Category: Hospitals

Categories : Hospitals Respiratory DiseasesTags :

Biofilms in Ventilation Tubes Make Pathogens Even More Resistant to Antibiotics

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Scientists at The University of Warwick have made a breakthrough which could help find new ways to prevent ventilator-associated pneumonia, which can affect up to 40% of hospital patients on mechanical ventilators.

Ventilator-associated pneumonia (VAP) is a common infection in ventilated patients, particularly for those with existing respiratory conditions. VAP is transmitted by pathogens, often antibiotic resistant, that form stubborn biofilms on the inside of endotracheal tubes. Up to 40% of ventilated patients in intensive care wards will develop VAP, with 10% of those patients dying as a result.

In a study recently published in Microbiology, researchers recreated hospital conditions to improve understanding of the infection. They used the same type of endotracheal tubes and created a special mucus to simulate the conditions inside a human body. Bacteria and fungi formed a biofilm on these tubes.

Dr Dean Walsh, Research Fellow, University of Warwick, said: “Our study found that the biofilms in our model were different and more complex than those usually grown in standard lab conditions, making them more realistic.

“The biofilms formed in this new model were very tough to get rid of, even with strong antibiotics, much like what happens in real patients.

“Significantly, when we combined antibiotics with enzymes that break down the biofilm’s protective slime layer, the biofilms were more successfully removed than with antibiotics alone. With the enzymes, we could halve the concentration of antibiotics needed to kill the biofilms. So, that suggests we can use our model to identify new VAP treatments that attack the slime layer.”

Dr Freya Harrison, School of Life Sciences, University of Warwick, added: “VAP is a killer, and there are currently no cost-effective ways of making the tubes harder for microbes to colonise. Our new model can help scientists develop better therapies and design special tubes that prevent biofilms, which could improve the health of patients on ventilators.”

This project was part of an international research program in antimicrobial resistance that brings together colleagues at the University of Warwick with those at Monash University in Melbourne and is supported by the Monash-Warwick Alliance.

Professor Ana Traven, co-Director of the Monash-Warwick Alliance programme in emerging superbug threats, and co-author of the study, added: “It is exciting that we could join forces with our colleagues at Warwick for this important study.  Many promising new anti-infectives fail because experiments done in the laboratory do not recapitulate very well the more complex infections that occur in patients. As such, the development of laboratory models that mimic disease, such as was done in this study, is important for accelerating the discovery of credible antimicrobial therapies that have a higher chance of clinical success.”

Source: Microbiology Society

Categories : Hospitals Respiratory DiseasesTags :

More Often than Not, Hospital Pneumonia Diagnoses are Revised

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Photo by engin akyurt on Unsplash

Pneumonia diagnoses are marked by pronounced uncertainty, according to an AI-based analysis of over 2 million hospital visits. The study, published in Annals of Internal Medicine, found that more than half the time, a pneumonia diagnosis made in the hospital will change from a patient’s entrance to their discharge – either because someone who was initially diagnosed with pneumonia ended up with a different final diagnosis, or because a final diagnosis of pneumonia was missed when a patient entered the hospital (not including cases of hospital-acquired pneumonia).

Understanding that uncertainty could help improve care by prompting doctors to continue to monitor symptoms and adapt treatment accordingly, even after an initial diagnosis. 

Barbara Jones, MD, pulmonary and critical care physician at University of Utah Health and the first author on the study, found the results by searching medical records from more than 100 VA medical centres across the country, using AI-based tools to identify mismatches between initial diagnoses and diagnoses upon discharge from the hospital. More than 10% of all such visits involved a pneumonia diagnosis, either when a patient entered the hospital, when they left, or both.

“Pneumonia can seem like a clear-cut diagnosis,” Jones says, “but there is actually quite a bit of overlap with other diagnoses that can mimic pneumonia.” A third of patients who were ultimately diagnosed with pneumonia did not receive a pneumonia diagnosis when they entered the hospital. And almost 40% of initial pneumonia diagnoses were later revised.

The study also found that this uncertainty was often evident in doctors’ notes on patient visits; clinical notes on pneumonia diagnoses in the emergency department expressed uncertainty more than half the time (58%), and notes on diagnosis at discharge expressed uncertainty almost half the time (48%). Simultaneous treatments for multiple potential diagnoses were also common.

When the initial diagnosis was pneumonia, but the discharge diagnosis was different, patients tended to receive a greater number of treatments in the hospital, but didn’t do worse than other patients as a general rule. However, patients who initially lacked a pneumonia diagnosis, but ultimately ended up diagnosed with pneumonia, had worse health outcomes than other patients.

A path forward

The new results call into question much of the existing research on pneumonia treatment, which tends to assume that initial and discharge diagnoses will be the same. Jones adds that doctors and patients should keep this high level of uncertainty in mind after an initial pneumonia diagnosis and be willing to adapt to new information throughout the treatment process. “Both patients and clinicians need to pay attention to their recovery and question the diagnosis if they don’t get better with treatment,” she says.

Source: University of Utah

Categories : Diseases, Syndromes and Conditions HospitalsTags :

Klebsiella Thrives in Nutrient-deprived Hospital Environments

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Photo by Hush Naidoo Jade Photography on Unsplash

Scientists at ADA Forsyth Institute (AFI) have identified a critical factor that may contribute to the spread of hospital-acquired infections (HAIs), shedding light on why these infections are so difficult to combat. Their study reveals that the dangerous multidrug resistant (MDR) pathogen, Klebsiella, thrives under nutrient-deprived polymicrobial community conditions found in hospital environments.

According to the World Health Organization, HAIs pose significant risks to patients, often resulting in prolonged hospital stays, severe health complications, and a 10% mortality rate. One of the well-known challenging aspects of treating HAIs is the pathogens’ MDR. In a recent study published in Microbiome, AFI scientists discovered that Klebsiella colonising a healthy person not only have natural MDR capability, but also dominate the bacterial community when starved of nutrients.

“Our research demonstrated that Klebsiella can outcompete other microorganisms in its community when deprived of nutrients,” said Batbileg Bor, PhD, associate professor at AFI and principal investigator of the study. “We analysed samples of saliva and nasal fluids to observe Klebsiella‘s response to starvation conditions. Remarkably, in such conditions, Klebsiella rapidly proliferates, dominating the entire microbial community as all other bacteria die off.”

Starvation environments

Klebsiella is one of the top three pathogens responsible for HAIs, including pneumonia and irritable bowel disease. As colonising opportunistic pathogens, they naturally inhabit the oral and nasal cavities of healthy individuals but can become pathogenic under certain conditions. “Hospital environments provide ideal conditions for Klebsiella to spread,” explained Dr Bor. “Nasal or saliva droplets on hospital surfaces, sink drains, and the mouths and throats of patients on ventilators, are all starvation environments.”

Dr Bor further elaborated, “When a patient is placed on a ventilator, they stop receiving food by mouth, causing the bacteria in their mouth to be deprived of nutrients and Klebsiella possibly outcompete other oral bacteria. The oral and nasal cavities may serve as reservoirs for multiple opportunistic pathogens this way.”

Additionally, Klebsiella can derive nutrients from dead bacteria, allowing it to survive for extended periods under starvation conditions. The researchers found that whenever Klebsiella was present in the oral or nasal samples, they persisted for over 120 days after being deprived of nutrition.

Other notable findings from the study include the observation that Klebsiella from the oral cavity, which harbours a diverse microbial community, was less prevalent and abundant than those from the nasal cavity, a less diverse environment. These findings suggest that microbial diversity and specific commensal (non-pathogenic) saliva bacteria may play a crucial role in limiting the overgrowth of Klebsiella species. 

The groundbreaking research conducted by AFI scientists offers new insights into the transmission and spread of hospital-acquired infections, paving the way for more effective prevention and treatment strategies.

Source: Forsyth Institute

Categories : General Interest HospitalsTags :

Meeting at Eye Level in Hospitals Improves Patient Experience and Outcomes

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Review of research suggests patients feel better when providers sit or crouch during bedside conversations

Photo by National Cancer Institute on Unsplash

Doctors and other healthcare workers, you may want to sit down for this news. A systematic review of studies suggests that getting at a patient’s eye level when talking with them about their diagnosis or care can really make a difference. 

Their findings, published in the Journal of General Internal Medicine, revealed that sitting or crouching at a hospitalised patient’s bedside was associated with more trust, satisfaction and even better clinical outcomes than standing, according to the review of evidence.

The study’s authors, from the University of Michigan and VA Ann Arbor Healthcare System, note that most of the studies on this topic varied with their interventions and outcomes, and were found to have high risk of bias. 

So, the researchers sat down and figured out how to study the issue as part of their own larger evaluation of how different nonverbal factors impact care, perceptions and outcomes.

Until their study ends, they say their systematic review should prompt clinicians and hospital administrators to encourage more sitting at the bedside. 

Something as simple as making folding chairs and stools available in or near patient rooms could help – and in fact, the VA Ann Arbor has installed folding chairs in many hospital rooms at the Lieutenant Colonel Charles S. Kettles VA Medical Center.

Nathan Houchens, MD, the U-M Medical School faculty member and VA hospitalist who worked with U-M medical students to review the evidence on this topic, says they focused on physician posture because of the power dynamics and hierarchy of hospital-based care. 

We hope our work will bring more recognition to the significance of sitting and the general conclusion that patients appreciate it.”

-Nathan Houchens, M.D.

An attending or resident physician can shift that relationship with a patient by getting down to eye level instead of standing over them, he notes. 

He credits the idea for the study to two former medical students, who have now graduated and gone on to further medical training elsewhere: Rita Palanjian, M.D., and Mariam Nasrallah, M.D. 

“It turns out that only 14 studies met criteria for evaluation in our systematic review of the impacts of moving to eye level, and only two of them were rigorous experiments,” said Houchens. 

“Also, the studies measured many different things, from length of the patient encounter and patient impressions of empathy and compassion, to hospitals’ overall patient evaluation scores as measured by standardised surveys like the federal HCAHPS survey.”

In general, he says, the data paint the picture that patients prefer clinicians who are sitting or at eye level, although this wasn’t universally true. 

And many studies acknowledged that even when physicians were assigned to sit with their patients, they didn’t always do so – especially if dedicated seating was not available. 

Houchens knows from supervising U-M medical students and residents at the VA that clinicians may be worried that sitting down will prolong the interaction when they have other patients and duties to get to. 

But the evidence the team reviewed suggests this is not the case. 

He notes that other factors, such as concerns about infection transmission, can also make it harder to consistently get to eye level. 

“We hope our work will bring more recognition to the significance of sitting and the general conclusion that patients appreciate it,” said Houchens. 

Making seating available, encouraging physicians to get at eye level, and senior physicians making a point to sit as role models for their students and residents, could help too. 

A recently launched VA/U-M study, funded by the Agency for Healthcare Research and Quality and called the M-Wellness Laboratory study, includes physician posture as part of a bundle of interventions aimed at making hospital environments more conducive to healing and forming bonds between patient and provider. 

In addition to encouraging providers to sit by their patients’ bedsides, the intervention also includes encouraging warm greetings as providers enter patient rooms and posing questions to patients about their priorities and backgrounds during conversations.

The researchers will look for any differences in hospital length of stay, readmissions, patient satisfaction scores, and other measures between the units where the bundle of interventions is being rolled out, and those where it is not yet.

Source: University of Michigan

Categories : Ethics and Law HospitalsTags :

Court Finds Netcare Failed to Protect Employee Against an Abusive Surgeon

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Operating theatre manager wins her case

Photo by Bill Oxford on Unsplash

By Tania Broughton

The former manager of an operating theatre at Universitas Hospital has successfully sued Netcare for failing to protect her and take action against an abusive surgeon because, she claimed, it was well known that he was a “money spinner” for the company.

Tilana Alida Louw also sued Dr Stephen Paul Grobler but, following his sudden death in June 2022, entered into a confidential settlement agreement with the executor of his estate.

She then pursued her case against Netcare Universitas Hospital.

In a ruling this month, Bloemfontein High Court Judge Ilsa van Rhyn directed Netcare to pay her R300 000 for damages, past and future medical expenses, and to pay part of her costs on a punitive scale.

Louw was appointed as surgical theatre manager at the hospital in 2005. Her role was to oversee and manage operating theatres and theatre staff and monitor patient care.

At that time, she was warned by the then hospital manager, and others, that Grobler had an “aggressive type personality”.

She said she soon experienced first hand his temper tantrums.

In her claim, she said he had verbally abused her continually, hurling profanities, insults, using blasphemous language and obscenities at her in the presence of other operating theatre staff and even members of the public.

She said Netcare had failed to come to her assistance, in spite of her numerous requests and complaints.

Netcare had also failed to act against Grobler, even though it was common knowledge that he behaved this way.

Louw alleged that Netcare had failed in its legal duty to create a work environment free from verbal abuse and intimidation and to take reasonable care of her safety and protect her from psychological harm.

As a result she was humiliated, degraded and suffered shock, anguish, fear and anxiety. She experienced post-traumatic stress syndrome.

She wanted to be compensated for this. And she wanted Netcare to publish a written apology in a local newspaper.

Netcare defended the action. It denied that it had breached its duty to Louw and said it had taken action against Grobler.

After Louw and her witness, labour law expert Professor Halton Cheadle, testified, Netcare offered to pay her for damages and to apologise.

Louw accepted the financial offer, but she was not happy with the wording of the apology and the scale of costs tendered.

And so the trial continued.

Read the judgment

Judge van Rhyn said Louw had testified that her complaints and those of others had been largely ignored by management.

“She explained that several of the scrub nurses refused to work with Dr Grobler and she would step in and assist him during surgeries. Her sense of duty and pity for the patients, many of them being cancer patients who were in dire need of urgent and timeous surgeries, caused her to bear the brunt and endure the constant abuse.”

Louw had said she and other personnel were “not allowed” to lay complaints against Grobler because he was a “so-called money-spinner for Netcare”.

Cheadle, in his evidence, said given the number of grievances lodged against Grobler and given Netcare’s professed zero-tolerance approach to harassment, a reasonable employer would have warned Grobler about his behaviour after the first complaint and would have terminated his contract at the very least, after the third complaint.

Judge van Rhyn said Netcare’s offer of damages during the trial had been made after Louw had endured years of abuse at the hands of Grobler and eight years of litigation.

“I also agree with argument on behalf of the Plaintiff (Louw) that Netcare evidently allowed its employees to be abused by Dr Grobler for its own financial interests. Netcare was acquainted with Dr Grobler’s disgusting behaviour even prior to her (Louw’s) appointment as the unit manager,” she said.

This conduct was deserving of a punitive costs order, the judge said.

Louw had rejected the proposed apology because it contained the words “we apologise sincerely that you felt that Netcare did not sufficiently support you”.

The judge said she agreed with Louw’s perception that this did not, in its plain and ordinary meaning, convey a sincere regret and remorseful apology.

She said she had been informed during argument that Netcare had published the apology in the local newspaper.

However, she said, she would not make any order regarding the apology, because it would not be lawful in a case which was not based on defamation.

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Read the original article

Categories : Hospitals Medical IndustryTags :

Rising Health Care Prices Result in Non-healthcare Job Cuts

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Photo by Inzmam Khan

Rising health care prices in the US are leading employers outside the health care sector to lay off employees, according to a new study co-authored by a Yale economist.

The study, published June 24 as a working paper by the National Bureau of Economic Research (NBER), found that when health care prices increased, non-health care employers responded by reducing their payroll and cutting the jobs of middle-class workers. For the average county, a 1% increase in health care prices would reduce aggregate income in the area by approximately $8 million annually.

The study was conducted by a team of leading economists from Yale, the University of Chicago, the University of Wisconsin-Madison, Harvard University, the US Internal Revenue Service (IRS), and the US Department of the Treasury.

“When health care prices go up, jobs outside the health care sector go down,” said Zack Cooper, an associate professor of health policy and of economics at Yale University. “It’s broadly understood that employer-sponsored health insurance creates a link between health care markets and labour markets. Our research shows that middle- and lower-income workers are shouldering rising health care prices, and in many cases, it’s costing them their jobs. Bottom line: Rising health care costs are increasing economic inequality.”

“Rising prices are hurting the employment outcomes for workers who never went to the hospital.”

Zack Cooper, Yale economist

To better understand how rising health care prices affect labour market outcomes, the researchers brought together insurance claims data on approximately a third of adults with employer-sponsored insurance, health insurance premium data from the US Department of Labor, and IRS data from every income tax return filed in the United States between 2008 and 2017. They then used these data to trace out how an increase in health care prices, such as a $2000 increase on a $20 000 hospital bill, flows through to health spending, insurance premiums, employer payrolls, income and unemployment in counties, and the tax revenue collected by the federal government. 

“Many think that it’s insurers or employers who bear the burden of rising health care prices. We show that it’s really the workers themselves who are impacted,” said Zarek Brot-Goldberg, an assistant professor at the University of Chicago. “It’s vital to understand that rising health care prices aren’t just impacting patients. Rising prices are hurting the employment outcomes for workers who never went to the hospital.”

Hospital Mergers Raised Prices

For the new study, the authors used hospital mergers as a vehicle to assess the effect of price increases. From 2000 to 2020, there were over 1000 hospital mergers among the approximately 5000 US hospitals. In past work, the authors found that approximately 20% of hospital mergers should have been expected to raise prices by lessening competition, according to merger guidelines from the Department of Justice and the Federal Trade Commission. These mergers, on average, raised prices by 5%.

“We can use our analysis to estimate the effect of hospital mergers,” said Stuart Craig, an assistant professor at the University of Wisconsin-Madison Business School. “Our results show that a hospital merger that raised prices by 5% would result in $32 million in lost wages, 203 lost jobs, a $6.8 million reduction in federal tax revenue, and a death from suicide or overdose of a worker outside the health sector.”

The study also showed that because rising health care prices leads firms to let go of workers, a knock-on effect of hospital mergers is that they lead to increases in government spending on unemployment insurance and reductions in the tax revenue collected by the federal government.

“It’s vital to point out that hospital mergers raise spending by the federal government and lower tax revenue at the same time,” said Cooper. “When prices in the US health sector rise, it’s actually a net negative for the economy. It’s leading to fewer jobs and precipitating all the consequences we associate with workers becoming unemployed.”

Source: Yale University

Categories : General Interest HospitalsTags :

Private Clinic Offers Affordable Healthcare for its Community

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Photo by Derek Finch

Only 16% of South Africans can afford private healthcare, and many low-income earners cannot afford healthcare and must rely on community clinics. These facilities are under intense pressure as they often cannot cope with the demand. For many workers, getting medical attention at these facilities means waiting for hours and being unable to work for a day and therefore losing wages. However, things could change if the pioneering efforts of a dedicated nurse with the financial backing of Standard Bank reach their full national potential.

“We assist this sector by working longer hours than do local government clinics that only open five days a week. Our services are available seven days a week at R300 per visit. Those able to pay for primary healthcare often must travel long distances to get to pharmacy-based primary healthcare clinics, mostly in the suburbs. The Rapha Clinic has been strategically placed between the city and the townships so that it can be easily reached by people commuting from their homes to the city,” says Ntombi Skosane, founder of Rapha Healthcare Services.

For Skosane, the clinic, which is located in the Montana area of Pretoria, realised her dream of being able to fill a vital gap in providing primary and basic healthcare to her community.

“As a nurse with 30 years in both the public and the private sector, I believed that I could open a clinic where I could establish a community service offering quality healthcare at affordable rates. The growing success of our operation shows that I was correct,” she adds.

Using her experience of clinics as a guide, Skosane has opted to have Rapha offer nine core services ranging from antenatal care and family planning to assisting with immunisations and wound care, as well as helping those with chronic illnesses and HIV testing and counselling.

“The Rapha Clinic met the stringent guidelines for being considered for a grant. These included an assessment of the viability of the business by the Standard Bank Enterprise Development Funding Committee, the commitment and required personal investment of the owner, and the sector in which the business operates. Although the business was operating successfully, it needed financial assistance to reach its full potential. In this case, the company needed additional stock and equipment to deliver a full service. After considering the application, Standard Bank purchased the required equipment for Rapha,” says Naledzani Mosomane, Head of Enterprise and Supplier Development at Standard Bank.

Skosane says that acquiring additional medical and surgical stock, emergency trollies, a vaccine fridge, wheelchairs, and air-conditioning through Standard Bank meant that the clinic would be able to attend to more patients more efficiently.

Rapha may be just a single clinic, but new outlets are being planned for Gauteng and the North West Province. Ten new clinics are being considered, as are health assessment centres in partnership with gyms and medical aids.

“We believe that Rapha Healthcare Services has a bright future. We look forward to playing a central role in growing the nation’s small business sector and developing relationships with a new generation of entrepreneurs,” says Mosomane.

Categories : HospitalsTags :

Wood May Have Natural Antiviral Properties

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Photo by National Cancer Institute on Unsplash

Thinking about getting a new desk for your practice? That might be a good idea. Viruses, including SARS-CoV-2, can get passed from person to person via contaminated surfaces. But can some surfaces reduce the risk of this type of transmission without the help of household disinfectants? As reported in ACS Applied Materials & Interfaces, wood has natural antiviral properties that can reduce the time viruses persist on its surface – and some species of wood are more effective than others at reducing infectivity.

Enveloped viruses, like the coronavirus, can live up to five days on surfaces; nonenveloped viruses, including enteroviruses linked to the common cold, can live for weeks, in some cases even if the surfaces are disinfected. Previous studies have shown that wood has antibacterial and antifungal properties, making it an ideal material for cutting boards. But wood’s ability to inactivate viruses has yet to be explored, which is what Varpu Marjomäki and colleagues set out to study.

The researchers looked at how long enveloped and nonenveloped viruses remained infectious on the surface of six types of wood: Scots pine, silver birch, gray alder, eucalyptus, pedunculate oak and Norway spruce. To determine viral activity, they flushed a wood sample’s surface with a liquid solution at different time points and then placed that solution in a petri dish that contained cultured cells. After incubating the cells with the solution, they measured the number (if any) infected with the virus.

Results from their demonstrations with an enveloped coronavirus showed that pine, spruce, birch and alder need one hour to completely reduce the virus’ ability to infect cells, with eucalyptus and oak needing two hours. Pine had the fastest onset of antiviral activity, beginning after five minutes. Spruce came in second, showing a sharp drop in infectivity after 10 minutes.

For a nonenveloped enterovirus, the researchers found that incubation on oak and spruce surfaces resulted in a loss of infectivity within about an hour, with oak having an onset time of 7.5 minutes and spruce after 60 minutes. Pine, birch and eucalyptus reduced the virus’ infectivity after four hours, and alder showed no antiviral effect.

Based on their study data, the researchers concluded that the chemical composition of a wood’s surface is primarily responsible for its antiviral functionality. While determining the exact chemical mechanisms responsible for viral inactivation will require further study, they say these findings point to wood as a promising potential candidate for sustainable, natural antiviral materials.

Source: American Chemical Society

Categories : HospitalsTags :

Global Trial Confirms Benefit of Antacids on Bleeding Prevention for Ventilated Patients

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Photo by Rodnae Productions on Pexels

A widely available drug helps prevent upper gastrointestinal bleeding in critically ill adults on a breathing machine, according to the results of a global study and meta-analysis led by researchers at McMaster University. 

The research, published on June 14, 2024 in The New England Journal of Medicine and NEJM Evidence, investigated the effect of the gastric acid suppressant pantoprazole, which is primarily used to treat heartburn caused by gastroesophageal reflux disease (GERD). 

Patients in the intensive care unit (ICU) who need a breathing machine (mechanical ventilator) also receive pantoprazole to prevent upper gastrointestinal bleeding, caused by stress-induced ulcers in the stomach. Concerns emerged about whether this complication of critical illness had disappeared over the years, and about side effects of pantoprazole, including increased risk of death in the sickest patients. The research provides critical care teams with certainty about whether the medications should be used in practice.   

“This is the largest randomized trial on this topic in the world, led by Canada. Physicians, nurses, and pharmacists working in the ICU setting will use this information in practice right away, and the trial results and the updated meta-analysis will be incorporated into international practice guidelines,” said lead author and principal investigator Deborah Cook, a professor in the Department of Medicine at McMaster. 

Global randomized control trial  

The Reevaluating the Inhibition of Stress Erosions (REVISE) Trial was a randomised control trial that compared the effect of pantoprazole to placebo in critically ill adults on a breathing machine. The trial was run in 68 centres in eight countries and over 4800 patients underwent randomization. Among patients undergoing invasive ventilation, pantoprazole resulted in a significantly lower risk of clinically important upper gastrointestinal bleeding than placebo but not in a lower risk of death. 

Clinically important upper gastrointestinal bleeding occurred in 25 of 2417 patients (one per cent) receiving pantoprazole and in 84 of 2404 patients (nearly four per cent) receiving placebo. At 90 days, death was reported in 696 of 2390 patients (29 per cent) in the pantoprazole group and in 734 of 2379 patients (30 per cent) in the placebo group.   

Updated systematic review 

Researchers conducted a meta-analysis of 12 randomised trials of proton-pump inhibitors for GI bleeding prevention in 10 000 critically ill patients to summarise the current evidence on the outcomes of gastrointestinal bleeding, mortality, pneumonia and C. difficile infection. 

The medications were associated with a reduced incidence of clinically important upper gastrointestinal bleeding and may have little or no effect on mortality. The evidence also showed the medications may have no effect on pneumonia and little or no effect on C. difficile infection. 

The research was funded by the Canadian Institutes for Health Research, the Accelerating Clinical Trials Fund, Physicians Services Incorporated of Ontario, Hamilton Association of Health Sciences Organization, and the National Health Medical Research Council of Australia. 

The original text of this story is licensed under a Creative Commons Attribution-No Derivs 2.5 Canada (CC BY-ND 2.5 CA).

Source: McMaster University

Categories : HospitalsTags :

A Little Humour Goes a Long Way in the Wards

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Study finds that a light joke can lift everybody’s mood – but sarcasm can sour things

Photo by Carmel Nsenga

A humorous remark at just the right time can go a long way. Benevolent humour helps medical assistants (MAs) cope positively with their stressful working day, according to a new study published in the journal BMC Primary Care. Researchers surveyed more than 600 MAs to find out how they experience their work and what style of humour they use in their daily working lives. They found that if the respondents preferred light, well-intended humour, they were more satisfied with their work and received more positive feedback. Dark humour, such as sarcasm, was more likely to have disadvantages.

Medical assistants mostly work in primary health care, especially medical practices. In Germany, working as an MA requires a three-year vocational training. The daily work routine of MAs can be very demanding. They are responsible for administrative work and, for example, taking blood samples and applying wound dressings. This new study by Martin Luther University Halle-Wittenberg (MLU) and the Federal Institute for Vocational Education and Training (BIBB) aimed to investigate how humour helps them get through their day.

“Medical assistants are in very close contact with patients for most of the day. They have a lot of responsibility and experience a lot of stress,” says Julia Raecke from BIBB, who is doing her doctorate at MLU. It has long been known that humour can help healthcare workers cope with stress. “However, little is known about the consequences of different humour styles. We set out to investigate those, as it should make a big difference, whether MAs use puns or sarcasm when dealing with patients. Talking to people that are potentially sick requires a lot of empathy and verbal dexterity,” explains Professor René Proyer, a psychologist at MLU.

The two researchers conducted an online survey of more than 600 MAs. The aim was to understand better the relationship between job satisfaction and different humour styles. In addition to the kind of humour they prefer, respondents also provided information about their well-being in the workplace and how competent they feel at work.

If the respondents preferred positive and benevolent humour, they were in general also more satisfied with their work. But not only that: “MAs with a preference for light humour stated that they received more positive feedback and were more likely to feel that they were making a difference at work,” says Julia Raecke. Surprisingly, presumably negative or dark humour did not score worse across the board. “Even though satire and irony are considered dark humour, we found no negative correlation with the respondents’ well-being,” adds Raecke. In contrast, cynicism and especially sarcasm had negative effects. Yet, this does not mean that sarcasm should be condemned completely. “A short sarcastic remark among colleagues might help to release frustration,” says René Proyer.

According to the researchers, humour is one of several factors that influence well-being at work. “Knowing about the effects of humour and different styles can help to make conversations with patients more pleasant. That said, waiting rooms are not supposed to become comedy clubs. It’s more about using humour consciously and appropriately,” concludes Proyer.

The results of the study could help to develop new training programmes. For example, Raecke is investigating whether the social and emotional skills of MAs can be improved with the help of online training.

Source: Martin-Luther-Universität Halle-Wittenberg