Articles: hospitals.
-
For hospitalized critically ill adults with suspected sepsis, procalcitonin (PCT) and C-reactive protein (CRP) monitoring protocols can guide the duration of antibiotic therapy, but the evidence of the effect and safety of these protocols remains uncertain. ⋯ Care guided by measurement of PCT reduces antibiotic duration safely compared with standard care, but CRP does not. All-cause mortality for CRP was inconclusive.
-
To explore the experiences of clinicians delivering, facilitating, and potentially affected by a hybrid virtual medical model servicing rural and remote hospitals in western New South Wales. ⋯ The hybrid VRGS model is widely accepted by clinicians as providing good quality care for patients and high job satisfaction for providers. The service supports the local health workforce and makes rural medical positions more attractive and sustainable. The in-person shift requirement is central to the model's effectiveness and acceptability. Further investment is needed to train and resource local nurses who play an integral role in providing virtual medical care.
-
Endotracheal intubation can be difficult or even fail under certain patient and anaesthesiologist conditions. During the COVID-19 pandemic a country-wide lockdown policy was enforced in Thailand which stipulated that anaesthesiologists wear personal protective equipment, powered air purifying respirator, or goggles and surgical/N95 mask during the intubation procedure. Thus, an anaesthesiologist's vision is restricted and grip on the equipment less sure. Under these conditions, the incidence of difficult intubation was expected to increase. ⋯ The decreased incidence of difficult intubation during the lockdown period was contrary to expectation but might be related to the deployment solely of anaesthesiologists and more experienced anaesthetic staff using videolaryngoscopes during lockdown following the recommendation for intubation during respiratory disease pandemics.
-
Both heart failure and type 2 diabetes are prevalent conditions and share similar pathogenesis, risk factors, and treatment medications. This review aims to inform clinical practice by summarizing the interaction between heart failure and type 2 diabetes, as well as the medications used to manage them. Novel medications such as Sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-likepeptide-1 receptor agonists, and finerenone have been shown to protect patients with type 2 diabetes from hospitalization for heart failure. ⋯ When choosing diabetes treatment medications for patients with heart failure and type 2 diabetes, shared decision-making can be helpful in weighing the benefits and harms based on individual scenarios. The selection of guideline-directed medical therapy aligns with patients without type 2 diabetes. Given the rapid evolution of knowledge in this field, clinicians need to stay updated with the latest evidence to provide optimal medical care.
-
Tohoku J. Exp. Med. · Dec 2024
Background Factors that Hospital-Based Geriatricians and General Practitioners Associate with Difficulty in Treating Older People with Multimorbidity: A Cross-Sectional Survey.
In recent years, hospital-based geriatricians and general practitioners in Japan who frequently manage older people with multimorbidity in an acute setting have often found treating these patients difficult. In this study, we surveyed geriatricians and general practitioners who treat older people with multimorbidity in hospitals to identify patient characteristics that make treatment provision difficult in these patients. In June 2022, we mailed an anonymous questionnaire to 3,300 family medicine specialists, primary care-certified physicians, and geriatric specialists in Japan. ⋯ In total, 490 cases were included in the analysis. The factors that were associated with difficulty in treating older people with multimorbidity were experience as a physician (adjusted odds ratio [AOR]: 0.935; 95% confidence interval [95% CI]: 0.905-0.965), the overall scores for difficult disease (AOR: 1.028; 95% CI: 1.004-1.053) and difficult background (AOR: 1.065; 95% CI: 1.005-1.129), and the lack of emphasis on general practice guidelines (AOR: 2.91; 95% CI: 1.305-6.491). To facilitate the treatment of older people with multimorbidity, it is desirable to enhance education and training and strengthen support systems within Japan's healthcare system based on the characteristics of hospital physicians who find treating these patients difficult.