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Independent Determinants of Ventilator-Associated Pneumonia in Critically Ill Mechanically Ventilated Patients: A Prospective Multicenter Cohort Study Ndlovu, Samuel; Mokoena, Thabo; Khumalo , Lerato
Journal of Society Medicine Vol. 5 No. 4 (2026): April
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.71197/jsocmed.v5i4.278

Abstract

Introduction: Procalcitonin (PCT) is increasingly used to support antibiotic stewardship in sepsis, particularly for guiding antimicrobial discontinuation. Although randomized trials suggest that PCT-guided strategies reduce antibiotic exposure without harm, their effectiveness in heterogeneous intensive care unit (ICU) populations remains unclear. Methods: We conducted a prospective multicenter cohort study of adult ICU patients with sepsis managed using either a PCT-guided discontinuation protocol or standard care protocol. The protocol recommended antibiotic discontinuation when PCT decreased by at least 80% from peak values or reached 0.5 ng/mL or lower, provided that stability was achieved. The primary outcome was the duration of antibiotics for the index sepsis episode. Secondary outcomes included 28-day mortality, ICU length of stay, antibiotic consumption measured by days of therapy and defined daily doses, and direct costs of treatment. Mixed-effects regression and propensity score weighting were used to adjust for confounding and center-level variabilities. Results: Among 1,284 patients, 642 received PCT-guided antibiotic stewardship and 642 received standard care. PCT-guided stewardship was associated with shorter antibiotic duration (6.1 vs. 7.5 days; adjusted difference, −1.2 days; 95% CI, −1.6 to −0.8; p<0.001). There was no increase in 28-day mortality (18.9% vs. 20.4%; adjusted OR, 0.92; 95% CI, 0.71–1.18). Antibiotic consumption was lower (612 vs. 742 DOT per 1,000 ICU-days), with reduced direct costs despite PCT testing. Conclusion: PCT-guided antibiotic stewardship reduced antibiotic exposure and costs without compromising survival, supporting its integration as a pragmatic adjunct to clinical judgment in ICU sepsis management.
Exploring cancer patients’ experiences of end-of-life care in hospital settings: A qualitative study Mensah, Kwame; Okafor, Amina; Ndlovu, Samuel
Lentera Perawat Vol. 7 No. 2 (2026): April - June
Publisher : School of Health Sciences Al-Ma'arif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52235/lp.v7i2.682

Abstract

Background: Cancer patients in the advanced stages of illness often receive end-of-life care in hospital settings where intensive medical interventions, complex decision-making, and limited family involvement may influence their physical, emotional, and existential experiences. Hospital-based end-of-life care presents unique challenges, particularly in contexts where palliative care integration is limited and care delivery is shaped by institutional priorities. Understanding patients’ lived experiences is essential to inform patient-centered and dignity-preserving end-of-life care practices. Objective: This study aimed to explore cancer patients’ experiences of end-of-life care in hospital settings. Methods: A qualitative phenomenological design was employed to capture the lived experiences of adult cancer patients receiving end-of-life care in hospital settings in Africa. Purposive sampling was used to recruit participants who met the inclusion criteria. Data were collected through in-depth semi-structured interviews and analyzed using thematic analysis. Strategies to ensure trustworthiness included member checking, reflexive journaling, peer debriefing, and the development of an audit trail. Results: Three main themes emerged from the analysis: experiencing physical and emotional vulnerability at the end of life, navigating relationships and communication in hospital-based end-of-life care, and seeking dignity and meaning during the final stage of life. Participants described persistent physical symptoms and emotional distress as central aspects of their end-of-life experiences. Limited communication and dependence on healthcare professionals shaped patients’ sense of control and security. Participants also emphasized the importance of dignity, respectful care, and opportunities for reflection on life and death during hospitalization. Conclusion: Cancer patients experience end-of-life care in hospital settings as a complex and deeply personal process influenced by symptom burden, communication quality, family involvement, and dignity-preserving practices. Hospital-based end-of-life care should prioritize holistic, patient-centered approaches that address physical, emotional, and existential needs.