nutritional risk preoperatively. Ten patients (8.2%) had probable sarcopenia based on SARC-F, whereas seven (5.7%) had measurably reduced HG. Incidence of postoperative complications was 23.8% (n = 29). Nutrition risk was associated with the development of complications (p = 0.018). In the nonday-case group, nutritional risk was associated with greater LOS (p = 0.013). Older age was associated with need for step-down care (p = 0.002) as was SARC-F (p = 0.003)., Conclusions: Preoperative nutritional screening can predict postoperative complications and LOS, whereas sarcopenia screening is predictive of the need for step-down care after discharge. Screening tools are quick and inexpensive and could provide valuable information to clinicians and allow patients the opportunity to enhance their physical preparedness for surgery thereby mitigating their risk for negative surgical outcomes., (© 2023 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Background: Physical activity (PA) is important for those with type 1 diabetes (T1DM); however, accurate information on PA in people with T1DM is limited., Aims: This study assessed adherence to PA guidelines using both objective and subjective PA measures and evaluated the relationship between accelerometer-measured PA and cardiovascular disease (CVD) risk factors. Barriers to PA were also assessed., Methods: Using an observational cross-sectional design, PA was measured objectively over 7 days in 72 participants (34 males) using an accelerometer (ActiGraph) and subjectively using the International Physical Activity Questionnaire (IPAQ). Perceived barriers to PA were assessed using the Barriers to Physical Activity in Diabetes (type 1) scale. Multiple linear regression models assessed the influence of PA on HbA1c and CVD risk factors., Results: Mean age ± SD was 40.9 ± 12.9 years, diabetes duration was 18 ± 11.6 years, and HbA1c was 65 ± 14 mmol/mol /8.0 ± 1.3%. Twenty-three (32%) participants exercised according to PA recommendations as measured by an accelerometer. Sixty-nine (97%) participants reported meeting the recommendations as per the IPAQ. Those meeting recommendations (accelerometry) had a lower HbA1c (p = 0.001), BMI (p = 0.032), waist circumference (p = 0.006), and fat mass (p = 0.032) and a greater number of hypoglycaemic events (p = 0.004). Fear of hypoglycaemia was the strongest barrier to PA (mean 3.4 ± 2.0)., Conclusion: The majority of participants failed to meet PA recommendations. Meeting the recommendations was associated with healthier CVD risk factor profiles. Individuals with T1DM possibly overestimate their PA using self-reported measures and require support and education to safely improve activity levels., (© 2021. The Author(s).)

Introduction: Bedside nurse (RN) presence during family-centered rounds (FCR) enhances communication and collaboration for safer, higher-quality care.1-3 At our institution, RN participation in FCR was variable and lower than desired. The content discussed at each bedside during rounds was inconsistent, contributing to the irregular achievement of established FCR checklist items., Methods: Using a scheduling tool with a prioritization algorithm and set time allotment/patient, we implemented schedule-based family-centered rounds (SBFCR) on a pediatric acute care unit. Primary outcome metrics included RN attendance and participation. We tracked rounding checklist compliance, parent presence on rounds, and adherence to the schedule. Surveys provided information on provider and family satisfaction. Perceived impact on teaching was the balancing measure because the structure discouraged spending extra time at the cost of team tardiness for the next patient., Results: We created a schedule for 95% workweek days, with the rounding order kept for 93%. Mean RN attendance increased from 69% to 87% and participation increased from 48% to 80% with SBFCR ( P < 0.001 for each). FCR checklist compliance increased from 60% to 94% ( P < 0.001). Families felt more informed and able to attend; their presence at rounds rose from 66% to 85% ( P < 0.001). Most faculty and trainees felt SBFCR was efficient and observed increased teaching with SBFCR., Conclusions: SBFCR provides an organizational framework for increased RN attendance and participation as well as greater family presence during rounds. The system elevated provider satisfaction with rounding without degrading the perceived educational experience., (Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.)

People who are socially excluded experience vastly poorer health outcomes compared to the general population. Inclusion Health seeks to directly address this health inequity. Despite the increased requirement for health care and the increased prevalence of complex health and social needs in socially excluded people, Inclusion Health features very little in health education curricula. This letter has been written by a group of clinicians, academics, clinical education specialists and students with a common interest in Inclusion Health. In the absence of established guidance on how best to incorporate the broad topic of inclusion health in undergraduate education, we have developed a two-pronged approach within Physiotherapy. We are writing to highlight the following initiatives; firstly, the provision of a dedicated undergraduate clinical placement devoted to the area of Inclusion Health. Secondly, we have also initiated a step-wise process of introducing the topic of Inclusion Health into the formal undergraduate curriculum. This letter demonstrates the need to implement strategies to incorporate Inclusion Health into the curriculum and the approaches described are applicable to diverse health professions and settings., Competing Interests: No competing interests were disclosed., (Copyright: © 2020 Broderick J et al.)

Socially marginalised groups suffer vastly poorer health outcomes compared to the general population. Inclusion health seeks to directly address the health inequities experienced by groups such as homeless people and refugees. Despite the unique healthcare needs experienced by these vulnerable groups, inclusion health features very little in health education curricula. This letter has been written by a group of clinicians, academics, clinical education specialists and students with a common interest in inclusion health. In the absence of established guidance on how best to incorporate the broad topic of inclusion health in undergraduate education, we have developed a two-pronged approach within physiotherapy. We are writing to highlight the following initiatives; firstly, the provision of a dedicated undergraduate clinical placement devoted to the area of inclusion health. Secondly, we have also initiated a step-wise process of introducing the topic of inclusion health into the formal undergraduate curriculum. This letter demonstrates the need to implement strategies to incorporate inclusion health into the curriculum and the approaches described are applicable to diverse health professions and settings., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 Broderick J et al.)

Objective: There is currently limited research exploring healthcare professionals' (HCPs) experiences of working with patients with dissociative seizures (DS). Existing studies do not focus on the role of psychiatrists in treating this complex condition. The objective of this study was to gain an understanding of UK-based psychiatrists' experiences of the DS patient group. Against the backdrop of a UK-wide randomised controlled trial (RCT), the focus was broadened to encompass issues arising in everyday practice with the DS patient group., Design, Participants and Methods: A qualitative study using semistructured interviews was undertaken with 10 psychiatrists currently working with DS patients within the context of a large RCT investigating treatments for DS. Thematic analysis was used to identify key themes and subthemes., Setting: The psychiatrists were working in Liaison or Neuropsychiatry services in England., Results: The key themes identified were other HCPs' attitudes to DS and the challenges of the DS patient group. There is a clear knowledge gap regarding DS for many HCPs and other clinical services can be reluctant to take referrals for this patient group. Important challenges posed by this patient group included avoidance (of difficult emotions and help), alexithymia and interpersonal difficulties. Difficulties with alexithymia meant DS patients could struggle to identify triggers for their seizures and to express their emotions. Interpersonal difficulties raised included difficulties in attachment with both HCPs and family members., Conclusions: A knowledge gap for HCPs regarding DS has been identified and needs to be addressed to improve patient care. Given the complexity of the patient group and that clinicians from multiple disciplines will come into contact with DS patients, it is essential for any educational strategy to be implemented across the whole range of specialties, and to account for those already in practice as well as future trainees., Trial Registration Number: ISRCTN05681227; NCT02325544; Pre-results., Competing Interests: Competing interests: LHG and JM report the grant from the NIHR HTA for the conduct of the study. None of the other authors have competing interests to declare., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Aim: Aboriginal young people are more likely to experience mental health issues and to access mental health services than other young Australians, yet there are few culturally informed mental health programs and services available. This study describes and documents the effectiveness of the culturally sensitive model within YouthLink, a state-wide mental health service program in Western Australia for young people aged 13 to 24 years of age., Methods: A mixed-method design including a descriptive approach reporting on the YouthLink framework and an empirical research design where 40 Aboriginal clients completed client feedback monitoring measures between 2014 and 2016., Results: The YouthLink culturally informed conceptual framework adheres to best practice principles relevant to work with Indigenous people, family and communities. Aboriginal young people indicated improvement across the treatment period as shown by within-group differences between the first and last session scores on feedback measures. Therapeutic alliance (together with lower baseline acuity and female gender) also contributed significantly to positive treatment outcomes., Conclusions: Through a strong role of Aboriginal practitioners, relationships with Aboriginal communities, and greater service flexibility that embraces cultural meaning and knowledge, YouthLink has sought to enhance its response to the needs of Aboriginal youth., (© 2018 John Wiley & Sons Australia, Ltd.)

Objectives: To implement data-driven vital sign parameters to reduce bedside monitor alarm burden., Methods: Single-center, quality-improvement initiative with historical controls assessing the impact of age-based, inpatient-derived heart rate (HR) and respiratory rate (RR) parameters on a 20-bed acute care ward that serves primarily pediatric cardiology patients. The primary outcome was the number of alarms per monitored bed day (MBD) with the aim to decrease the alarms per MBD. Balancing measures included the frequency of missed rapid response team activations, acute respiratory code events, and cardiorespiratory arrest events in the unit with the new vital sign parameters., Results: The median number of all cardiorespiratory monitor alarms per MBD decreased by 21% from 52 (baseline period) to 41 (postintervention period) ( P < .001). This included a 17% decrease in the median HR alarms (9-7.5 per MBD) and a 53% drop in RR alarms (16.8-8.0 per MBD). There were 57 rapid response team activations, 8 acute respiratory code events, and no cardiorespiratory arrest events after the implementation of the new parameters. An evaluation of HRs and RRs recorded at the time of the event revealed that all patients with HRs and/or RRs out of range per former default parameters would also be out of range with the new parameters., Conclusions: Implementation of data-driven HR and iteratively derived RR parameters safely decreased the total alarm frequency by 21% in a pediatric acute care unit., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2017 by the American Academy of Pediatrics.)

It has been found that many organisations still fail to meet the basic rights of those in their care, in terms of access to food, drink and support when they need it. In acknowledgment that food service in hospitals must be given a higher priority, and be recognised as an integral part of the patient's treatment and care, Irish hospitals must now have a system to evaluate the nutritional and hydrational care for patients admitted to hospital. The purpose of this audit was to examine the level of mealtime support available to patients during the main mealtime service in our hospital. As the audit highlighted the need to alter ward processes around the mealtime service, quality improvement initiatives were introduced. These initiatives had a positive impact, enabling ward staff to improve adequacy of mealtime support to patients, leading to better patient quality care at this time.

Background: Patients with chronic pancreatitis are at risk of malnutrition and nutrient deficiency due to malabsorption, pain, and poor diet. We sought to examine fat-soluble vitamin levels and malnutrition parameters in patients with chronic pancreatitis., Materials and Methods: In a prospective controlled cohort study, 128 subjects (62 chronic pancreatitis patients and 66 age-/sex-matched controls) were recruited. Body mass index (BMI), handgrip strength (measure of functional capacity), fat stores (triceps skin fold), muscle stores (mid-arm muscle circumference), exocrine function, and serum levels of fat-soluble vitamins (A, D, E) were measured., Results: Half of patients in the chronic pancreatitis group were overweight or obese, although the mean BMI was lower in patients than in controls (P = .007). Handgrip strength (P = .048), fat stores (P = .000), and muscle stores (P = .001) were lower in patients than in controls. Of the patients, 14.5% and 24.2% were deficient in vitamins A and E, respectively. Nineteen percent of patients had excess serum vitamin A levels., Conclusions: Despite the prevalence of overweight and obesity, patients had lower muscle stores, strength, and abnormal vitamin levels. Detailed nutrition assessment including anthropometry and vitamin status is warranted in chronic pancreatitis.

Background: Although parenteral nutrition (PN) has become an integral component of patient care, the risks and costs associated with this therapy must be weighed against the benefits. The Department of Nutrition and Dietetics at our tertiary referral, university-affiliated hospital has audited the use of enteral nutrition and PN based on criteria devised from guidelines developed by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). We aimed to examine the use of PN over time and in particular to investigate the appropriate and inappropriate use of this feeding method., Materials and Methods: Each patient referred for PN was assessed by a dietitian and need for PN evaluated. The appropriateness of the PN was categorized according to predefined criteria., Results: A total of 1191 patients had 1409 episodes of PN during the study period. According to the predefined criteria, 82% of PN episodes were considered "appropriate." PN was "appropriate but avoidable" in 13% of cases. In 5% of episodes, the commencement of PN was considered "inappropriate." The use of appropriate PN increased significantly over the study period (P = .018)., Conclusion: Most PN episodes were deemed appropriate. We saw 5% inappropriate usage, which is lower than reported in comparable studies. This study underlines the importance of continuous audit and evaluation of practice to maintain appropriate and evidence-based practice in nutrition support.

This article describes the case of a 16-year-old boy with cystic fibrosis who presented with difficulty seeing in the dark. He had a history of bowel surgery at birth, and he developed cystic fibrosis liver disease and osteopenia during his teenage years. He always had good lung function. When his serum vitamin A level was checked, it was undetectable in sample. He was diagnosed with night blindness and commenced on high-dose vitamin A. His symptoms resolved within 3 days. However, it took over 1 year for his vitamin A level to return to normal. This case emphasizes the importance of monitoring vitamin levels in cystic fibrosis to detect deficiency and prevent long-term consequences, and it highlights the challenges encountered during the course of night blindness treatment.

Background: Care for adults with sickle cell disease (SCD) is often fragmented and costly. The chronic care model is recommended as a best practice approach to providing care for patients with chronic disease. However, no published reports exist examining the effectiveness of this approach in adults with SCD., Purpose: To examine selected quality and utilization measures at baseline and following implementation of a new multidisciplinary program for adults with SCD at one academic institution., Methods: Administrative data were obtained for all adults with SCD admitted to the adult emergency department or hospital or seen in the adult outpatient clinic during calendar years 2000-2009. Charts of all patients seen in the adult multidisciplinary sickle cell clinic were abstracted using prespecified criteria., Results: Prescribing of hydroxyurea increased from 13% at baseline to 44%. An additional 53% of patients had a documented reason for no prescription. Decreases in admissions, 30-day readmissions, and lengths of stay resulted in an average savings of 458 bed days per year., Conclusion: Multidisciplinary care for the adult with SCD provided in the context of the chronic care model can result in significant improvements in important quality targets and may reduce acute resource use.

Chronic pancreatitis results in exocrine and endocrine dysfunction, affecting normal digestion and absorption of nutrients. In individuals with chronic pancreatitis, nutrition status may be further affected by poor dietary intake, often related to alcoholism. However, some deficiencies may be overlooked, potentially leading to nutrition-related problems with bone health and fatigue. The aim of this article is to describe the deficiencies that occur and to propose an evidence-based algorithm for the nutrition assessment and treatment of patients with chronic pancreatitis.