The Critical Role of Supervision in Retaining Staff in Obstetric Services: A Three Country Study

Millennium Development Goal (MDG) 5 commits us to reducing maternal mortality rates by three quarters and MDG 4 commits us to reducing child mortality by two-thirds between 1990 and 2015. In order to reach these goals, greater access to basic emergency obstetric care (EmOC) as well as comprehensive EmOC which includes safe Caesarean section, is needed.. The limited capacity of health systems to meet demand for obstetric services has led several countries to utilize mid-level cadres as a substitute to more extensively trained and more internationally mobile healthcare workers. Although this does provide greater capacity for service delivery, concern about the performance and motivation of these workers is emerging. We propose that poor leadership characterized by inadequate and unstructured supervision underlies much of the dissatisfaction and turnover that has been shown to exist amongst these mid-level healthcare workers and indeed health workers more generally. To investigate this, we conducted a large-scale survey of 1,561 mid-level cadre healthcare workers (health workers trained for shorter periods to perform specific tasks e.g. clinical officers) delivering obstetric care in Malawi, Tanzania, and Mozambique. Participants indicated the primary supervision method used in their facility and we assessed their job satisfaction and intentions to leave their current workplace. In all three countries we found robust evidence indicating that a formal supervision process predicted high levels of job satisfaction and low intentions to leave. We find no evidence that facility level factors modify the link between supervisory methods and key outcomes. We interpret this evidence as strongly supporting the need to strengthen leadership and implement a framework and mechanism for systematic supportive supervision. This will promote better job satisfaction and improve the retention and performance of obstetric care workers, something which has the potential to improve maternal and neonatal outcomes in the countdown to 2015

Challenging the holy grail of hospital accreditation: A cross sectional study of inpatient satisfaction in the field of cardiology

Extent: 7p.Background: Subjective parameters such as quality of life or patient satisfaction gain importance as outcome parameters and benchmarks in health care. In many countries hospitals are now undergoing accreditation as mandatory or voluntary measures. It is believed but unproven that accreditations positively influence quality of care and patient satisfaction. The present study aims to assess in a defined specialty (cardiology) the relationship between patient satisfaction (as measured by the recommendation rate) and accreditation status. Methods: Consecutive patients discharged from 25 cardiology units received a validated patient satisfaction questionnaire. Data from 3,037 patients (response rate > 55%) became available for analysis. Recommendation rate was used as primary endpoint. Different control variables such as staffing level were considered. Results: The 15 accredited units did not differ significantly from the 10 non-accredited units regarding main hospital (i.e. staffing levels, no. of beds) and patient (age, gender) characteristics. The primary endpoint "recommendation rate of a given hospital" for accredited hospitals (65.6%, 95% Confidence Interval (CI) 63.4 - 67.8%) and hospitals without accreditation (65.8%, 95% CI 63.1 - 68.5%) was not significantly different. Conclusion: Our results support the notion that - at least in the field of cardiology - successful accreditation is not linked with measurable better quality of care as perceived by the patient and reflected by the recommendation rate of a given institution. Hospital accreditation may represent a step towards quality management, but does not seem to improve overall patient satisfaction.Cornelia Sack, Peter Lütkes, Wolfram Günther, Raimund Erbel, Karl-Heinz Jöckel and Gerald J Holtman

Impact of supplemental thiamin on lactate levels in adults with septic shock

BACKGROUND: Elevated lactate levels at 24 h are highly predictive of in-hospital mortality in adults with septic shock. Thiamin is closely involved in carbohydrate metabolism, and in thiamin-deficient states, increased lactic acid levels can be found, exacerbated by critical illness. This integrative literature review focused on the relationship between supplemental thiamin, lactate clearance, and impact on mortality in sepsis. METHODS: A search in PubMed, Embase, and CINAHL was conducted for literature published between January 2016 and January 2021. We included observational studies and clinical trials with ≥10 participants. We excluded studies involving pediatric (old) populations, animal studies, case studies, dropout rate of \u3e20%, nonhospitalized patients, or patients receiving comfort measures only. RESULTS: A total of 48 full-text articles were assessed for eligibility, with 15 evaluated for this integrative review. Included were five retrospective, two prospective observational, and eight randomized controlled trials. In almost all retrospective studies, thiamin administration was associated with decreased mortality, and in observational studies, with decreased lactate and improved clinical outcomes. In clinical trials, thiamin with or without vitamin C/hydrocortisone did not impact clinical outcomes or mortality. However, four trials testing intravenous thiamin 200-500 mg two to three times daily for up to 3 days reported improved lactate clearance. CONCLUSIONS: Thiamin supplementation may improve lactate clearance when administered in the first 24 h. Those deficient in thiamin may benefit more from supplementation. The combination of thiamin, vitamin C, and/or hydrocortisone may not be advantageous. Lactate reduction in response to thiamin needs further rigorous research

Bowel Dysfunction and Enteral Nutrition in Critically Ill Adult Patients: A retrospective, Observational Study

This retrospective study investigated diarrhea, constipation, associations of enteral nutrition (EN), and medications in critically ill patients (n = 4118). Data were retrieved from electronic health records. Over half (68%) of patients had diarrhea and 8% had constipation. Diarrhea and constipation were more common in patients in the EN group (n = 799) than in the no-EN group (n = 802). Interestingly, patients who received EN were administered more medications with lower incidence of diarrhea than patients who did not receive EN. The findings of this study highlight the importance of reviewing medications (i.e., opioids, prophylactic laxative regimens, and antibiotics) as well as formula composition for potential contributing etiologies to bowel movement abnormalities in critically ill patients

Quality of Life after High Dose Chemotherapy with Autologous Hematopoietic Progenitor Cell Support Long Term Follow-Up.

Abstract Background: High Dose Chemotherapy with Autologous Hematopoietic Progenitor Cell Support (HDC/AutHPCS) is a cancer treatment which provides potential for improved survival and risk for short and long term treatment side effects. Self report of QOL outcomes can guide risk assessment and system improvements to optimize care and rehabilitation. Purpose: This study examined and compared over time, the quality of life outcomes for patients who have undergone this treatment. Design: The Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT v.3) was the survey instrument used to measure QOL. Respondents were also asked to report their performance status based on the Eastern Co-operative Oncology Group (ECOG) and the New York Heart Association (NYHA) Performance status scales. Two open-ended questions were asked: what ”Good”, or “Bad” things occurred related to the treatment. Additional questions were asked about sleep problems that occurred after transplant, and whether a structured exercise program would have helped after discharge. Method: A survey was mailed in November, 2005. Sample: Patients (n=145) who had this treatment at our institution were contacted by mail. Diagnoses included acute myeloid leukemia, lymphoma, multiple myeloma, amyloid, breast cancer, and testicular cancer. Data analysis: Scores for the FACT-BMT were analyzed using SPSS 14 (SPSS Inc., Chicago IL). Qualitative responses were analyzed using NVivo v.7 software. Results: The return rate was 57% (n=81). The FACT-BMT Scores, subscales and total scores were comparable to other findings in similar studies and populations. FACT BMT SCORES 2006 FactG Score (Mean+/−SD) Range(0–112) 89.24+/−17.32 (45–112) FACT BMT Score (Mean+/−SD Range (0–40) 29.14+/−6.37 (16–40) FACTG/BMT Total (Mean+/−SD) Range (0–152) 118.29+/−22.78 (61–152) There were no statistically significant differences in scores from past studies with this population at this institution. Significant correlations were found between the scores of items in the FACT-BMT for which ≥ 25% of respondents reported low item ratings and the self rating ECOG and/or NYHA performance scales. Significant differences were also found when comparing the FACT-BMT Scores, subscales and total scores with demographic attributes such as, marital status, living situation, health insurance, employment status, and income. Twenty-five per cent (n=21) of respondents described new problems with sleep and 54% (n= 41) of respondents reported that a structured exercise program would have been beneficial for recovery. There were 21 respondents who participated in this survey (2006) and two prior surveys (1997 and 1999). Content and themes of their unsolicited and solicited written responses of their self reported lived experiences over time will be presented. Conclusions: Overall, participants reported good quality of life. Based on demographics, there were subgroups identified potentially needing assessments and interventions focused on physical, social, emotional, and functional well being. This could be accomplished through a more focused pre-admission and follow-up needs assessment to identify patients who would potentially benefit from additional resources for psychosocial support, sleep and exercise/activity issues.</jats:p