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Adin DB, Royal KD, Adin CA. Cross-Sectional Assessment of the Emotional Intelligence of Fourth-Year Veterinary Students and Veterinary House Officers in a Teaching Hospital. J Vet Med Educ 2020; 47:193-201. [PMID: 31194633 DOI: 10.3138/jvme.0518-065r] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Emotional intelligence (EI) is the recognition and management of emotions. This skill set is important to work relationships and professional success. In this cross-sectional, observational study, we investigated EI scores of 4th-year veterinary students, interns, and residents in a teaching hospital, using a psychometric tool with professional population norms. Participants' EI scores were compared with professional norms and between the sample groups. Scores were examined on the basis of demographics and residency program type. Twenty-four 4th-year students and 43 interns and residents completed the survey. Total, composite, and subscale scores for all groups were lower than professional means. We noted no statistically significant differences in EI scores between training levels, but evaluation of effect sizes showed a medium negative effect of higher training levels on Self-Perception Composite, Self-Regard, Emotional Expression, Interpersonal Composite, Flexibility, and Optimism and a medium positive effect of higher training levels on Impulse Control. Medium effects for residency type were found for Stress Tolerance, Flexibility, and Stress Management, with higher scores for residencies with heavy inpatient loads. Medium effects for residency type were found on Flexibility scores, with higher scores for residents in disciplines with a perceived high stress level. We found that baseline EI scores of 4th-year veterinary students, interns, and residents at a teaching hospital were similar to, but uniformly lower than, those of other professionals and did not increase with training level. These results may be used to build on strengths and address weaknesses associated with EI of students and house officers at this institution.
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Affiliation(s)
| | - Kenneth D Royal
- Educational Assessment and Outcomes, College of Veterinary Medicine
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Joshi RS, Jadhav SA. Frequency of Corneal Astigmatism in Patients Presenting for Senile Cataract Surgery at a Teaching Hospital in Indian Rural Population. Asia Pac J Ophthalmol (Phila) 2020; 9:126-129. [PMID: 31923034 DOI: 10.1097/apo.0000000000000262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE The aim of this study was to assess prevalence of corneal astigmatism before cataract surgery in old age in Indian rural population. DESIGN Prospective, cross-sectional, and observational study. METHODS Keratometric values were measured with an auto refractokeratometer in patients presenting for cataract surgery between January 2017 and May 2018. The demographic profiles of patients were recorded. Axial length and intraocular lens power were measured. Data were analyzed in SPSS software. RESULTS This study included 1000 eyes of 880 patients with a mean age of 65.1 ± 10.12 years. The mean astigmatism was 0.89 ± 0.63 D. A total of 179 eyes (17.9%) had astigmatism between 1.00 and 1.49 D; 34 eyes (3.4%) had astigmatism between 2.00 and 2.5 D; and 20 eyes (2%) had astigmatism >3 D. Overall, 325 eyes (32.5%) had astigmatism >1.00 D. Against the rule astigmatism was seen in 44.6% cases, oblique astigmatism was seen in 32% cases, and with the rule astigmatism was seen in 20.7% cases. Against the rule astigmatism increased with age and reached a maximum between 60 and 69 years. Male eyes had flatter corneal curvature than female eyes. The mean axial length was 25.59 mm, and the mean intraocular lens power was 21.05 ± 1.0D. CONCLUSIONS We found that 32.5% patients had corneal astigmatism >1 D and may benefit from toric intraocular lenses implantation. The results of this analysis provide normative data for the hospital to plan for correction of corneal astigmatism in patients undergoing cataract surgery.
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Affiliation(s)
- Rajesh Subhash Joshi
- Associate Professor, Department of Ophthalmology, Vasantrao Naik Government Medical College, Yavatmal-400001, Maharashtra India
| | - Sonali Arun Jadhav
- Resident ophthalmology, Department of Ophthalmology, Vasantrao Naik Government Medical College, Yavatmal- 445001, Maharashtra, India
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Carey D, Price K, Neal S, Compton C, Ash C, Bryan N, Kaplan P, McMullen K. The impact of discontinuing contact precautions for multidrug resistant organisms at a less than 400-bed level II teaching hospital and a community hospital: A 3-month pilot study. Am J Infect Control 2020; 48:333-336. [PMID: 31519476 DOI: 10.1016/j.ajic.2019.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND The impact of discontinuing contact precautions (CPs) for patients with select multidrug-resistant organisms on bacteremia infection rates was evaluated in this quality improvement project. METHODS The removal of use of CPs, with increased focus on standard precautions, for all patients with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization/infection was piloted via a quality improvement project over a 3-month period. RESULTS CP was discontinued in December 2018. Comparing 3 months pre- and postchange, the overall incidence density rate decreased for hospital-onset (HO) laboratory-identified (LabID) MRSA bacteremia (0.07 vs 0.02; P = .52), whereas HO LabID VRE bacteremia rates remained the same (0.00 vs 0.00). Overall estimated financial savings, including personal protective equipment ($15,375) and staff time ($17,165), was $32,540 for the project period, with annualized estimated savings of $130,160. CONCLUSIONS In this pilot study evaluating the discontinuance of CPs, there was no evidence of an increase in HO MRSA or VRE LabID bacteremia incidence density rates. This practice change may be safely implemented at similar health care facilities.
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Affiliation(s)
- Darlene Carey
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA.
| | - Kaleb Price
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA
| | - Shylanda Neal
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA
| | - Cinnamon Compton
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA
| | - Charles Ash
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA
| | - Nicole Bryan
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA
| | - Peter Kaplan
- Infection Prevention and Control, Gwinnett Medical Center, Lawrenceville, GA
| | - Kathleen McMullen
- Infection Prevention, Occupational Health and Wound Care, Christian Hospital and Northwest Healthcare, St. Louis, MO
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Masich AM, Vega AD, Callahan P, Herbert A, Fwoloshi S, Zulu PM, Chanda D, Chola U, Mulenga L, Hachaambwa L, Pandit NS, Heil EL, Claassen CW. Antimicrobial usage at a large teaching hospital in Lusaka, Zambia. PLoS One 2020; 15:e0228555. [PMID: 32040513 PMCID: PMC7010251 DOI: 10.1371/journal.pone.0228555] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/17/2020] [Indexed: 12/19/2022] Open
Abstract
Antimicrobial resistance is a growing global health concern. Antimicrobial stewardship (AMS) curbs resistance rates by encouraging rational antimicrobial use. However, data on antimicrobial stewardship in developing countries is scarce. The objective of this study was to characterize antimicrobial use at the University Teaching Hospital (UTH) in Lusaka, Zambia as a guiding step in the development of an AMS program. This was a cross-sectional, observational study evaluating antimicrobial appropriateness and consumption in non-critically ill adult medicine patients admitted to UTH. Appropriateness was defined as a composite measure based upon daily chart review. Sixty percent (88/146) of all adult patients admitted to the general wards had at least one antimicrobial ordered and were included in this study. The most commonly treated infectious diseases were tuberculosis, pneumonia, and septicemia. Treatment of drug sensitive tuberculosis is standardized in a four-drug combination pill of rifampicin, isoniazid, pyrazinamide and ethambutol, therefore appropriateness of therapy was not further evaluated. The most common antimicrobials ordered were cefotaxime (n = 45), ceftriaxone (n = 28), and metronidazole (n = 14). Overall, 67% of antimicrobial orders were inappropriately prescribed to some extent, largely driven by incorrect dose or frequency in patients with renal dysfunction. Antimicrobial prescribing among hospitalized patients at UTH is common and there is room for optimization of a majority of antimicrobial orders. Availability of certain antimicrobials must be taken into consideration during AMS program development.
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Affiliation(s)
- Anne M. Masich
- Virginia Commonwealth University Health System, Richmond, Virginia, United States of America
| | - Ana D. Vega
- Jackson Health System, Miami, Florida, United States of America
| | - Patricia Callahan
- University of Maryland School of Pharmacy, Baltimore, Maryland, United States of America
| | - Amber Herbert
- University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Sombo Fwoloshi
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - Paul M. Zulu
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - Duncan Chanda
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
| | - Uchizi Chola
- Department of Pharmacy, University Teaching Hospital, Lusaka, Zambia
| | - Lloyd Mulenga
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America
- Ministry of Health, Ndeke House, Lusaka, Zambia
| | - Lottie Hachaambwa
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Neha S. Pandit
- University of Maryland School of Pharmacy, Baltimore, Maryland, United States of America
| | - Emily L. Heil
- University of Maryland School of Pharmacy, Baltimore, Maryland, United States of America
| | - Cassidy W. Claassen
- Division of Infectious Diseases, Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
- Adult Infectious Diseases Center, University Teaching Hospital, Lusaka, Zambia
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Bello S, Ajayi DT, Bamgboye EA, Mpama EA. Is evidence-based medicine a mirage in resource-constrained settings? A survey among resident doctors in selected teaching hospitals in Nigeria. J Evid Based Med 2020; 13:17-24. [PMID: 32072768 DOI: 10.1111/jebm.12374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/02/2020] [Indexed: 01/11/2023]
Abstract
AIM The study aimed to assess the self-rated knowledge, attitude toward, and practice (KAP) of evidence-based medicine (EBM) among resident doctors in Nigeria. METHODS This was a cross-sectional web-based survey among 238 resident doctors in four selected teaching hospitals in southern Nigeria. Survey questionnaire contained items assessing the KAP of EBM, familiarity with and understanding of key EBM terms, the use of EBM in decision making, barriers militating against EBM and ways to improve EBM adoption. Proportions and summary statistics were reported for the distribution of survey items. RESULTS Mean number of years in clinical practice was 9.3 ± 4.5 years. Respondents were uniformly distributed in major clinical specialties. The majority (70.5%) were senior registrars. Respondents' understanding of EBM components included; current best clinical evidence (98.3%), clinical expertise (65.5%), and patients' choices (36.6%). Self-rated familiarity with EBM terms was high while perceived understanding of the terms was lower. The least understood concept was heterogeneity (20.6%). The attitude toward EBM was generally positive. Only about half (53.6%) had used medical bibliographic databases within the last 6 months prior to the survey. Barriers against EBM included lack of time (47.1%) and lack of requisite skills (32.4%). Suggestions to improve EBM adoption included training (58.1%), provision of free Wi-Fi, and free access to bibliographic databases (25.2%) and increased political will (23.1%). CONCLUSION A further understanding of the EBM concept, provision of enabling infrastructure, regular clinical audit and advocacy to hospital management and clinical consultants, may improve the level of adoption of EBM.
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Affiliation(s)
- Segun Bello
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - David Taiwo Ajayi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Eniola Adetola Bamgboye
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Enagu Akwa Mpama
- Department of Community Medicine, College of Health Sciences, University of Calabar, Calabar, Nigeria
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Abstract
To assess the mental health of nurses and to find the post responsibility and psychological status of clinical nurses.A total of 447 nursing staff at different levels in a teaching hospital was assessed by nursing post responsibility scale and mental symptom checklist (SCL-90) then compared with each other. The study period was from April 1, 2018 to April 30, 2018.There was a positive correlation between the responsibility of post and interpersonal relationship (r = 0.11, P < .05), depression (r = 0.10, P < .05) and hostility (r = 0.10, P < .05). Post risk was negatively correlated with somatization (r = -0.10, P < .05), job involvement scope and communication ability were negatively correlated (r = -0.11, P < .05). Based on the multiple linear regression, knowledge and skills (β = -0.20, P = .02) and risks of the post (β=0.20, P < .01) both significantly related to SCL-90 total score.In conclusion, knowledge and skills and risks of the post associated with mental health of clinical nurses. The sustainable development of nursing post responsibility requires healthy physiological and mental health.
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Affiliation(s)
- Man-Li Du
- Huadu District of Guangzhou Maternal and Child Health Hospital (Huzhong Hospital), Guangzhou, China
| | - Wan-Xin Deng
- Huadu District of Guangzhou Maternal and Child Health Hospital (Huzhong Hospital), Guangzhou, China
| | - Wen Sun
- Huadu District of Guangzhou Maternal and Child Health Hospital (Huzhong Hospital), Guangzhou, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, China
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Xin-Chun Zou
- The Affiliated Stomatology Hospital of Kunming Medical University, Kunming City, China
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Shrestha A, Madhikarmi NL. Prevalence of Self Medication Practice among Dental Undergraduates in a Dental college. JNMA J Nepal Med Assoc 2020. [PMID: 32335634 PMCID: PMC7580486 DOI: 10.31729/jnma.4740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction: Self-medication practice among future prescribers can cause a serious threat to thehealth care profession. There has been an increasing trend among medical and dental students forself-medication. The objective of our study was to find the prevalence and practice of self-medicationamong dental undergraduates in Kantipur Dental College and Teaching Hospital.
Methods: A descriptive cross-sectional study was conducted among all the dental undergraduatestudents of Kantipur Dental College, Kathmandu, from July to September 2018. Ethical clearancewas obtained from the institutional review board. A convenience sampling method was used. A prevalidated questionnaire was handed to the students in their classroom to collect the data. The datawere analyzed using Statistical Package for the Social Sciences version 16 and Microsoft Excel 2010and presented as frequency and percentage.
Results: The prevalence of self-medication among dental undergraduates was found to be in 150(83.3%) out of a total of 180 students who participated in the study.
Conclusions: Self-medication was commonly practiced by dental students. Self-medication shouldbe considered as a serious threat, especially among the students with inadequate knowledge of drug,dose, and duration of treatment.
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Affiliation(s)
- Aastha Shrestha
- Department of Pharmacology, Kantipur Dental College, Basundhara, Kathmandu, Nepal
- Correspondence: Mrs. Aastha Shrestha, Department of Pharmacology, Kantipur Dental College, Basundhara, Kathmandu, Nepal. , Phone: +977-9841457047
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Abstract
Introduction: Medical students are more prone to suffer from various physiological and psychologicalproblems but rather than seeking for formal health care, they tend to do informal consultation andoften practice self medication. Thus, this study aimed to find out the health seeking behavior ofmedical students.
Methods: This descriptive cross-sectional study was done among first and second year medicalstudents of a teaching hospital from September to November 2019 after taking ethical approvalfrom Institutional Review Committe. Total of 235 students were included in the study and selfadministered questionnaire was used. Data entry and analysis was done using Statistical Packagefor Social Sciences version 20.0.
Results: Among 235 students who participated in the study, 172 (73%) reported having healthproblems in the last 12 months, and fever and headache were commonly reported by 21 (13%) and 18(50%) students, respectively. Total of 112 (65%) students visited hospital/clinic for health problemsand reason given for not visiting hospital/clinic was 12 (28%) thinking that the problem was minor.University hospital was the most preferred place 189 (80%) during health problem and parents werethe first people for consultation 116 (49%). Mean duration of absenteeism was 2.17±4.1 days and 167(88%) visited hospital more than five times.
Conclusions: Health problems were common among students and most of them required multiplehospital visits. Many students seeked for health from hospital/ clinic but informal consultationswere also seen.
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Affiliation(s)
- Mukta Singh Bhandari
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
- Correspondence: Dr. Mukta Singh Bhandari, Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal. , Phone: +977-9841383826
| | - Jagdish Chataut
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
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Jacobs BL, Yabes JG, Lopa SH, Heron DE, Chang CCH, Bekelman JE, Nelson JB, Bynum JPW, Barnato AE, Kahn JM. The Development and Validation of Prostate Cancer-specific Physician-Hospital Networks. Urology 2020; 138:37-44. [PMID: 31945379 DOI: 10.1016/j.urology.2019.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/16/2019] [Accepted: 11/26/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To develop prostate cancer-specific physician-hospital networks to define hospital-based units that more accurately group hospitals, providers, and the patients they serve. METHODS Using Surveillance, Epidemiology, and End Results-Medicare, we identified men diagnosed with localized prostate cancer between 2007 and 2011. We created physician-hospital networks by assigning each patient to a physician and each physician to a hospital based on treatment patterns. We assessed content validity by examining characteristics of hospitals anchoring the physician-hospital networks and of the patients associated with these hospitals. RESULTS We identified 42,963 patients associated with 344 physician-hospital networks. Networks anchored by a teaching hospital (compared to a nonteaching hospital) had higher median numbers of prostate cancer patients (117 [interquartile range {71-189} vs 82 {50-126}]) and treating physicians (7 [4-11] vs 4 [3-6]) (both P <0.001). On average, patients traveled farther to networks anchored by a teaching hospital (49 miles [standard deviation] [207] vs 41 [183]; P <.001). Hospitals known as high-volume centers for robotic prostatectomies, proton-beam therapy, and active surveillance had network rates for these procedures well above the mean. Hospitals known as safety net providers served higher proportions of minorities. CONCLUSION We empirically developed prostate-cancer specific physician-hospital networks that exhibit content validity and are relevant from a clinical and policy perspective. They have the potential to become targets for policy interventions focused on improving the delivery of prostate cancer care.
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Affiliation(s)
- Bruce L Jacobs
- Department of Urology, University of Pittsburgh, Pittsburgh, PA; Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA.
| | - Jonathan G Yabes
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Samia H Lopa
- Department of Urology, University of Pittsburgh, Pittsburgh, PA
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA
| | - Chung-Chou H Chang
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Justin E Bekelman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA; Division of General Internal Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Joel B Nelson
- Department of Urology, University of Pittsburgh, Pittsburgh, PA
| | - Julie P W Bynum
- Department of Medicine, Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, MI
| | - Amber E Barnato
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Jeremy M Kahn
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA
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Yang Z, Huang Q, Qin J, Zhang X, Jian Y, Lv H, Liu Q, Li M. Molecular Epidemiology and Risk Factors of Clostridium difficile ST81 Infection in a Teaching Hospital in Eastern China. Front Cell Infect Microbiol 2020; 10:578098. [PMID: 33425775 PMCID: PMC7785937 DOI: 10.3389/fcimb.2020.578098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/20/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of Clostridium difficile causes an increased morbidity and mortality of inpatients, especially in Europe and North America, while data on C. difficile infection (CDI) are limited in China. METHODS From September 2014 to August 2019, 562 C. difficile isolates were collected from patients and screened for toxin genes. Multilocus sequence typing (MLST) and antimicrobial susceptibility tests by E-test and agar dilution method were performed. A case group composed of patients infected with sequence type (ST) 81 C. difficile was compared to the non-ST81 infection group and non CDI diarrhea patients for risk factor and outcome analyses. RESULTS The incidence of inpatients with CDI was 7.06 cases per 10,000 patient-days. Of the 562 C. difficile isolates, ST81(22.78%) was the predominant clone over this period, followed by ST54 (11.21%), ST3 (9.61%), and ST2 (8.72%). Toxin genotype tcdA+tcdB+cdt- accounted for 50.18% of all strains, while 29.54% were tcdA-tcdB+cdt- genotypes. Overall, no isolate was resistant to vancomycin, teicoplanin or daptomycin, and resistance rates to meropenem gradually decreased during these years. Although several metronidazole-resistant strains were isolated in this study, the MIC values decreased during this period. Resistance rates to moxifloxacin and clindamycin remained higher than those to the other antibiotics. Among CDI inpatients, longer hospitalization, usage of prednisolone, suffering from chronic kidney disease or connective tissue diseases and admission to emergency ward 2 or emergency ICU were significant risk factors for ST81 clone infection. All-cause mortality of these CDI patients was 4.92%(n=18), while the recurrent cases accounted for 5.74%(n=21). The 60-day mortality of ST81-CDI was significantly higher than non-ST81 infected group, while ST81 also accounted for most of the recurrent CDI cases. CONCLUSION This study revealed the molecular epidemiology and risk factors for the dominant C. difficile ST81 genotype infection in eastern China. Continuous and stringent surveillance on the emerging ST81 genotype needs to be initiated.
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Affiliation(s)
- Ziyu Yang
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qian Huang
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Juanxiu Qin
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiaoye Zhang
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Ying Jian
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Huiying Lv
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qian Liu
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- *Correspondence: Qian Liu, ; Min Li,
| | - Min Li
- Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- *Correspondence: Qian Liu, ; Min Li,
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Okenwa W, Edeh A. A review of clinical presentation and physiotherapy management of cerebral palsy patients in Esut teaching hospital, Enugu, Nigeria. Afr Health Sci 2019; 19:3085-3090. [PMID: 32127884 PMCID: PMC7040352 DOI: 10.4314/ahs.v19i4.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cerebral palsy affects the general neurological development of those involved. This usually culminates into various muscular deficits some of which are amenable to physiotherapy intervention and rehabilitation. METHOD A 6 year retrospective study was conducted to find out the clinical presentation and physiotherapy management of cerebral palsy patients in ESUT Teaching Hospital Enugu, Nigeria, between June 2009 and May, 2015. RESULT 146(30.2%) cases of cerebral palsy were noted out of 483 children seen within the period. There was male predominance n- 86(58.9%) and the commonest cause of cerebral palsy was birth asphyxia n- 56(38.4%).Several physiotherapy treatment modalities were applied, the common ones being neurodevelopment therapy, trans-cutaneous electric nerve stimulation, and passive and active exercise modules.Majority of the patients' accessed treatment less than 5 times n- 86(59%) and were lost to follow up subsequently. Slightly more than 10% of the patients accessed treatment consistently for 3 months. CONCLUSION High level of abandonment of treatment and lack of more modern physiotherapy modalities were noted. There is need to emphasize better health education of parents/guardians of the patients and improve social welfare benefits for the patients.
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Md Habibulla SK, Bhowmik A, Saha J, Hazra A, Halder SK, Mondal R. Electrocardiographic Parameters in Indian Newborns. Indian Pediatr 2019; 56:917-922. [PMID: 31729321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To generate data of electrocardiogram (ECG) parameters according to gestational age in Indian newborns. METHODS An observational study was carried out over 7 months in neonatology unit of a tertiary care teaching hospital. Following auscultation, ECG parameters were recorded simultaneously in 12 leads, on third day of life, in hemodynamically stable neonates. Data from 364 babies were analyzed, keeping at least 30 records for each gestational age between 30 to 42 weeks. RESULTS There was no difference in mean heart rate recorded through auscultation and ECG traces. The mean (SD) values recorded were: P wave duration 0.04 (0.01) s, P wave amplitude 1.3 (0.4) mm, T wave duration 0.07 (0.02) s, T wave amplitude 1.1 (0.6) mm, PR interval 0.09 (0.02) s, QRS duration 0.04 (0.01) s, QT interval 0.26 (0.02) s, QTc 0.4 (0.03) s and QRS axis 127 (22) degree. Gestation age-wise percentile charts of different ECG parameters were generated. CONCLUSIONS These gestational age-wise percentile charts of different ECG parameters for Indian newborns can be used as reference for neonatal ECG.
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Affiliation(s)
- S K Md Habibulla
- Department of Pediatrics, Medical College Kolkata, Kolkata, West Bengal, India
| | - Arijit Bhowmik
- Department of Neonatology, Medical College Kolkata, Kolkata, West Bengal, India
| | - Jayanta Saha
- Department of Cardiology, Medical College Kolkata, Kolkata, West Bengal, India
| | - Avijit Hazra
- Department of Pediatric Medicine, Medical College Kolkata, Kolkata, West Bengal, India
| | - Sanjay K Halder
- Department of Cardiology, Medical College Kolkata, Kolkata, West Bengal, India
| | - Rakesh Mondal
- Department of Pharmacology, IPGMER and SSKM Hospital, Kolkata, West Bengal, India. Correspondence to: Dr Rakesh Mondal, Premises no 50, Shibrampur Bye Lane, Sarsuna, Kolkata 700061, West Bengal, India.
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Sharifi M, Raeissi P, Gorji HA, Aryankhesal A. Developing a Model for Accreditation of Iranian Teaching Hospitals: A Qualitative Study. Ethiop J Health Sci 2019; 29:657-668. [PMID: 31741636 PMCID: PMC6842710 DOI: 10.4314/ejhs.v29i6.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/08/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Among different factors, accreditation is being widely used across the world to improve quality and safety in hospitals. Therefore, the purpose of the present study was to develop an accreditation model for teaching hospitals in Iran. METHODS This qualitative study was conducted in four phases from January, 2017 to March, 2018. To this end; firstly, existing accreditation models were extracted and reviewed comparatively. Within the second stage, dimensions and components of the accreditation model were extracted through semi-structured interviews. In the third stage, a new instruction was developed via integrating the findings from the first and the second stages. Finally, the model was validated in two phases of Delphi method and a specialized forum in the fourth step. Qualitative findings were then analyzed using content analysis method. RESULTS Models of Joint Commission International (JCI) and Word Federation for Medical Education (WFME) in other 6 countries were reviewed and compared with the current Iranian model. Extracted dimensions discovered to complement the present model included learner assessment, continuous reviews and revisions, and educational productivity. The final model was also developed with 12 dimensions and 94 standards. Content validity ratio (CVR) and content validity index (CVI) were also estimated to be 0.40 and 0.80, respectively. As well, the second round of Delphi method could increase the number of model standards to 97. Moreover, Cohen's kappa coefficient was calculated to be at least 0.71. CONCLUSION This study led to the development of a comprehensive model for scientific accreditation of teaching hospitals through reviewing documentation, combining and comparing global approaches, as well as integrating them with the views of domestic experts.
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Affiliation(s)
- Marziye Sharifi
- Department of Health Services Management, School of Health Management and Information Sciences, International Campus (IUMS-IC), Iran University of Medical Sciences, Tehran, Iran
| | - Pouran Raeissi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Abolghasem Gorji
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Aryankhesal
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Ferreira RC, Duran ECM. Clinical validation of nursing diagnosis "00085 Impaired Physical Mobility" in multiple traumas victims. Rev Lat Am Enfermagem 2019; 27:e3190. [PMID: 31664408 PMCID: PMC6818657 DOI: 10.1590/1518-8345.2859.3190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 06/11/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE to clinically validate the nursing diagnosis "Impaired Physical Mobility", identifying its prevalence, defining characteristics, related factors, and associated conditions with the calculation of accuracy measures and generation of Decision Trees, as well as clinically and etiologically characterize the multiple traumas victims. METHOD methodological, cross-sectional study of clinical validation type, using diagnostic accuracy measures and generating decision tree. RESULTS the sample consisted of 126 patients, 73% male, with a mean age of 38.29 years. The frequency of the nursing diagnosis studied was 88.10%; the defining characteristic with the highest prevalence was "Difficulty turning" (58.73%), with a predictive power of 98.6%; the associated condition "Alteration in bone structure integrity" stood out with 72.22%. The accuracy measures also indicated their predictive power. CONCLUSION the components aforementioned were considered predictors of this diagnosis. This study contributed to improve the identification of clinical indicators associated with advanced methods of diagnostic validation, directing care and reducing the variability present in clinical situations.
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Affiliation(s)
- Raisa Camilo Ferreira
- Universidade Estadual de Campinas, Faculdade de Enfermagem,
Campinas, SP, Brazil
- Centro Universitário de Itapira, Itapira, SP, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal
de Nível Superior (CAPES), Brazil
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Schang L, Koller D, Franke S, Sundmacher L. Exploring the role of hospitals and office-based physicians in timely provision of statins following acute myocardial infarction: a secondary analysis of a nationwide cohort using cross-classified multilevel models. BMJ Open 2019; 9:e030272. [PMID: 31619423 PMCID: PMC6797264 DOI: 10.1136/bmjopen-2019-030272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To examine the role of hospitals and office-based physicians in empirical networks that deliver care to the same population with regard to the timely provision of appropriate care after hospital discharge. DESIGN Secondary data analysis of a nationwide cohort using cross-classified multilevel models. SETTING Transition from hospital to ambulatory care. PARTICIPANTS All patients discharged for acute myocardial infarction (AMI) from Germany's largest statutory health insurance fund group in 2011. MAIN OUTCOME MEASURE Patients' odds of receiving a statin prescription within 30 days after hospital discharge. RESULTS We found significant variation in 30-day statin prescribing between hospitals (median OR (MOR) 1.40; 95% credible interval (CrI) 1.36 to 1.45), hospital-physician pairs caring for the same patients (MOR 1.32; 95% CrI 1.26 to 1.38) and to a lesser extent between physicians (MOR 1.14; 95% CrI 1.11 to 1.19). About 67% of the variance between hospital-physician pairs and about 45% of the variance between hospitals was explained by hospital characteristics including a rural location, teaching status and the number of beds, the number of patients shared between a hospital and an office-based physician as well as 16 patient characteristics, including multimorbidity and dementia. We found no impact of physician characteristics. CONCLUSIONS Timely prescription of appropriate secondary prevention pharmacotherapy after AMI is subject to considerable practice variation which is not consistent with clinical guidelines. Hospitals contribute more to the observed variation than physicians, and most of the variation lies at the patient level. To ensure care continuity for patients, it is important to strengthen hospital capacity for discharge management and coordination between hospitals and office-based physicians.
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Affiliation(s)
- Laura Schang
- Department of Health Services Management, Ludwig-Maximilians-Universitat München, Munich, Germany
| | - Daniela Koller
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sebastian Franke
- Department of Health Services Management, Ludwig-Maximilians-Universitat München, Munich, Germany
| | - L Sundmacher
- Department of Health Services Management, Ludwig-Maximilians-Universitat München, Munich, Germany
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Odelola OI, Akadri AA, Ogunsowo KM. Placenta Praevia: A Retrospective Review of Experience at Olabisi Onabanjo University Teaching Hospital, Sagamu. West Afr J Med 2019; 36:217-221. [PMID: 31622483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Placenta praevia is the most common cause of antepartum haemorrhage. It is a potentially life threatening condition associated with morbidity and mortality. There is no study on the pattern and management of placenta praevia in Sagamu. AIM AND OBJECTIVES To determine the risk factors, pattern of presentation and management outcome of pregnancies complicated by placenta praevia. DESIGN This was a five-year retrospective study Setting: Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. MATERIALS AND METHODS Relevant information was retrieved from the case notes of all patients who presented with placenta praevia from 1st January, 2013 to 31st December, 2017. The data were analyzed by using SPSS version 21. RESULTS Out of the 5124 deliveries, there were 47 cases of placenta praevia giving a prevalence of 0.92%. Twenty-one subjects (50%) were within 31-40 years age group. The modal parity was 1. Twenty women (47.6%) had parity of 1-2. Thirty subjects (71.4%) were unbooked. Painless vaginal bleeding was the commonest mode of presentation in 30(73.8%) women while Type III was the commonest grade 15(35.7%). Nineteen subjects (45.2%) had no identifiable risk factors. Postpartum haemorrage was the most common complication (23.8%). There was no maternal death while the perinatal mortality was 13.5%. There was no significant association between booking status, type of placenta praevia, mode of delivery, blood loss at delivery, and the one minute APGAR score. CONCLUSION The prevalence of placenta praevia in Olabisi Onabanjo University Teaching Hospital is comparable with other tertiary facilities in Nigeria. Upgrading comprehensive emergency obstetric services, improving neonatal services and a multidisciplinary approach to management of all cases will ensure good outcome for the mother and baby.
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Affiliation(s)
- O I Odelola
- Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun State, Nigeria
| | - A A Akadri
- Department of Obstetrics and Gynaecology,Babcock University Ilishan-Remo, Ogun State, Nigeria
| | - K M Ogunsowo
- Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun State, Nigeria
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Affiliation(s)
- Dhruv Khullar
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Austin B Frakt
- Partnered Evidence-Based Policy Resource Center, Veterans Health Administration, Boston, Massachusetts
- Boston University School of Public Health, Boston, Massachusetts
| | - Laura G Burke
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Das SK, Dhar SS, Panigrahi A. Prevalence of Pain and Its Characteristics in Hospitalized Patients in an Indian Teaching Hospital. Pain Manag Nurs 2019; 21:299-303. [PMID: 31303530 DOI: 10.1016/j.pmn.2019.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/22/2019] [Accepted: 06/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pain has a great impact on the physical and mental condition of hospitalized patients, reduces quality of life, and increases economic burden. AIMS The study aimed to determine pain prevalence, its characteristics, analgesic treatment, and associated factors for severity and chronicity of pain in hospitalized patients. METHODS A cross-sectional study was carried out including 847 eligible adult in-patients, aged ≥18 years, admitted to the All India Institute of Medical Sciences, Bhubaneswar, India, from June to August 2018. Pain severity was evaluated by visual analog scale (VAS) at the time of interview and after 1 week/completion of pain treatment. RESULTS The prevalence of pain during the 24 hours preceding the interview was 70.6%. The duration of pain was ≥4 weeks in 162 (27.1%) patients and severe (VAS ≥ 7) in 144 (24.1%) patients. The mean VAS score was 6.27 ± 1.97 at the time of interview and 3.31 ± 1.89 after 1 week/completion of pain treatment (p < .001). Use of opioid analgesics (adjusted odds ratio [aOR]: 3.18; confidence interval [CI]: 2.23-4.55) was significantly related to pain severity, whereas patients ≥60 years (aOR: 1.64; CI: 0.99-2.70), patients in a nonsurgical ward (aOR: 1.78; CI: 1.21-2.60), and patients using opioid analgesics (aOR: 2.63; CI: 1.73-3.98) had prolonged pain, defined as ≥4 weeks. CONCLUSION Pain prevalence and intensity in this Indian hospital were high and pain treatment was adequate in many cases. Timely assessment and appropriate management of pain in hospitalized patients is needed to prevent further pain and its complications in these patients.
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Affiliation(s)
- Saroj Kumar Das
- Department of Radiotherapy, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sovan Sarang Dhar
- Department of Radiotherapy, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Ansuman Panigrahi
- Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India.
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Ahmadi F, Moogahi S, Bahrami H. Determining frequency and pattern of infections associated with diabetes based educational hospitals in Ahvaz city; Iran. Diabetes Metab Syndr 2019; 13:2441-2444. [PMID: 31405657 DOI: 10.1016/j.dsx.2019.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/10/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Diabetes mellitus is a metabolic disease known as one of the most common illness in the world. It is believed that diabetic patients are at high risk of varied infections than non-diabetics. The aim of this study was to determine the frequency and pattern of infections in diabetic patients admitted to the internal wards of educational hospitals of Ahvaz Jundishapur University of Medical Sciences. METHODS This descriptive cross-sectional study was performed on 700 diabetic patients from January 2014 to December 2015 in internal wards (general, endocrine, gastroenterology, lung, nephrology, cardiology, neurology and infectious diseases) of educational hospitals affiliated to Ahvaz JundishapurUniversity of Medical Sciences. Data includeddemographic information, type of diabetes treatment, duration of diabetes mellitus, final diagnosis, and blood sugar on admission that were analyzed statistically. RESULTS Out of 700 patients, 374 (53.4%) women and 326 (46.6%) men were entered into this study. The number of non-infectious and infectious patients were 506 (72.3%) and 194 (27.7%). The mean of age,duration of diabetes, and glucose were 62.34 ± 14.38 years, 11.11 ± 7.18 years, and 271.98 ± 90 (mg/dl) in patients with infectious diseases respectively. The most common infectious illnesses were diabetic foot infections (32.5%), pneumonia (18%), soft tissue abscess(13.9%), and urinary tract infections (11.3%). CONCLUSION Infectious diseases are one of the most common factorsto hospitalize diabetic patients (27.7%), most of whom had diabetic foot infections, pneumonia, and soft tissue abscess.
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Affiliation(s)
- Fatemeh Ahmadi
- Department of Infectious Diseases, School of Medicine, Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sasan Moogahi
- Department of Infectious Diseases, School of Medicine, Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Hoda Bahrami
- Medical Student of Ahvaz Jundishapur University of Medical Sciences, Student Research Committee, Ahvaz jundishapur University of Medical Sciences, Ahvaz, Iran
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Abstract
PURPOSE We aim to evaluate the sociodemographic and medical features of child-aged refugee patients and identify their health-related problems. METHODS Refugee children admitted to pediatric surgery department of a teaching hospital during the years 2012-2017 were included. Patients' files were reviewed retrospectively for sociodemographic and medical features. RESULTS A total of 254 patients with the mean age of 4.6 ± 4.15 years (0-16 years) were treated. Male-to-female ratio was 1.7. Most common diagnosis were inguino-scrotal pathologies (n = 50, 19.7%) followed by foreign body ingestion (n = 37, 14.6%) and corrosive esophagitis (n = 22, 8.7%). The cause of admission was a potentially preventable trauma in 24.4% of cases. Comorbid medical conditions were present in 49 patients (19.3%). Anemia was detected in 23.2% of cases. Weight according to age and gender were < 3 percentile in 29.1% of patients. Difficulties in communication, lack of former medical history and advanced presentation of disease were the challenges faced by caregivers. CONCLUSION The primary diagnoses for admission of refugee children were different from the routine practice and a significant part were from preventable causes. Comorbidities were common potentially having a negative influence on treatment processes. This can be a result of unfavorable living conditions and lack of medical care during migration.
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Affiliation(s)
- Idil Rana User
- Department of Pediatric Surgery, Faculty of Medicine, Gaziantep University, Sahinbey, Turkey.
- Sahinbey Arastirma Uygulama Hast., Cocuk Cerrahisi AD, Sahinbey, Gaziantep, Turkey.
| | - Bulent Hayri Ozokutan
- Department of Pediatric Surgery, Faculty of Medicine, Gaziantep University, Sahinbey, Turkey
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Abstract
BACKGROUND Sepsis is a major cause of child mortality and morbidity. To enhance outcomes, children with severe sepsis or septic shock often require escalated care for organ support, sometimes necessitating interhospital transfer. The association between transfer admission for the care of pediatric severe sepsis or septic shock and in-hospital patient survival and resource use is poorly understood. METHODS Retrospective study of children 0-20 years old hospitalized for severe sepsis or septic shock, using the 2012 Kids' Inpatient Database. After descriptive and bivariate analysis, multivariate regression methods assessed the independent relationship between transfer status and outcomes of in-hospital mortality, duration of hospitalization, and hospital charges, after adjustment for potential confounders including illness severity. RESULTS Of an estimated 11,922 hospitalizations (with transfer information) for pediatric severe sepsis and septic shock nationally in 2012, 25% were transferred, most often to urban teaching hospitals. Compared to non-transferred children, transferred children were younger, and had a higher frequency of extreme illness severity (84% vs. 75%, p < .01), and of multiple organ dysfunction (32% vs. 24%, p < .01). They also had higher use of invasive medical devices including arterial catheters, invasive mechanical ventilation, and central venous catheters; and of specialized technology, including renal replacement therapy (6.2% vs. 4.6%, p < .01) and extracorporeal membrane oxygenation (5.7% vs. 1.8%, p < .01). Transferred children had longer hospitalization and accrued higher charges than non-transferred children (p < .01). Crude mortality was higher among transferred than non-transferred children (21.4% vs.15.0%, p < .01), a difference no longer statistically significant after multivariate adjustment for potential confounders (Odds Ratio:1.04, 95% Confidence interval: 0.88-1.24). Similarly, adjusted length of hospital stay and hospital charges were not statistically different by transfer status. CONCLUSION One in four children with severe sepsis or septic shock required interhospital transfer for specialized care associated with greater use of invasive medical devices and specialized technology. Despite higher crude mortality and resource consumption among transferred children, adjusted mortality and resource use did not differ by transfer status. Further research should identify quality-of-care factors at the receiving hospitals that influence clinical outcomes and resource use.
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Affiliation(s)
- Folafoluwa O. Odetola
- Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, 6C07, 300 North Ingalls Street, Ann Arbor, MI 48109 USA
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI 48109 USA
| | - Achamyeleh Gebremariam
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI 48109 USA
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Bustraan J, Dijkhuizen K, Velthuis S, van der Post R, Driessen E, van Lith JMM, de Beaufort AJ. Why do trainees leave hospital-based specialty training? A nationwide survey study investigating factors involved in attrition and subsequent career choices in the Netherlands. BMJ Open 2019; 9:e028631. [PMID: 31175199 PMCID: PMC6589009 DOI: 10.1136/bmjopen-2018-028631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To gain insight into factors involved in attrition from hospital-based medical specialty training and future career plans of trainees who prematurely left their specialty training programme. DESIGN Nationwide online survey study. SETTING Postgraduate education of all hospital-based specialties in the Netherlands. PARTICIPANTS 174 trainees who prematurely left hospital-based medical specialty training between January 2014 and September 2017. MAIN OUTCOME MEASURES Factors involved in trainees' decisions to leave specialty training and their subsequent career plans. RESULTS The response rate was 38%. Of the responders, 25% left their programme in the first training year, 50% in year 2-3 and 25% in year 4-6. The most frequently reported factors involved in attrition were: work-life balance, job content, workload and specialty culture. Of the leaving trainees, 66% switched to another specialty training programme, of whom two-thirds chose a non-hospital-based training programme. Twelve per cent continued their career in a non-clinical role and the remainder had no specific plans yet. CONCLUSIONS This study provides insight in factors involved in attrition and in future career paths. Based on our findings, possible interventions to reduce attrition are: (1) enable candidates to develop a realistic view on job characteristics and demands, prior to application; (2) provide individual guidance during specialty training, with emphasis on work-life balance and fit with specialty.
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Affiliation(s)
- Jacqueline Bustraan
- Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kirsten Dijkhuizen
- Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sophie Velthuis
- Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Erik Driessen
- Department of Education Development and Research, Maastricht University, Maastricht, The Netherlands
| | - Jan M M van Lith
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arnout Jan de Beaufort
- Centre for Innovation in Medical Education, Leiden University Medical Centre, Leiden, The Netherlands
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Enyuma COA, Anah MU, Pousson A, Olorunfemi G, Ibisomi L, Abang BE, Imoke EJ. Patterns of paediatric emergency admissions and predictors of prolonged hospital stay at the children emergency room, University of Calabar Teaching Hospital, Calabar, Nigeria. Afr Health Sci 2019; 19:1910-1923. [PMID: 31656474 PMCID: PMC6794543 DOI: 10.4314/ahs.v19i2.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is a high prevalence of paediatric emergency cases in less developed countries. However, prolonged hospital stay at emergency units may further overstretch the facilities. OBJECTIVE To assess the patterns of presentations, services offered and predictors of a prolonged stay at the Children Emergency Room of a tertiary hospital in Southern Nigeria. METHODS This prospective cross-sectional, study was conducted at the University of Calabar Teaching Hospital, Nigeria from 1st January-31st December 2014. Socio-demographic and clinical characteristics of consecutively recruited children (n=633) were recorded in a proforma. Binary logistic regression was conducted to determine predictors of prolonged stay (>72 hours). RESULT The median age of participants was 2 (1 - 4.6) years. Three-fifths of children were admitted at off-hours and the commonest symptom was fever (73.9%). About 16.4% (95%CI:13.6% - 19.4%, n= 103/633) of the children had prolonged stay while those with sepsis had the longest mean stay (65.5±72.1 hours). Children admitted on account of Sickle cell disease (OR:11.2, 95%CI:1.3-95.1, P-value = 0.03), Malaria (OR:10.7, 95%CI:1.4-82.5, P-value = 0.02) or sepsis (OR:10.5, 95%CI:1.3 - 82.7, P-value = 0.03) had higher odds of prolonged hospital stay. There was no significant difference in hospital stay among children admitted by the consultant as compared to other health personnel (P-value = 0.08). CONCLUSION Prevention and proper management of Sickle cell disease and malaria reduces paediatric hospital stay in our environment. Paediatric emergency medicine should be re-organized to cater for high volume of off-hour admissions.
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Affiliation(s)
- Callistus OA Enyuma
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, Faculty of Medicine, University of Calabar, Nigeria
- Department of Paediatrics, University of Calabar Teaching Hospital. Nigeria
| | - Maxwell U Anah
- Department of Paediatrics, Faculty of Medicine, University of Calabar, Nigeria
- Department of Paediatrics, University of Calabar Teaching Hospital. Nigeria
| | - Amelia Pousson
- John Hopkins school of Medicine, Baltimore, Maryland, USA
| | - G Olorunfemi
- Division of Epidemiology and Biostatistics, School of Public health, University of the Witwatersrand, Johannesburg, South Africa
| | - L Ibisomi
- Division of Epidemiology and Biostatistics, School of Public health, University of the Witwatersrand, Johannesburg, South Africa
| | - B E Abang
- Department of Paediatrics, University of Calabar Teaching Hospital. Nigeria
| | - EJ Imoke
- Department of Paediatrics, University of Calabar Teaching Hospital. Nigeria
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Berhe YH, Amaha ND, Ghebrenegus AS. Evaluation of ceftriaxone use in the medical ward of Halibet National Referral and teaching hospital in 2017 in Asmara, Eritrea: a cross sectional retrospective study. BMC Infect Dis 2019; 19:465. [PMID: 31126242 PMCID: PMC6534921 DOI: 10.1186/s12879-019-4087-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 05/14/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Antibiotic resistance due to overuse of antimicrobials is an issue that has been of concern to many health institutions and society in general. Resistant infections have high impact in low income countries since they can't afford more recent and expensive antibiotics. Studies that evaluate antibiotic use in hospitals are scarce in Eritrea. Ceftriaxone is commonly available in Halibet National Referral and teaching hospital (HNRTH). Resistance to this antibiotic would have a great impact on the hospital since there is no other available third generation cephalosporin or higher classes of antibiotics. METHOD A retrospective cross sectional design was used to evaluate the use of ceftriaxone in patients admitted to the medical ward in 2017. Clinical card number of inpatients who took ceftriaxone was extracted from the database of the Satellite Pharmacy Department of HNRTH and collected using a standardized data collection form. A descriptive analysis was employed and the Statistical package for social sciences (SPSS), version 20 was used for analysis. RESULTS A total of 120 patients were taking ceftriaxone for various indications. There were 55 (50.5%) males and 54 (49.5%) females. 59.8% of the patients were treated in the range of 0-7 days. The mean age was 56 (SD: 20.7). On average patients were under treatment for 6 days. The proportion of patients taking ceftriaxone was 11.43% out of all admissions in the medical ward. One, two or three antibiotics were co-prescribed with ceftriaxone in 39.4%. The most commonly co-prescribed antibiotic was gentamycin, accounting for 16.4% of the co-administered antibiotics. The most common indications for ceftriaxone were pneumonia, sepsis, TB, and CHF. Ceftriaxone therapy was appropriate in 30 (27.5%) cases and 68 (62.4%) cases were inappropriate in any of the four parameters of assessment used. CONCLUSION Inappropriate use of ceftriaxone was found to be high in the hospital. This calls for establishment of hospital and national guidelines of antimicrobial treatment. Moreover drug restriction and antibiotic stewardship implementation in the hospital should be sought to prolong the lives of important drugs like ceftriaxone.
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Affiliation(s)
- Yohana Haile Berhe
- Pharmacy, Halibet National Referral and teaching Hospital, Asmara, Eritrea
| | - Nebyu Daniel Amaha
- Department of Pharmacology, School of Pharmacy, Asmara College of Health Sciences, Asmara, Eritrea
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Oh DK, Na W, Park YR, Hong SB, Lim CM, Koh Y, Huh JW. Medical resource utilization patterns and mortality rates according to age among critically ill patients admitted to a medical intensive care unit. Medicine (Baltimore) 2019; 98:e15835. [PMID: 31145326 PMCID: PMC6709157 DOI: 10.1097/md.0000000000015835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
There is ongoing controversy about how to address the growing demand for intensive care for critically ill elderly patients. We investigated resource utilization patterns and mortality rates according to age among critically ill patients.We retrospectively analyzed the medical records of patients admitted to a medical intensive care unit (ICU) in a tertiary referral teaching hospital between July 2006 and June 2015. Patients were categorized into non-elderly (age <65 years, n = 4140), young-elderly (age 65-74 years, n = 2306), and old-elderly (age ≥75 years, n = 1508) groups.Among 7954 admissions, the mean age was 61.5 years, and 5061 (63.6%) were of male patients. The proportion of comorbidities increased with age (64.6% in the non-elderly vs 81.4% in the young-elderly vs 82.8% in the old-elderly, P < .001 and P for trend <.001), whereas the baseline Sequential Organ Failure Assessment (SOFA) score decreased with age (8.1 in the non-elderly vs 7.2 in the young-elderly vs 7.2 in the old-elderly, P < .001, R = -.092 and P for trend <.001). Utilization rates of mechanical ventilation (48.6% in the non-elderly vs 48.3% in the young-elderly vs 45.5% in the old-elderly, P = .11) and renal replacement therapy (27.5% in the non-elderly vs 25.5% in the young-elderly vs 24.8% in the old-elderly, P = .069) were comparable between the age groups. The 28-day ICU mortality rates were lower in the young-elderly and the old-elderly groups than in the non-elderly group (35.6% in the non-elderly vs 34.2% in the young-elderly, P = .011; and vs 32.6% in the old-elderly, P = .002).A substantial number of critically ill elderly patients used medical resources as non-elderly patients and showed favorable clinical outcomes. Our results support that underlying medical conditions rather than age per se need to be considered for determining intensive care.
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Affiliation(s)
- Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine
| | - Wonjun Na
- Department of Medical Engineering, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine
| | - Yu Rang Park
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine
| | - Younsuck Koh
- Department of Pulmonary and Critical Care Medicine
| | - Jin-Won Huh
- Department of Pulmonary and Critical Care Medicine
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Kelbore AG, Owiti P, Reid AJ, Bogino EA, Wondewosen L, Dessu BK. Pattern of skin diseases in children attending a dermatology clinic in a referral hospital in Wolaita Sodo, southern Ethiopia. BMC Dermatol 2019; 19:5. [PMID: 30961561 PMCID: PMC6454754 DOI: 10.1186/s12895-019-0085-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 03/28/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Epidemiological studies to determine the pattern of skin diseases among children are important for proper health care planning and management. The purpose of this study was to describe the pattern of skin diseases among pediatric patients seen at a dermatology outpatient clinic of Wolaita Sodo Teaching and Referral Hospital, southern Ethiopia. METHOD We conducted a retrospective hospital-based, cross-sectional study between January 2016 and December 2017 at a teaching and referral hospital dermatology outpatient department. All children younger than 15 years presenting with newly-diagnosed skin diseases were included. Diagnosis was mainly made clinically, with some laboratory support. RESULTS A total of 1704 children with 1869 new skin diagnoses were included, of whom 139 (8.2%) had more than one disease. Of the children, 52.4% were males and 44.9% within the age-group 5-10 years. Eczematous dermatitis accounted for the largest group (23.9%, n = 447) of skin conditions followed by bacterial infections (21.3%, n = 398), fungal infections (18.8%, n = 351) and infestations (9.9%, n = 185). Seasonal variation was demonstrated, with eczematous conditions and bacterial infections being higher during autumn and winter. CONCLUSION Overall, eczema, bacterial and fungal infections were the three major pediatric skin diseases occurring among children attending this hospital's outpatient department. There was seasonal variation in some of the skin diseases. This study gives a snapshot of skin disorders presenting to hospital in children in southern Ethiopia and may help to plan dermatology service expansion, educational programs and preventive measures.
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Affiliation(s)
- Abraham Getachew Kelbore
- College of Health Sciences and Medicine, Dermatology Department, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Philip Owiti
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The National Tuberculosis, Leprosy and Lung Disease Programme, Ministry of Health, Nairobi, Kenya
| | - Anthony J. Reid
- Operational Research Unit, MedicalDepartment, Operational Centre Brussels, Médecins Sans Frontières, LuxOR, Luxembourg City, Luxembourg
| | - Efa Ambaw Bogino
- College of Health Sciences and Medicine, Dermatology Department, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Lantesil Wondewosen
- College of Health Sciences and Medicine, Dermatology Department, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Blen Kassahun Dessu
- College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Cram P, Chopra V, Soong C, Wu R. Reimagining Inpatient Care in Canadian Teaching Hospitals: Bold Initiatives or Tinkering at the Margins? J Hosp Med 2019; 14:251-253. [PMID: 30933678 DOI: 10.12788/jhm.3146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/14/2018] [Indexed: 11/20/2022]
Affiliation(s)
- Peter Cram
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, Ontario
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Vineet Chopra
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Christine Soong
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, Ontario
- Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Robert Wu
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, Ontario
- Faculty of Medicine, University of Toronto, Toronto, Ontario
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Bhattarai M, Sainju NK, Bhandari B, Kc V, Karki DB. Prevalence of White Coat Hypertension among the Patients Visiting in a Tertiary Care Center, Kathmandu, Nepal. Kathmandu Univ Med J (KUMJ) 2019; 17:119-122. [PMID: 32632058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background Hypertension is a major cardiovascular risk factor. White coat hypertension refers to elevated office blood pressure but normal out of office blood pressure. White-coat hypertension has a risk of cardiovascular events more than normotensives. Objective To identify the prevalence of white coat hypertension among patients presented in the cardiology department. Method The descriptive cross-sectional study was conducted among 165 patients who visited the cardiology outpatient department of Kathmandu Medical College and Teaching Hospital from December 2017 to November 2018. Blood pressure was measured at the hospital, and ambulatory blood pressure device was used to monitor 24hrs pattern. Hypertension is classified as per recent guideline. Data were entered and analysed using Statistical Package for social sciences version 20. Result Out of 165 ambulatory blood pressure monitoring conducted patients, 140 participants were enrolled in the study based on inclusion criteria. Among them 55% (77) were male, and 45% (63) were female. Age ranged from 18-78 years with a mean of 43.82 ± 12.31 years. Overall among 140 participants 14.28% had white coat hypertension, however, after excluding twenty-two high normal group, among 118 participants who were hypertensive according to office BP, 16.9% (20) had white coat hypertension, and 33.57% of patients did not have nocturnal dipping of blood pressure. Conclusion The white coat hypertension is prevalent among around one-sixth of hypertensive patients visiting tertiary care centre, and one third have non-dipping which needs to be considered in the management of hypertension.
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Affiliation(s)
- M Bhattarai
- Department of Cardiology, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - N K Sainju
- Medical Education Department, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - B Bhandari
- Department of Community Medicine and Public Health, Tribhuvan University Institute of Medicine, Kathmandu, Nepal. and School of Public Health and Community Medicine, University of New South Wales, Australia
| | - V Kc
- Department of Cardiology, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - D B Karki
- Department of Cardiology, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
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Tay CL, Myint PK, Mohazmi M, Soiza RL, Tan MP. Prevalence and documented causes of hyponatraemia among geriatric patients attending a primary care clinic. Med J Malaysia 2019; 74:121-127. [PMID: 31079122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Hyponatraemia is the commonest electrolyte abnormality and has major clinical implications. However, few studies of hyponatraemia in the primary care setting has been published to date. OBJECTIVES To determine the prevalence, potential causes and management of hyponatraemia and to identify factors associated with severity of hyponatraemia among older persons in a primary care setting. METHODS Electronic records were searched to identify all cases aged ≥60 years with a serum sodium <135mmol/l, attending outpatient clinic in 2014. Patients' medical records with the available blood test results of glucose, potassium, urea and creatinine were reviewed. RESULTS Of the 21,544 elderly, 5873 patients (27.3%) had electrolyte profile tests. 403 (6.9%) had hyponatraemia in at least one blood test. Medical records were available for 253, mean age 72.9±7.3 years, 178 (70.4%) had mild hyponatraemia, 75 (29.6%) had moderate to severe hyponatraemia. Potential causes were documented in 101 (40%). Patients with moderate to severe hyponatraemia were five times more likely to have a cause of hyponatraemia documented (p<0.01). Medications were the commonest documented cause of hyponatraemia (31.7%). Hydrochlorothiazide use was attributed in 25 (78.1%) of 32 with medication-associated hyponatraemia. Repeat renal profile (89%) was the commonest management of hypotonic hyponatraemia. CONCLUSION Whilst hyponatraemia was common in the clinic setting, many cases were not acknowledged and had no clear management strategies. In view of mild hyponatraemia has deleterious consequences, future studies should determine whether appropriate management of mild hyponatraemia will lead to clinical improvement.
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Affiliation(s)
- C L Tay
- Simpang Health Clinic, Taiping, Perak, Malaysia.
| | - P K Myint
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition College of Life Sciences & Medicine, University of Aberdeen, United Kingdom
| | - M Mohazmi
- University of Malaya Medical Centre, Department of Primary Care Medicine, Kuala Lumpur, Malaysia
| | - R L Soiza
- Aberdeen Royal Infirmary Foresterhill, Department of Geriatric Medicine, Aberdeen, United Kingdom
| | - M P Tan
- University of Malaya Medical Centre, Department of Medicine, Geriatric Unit, Kuala Lumpur, Malaysia
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Wang S, Hu YJ, Little P, Wang Y, Chang Q, Zhou X, Moore M, Harwell JI. The impact of the national action plan on the epidemiology of antibiotic resistance among 352,238 isolates in a teaching hospital in China from 2015 to 2018. Antimicrob Resist Infect Control 2019; 8:22. [PMID: 30728954 PMCID: PMC6352357 DOI: 10.1186/s13756-019-0473-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/14/2019] [Indexed: 12/16/2022] Open
Abstract
Background We sought to understand the epidemiology and characteristics of antimicrobial resistance (AMR) and the impact of the National Action Plan (NAP) on AMR. This information will be critical to develop interventions and strengthen antibiotic stewardship in hospital settings in China. Methods Cross-sectional data collection from the hospital information management system from 1 January 2015 to 30 August 2018. Variables included patient age, sex, diagnosis, hospital department and antibiotic sensitivity test. T-test for two samples method was applied to compare the results before and after NAP implementation. Multivariate analysis with binary logistic regression was conducted to examine the associations of risk factors for antimicrobial resistance. Results In total there were 352,238 isolates in the final analysis after excluding contamination strains and isolates with incomplete information. More than 50% of patients were > 66 years old. 62% were male. 40% of the total samples were sputum. Among the total sample, the total resistance rate was 42% among all isolates. The rate of resistance to all antibiotics declined by 5.3% (95% CI 4.96-5.64%, p < 0.0001) and culture positivity rate declined by 9.8% (95% CI 9.22-10.34%, p < 0.0001) after NAP. Logistical regression showed that the NAP had effect with an adjusted odds ratio of 0.76 (95% CI 0.71-0.81, p = 0.002). Being male, age > 65 years, ICU department, diagnosed with certain diseases were more likely to be associated with antimicrobial resistance. Conclusions Antibiotic resistance rates were high in this teaching hospital. However, the introduction of the China NAP since 2016 followed by hospital policy emphasis was associated with a declining AMR trend. Policies will need to incorporate antimicrobial stewardship with a focus on certain departments, with infection control practices and with increases in vaccination coverage among elderly.
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Affiliation(s)
- Shanjuan Wang
- Shanghai General Practice Medical Education and Research Center, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, No 1 Chengbei Rd, Jiading, Shanghai, 201800 China
| | - Yanhong Jessika Hu
- School of Public Health, The University of Hong Kong, G/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong
| | - Paul Little
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST UK
| | - Yifei Wang
- Shanghai General Practice Medical Education and Research Center, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, No 1 Chengbei Rd, Jiading, Shanghai, 201800 China
| | - Qing Chang
- Shanghai General Practice Medical Education and Research Center, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, No 1 Chengbei Rd, Jiading, Shanghai, 201800 China
| | - Xudong Zhou
- School of Public Health, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058 Zhejiang China
| | - Michael Moore
- Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Aldermoor Close, Southampton, SO16 5ST UK
| | - Joseph Irvin Harwell
- Clinical Science Team, Clinton Health Access Initiative, 383 Dorchester Ave, Boston, MA 02127 USA
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Osanyin GE, Odeseye AK, Okojie OO, Akinajo OR, Okusanya BO. Fetal Congenital Anomaly in Tertiary Hospital in Lagos, South-West Nigeria: A Review of Presentation and its Outcome. West Afr J Med 2019; 36:25-28. [PMID: 30924113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Congenital Anomalies are a major contributor to perinatal deaths worldwide. The World Health Organization (WHO) estimates that 303,000 newborns die within the first 4 weeks of life worldwide as a result of it. The exact cause is often difficult to determine and as such efforts are geared towards prevention AIM AND OBJECTIVE: This study was done to determine the common presentations as well as epidemiological features of pregnant women with anomalous fetus and at the Lagos University Teaching Hospital. This may help to develop strategies for patient counseling and management. METHOD This study is a retrospective, cross sectional hospital based study conducted at the department of Obstetrics and Gyneacology of the Lagos University Teaching Hospita,l Idi-Araba during the period Jan 2012-Dec 2016. Relevant information regarding maternal age, parity, gestational age and pregnancy outcomes was documented from the delivery records of the mothers. RESULTS One hundred (100) babies out of the total of 5,747 babies within the period under study were born with congenital anomalies giving a prevalence rate of 1.7% at the Lagos University Teaching Hospital. The commonest congenital anomaly seen was hydrocephalus, others were omphalocele, anorectal anomalies and multiple congenital anomalies (in particular neural tube defects coexisting with various forms of limb defects). CONCLUSIONS Public awareness of the importance of preconceptional care, elimination of environmental risk factors as well as provision of prenatal diagnostic facilities and improvement of antenatal care are of great benefit in early detection and management of congenital anomalies.
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Affiliation(s)
- G E Osanyin
- Department of Obstetrics and Gynaecology College of Medicine, University of Lagos
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Lim CY, Park JY, Kim DY, Yoo KD, Kim HJ, Kim Y, Shin SJ. Terminal lucidity in the teaching hospital setting. Death Stud 2018; 44:285-291. [PMID: 30513269 DOI: 10.1080/07481187.2018.1541943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 09/27/2018] [Accepted: 10/02/2018] [Indexed: 06/09/2023]
Abstract
Terminal lucidity is an unpredictable end-of-life experience that has invaluable implications in preparation for death. We retrospectively evaluated terminal lucidity at a university teaching hospital. Of 338 deaths that occurred during the study period (187 in the ICU and 151 in general wards), terminal lucidity was identified in 6 cases in general wards. Periods of lucidity ranged from several hours to 4 days. After experiencing terminal lucidity, half of the patients died within a week, and the remainder died within 9 days. More attention should be directed toward understanding terminal lucidity to improve end-of-life care in a meaningful way.
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Affiliation(s)
- Chi-Yeon Lim
- Clinical Trial Center, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Do Yeun Kim
- Department of Hematology and Medical Oncology, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
| | - Kyung Don Yoo
- Department of Internal Medicine Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Hyo Jin Kim
- Department of Internal Medicine Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Yunmi Kim
- Department of Internal Medicine Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Sung Joon Shin
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Seoul, Republic of Korea
- W Maurice Young Center for Applied Ethics, University of British Columbia, Vancouver, Canada
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Zoucha J, Hull M, Keniston A, Mastalerz K, Quinn R, Tsai A, Berman J, Lyden J, Stella SA, Echaniz M, Scaletta N, Handoyo K, Hernandez E, Saini I, Smith A, Young A, Walsh M, Zaros M, Albert RK, Burden M. Barriers to Early Hospital Discharge: A Cross-Sectional Study at Five Academic Hospitals. J Hosp Med 2018; 13:816-822. [PMID: 30496327 DOI: 10.12788/jhm.3074] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Understanding the issues delaying hospital discharges may inform efforts to improve hospital throughput. OBJECTIVE This study was conducted to identify and determine the frequency of barriers contributing to delays in placing discharge orders. DESIGN This was a prospective, cross-sectional study. Physicians were surveyed at approximately 8:00 AM, 12:00 PM, and 3:00 PM and were asked to identify patients that were "definite" or "possible" discharges and to describe the specific barriers to writing discharge orders. SETTING This study was conducted at five hospitals in the United States. PARTICIPANTS The study participants were attending and housestaff physicians on general medicine services. PRIMARY OUTCOMES AND MEASURES Specific barriers to writing discharge orders were the primary outcomes; the secondary outcomes included discharge order time for high versus low team census, teaching versus nonteaching services, and rounding style. RESULTS Among 1,584 patient evaluations, the most common delays for patients identified as "definite" discharges (n = 949) were related to caring for other patients on the team or waiting to staff patients with attendings. The most common barriers for patients identified as "possible" discharges (n = 1,237) were awaiting patient improvement and for ancillary services to complete care. Discharge orders were written a median of 43-58 minutes earlier for patients on teams with a smaller versus larger census, on nonteaching versus teaching services, and when rounding on patients likely to be discharged first (all P < .003). CONCLUSIONS Discharge orders for patients ready for discharge are most commonly delayed because physicians are caring for other patients. Discharges of patients awaiting care completion are most commonly delayed because of imbalances between availability and demand for ancillary services. Team census, rounding style, and teaching teams affect discharge times.
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Affiliation(s)
- Jeff Zoucha
- Division of Hospital Medicine, Denver Health, Denver, Colorado, USA
- Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
| | - Madelyne Hull
- Department of Medicine, Denver Health, Denver, Colorado, USA
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
- Department of Medicine, Denver Health, Denver, Colorado, USA
| | - Katarzyna Mastalerz
- Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
- Presbyterian St-Luke's Medical Center, Denver, Colorado, USA
| | - Roswell Quinn
- University of California Los Angeles-Ronald Reagan, Los Angeles, California, USA
| | - Arnold Tsai
- Division of Geriatric, Hospital, Palliative and General Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Jacob Berman
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Jennifer Lyden
- Division of Hospital Medicine, Denver Health, Denver, Colorado, USA
- Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Sarah A Stella
- Division of Hospital Medicine, Denver Health, Denver, Colorado, USA
- Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
| | - Marisa Echaniz
- Division of Hospital Medicine, Denver Health, Denver, Colorado, USA
- Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
| | - Nicholas Scaletta
- Division of Hospital Medicine, Denver Health, Denver, Colorado, USA
- Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
| | - Karina Handoyo
- Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
- Presbyterian St-Luke's Medical Center, Denver, Colorado, USA
| | - Estebes Hernandez
- University of California Los Angeles-Ronald Reagan, Los Angeles, California, USA
| | - Inderpreet Saini
- University of California Los Angeles-Ronald Reagan, Los Angeles, California, USA
| | - Aneesah Smith
- Division of Geriatric, Hospital, Palliative and General Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Andrew Young
- Division of Geriatric, Hospital, Palliative and General Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Meghaan Walsh
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Mark Zaros
- University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Richard K Albert
- Department of Medicine, University of Colorado, Denver, Colorado, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA.
- Department of Medicine, University of Colorado, Denver, Colorado, USA
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Abstract
PURPOSE To identify the factors associated with total Hospital-Acquired Condition Reduction Program (HACRP) score and with receiving a Centers for Medicare and Medicaid Services (CMS) penalty (1% reduction in payment to those hospitals in the lowest-performing quartile of HACRP scores) for fiscal years (FYs) 2015-2017 with a particular focus on trends over this period. METHOD The authors evaluated the following variables: (1) type of hospital (teaching vs. nonteaching); (2) disproportionate patient percentage; (3) case mix index (CMI); (4) number of staffed beds; (5) length of stay (LOS); (6) gross patient revenue; and (7) region, using data from CMS and the American Hospital Directory. They conducted multivariate linear and logistic regressions. RESULTS A total of 2,249 hospitals were included. The mean total HACRP scores across hospitals for FY15, FY16, and FY17 were 5.38, 5.35, and 5.18, respectively. In FY15, 21.2% (476/2,249) of hospitals received a penalty compared with 22.6% (508/2,249) in FY16 and 31.3% (704/2,249) in FY17 (P < .001). The logistic regression model showed that teaching hospitals, larger hospitals (> 400 beds), hospitals with high CMI or long LOS, and hospitals in the Northeast and Western United States were more likely to receive a penalty. Teaching hospitals and larger hospitals did not improve their scores over time compared with nonteaching and small hospitals. CONCLUSIONS A reevaluation of the scoring methodology for the HACRP is needed. CMS could stratify hospitals into homogeneous categories and apply penalties to those that have the worst scores in each category.
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Affiliation(s)
- Mayar Al Mohajer
- M. Al Mohajer is associate professor of medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas. K.A. Joiner is professor of medicine and economics, Center for Management Innovations in Health Care, Eller College of Management, University of Arizona, Tucson, Arizona. D.E. Nix is professor of pharmacy, Department of Pharmacy Science and Practices, University of Arizona, Tucson, Arizona
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Seo HK, Hwang JH, Shin MJ, Kim SY, Song KH, Kim ES, Kim HB. Two-Year Hospital-Wide Surveillance of Central Line-Associated Bloodstream Infections in a Korean Hospital. J Korean Med Sci 2018; 33:e280. [PMID: 30402047 PMCID: PMC6209765 DOI: 10.3346/jkms.2018.33.e280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/13/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Surveillance and interventions of central line-associated bloodstream infections (CLABSIs) had mainly been targeted in intensive care units (ICUs). Central lines are increasingly used outside ICUs. Therefore, we performed a hospital-wide survey of CLABSIs to evaluate the current status and develop strategies to reduce CLBASI rates. METHODS All hospitalized patients with central venous catheters (CVCs) were screened for CLABSIs from January 2014 through December 2015 at a 1,328 bed tertiary care teaching hospital in Korea using an electronic data-collecting system. Clinical information including type of CVC was collected. CLABSI rates were calculated using the definitions of the National Health and Safety Network after excluding mucosal barrier injury laboratory-confirmed bloodstream infection (BSI). RESULTS A total of 154 CLABSIs were identified, of which 72 (46.8%) occurred in general wards and 82 (53.2%) in ICUs (0.81 and 2.71 per 1,000 catheter days), respectively. Non-tunneled CVCs were most common (68.6%) among 70 CLABSI events diagnosed within one week of their maintenance. On the other hand, tunneled CVCs and peripherally inserted central catheters (PICCs) were more common (60.5%) among 114 CLABSI events diagnosed more than a week after maintenance. Whereas the majority (72.2%) of CLABSIs in ICUs were associated with non-tunneled CVCs, tunneled CVCs (38.9%) and PICCs (36.8%) were more common in general wards. CONCLUSION CLABSIs are less common in general wards than in ICUs, but they are more often associated with long-term indwelling catheters. Therefore, interventions to prevent CLABSIs should be tailored according to the type of ward and type of catheter.
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Affiliation(s)
- Hye Kyung Seo
- Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joo-Hee Hwang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myoung Jin Shin
- Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Su young Kim
- Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eu Suk Kim
- Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Groves DK, Altieri MS, Sullivan B, Yang J, Talamini MA, Pryor AD. The Presence of an Advanced Gastrointestinal (GI)/Minimally Invasive Surgery (MIS) Fellowship Program Does Not Impact Short-Term Patient Outcomes Following Fundoplication or Esophagomyotomy. J Gastrointest Surg 2018; 22:1870-1880. [PMID: 29980972 DOI: 10.1007/s11605-018-3704-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/25/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The current surgical landscape reflects a continual trend towards sub-specialization, evidenced by an increasing number of US surgeons who pursue fellowship training after residency. Despite this growing trend, however, the effect of advanced gastrointestinal (GI)/minimally invasive surgery (MIS) fellowship programs on patient outcomes following foregut/esophageal operations remains unclear. This study looks at two representative foregut surgeries (laparoscopic fundoplication and esophagomyotomy) performed in New York State (NYS), comparing hospitals which do and do not possess a GI/MIS fellowship program, to examine the effect of such a program on perioperative outcomes. We also aimed to identify any patient or hospital factors which might influence perioperative outcomes. METHODS The SPARCS database was examined for all patients who underwent a foregut procedure (specifically, either an esophagomyotomy or a laparoscopic fundoplication) between 2012 and 2014. We compared the following outcomes between institutions with and without a GI/MIS fellowship program: 30-day readmission, hospital length of stay (LOS), and development of any major complication. RESULTS There were 3175 foregut procedures recorded from 2012 to 2014. Just below one third (n = 1041; 32.8%) were performed in hospitals possessing a GI/MIS fellowship program. Among our entire included study population, 154 patients (4.85%) had a single 30-day readmission, with no observed difference in readmission between hospitals with and without a GI/MIS fellowship program, even after controlling for potential confounding factors (p = 0.6406 and p = 0.2511, respectively). Additionally, when controlling for potential confounders, the presence/absence of a GI/MIS fellowship program was found to have no association with risk of having a major complication (p = 0.1163) or LOS (p = 0.7562). Our study revealed that postoperative outcomes were significantly influenced by patient race and payment method. Asians and Medicare patients had the highest risk of suffering a severe complication (10.00 and 7.44%; p = 0.0311 and p = 0.0036, respectively)-with race retaining significance even after adjusting for potential confounders (p = 0.0276). Asians and uninsured patients demonstrated the highest readmission rates (15.00 and 12.50%; p = 0.0129 and p = 0.0012, respectively)-with both race and payment method retaining significance after adjustment (p = 0.0362 and p = 0.0257, respectively). Lastly, payment method was significantly associated with postoperative LOS (p < 0.0001), with Medicaid patients experiencing the longest LOS (mean 3.99 days) and those with commercial insurance experiencing the shortest (mean 1.66 days), a relationship which retained significance even after adjusting for potential confounders (p < 0.0001). CONCLUSION The presence of a GI/MIS fellowship program does not impact short-term patient outcomes following laparoscopic fundoplication or esophagomyotomy (two representative foregut procedures). Presence of such a fellowship should not play a role in choosing a surgeon. Additionally, in these foregut procedures, patient race (particularly Asian race) and payment method were found to be independently associated with postoperative outcomes, including postoperative LOS.
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Affiliation(s)
- Donald K Groves
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University, Stony Brook, NY, USA.
| | - Maria S Altieri
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Brianne Sullivan
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Jie Yang
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Mark A Talamini
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Aurora D Pryor
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University, Stony Brook, NY, USA
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Shrestha B, Dixit SM. The Assessment of Drug Use Pattern Using WHO Prescribing Indicators. J Nepal Health Res Counc 2018; 16:279-284. [PMID: 30455486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND In order to promote rational drug use in developing countries, assessment of drug use pattern using the World Health Organization drug use indicators is important. The aim of this study was to assess the drug prescription patterns at Kathmandu Medical College Teaching Hospital, using some of the World Health Organization core drug use indicators. METHODS A prospective cross-sectional study was carried out in order to determine current prescribing trends at Kathmandu Medical College Teaching Hospital. A total of 605 prescriptions were collected and analyzed in the study. RESULTS The average number of drugs per prescription was 5.85 considering the total amount of prescriptions. Furthermore, assuming each prescription as an individual patient, 64.1% of patients received antibiotics, and 71% of patients received injectable form of drugs. Among antibiotics the most common antibiotics prescribed were Ceftriaxone, Amoxicillin/Cloxacillin, Azithromycin, Cefixime, and Cloxacillin. Only 16.94% of the medicines were prescribed in generic names with the rest 83.06% of the medicines being prescribed in brand names and 47.55% of medicines prescribed were from the National List of Essential Medicines-Nepal. CONCLUSIONS The current study revealed that polypharmacy and prescription writing using brand names were common. Prescriptions writing in generic name needs to be promoted and encouraged. There appears to be a crucial need for the development of prescribing guidelines when it comes to antibiotics.
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Affiliation(s)
- Binaya Shrestha
- Department of Pharmacology, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Sanjaya Mani Dixit
- Department of Pharmacology, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Al-Amad SH. Prevalence of hepatitis B, C, and HIV among patients attending a teaching dental hospital. A 7-year retrospective study from the United Arab Emirates. Saudi Med J 2018; 39:500-505. [PMID: 29738011 PMCID: PMC6118177 DOI: 10.15537/smj.2018.5.22116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objectives To determine the seroprevalence and case characteristics of hepatitis B, C and human immunodeficiency virus (HIV), and their transmissibility from patients to dental personnel following percutaneous and mucocutaneous injuries. Methods All incidents of sharp and splash injuries reported between January 2010 and January 2017 were retrospectively reviewed and analyzed. Descriptive statistics were calculated using the Statistical Package for the Social Science (SPSS). Prevalence was calculated as percentages, and chi-square test was used to assess categorical variables where a p-value of ≤0.05 was considered significant. Results Among the 436 reported incidents, 372 patients underwent serological screening. Fourteen patients (3.8%) had antibodies against hepatitis C virus, and 8 patients (2.2%) were positive for hepatitis B surface antigens. All positive cases were clinically asymptomatic. There were no positive cases for HIV. Three of the 14 hepatitis C positive patients were actively infectious upon polymerase chain reaction (PCR) analysis, but none of the injured dental personnel seroconverted upon a 6-month follow up. Approximately 88% of dental personnel were vaccinated against hepatitis B. Female personnel showed better vaccination rate by comparison to male personnel (p=0.005). Among the 5 different categories of professional status, cleaners showed a significantly low hepatitis B vaccination rate (p<0.000). Conclusion The prevalence of hepatitis B and C is higher than that previously reported from the United Arab Emirates, but transmissibility of viral hepatitis seems to be negligible.
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Affiliation(s)
- Suhail H Al-Amad
- College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates. E-mail.
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Nisbet AI, Omuse G, Revathi G, Adam RD. Seroprevalence data at a private teaching hospital in Kenya: An examination of Toxoplasma gondii, cytomegalovirus, rubella, hepatitis A, and Entamoeba histolytica. PLoS One 2018; 13:e0204867. [PMID: 30325924 PMCID: PMC6191086 DOI: 10.1371/journal.pone.0204867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 09/14/2018] [Indexed: 12/24/2022] Open
Abstract
Background Relevant seroprevalence data for endemic pathogens in a given region provide insight not only into a population’s susceptibility to acute infection or risk for reactivation disease but also into the potential need for policy initiatives aimed at reducing these risks. Data from sub-Saharan Africa are sparse and since Aga Khan University Hospital Nairobi is an internationally accredited hospital equipped with a laboratory electronic medical record system, analysis of pertinent local seroprevalence data has been made possible. Methods We have analyzed serology data from laboratory electronic records at a 300 bed tertiary private teaching hospital in Kenya for the dates, 2008 to 2017 for Toxoplasma gondii, cytomegalovirus, and rubella, which were used primarily for antenatal screening. We also analyzed the data from hepatitis A and amebiasis serologies, which were used primarily for diagnostic purposes. Results For T. gondii, cytomegalovirus, and rubella, we used IgG serology to determine seroprevalence, finding rates of 32%, 86%, and 89%, respectively. There was no significant age-related difference in the 20 to 49 year old age range for any of these three pathogens. Of the Hepatitis A IgM tests that were ordered, 33% were positive with a peak positive rate of 70% in the five to nine year old age range. The seroprevalence of amebiasis was 4% and all cases of seropositivity were accompanied by compatible clinical illness (hepatic abscess). Conclusions These data provide insight into seroprevalence rates of selected pathogens that can be used to guide screening and diagnostic laboratory testing as well as private and public immunization practices.
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Affiliation(s)
- Audrey I. Nisbet
- University of Arizona College of Medicine, Tucson, Arizona, United States of America
| | - Geoffrey Omuse
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Gunturu Revathi
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Rodney D. Adam
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
- Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
- * E-mail:
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Merhabene T, Blel F, Jamoussi A, Ayed S, Ben Khelil J, Besbes M. Extent and pattern of intensive care unit refusal in Tunisian 3rd line hospitals. Tunis Med 2018; 96:746-753. [PMID: 30746668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Rationing in intensive care unit (ICU) beds is common and can leads to admission refusal. Understanding factors involved in triage practices is the first step towards an ethically optimal decision-making process. AIM To identify determinants and patients' characteristics associated with decisions to deny ICU admission. METHODS This prospective observational study was conducted in AbderrahmeneMami Hospital's medical ICU, in Ariana, between 1st January and 31th December 2016. No predefined admission criteria were determined. All consecutive patients referred to ICU for admission during the study period were included. Two groups were defined GI: Admitted patients and GII: Refused patients. The reasons for refusal were categorized as follows: full unit, necessity of reorientation, patient too well to benefit, patient too sick to benefit and patient or family refusal. RESULTS During the study period, ICU admission was requested for 1081 patients of whom 491 (45.4%) were refused. Logistic regression identified factors positively associated with ICU refusal. A surgical status (AOR 15,80 ; IC95% 1,34-186,17 ; p=0,028), was found to be the main factor, followed by cardiopulmonary arrest (AOR 5,91 ; IC 95% 2,54-13,76 ; p<0,001) and hematologic malignancies (AOR 2,82 ; IC 95% 1,32-6,02 ; p=0,007). In contrast, other factors were shown to be negatively associated with ICU refusal; it was essentially ICU admission requested from our hospital (AOR 0,06; IC 95% 0,04-0,08 ; p<0,001). Full unit was the predominant reason for refusal (76.2%). CONCLUSION Our study confirms that ICU refusal is common. It depends on both organizational and patient-related factors.
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Salim M, Hamid S. Independent Review Of Research Proposals From Ethical Point Of View In Pakistan. J Ayub Med Coll Abbottabad 2018; 30:588-591. [PMID: 30632343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Ethics is a part of subject philosophy and gained importance in research after the Nuremberg Code that led to Helsinki's Declaration on research ethics. In most developed countries stringent measures are taken to implement ethics in research. Awareness is on the rise in developing countries too. METHODS This cross-sectional part of mixed methods design of study is part of a PhD thesis. Data was collected from medical institutions including medical colleges, medical universities, dental colleges, and teaching hospitals of Pakistan. Questionnaires were developed, and final version was adopted after pretesting. Questionnaires were sent via registered post. RESULTS A total of 78 institutions responded. Out of 78, 48 (61.5%) were in public sector and 30(38.5%) in private sector. Seventy-four (94%) had institutional review boards. The numbers of members ranged from 1 to 15 with 40(54%) having number of members from 3 to 7. Out of 74 with IRBs, 17(23%) had members from community, 11(15%) had religious scholars and 8(11%) had members from legal background. Sixty-four (86.5%) responded that they had time frames for research proposal processing that ranged from one to 26 weeks (6.2±5.6). CONCLUSIONS It is concluded that most of the medical institutions where research is conducted and approved through deficient research ethical boards in terms of their constitution. Research ethics is not a priority area for most of the institutions. Representation of society at large is missing. National action is required at government level.
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Abstract
Hospitalists responsible for specific inpatients may change during their hospitalization. To measure the association of hospitalist continuity with the adjusted daily discharge probability, 6,405 admissions (38,967 patientdays, 5,208 patients) to a general medicine service at a tertiary care teaching hospital in 2015 were investigated. Continuity was measured as the consecutive number of days-including weekends-a hospitalist treated a particular team of patients. After accounting for important covariables, discharge probability increased significantly with hospitalist continuity; the adjusted daily discharge probabilities for an average patient with a new physician vs. one on service for 4 continuous weeks were 18.1% and 25.7%, respectively (P < .001). Hospitalist continuity did not influence hospital mortality. Increasing hospitalist continuity could decrease hospital length of stay.
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Affiliation(s)
- Carl van Walraven
- Professor of Medicine and Epidemiology & Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Cho HE, Zhong L, Kotsis SV, Chung KC. Finger Replantation Optimization Study (FRONT): Update on National Trends. J Hand Surg Am 2018; 43:903-912.e1. [PMID: 30286850 PMCID: PMC6176738 DOI: 10.1016/j.jhsa.2018.07.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Traumatic digit amputations have an adverse impact on patients' daily living. Despite experts advocating for digit replantation, studies have shown a continued decrease in rate of replantation. We performed a national-level investigation to examine the recent trend of practice for digital replantation. METHODS We used the National Inpatient Sample database under the Healthcare Cost and Utilization Project to select adult patients with traumatic digit amputation from 2001 to 2014. We calculated the rate of attempted and rate of successful digit replantation per year, subcategorizing for digit type (thumb or finger) and for hospital type (rural, urban nonteaching, or urban teaching). We also analyzed the pattern of distribution of case volume to each hospital type per year. We used 2 multivariable logistic regression models to investigate patient demographic and hospital characteristics associated with the odds of replantation attempt and success. RESULTS Among the 14,872 adult patients with a single digit amputation from 2001 to 2014, only 1,670 (11.2%) underwent replantation. The rate of replantation attempt trended down over the years for both thumb and finger injuries at all hospital types, despite increasing proportions of cases being sent to urban teaching hospitals where they were more than twice as likely to undergo replantation. The rate of successful replantation stayed stable for the thumb at 82.9% and increased for fingers from 76.1% to 82.4% over the years. Patients were more likely to undergo replantation if they had private insurance or a higher level of income. Neither hospital case volume nor hospital type was predictive of successful replantation. CONCLUSIONS Although more single-digit amputations were treated by urban teaching hospitals with higher likelihood to replant, the downward trend in rate of attempt regardless of hospital type demonstrates that concentration of case volume is not the solution to reverse the declining trend. CLINICAL RELEVANCE Financial aspects of digit replantation need to be considered from both the patients' and the surgeons' perspectives to improve delivery of care for digit replantation.
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Affiliation(s)
- Hoyune E Cho
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Lin Zhong
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Sandra V Kotsis
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI.
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Chough I, Zaghiyan K, Ovsepyan G, Fleshner P. Practice Changes in Postoperative Feeding after Elective Colorectal Surgery: From Prospective Randomized Study to Everyday Practice. Am Surg 2018; 84:1675-1678. [PMID: 30747693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Early postoperative feeding is the standard of care after colorectal surgery and is associated with improved outcomes. A controlled study performed at our center demonstrated faster bowel function recovery and shorter hospital stay without an increase in postoperative morbidity for a solid versus clear-liquid diet on postoperative day (POD) 1 after colorectal surgery. The present study aims to evaluate the impact of these findings on the practice of diet advancement by board-certified general surgeons (GS) and colorectal surgeons (CRS) at an urban teaching hospital. Patients undergoing elective colorectal surgery were prospectively evaluated. Data were compared with that of a study cohort that underwent elective colorectal surgery reported in 2012. Early postoperative feeding in the more recent cohort statistically increased for all cases on POD 0 and POD 1. Diet advancement over time revealed significant changes in early feeding on POD 0 for patients operated on by CRS (0% vs 83%; P < 0.0001) but not GS (13% vs 13%; P = 1). Patients operated on by either CRS or GS and offered early feeding on POD 1 did not significantly differ between time periods. Despite well-documented evidence of the advantages of early feeding, GS, but not CRS, remain reluctant to administer early diets to patients after colorectal surgery.
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Affiliation(s)
- Ino Chough
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Richardson T, Rodean J, Harris M, Berry J, Gay JC, Hall M. Development of Hospitalization Resource Intensity Scores for Kids (H-RISK) and Comparison across Pediatric Populations. J Hosp Med 2018; 13:602-608. [PMID: 29694460 DOI: 10.12788/jhm.2948] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In the Medicare population, measures of relative severity of illness (SOI) for hospitalized patents have been used in prospective payment models. Similar measures for pediatric populations have not been fully developed. OBJECTIVE To develop hospitalization resource intensity scores for kids (H-RISK) using pediatric relative weights (RWs) for SOI and to compare hospital types on case-mix index (CMI). DESIGN/METHODS Using the 2012 Kids' Inpatient Database (KID), we developed RWs for each All Patient Refined Diagnosis Related Group (APR-DRG) and SOI level. RW corresponded to the ratio of the adjusted mean cost for discharges in an APR-DRG SOI combination over adjusted mean cost of all discharges in the dataset. RWs were applied to every discharge from 3,117 hospitals in the database with at least 20 discharges. RWs were then averaged at the hospital level to provide each hospital's CMI. CMIs were compared by hospital type using Kruskal- Wallis tests. RESULTS The overall adjusted mean cost of weighted discharges in Healthcare Cost and Utilization Project KID 2012 was $6,135 per discharge. Solid organ and bone marrow transplantations represented 4 of the 10 highest procedural RWs (range: 35.5 to 91.7). Neonatal APRDRG SOIs accounted for 8 of the 10 highest medical RWs (range: 19.0 to 32.5). Free-standing children's hospitals yielded the highest median (interquartile range [IQR]) CMI (2.7 [2.2-3.1]), followed by urban teaching hospitals (1.8 [1.3-2.6]), urban nonteaching hospitals (1.1 [0.9-1.5]), and rural hospitals (0.8 [0.7-0.9]; P < .001). CONCLUSIONS H-RISK for populations of pediatric admissions are sensitive to detection of substantial differences in SOI by hospital type.
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Affiliation(s)
- Troy Richardson
- Children's Hospital Association, Lenexa, Kansas and Washington, DC, USA.
| | - Jonathan Rodean
- Children's Hospital Association, Lenexa, Kansas and Washington, DC, USA
| | - Mitch Harris
- Children's Hospital Association, Lenexa, Kansas and Washington, DC, USA
| | - Jay Berry
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - James C Gay
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas and Washington, DC, USA
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Vafaee-Najar A, Amiresmaeili M, Nekoei-Moghadam M, Tabatabaee SS. The design of an estimation norm to assess nurses required for educational and non-educational hospitals using workload indicators of staffing need in Iran. Hum Resour Health 2018; 16:42. [PMID: 30139364 PMCID: PMC6107950 DOI: 10.1186/s12960-018-0309-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 08/14/2018] [Indexed: 05/14/2023]
Abstract
BACKGROUND One of the effective strategies in the fair distribution of human resources is the use of estimation norm of human workforce. A norm is a coefficient or an indicator for estimating the required human resources in an organization. Due to the changes in the available working hours of nurses in recent years and to use of a standard method, the Iranian Ministry of Health decided to update nursing estimation norm in hospitals in 2014-2015. This study aimed to design a nurse-required estimation norm for educational and non-educational hospitals based on the workload indicator in Iran. METHODS This was a descriptive cross-sectional study, carried out from December 2015 to November 2016 in 49 wards in 12 educational and 17 non-educational hospitals in Mashhad, Iran. The wards and hospitals who had the best performance in nursing care quality indicators were selected. Focus group, work study, consensus, interview, and reviewing documents, staff and patient records, and the calculations of modified Workload Indicators of Staffing Needs (WISN) were used to collect the data. RESULTS Patient care, cardiopulmonary resuscitation, and transfer out of the hospital were identified as the main activities of holding focus groups. Interviews and reviewing documents led to the identification of 10 factors associated with nurses' available working time. In both educational and non-educational hospitals, the annual working time of all nurses except nurses working in the burn and psychiatric, burn ICU, and pediatric psychiatry wards, which was 1302 h per year, was 1411 h per year. The calculations of the modified WISN method showed that the lowest norm in educational hospitals was for psychiatric, eye surgery, and dermatology wards (0.53) and in non-educational hospitals was for ENT ward (0.57). The highest norm in educational and non-educational hospitals was for burn ICU (3.95) and general ICU (3.07) wards, respectively. CONCLUSION The nursing estimation norm in different wards of the hospital varies, considering that the time available to nurses and their workload in different wards and hospitals are different, and each ward has its special norm therefore, a single norm for all wards and hospitals cannot be used for a fair distribution of nurses.
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Affiliation(s)
- Ali Vafaee-Najar
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammadreza Amiresmaeili
- Department of Health Management, Policy and Economic, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahmoud Nekoei-Moghadam
- Department of Health Management, Policy and Economic, Research Center for Health Services Management, Kerman University of Medical Sciences, Kerman, Iran
| | - Seyed Saeed Tabatabaee
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Gudina EK, Tesfaye M, Wieser A, Pfister HW, Klein M. Outcome of patients with acute bacterial meningitis in a teaching hospital in Ethiopia: A prospective study. PLoS One 2018; 13:e0200067. [PMID: 30020952 PMCID: PMC6051621 DOI: 10.1371/journal.pone.0200067] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 06/19/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The mortality and neurologic sequelae associated with acute bacterial meningitis (ABM) remain high despite advances in medical care. The main aim of this study was to evaluate short-term outcome in patients treated as bacterial meningitis at a teaching hospital in Ethiopia to identify factors that could be focused on to improve outcome in this setting. METHODS A hospital based longitudinal study was conducted at Jimma University Hospital in southwest Ethiopia from March 1, 2013 to December 31, 2015. Participants of this study were patients of age 18 years and older who were treated as confirmed or possible cases of ABM. Patients were followed throughout their hospital stay for change in their clinical course and predefined end points. A multivariable analysis was done to identify factors associated with unfavorable outcomes. RESULT 90 patients admitted with diagnosis of acute bacterial meningitis were included in the study; cerebrospinal fluid was analysed for 85 (94.4%) of them. Causative bacteria were isolated in 26 (28.9%) patients only; most of these isolates (84.6%) were either Streptococcus pneumoniae or Neisseria meningitidis. Patients managed as cases of ABM at the hospital suffered from a high rate of unfavorable outcome (36.7%) and an overall mortality rate of 22.2%. Impaired level of consciousness (AOR = 0.766, 95% CI = 0.589-0.995), dexamethasone therapy (AOR = 4.676, 95% CI = 1.12-19.50) and fever persisting after two days of admission (AOR = 24.226, 95% CI = 5.24-111.96) were found to be independently associated with unfavorable outcome. CONCLUSION Outcome in patients treated for ABM at the hospital was found to be poor. Impaired mentation, treatment with adjunctive dexamethasone and persistent fever were found to be associated with poor outcome. Thus, development of clinical guidelines for treatment of ABM that suit the local context is essential to improve patient management and outcome.
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Affiliation(s)
- Esayas Kebede Gudina
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
- Centre for International Health, Ludwig-Maximilians-University, Munich, Germany
| | - Markos Tesfaye
- Centre for International Health, Ludwig-Maximilians-University, Munich, Germany
- Department of Psychiatry, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Andreas Wieser
- Department of Bacteriology, Max von Pettenkofer Institute, Ludwig-Maximilians-University, Munich, Germany
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Ludwig-Maximilians-University, Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Hans-Walter Pfister
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
| | - Matthias Klein
- Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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98
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Bao Z, Ji C, Hu J, Luo C, Fang W. Clinical and economic impact of pharmacist interventions on sampled outpatient prescriptions in a Chinese teaching hospital. BMC Health Serv Res 2018; 18:519. [PMID: 29973200 PMCID: PMC6031100 DOI: 10.1186/s12913-018-3306-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limited studies have evaluated the effectiveness of pharmacist interventions on outpatient prescription. The goal of this study was to evaluate the clinical and economic impacts of pharmacist interventions on randomly sampled outpatient prescriptions. METHOD Outpatient prescriptions of our hospital were sampled automatically and reviewed by pharmacists since 2011. Pharmacists intervened in inappropriate prescriptions (IPs) real-timely, and summarized and analyzed the information monthly. Cost-benefit analysis was performed to estimate the economic benefit of the pharmacist intervention. RESULTS From 2011 to 2016, pharmacists reviewed 101,271 prescriptions and intervened in 5155 prescriptions. With the interventions of pharmacists, the number of IPs decreased from 1845 to 238, while the inappropriate percentage decreased from 12.60 to 1.22%. The inappropriate rates of different departments and the types decreased annually. IPs were mainly from the Department of Medicine and Department of Surgery and category 1 (Non-indicated medications) in all years. The benefit-to-cost ratios of pharmacist interventions were always more than 1. In the same years, the benefit-to-cost ratios in public payments were higher than those with insurance and self-payment. CONCLUSION This form of pharmacist intervention constitutes a method that showed positive clinical and economic benefits and is worth expanding in large hospitals. Pharmacists should pay more attention on prescriptions in department of surgery or prescriptions with public payments.
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Affiliation(s)
- Zhiwei Bao
- Department of Pharmacy, Jiangsu Jianhu People’s Hospital, Yancheng, 224700 China
| | - Chunmei Ji
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
| | - Jing Hu
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
| | - Can Luo
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
| | - Wentong Fang
- Department of Pharmacy, First Affiliated Hospital of Nanjing Medical University, No 300 Guangzhou Road, Nanjing City, Jiangsu Province 210029 People’s Republic of China
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99
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Braga PR, Cruz IL, Ortiz I, Barreiros G, Nouér SA, Nucci M. Secular trends of candidemia at a Brazilian tertiary care teaching hospital. Braz J Infect Dis 2018; 22:273-277. [PMID: 30118654 PMCID: PMC9427822 DOI: 10.1016/j.bjid.2018.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Paula Rocha Braga
- Universidade Federal do Rio de Janeiro, Hospital Universitário, Rio de Janeiro, RJ, Brazil
| | - Isabela L Cruz
- Universidade Federal do Rio de Janeiro, Hospital Universitário, Rio de Janeiro, RJ, Brazil
| | - Isadora Ortiz
- Universidade Federal do Rio de Janeiro, Hospital Universitário, Rio de Janeiro, RJ, Brazil
| | - Gloria Barreiros
- Universidade Federal do Rio de Janeiro, Hospital Universitário, Rio de Janeiro, RJ, Brazil
| | - Simone A Nouér
- Universidade Federal do Rio de Janeiro, Hospital Universitário, Rio de Janeiro, RJ, Brazil
| | - Marcio Nucci
- Universidade Federal do Rio de Janeiro, Hospital Universitário, Rio de Janeiro, RJ, Brazil.
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100
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Richardson SK, Grainger PC, Ardagh MW, Morrison R. Violence and aggression in the emergency department is under-reported and under-appreciated. N Z Med J 2018; 131:50-58. [PMID: 29879726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To examine levels of reporting of violence and aggression within a tertiary level emergency department in New Zealand, and to explore staff attitudes to violence and reporting. METHOD A one-month intensive, prospective audit of the emergency department's violence and aggression reporting was undertaken and compared with previously reported data. RESULTS There was a significant mismatch between the number of events identified during the campaign month and previously reported instances of violence and aggression. The findings identified that failure to report acts of violence was common. CONCLUSIONS Reports of violence and aggression in the emergency department underestimate the true incidence. Failure to report has potential impacts on organisational recognition of risk and the ability to develop appropriate policy responses.
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Affiliation(s)
- Sandra K Richardson
- Nurse Researcher, Emergency Department, Christchurch Hospital, Canterbury District Health Board, Christchurch; Senior Lecturer, Centre for Postgraduate Nursing Studies, University of Otago
| | - Paula C Grainger
- Nurse Coordinator Clinical Projects, Emergency Department, Christchurch Hospital, Canterbury District Health Board, Christchurch
| | - Michael W Ardagh
- Professor of Emergency Medicine, University of Otago, Christchurch; Emergency Medicine Physician, Emergency Department, Christchurch Hospital, Canterbury District Health Board, Christchurch
| | - Russell Morrison
- Injury Management Co-ordinator, Canterbury District Health Board, Christchurch
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