Is patients’ rurality associated with in-hospital sepsis death in US hospitals?

BackgroundThe focus of this study was to explore the association of patients’ rurality and other patient and hospital-related factors with in-hospital sepsis mortality to identify possible health disparities across United States hospitals.MethodsThe National Inpatient Sample was used to identify nationwide sepsis patients (n = 1,977,537, weighted n = 9,887,682) from 2016 to 2019. We used multivariate survey logistic regression models to identify predictors for how patients’ rurality is associated with in-hospital death.FindingsDuring the study periods, in-hospital death rates among sepsis inpatients continuously decreased (11.3% in 2016 to 9.9% in 2019) for all rurality levels. Rao-Schott Chi-Square tests demonstrated that certain patient and hospital factors had varied in-hospital death rates. Multivariate survey logistic regressions suggested that rural areas, minorities, females, older adults, low-income, and uninsured patients have higher odds of in-hospital mortality. Further, specific census divisions like New England, Middle Atlantic, and East North Central had greater in-hospital sepsis death odds.ConclusionRurality was associated with increased in-hospital sepsis death across multiple patient populations and locations. Further, rurality in New England, Middle Atlantic, and East North Central locations is exceptionally high odds. In addition, minority races in rural areas also have an increased odds of in-hospital death. Therefore, rural healthcare requires a more significant influx of resources and should also include assessing patient-related factors

Accelerometer-assessed light physical activity is protective of future cognitive ability: A longitudinal study among community dwelling older adults

OBJECTIVE: Physical activity (PA), especially moderate-to-vigorous intensity, could protect older adults from cognitive impairment. However, most literature is based on self-reported PA which is limited by recall bias. Light PA is popular among older adults, but a paucity of objective longitudinal data has considered the relationship between light PA and cognitive ability. We examined if a higher level of objectively measured light PA, independent of moderate-to-vigorous physical activity (MVPA), was prospectively associated with better cognitive ability in older adults. METHODS: A longitudinal study over 22.12 (±1.46) months including 274 community-dwelling older adults across 14 regions in Taiwan was undertaken. Cognitive ability was obtained using a Chinese version of the Ascertain Dementia 8-item Questionnaire (AD8) and light PA and MVPA captured by 7days accelerometer positioned on waist. Multivariable negative binomial regression adjusted for confounders were undertaken. RESULTS: 274 participants (74.52years, 45.6% male) attended the follow-up (96.1%). Higher light PA, independent from MVPA, was associated with a reduced rate of decline in cognitive ability (rate ratio 0.75 [0.60-0.92]). MVPA, was also associated with a reduced decline in cognitive ability (rate ratio 0.85 [0.75-0.95]). Light PA was protective of cognitive ability in sensitivity analyses removing participants with activities of daily living difficulties, depressive symptoms and cognitive impairment at baseline. CONCLUSION: Our data suggest that light PA may offer a protective influence of future cognitive ability in community dwelling older adults. The promotion of light PA may be a valuable means to maintain cognitive ability in older age

Improving disclosure of medical error through educational program as a first step toward patient safety

Participant’s Response to medical errors. Description of data: Raw data of participant’s response to medical errors (3 clinical cases with different severity of error outcome), satisfaction and change after the education program. (XLSX 18 kb

The Effects of Furosemide and Hypoxia on CIick-Evoked Otoacoustic Emissions in Anesthetized Guinea Pigs

From the concepts of well known ototoxic effects of loop diuretics and hypoxic state, twenty anesthetized guinea pigs with diuretics and/or hypoxia were evaluated with click-evoked otoacoustic emissions (CEOAEs) by timesequential monitoring. Furosemide 25 mg/kg was infused intravenously and CEOAEs were measured before and 5, 10, 20, 30, 45 and 60 minutes after injection in 8 guinea pigs. Both echo responses and reproducibilities were decreased significantly at 10 minutes after injection and showed minimal level at 20 minutes. Recovery of CEOAEs was noted by spectral analysis at 30 minutes after injection, and full recovery of CEOAEs was evident after then. At 60 minutes after injection, hypoxia of 20 seconds by turning off the artificial respirator was added. The CEOAEs showed statistically significant decreases compared with those of prehypoxic state (p<O.OI). The CEOAEs of 8 guinea pigs with injection of furosemide. 50 mg/kg showed decreased responses and no fr recoveries for the 60 minutes observation periods. Findings from this study support the clinical utility of CEOAEs as a screening test for early detection of various ototoxicities

Psychological experiences of Korean missionary “kids” (MKs): A qualitative inquiry

The present study is a qualitative investigation of the psychological experiences of children of Korean missionaries, through the eyes of Korean missionary kids (MKs) and missionary workers. A semi-structured interview was conducted with 11 MKs and MK workers, and data were analysed using the Consensual Qualitative Research method. Several domains emerged: challenges associated with the MK experience, resiliency of MKs, intrapersonal and interpersonal coping skills, mental health concerns, religion and spirituality, a complex cultural identity, preparation for college transition, and hopes for MKs and their missionary parents. Categories corresponding to the domains are highlighted. The present study addresses a need for more attention paid to the non-American MK experience, and it presents some implications for the church and higher educational institutions

Assessment of Changes in Knowledge and Stigmatization Following Tuberculosis Training Workshops in Taiwan

Background/PurposeThere is little understanding of the depth of knowledge of health workers involved in tuberculosis (TB) control programs, and even less is known about health workers attaching stigma to TB patients. This study surveyed health workers enrolled in TB training workshops prior to the execution of the directly observed treatment, short course (DOTS) program.MethodsAll participants attended the training course and completed structured questionnaires before (pre-test) and after training (post-test). The questionnaires were collected immediately following completion and the scores were analyzed.ResultsPair comparison of knowledge scores revealed that all participants made statistically significant improvements in level of TB knowledge, except those who had a history of TB (p = 0.331). Pair comparison of stigmatization scores revealed a reduction in stigmatization, with the DOTS workers attaching less stigma to TB patients. After training, caregivers, including women (p = 0.012), public health workers (p = 0.028), 40–49-year-old subjects (p = 0.035), those with an education of < 12 years (p = 0.024), those who had been a volunteer (p = 0.018), and those who had a history of TB and those who did not (p = 0.034, p = 0.036), were significantly less likely to stigmatize patients. TB knowledge was not found to be significantly correlated with stigmatization (pre-test, p = 0.298; post-test, p = 0.821).ConclusionTraining workshops in TB control were effective for promotion of knowledge and elimination of stigmatization in first-line caregivers. DOTS workers attached less stigma to TB patients than public health workers, and older workers who had been volunteers attached the least stigma