Prim. Hosp. Care, Volume 25, Issue 2 (September 2026) – 3 articles

Antimicrobial resistance—partly driven by inappropriate antibiotic consumption—is a major public health threat. Point-of-care (POC) procalcitonin testing can reduce antibiotic prescribing safely. Within an implementation-effectiveness trial, we conducted a two-phase participatory context analysis to identify and prioritise determinants of POC procalcitonin adoption, implementation and continued use in Swiss primary care. First, we conducted 32 semi-structured interviews with 34 participants, including physicians, representatives of medical organisations, patient representatives and other stakeholders. By coding transcripts deductively using the Consolidated Framework for Implementation Research and inductively, we identified 86 potential determinants. Second, in a focus group with ten ImpPro research team members, 15 determinants were identified as ‘not requiring change’, and ten were considered ‘unchangeable’. Among the remaining 61 determinants, 41 were prioritised through dot-voting and group discussion. These key implementation determinants were inductively grouped into eight themes. The themes with the highest priority were: (1) physicians’ awareness, knowledge, and access to education regarding POC procalcitonin, (2) scientific evidence supporting POC procalcitonin-guided antibiotic prescribing, (3) physician motivation and (4) endorsement of POC procalcitonin by credible organisations and experts. Addressing these determinants will likely require a tailored, multifaceted (combining several unique strategies), and multilevel (targeting different levels of the system) implementation strategy. Full article

This study explored communication access and barriers from the perspectives of 96 hospital staff across Canada in February 2025. A cross-sectional observational design was used, with an online survey distributed through social media platforms. Statistical analyses, including binary logistic regression, were conducted using IBM SPSS Statistics version 29. Most respondents identified as female (89.0%) and were between 19 and 49 years old. One in ten hospital staff reported that patients always received communication support from staff, and fewer than 5.0% reported consistent access to communication devices. Support from communication professionals was limited, with 20.2% indicating that this support was never available. Environmental barriers included difficulty accessing devices independently (24.8%), lack of privacy (21.7%), poor Wi-Fi or cellular connectivity (17.2%), and noise (14.7%). When communicating with older adults, staff cited time constraints (53.0%), unclear explanations (13.0%), language barriers (13.0%), and emotional stress (7.0%) as key challenges. Hospital staff appeared committed to supporting patient communication; however, barriers such as limited time, staffing availability, access to communication devices, and environmental challenges may affect the consistency of this support. Communication training was associated with staff perceptions of communication needs and inequities among patients. These findings highlight perceived communication gaps and may support further assessment of communication resources, staff support, and organizational approaches to improving patient-centered communication in hospital settings. Full article

Accurate assessment of volume status in acute decompensated heart failure (ADHF) remains challenging. Point-of-care ultrasound (POCUS) offers a rapid, non-invasive approach to directly evaluate venous and pulmonary congestion. In this exploratory study, 25 veterans admitted with ADHF underwent serial POCUS examinations of jugular venous pressure (JVP), inferior vena cava (IVC) diameter and collapsibility, and pulmonary B-lines. Pulmonary B-lines were measured using a novel 4-quadrant method. Daily clinical assessments and laboratory data were used to adjudicate volume status. Associations between POCUS findings and clinical congestion were analyzed using chi-square testing. Twenty-four patients were included in the final analysis (mean age 76 years; 96% male; mean BMI 30.86 kg/m²). Elevated JVP on POCUS (≥10 cm H₂O) and IVC diameter > 21 mm were strongly associated with clinical volume overload (p < 0.001 for both). B-lines showed no significant association (p = 0.806). Obesity limited bedside JVP evaluation but did not affect POCUS JVP acquisition. Combined JVP + IVC positivity produced the highest diagnostic concordance with overload status (p <0.001). POCUS assessment of JVP and IVC diameter provided a feasible and reliable method for evaluating congestion in hospitalized patients with ADHF. A novel four-quadrant method of lung ultrasound offered limited additional value. Full article