Incidence of hospital-acquired pressure injuries and predictors of severity in a paediatric hospital

BACKGROUND

Hospital-acquired pressure injuries (HAPIs) pose significant challenges in healthcare and cause increased patient suffering, longer hospital stays, and higher healthcare costs. Paediatric patients face unique risks, but evidence remains scarce. This study aimed to identify and describe HAPI admission incidence and severity predictors in a large Australian children's hospital.

METHODS

This retrospective cohort study investigated all paediatric patients between January 2020 and December 2021 using a census approach. Demographic and clinical data including HAPI-related data were accessed from the incident monitoring and hospital administration databases. The incidence rate (per 1000 patient admissions) was calculated based on all admissions. Predictors of HAPI severity were identified using multivariable multinomial logistic regression. The study adhered to the STROBE guidelines for retrospective cohort studies.

RESULTS

The HAPI incidence rate was 6.96 per 1000 patient admissions. Of the age groups, neonates had the highest HAPI incidence (15.5 per 1000 admissions). Critically ill children had the highest rate for admission location (12.8 per 1000 patient admissions). Most reported cases were stage I (64.2%). Age was associated with injury severity, with older paediatric patients more likely to develop higher-stage HAPIs. Additionally, Aboriginal and/or Torres Strait Islander patients had a higher HAPI severity risk.

CONCLUSION

HAPI injuries in paediatric patients are unacceptably high. Prevention should be prioritized, and the quality of care improved in Australia and beyond. Further research is needed to develop targeted prevention strategies for these vulnerable populations.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This research emphasizes the need for standardized reporting, culturally sensitive care and tailored prevention strategies.

IMPACT

The research has the potential to influence healthcare policies and practices, ultimately enhancing the quality of patient care.

REPORTING METHOD

STROBE guidelines.

NO PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution to the conduct of this study.

Evaluation of antibiotic prescription patterns using WHO AWaRe classification

Background

Antimicrobial resistance is a rising problem worldwide and it poses a serious risk to public health. In Pakistan, about 70.0% of the Acinetobacter group of bacteria were resistant to all antibiotics and were responsible for high mortality among neonates within the first week of life.

Aim

To evaluate the pattern of antibiotic prescription in the Ear, Nose and Throat (ENT) Department of Shalamar Hospital, Lahore, Pakistan, using the WHO AWaRe 2021 classification.

Methods

We collected prescription data from the ENT outpatient department of Shalamar Hospital from October to December 2021. We compared the quantitative analysis of antibiotics with the WHO AWaRe classification. We analysed the data using SPSS version 26 and discussed the results with the ENT Department for possible improvements.

Results

Some 862 (12.1%) of the total 7126 entries were assessed. Others were excluded because they had some missing data or had no antibiotic prescription. Of all the antibiotics prescribed, around 54.9% belonged to the access category. The WHO 13th General Programme of Work 2019-2023 recommends a country-level target of at least 60% of the total antibiotic consumption in the access group antibiotics.

Conclusion

The outpatient department of the ENT did not prescribe any reserve or not recommended antibiotics. The use of watch antibiotics was higher than recommended by the WHO AWaRe classification. More efforts should be made to increase prescriptions from the AWaRe access group to achieve the 60% minimum target recommended by WHO for the country.

Perioperative care to patients living with HIV by theatre nurses at a South African tertiary hospital

Background

Human Immunodeficiency Virus (HIV) is one of the leading health challenges worldwide that influences the provision of quality patient care. Stigma and discrimination around this condition and the health care needs affect the health care provision. This study aimed to gain an in-depth understanding of theatre nurses' experiences in providing perioperative care to patients living with HIV at a tertiary hospital in South Africa.

Methods

This study was conducted at a tertiary hospital in Tshwane district, South Africa. The study was underpinned by an interpretative phenomenological analysis design. Data were collected from 10 criterion purposively selected theatre nurses using in-depth individual interviews. Data were thematically analyzed and guided by an interpretive phenomenological analysis framework for data analysis.

Results

The study revealed that theatre nurses work in an under-resourced environment. The resources highlighted are human, materials, including personal protective equipment and life support. The situation negatively affects the perioperative care of HIV-positive patients, who are always prone to perioperative complications, such as profuse bleeding, and even death. The situation increases the occupational risk to the nurses.

Conclusions

The researchers proposed several recommendations targeted at improving the resources needed by theatre nurses when caring for people living with HIV perioperatively at South African tertiary hospitals. Findings will add to the body of knowledge of the Nursing profession about offering perioperative care to persons living with HIV.

Registered nurses' knowledge and practice of preoperative fasting and medication administration

Background

Knowledge of fasting or Nil Per Os (NPO) guidelines is an essential component of nursing care in the preoperative period.

Aim

To describe registered nurses' (RNs) knowledge and management of the preoperative NPO period.

Setting

Selected surgical wards in a tertiary hospital in the Western Cape, South Africa.

Methods

Quantitative descriptive, cross-sectional study utilising a structured questionnaire. The population consisted of RNs working in selected surgical wards. Convenience sampling was used and adequate knowledge was determined as ≥ 90%.

Results

The response rate was 100%. Of the 68 participants, 48 (70.6%) held a diploma and 20 (29.4%) held a degree as the highest academic qualification achieved. Sixty-one (89.7%) participants knew the correct reason for keeping patients NPO. Sixty-five (95.6%) knew the correct answer for the NPO time for solids while only 27 (39.7%) knew the correct answer for clear fluids. Only 30 (44.1%), 26 (38.2%) and 33 (48.5%) participants, respectively, answered the questions about oral analgesia, oral antibiotics and chronic medication administration during the NPO period correctly. Significantly more degree participants knew the correct answer for the fasting time for non-human milk (p = 0.005) and more diploma participants would administer chronic medication during the NPO period (p = 0.037).

Conclusion

Inadequate knowledge of NPO times for various fluids and unsatisfactory practice of medication administration for oral and chronic medication require attention.

Contribution

This study highlights the importance that ongoing education is needed to ensure that patients receive the most up-to-date evidence-based care during the NPO period.

Clinical characteristics and risk factors analysis of 505 cases of infusion reactions in a tertiary hospital

Background: The clinical characteristics and risk factors of infusion reactions (IRs) are inadequately described in clinical practice due to underreported cases. In the present study, we reported the current status of IRs based on an in-hospital pharmacovigilance database of a tertiary care hospital. Methods: Our study conducted a retrospective analysis of drug-induced IRs recorded at an in-hospital pharmacovigilance center between January 2015 to December 2019. The descriptive statistical analysis encompassed main causative agents, clinical manifestations, organ/system involvement and outcome. The severity of IRs was assessed with reference to the CTCAE version 5.0 criteria and we investigated risk factors associated with severe IRs. Results: During the study period, a total of 505 cases of inpatient drug-induced IRs were detected, of which 79.2% (400 cases) were classified as general IRs and 20.8% (105 cases) were categorized as severe IRs. The primary drugs responsible for these reactions were antibiotics (23%, 116 cases), with piperacillin sodium-sulbactam sodium being the most prevalent, followed by antineoplastic agents (18.4%, 93 cases) and traditional Chinese medicine injections (TCMIs) (12.9%, 65 cases). The administration of cefoperazone - sulbactam, mannatide, Shenqi Fuzheng, elemene, and diterpene ginkgolides meglumine resulted in a higher incidence of critical IRs. Among all cases of IRs, 43.2%, 41.2%, and 23.4% showed signs and symptoms of circulation, skin mucosa, and respiratory organs/systems, respectively. 9.1% of cases experienced systemic damage, while 7.1% and 5.9% of cases reported neurological and gastrointestinal related adverse reactions, respectively. The multivariate analysis revealed that alcohol consumption (OR = 2.389%, 95% CI 1.141-5.002, p = 0.021), age over 65 (OR = 1.814%, 95% CI 1.052-3.127, p = 0.032) and the utilization of contrast media (OR = 4.072%, 95% CI 1.903-8.713, p < 0.001) were identified as risk factors for the development of severe IRs. Conclusion: Understanding the clinical characteristics of IRs helps to implement effective pharmaceutical monitoring and appropriate preventive measures for susceptible populations with risk factors.

The influence of the merger process between two tertiary hospitals in Romania on job satisfaction among staff

Aim

The purpose of this study is to evaluate the influence of the merger process of two tertiary hospitals located in the northwest of Romania on the professional satisfaction among medical and non-medical staff and to develop a standardized satisfaction questionnaire for romanian hospitals.

Methods

1750 questionnaires distributed within County Clinical Emergency Hospital Bihor (CCEHBh) ten months and one year and four months after the merger process were analyzed.

Results

The percentage of staff who declare themselves satisfied with their work one year and four months after the merger is 80.14%. It has a downward trend compared to the result measured 10 months after the merger (86.14%) (χ2 test, p < 0.01). The aspects that were rated with the lowest percentage as satisfactory were the possibility of promotion (41.89%) and job security (53.38%). A statistically significant decrease was also recorded in the assessment of career prospects (from 81.49% to 74.73%, χ2 test, p < 0.0001).

Conclusions

Even if there was a decrease in job satisfaction between the two evaluated periods, we can state that the general level at the last measurement is a good one (4.07 out of a maximum of 5). There was no significant difference in job satisfaction 1 year and 4 months after the merger for staff in the merged unit (4.06) compared to staff in the absorbing unit (4.09). The questionnaire applied in 2023 is one that has proven validity and reliability, being a good starting point for creating a standardized questionnaire that could be implemented in the vast majority of hospitals in Romania. The application of the questionnaire at an interval of 3-6 months would highlight the result of the implemented measures and the trend of employee satisfaction within CCEHBh.

Variables related to bronchopulmonary dysplasia severity: a Six-Year retrospective study

OBJECTIVES

This was a retrospective observational study conducted in a tertiary neonatal intensive care unit, in order to investigate factors which influenced the severity of bronchopulmonary dysplasia under NICHD new classification.

METHODS

Six years of clinical data with different grades of bronchopulmonary dysplasia patients were collected and analyzed, bivariate ordinal logistic regression model and multivariable ordinal logistic regression model were used with sensitivity analyses.

RESULTS

We identified seven variables were associated with the severity of BPD via a bivariate ordinal logistic regression model, including the level of referral hospital (OR 0.273；95% CI 0.117, 0.636), method of caffeine administration (OR 00.418；95% CI 0.177, 0.991), more than two occurrences of reintubation (OR 4.925；95% CI 1.878, 12.915), CPAP reapplication (OR 2.255；95% CI 1.059, 4.802), presence of positive sputum cultures (OR 2.574；95% CI 1.200, 5.519), the cumulative duration of invasive ventilation (OR 1.047；95% CI 1.017, 1.078), and postmenstrual age at the discontinuation of oxygen supplementation (OR 1.190；95% CI 1.027, 1.38). These seven variables were further analyzed via all multivariable ordinal logistic regression models, and we found that tertiary hospital birth and early administration of caffeine could reduce the severity of BPD by approximately 70% (OR 0.263；95% CI 0.090, 0.770) and 60% (OR 0.371；95% CI 0.138, 0.995), respectively. In contrast, multiple reintubations were related to higher BPD severity with an OR of 3.358 (95% CI 1.002, 11.252).

CONCLUSION

Improving perinatal care in level II hospitals, standardized caffeine administration, and optimized extubation strategy could potentially decrease the severity of BPD.

Perceived barriers and facilitators to preventing hospital-acquired pressure injury in paediatrics: A qualitative analysis

AIM

This qualitative study aimed to identify nurses' and allied health professionals' perceptions and experiences of providing hospital-acquired pressure injury (HAPI) prevention in a paediatric tertiary hospital in Australia, as well as understand the perceived barriers and facilitators to preventing HAPI.

DESIGN

A qualitative, exploratory study of hospital professionals was undertaken using semi-structured interviews between February 2022 and January 2023.

METHODS

Two frameworks, the Capability, Opportunity and Motivation Model of Behaviour (COM-B) and the Theoretical Domains Framework (TDF), were used to give both theoretical and pragmatic guidance. Participants included 19 nursing and allied health professionals and data analysis was informed by the framework approach.

RESULTS

Analysis revealed nine core themes regarding professionals' beliefs about the barriers and facilitators to HAPI prevention practices across seven TDF domains. Themes included HAPI prevention skills and education, family-centred care, automated feedback and prompts, allocation and access to equipment, everybody's responsibility, prioritizing patients and clinical demands, organizational expectations and support, integrating theory and reality in practice and emotional influence.

CONCLUSION

These findings provide valuable insights into the barriers and facilitators that impact paediatric HAPI prevention and can help identify and implement strategies to enhance evidence-based prevention care and prevent HAPI in paediatric settings.

IMPACT

Overcoming barriers through evidence-based interventions is essential to reduce HAPI cases, improve patient outcomes, and cut healthcare costs. The findings have practical implications, informing policy and practice for improved preventive measures, education, and staffing in paediatric care, ultimately benefiting patient well-being and reducing HAPIs.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. The focus of the study is on healthcare professionals and their perspectives and experiences in preventing HAPIs in paediatric patients. Therefore, the involvement of patients or the public was not deemed necessary for achieving the specific research objectives.

NGS Custom Panel Implementation in Patients with Non-Syndromic Autism Spectrum Disorders in the Clinical Routine of a Tertiary Hospital

Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by deficiencies in communication, social interaction, and repetitive and restrictive behaviors. The discovery of genetic involvement in the etiology of ASD has made this condition a strong candidate for genome-based diagnostic tests. Next-generation sequencing (NGS) is useful for the detection of variants in the sequence of different genes in ASD patients. Herein, we present the implementation of a personalized NGS panel for autism (AutismSeq) for patients with essential ASD over a prospective period of four years in the clinical routine of a tertiary hospital. The cohort is composed of 48 individuals, older than 3 years, who met the DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders) diagnostic criteria for ASD. The NGS customized panel (AutismSeq) turned out to be a tool with good diagnostic efficacy in routine clinical care, where we detected 12 "pathogenic" (including pathogenic, likely pathogenic, and VUS (variant of uncertain significance) possibly pathogenic variations) in 11 individuals, and 11 VUS in 10 individuals, which had previously been negative for chromosomal microarray analysis and other previous genetic studies, such as karyotype, fragile-X, or MLPA/FISH (Multiplex Ligation dependent Probe Amplification/Fluorescence in situ hybridization) analysis. Our results demonstrate the high genetic and clinical heterogeneity of individuals with ASD and the current difficulty of molecular diagnosis. Our study also shows that an NGS-customized panel might be useful for diagnosing patients with essential/primary autism and that it is cost-effective for most genetic laboratories.

The Burden and Contributing Factors of Cardiogenic Pulmonary Edema Among Acute Heart Failure Patients Admitted to Tertiary Hospital, Eastern Ethiopia

Background

Despite cardiogenic pulmonary edema is the most common phenotype of acute heart failure (AHF), studies on its burden and associated factors are limited. This study aimed to assess the burden and contributing factors of cardiogenic pulmonary edema in patients with acute heart failure admitted to a tertiary hospital in eastern Ethiopia.

Patients and Methods

An institution-based cross-sectional study was conducted on the medical records (n = 276) of patients with AHF between February 01, 2018, and January 31, 2023. A simple random sampling technique was used to select participants from the study population. Bivariable and multivariable logistic regression analyses were used to assess factors associated with the development of cardiogenic pulmonary edema. A P-value ≤0.05 was considered as statistically significant.

Results

The prevalence of cardiogenic pulmonary edema was 47.8% in AHF patients. Rural residence (adjusted odds ratio (AOR),9.54), smoking (AOR,3.17), comorbidity (AOR,2.1), and underlying cardiovascular disease (ischemic heart disease, chronic rheumatic valvular heart disease, and hypertensive heart disease with AOR: 6.71, 8.47, and 12.07, respectively) were significantly associated with the development of cardiogenic pulmonary edema in patients with AHF.

Conclusion

Nearly half of the patients with AHF had cardiogenic pulmonary edema. Being a rural dweller, cigarette smoking, comorbidities, and underlying cardiac illness were significantly associated with the development of cardiogenic pulmonary edema in patients with AHF.

AWaRe classification of antibiotics prescribed within 2018-2021 for hospitalised medical and surgical patients in Uyo, Nigeria

Introduction

point prevalence surveys have been used as a standardized tool to monitor antibiotic consumption to inform antimicrobial stewardship interventions in many countries. The 2021 WHO model list of Essential Medicines has classified antibiotics into three groups: access, watch and reserve. The aim of this paper is to describe the antibiotics used within a space of three years between 2018 and 2021 at the University of Uyo Teaching Hospital based on WHO AWaRe classification.

Methods

three point-prevalence surveys were conducted in the wards in our 500-bed tertiary hospital in 2018, 2019 and 2021. Each ward was surveyed on a particular day within a four-week period. The wards were grouped into medical and surgical for comparison. Antibiotics were classified as access, watch, and reserve. Validated data were analyzed with IBM SPSS Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp.).

Results

a total of 526 patients were surveyed out of which 344 were on antimicrobial therapy with a total of 687 antibiotic prescriptions. The overall prevalence of patients who received at least one antimicrobial was 65.4% (62.4 -72.8%). The Access group of antibiotics made up 48.2% of prescriptions while the watch group made up 50.5% of prescriptions. More watch Antibiotics were prescribed by surgical wards (49.7%) than by medical wards (43.7%).

Conclusion

the use of Access group antibiotics in our hospital falls below the WHO target level in both medical and surgical wards. There is a need for strengthening antibiotic stewardship activities to reduce the use of watch group antibiotics and limit antimicrobial resistance.

Examining the adequacy of preoperative informed consent in a developing country: Challenges in the era of surgical specialisation

Preoperative informed consent is a legal and ethical requirement that ensures patients understand a procedure, its associated risks and benefits, alternative treatment options, and potential complications to make an informed decision about their care. This cross-sectional study evaluated the informed consent process for major orthopaedic surgeries at a tertiary hospital in Nigeria. A self-administered questionnaire was used to collect data from 120 adult participants. Results showed that many patients do not read the consent form before signing it, and surgeons do not adequately explain the alternatives to surgery, potential risks, and available anaesthetic options. Higher-educated patients are more likely to read the consent form. Surgeons performed well in explaining the nature of the condition and prognosis, the procedure's potential benefits, and answering patients' questions. The study emphasises the need to improve the informed consent process to ensure patients understand and can make rational decisions about their healthcare.

Readiness for Change in the Implementation of a 3D Printing Initiative in a Catalan Tertiary Hospital Using the Normalization Process Theory: Survey Study

BACKGROUND

The high failure rate of innovation projects motivates us to understand the perceptions about resistances and barriers of the main stakeholders to improving success rates.

OBJECTIVE

This study aims to analyze the readiness for change in the implementation of a 3D printing project in a Catalan tertiary hospital prior to its implementation.

METHODS

We used a web-based, voluntary, and anonymous survey using the Normalization Measurement Development questionnaire (NoMAD) to gather views and perceptions from a selected group of health care professionals at Germans Trias i Pujol University Hospital.

RESULTS

In this study, 58 professionals, including heads of service (n=30, 51%), doctors (n=18, 31%), nurses (n=7, 12%), and support staff (n=3, 5%), responded to the questionnaire. All groups saw the value of the project and were willing to enroll and support it. Respondents reported the highest scores (out of 5) in cognitive participation (mean 4.45, SD 0.04), coherence (mean 3.72, SD 0.13), and reflective monitoring (mean 3.80, SD 0.25). The weakest score was in collective action (mean 3.52, SD 0.12). There were no statistically significant differences in scores among professions in the survey.

CONCLUSIONS

The 3D printing project implementation should pay attention to preparing, defining, sharing, and supporting the operational work involved in its use and implementation. It should also understand, assess, and communicate the ways in which the new set of practices can affect the users and others around them. We suggest that health officers and politicians consider this experience as a solid ground toward the development of a more efficient health innovation system and as a catalyst for transformation.

Evaluation of Orthopaedics and Traumatology Patients Referred From a Tertiary Hospital

Background This study aims to determine the rate of interhospital transfer, transfer diagnoses, where they were referred, and the reasons for the transfer of patients who presented to the emergency department and requested orthopaedic and traumatology consultations and to evaluate measures that may be effective in reducing the number of referrals for a more effective health service provision as a result of this information. Material and methods In this descriptive study, 59 patients were transferred to the emergency department of our hospital between January 1, 2019, and January 1, 2022, for whom orthopaedic and traumatology consultations were requested and for whom the orthopaedic physician requested transfer (training and research hospitals, university hospitals and private hospitals), and they were retrospectively evaluated. Results The ages of the study participants ranged from 1 to 91 years, with a mean age of 39.8 ± 20.9 years. Therefore, the majority of referred patients were male and Turkish citizens aged 18-65 years; there were no forensic cases; they were evaluated in the yellow area as a result of triage; and most of the transfers were from training and research hospitals and university hospitals, which are tertiary health institutions. On categorising patients based on their transfer diagnoses, it was found that patients with subtotal amputation of the finger were the most common among the referred patients. Conclusion To reduce the number of referrals, it is recommended to increase the standards in assistant training, especially in pelvis, acetabulum, and hand surgeries. It is also recommended to optimise material supply and skilled labour distribution.

Male Infertility: Causes and Management at a Tertiary Care Center in India

Background Infertility and problems of impaired fecundity have been a concern through the ages and are also considerable clinical problems today, affecting many couples worldwide. Most infertility cases are primarily attributed to male factors, which play a significant role. Additionally, a substantial number of these patients exhibit suboptimal sperm parameters. The study is mainly designed for individual intervention and outcome. We aim to evaluate the demographics, etiology, utilization of treatments, and outcomes of males undergoing infertility treatment. Methodology We retrospectively enrolled infertile couples from January 2021 to March 2023, covering the past two years. All patients were evaluated and investigated per the study protocol to identify the cause of infertility. Results Two thousand three hundred forty-eight males were enrolled in the study, of whom 1,484 (63%) were found to have a standard semen analysis. A total of 868 (37%) had abnormal semen parameters. Two hundred and seventy-two (12%) patients completed the evaluation. All parameters, except for hypospermia, displayed lower percentages of motility compared to normozospermia. All semen parameters, except for hypospermia, showed a significantly lower normal morphology in comparison to normozospermia. This reduction increased by 10% for each year of age increment. Conclusions The study concluded by following a protocol for evaluating male patients. If an abnormal sperm parameter is identified before considering intracytoplasmic sperm injection (ICSI), it is recommended to conduct at least karyotyping and microdeletion analysis on the Y-chromosome's q arm.

The Use of Social Media by Clinical Nurse Specialists at a Tertiary Hospital: Mixed Methods Study

BACKGROUND

Recently, many health care professionals, who use social media to communicate with patients and colleagues, share information about medical research and promote public health campaigns.

OBJECTIVE

This study aimed to examine the motives, barriers, and implementation of social media use among clinical nurse specialists in Oman.

METHODS

A mixed methods study was conducted among 47 clinical nurse specialists at Sultan Qaboos University Hospital between November and December 2020. Qualitative data were collected using an open-ended questionnaire and analyzed using thematic analysis, and quantitative data were collected with a questionnaire and analyzed using SPSS (version 21.0; IBM Corp).

RESULTS

Of the 47 clinical nurse specialists surveyed, 43 (91.5%) responded. All respondents reported using social media applications, with WhatsApp being the most commonly used platform. Most respondents (n=18, 41.9%) spent 1-2 hours per day on social media. The main motives for using social media were increasing knowledge, communication, reaching patients easily, and reducing the number of hospital visits. The main barriers to social media use were privacy concerns, time constraints, and a lack of awareness of legal guidelines for social media use in the workplace. All participants requested clear rules and regulations regarding the use of social media among health care providers in the future.

CONCLUSIONS

Social media has the option to be a powerful institutional communication and health education tool for clinical nurse specialists in Oman. However, several obstacles must be addressed, including privacy concerns and the need for clear guidelines on social media use in the workplace. Our findings suggest that health care institutions and clinical nurse specialists must work together to overcome these impediments and leverage the benefits of social media for health care.Bottom of Form.

Staphylococcus aureus Induced Wound Infections Which Antimicrobial Resistance, Methicillin- and Vancomycin-Resistant: Assessment of Emergence and Cross Sectional Study

Background

Wound infection is a prevalent concern in the medical field, being is a multi-step process involving several biological processes. Methicillin-resistant S. aureus (MRSA) and vancomycin-resistant S. aureus (VRSA) infections often occur in areas of damaged skin, such as abrasions and open wounds.

Methods

This research aims to light the incidence of MRSA and VRSA in wound swabs, the antimicrobial susceptibility configuration of isolated S. aureus patterns in pus/wound samples collected from Saudi Arabian tertiary hospital. The cross section study, β- lactamase detection, VRSA genotyping, MAR index, D-test and VRSA genotyping are methods, which used for completed this research.

Results

Patients of several ages and genders delivered specimens from two hospitals in the Al jouf area, in the northern province of Saudi Arabia. S. aureus was found in 188 (34.7%) of the 542 wounds. The traumatized wounds provided 71 isolates (38.8%), surgical wound provided 49 isolates (26.8%) and abscess were represented 16 by isolates (8.7%). In the study, 123 (65.4%) out of 188 were MRSA, 60 (31.9%) were MSSA, and five (2.7%) were VRSA. Linezolid and rifampin were found to be the most effective antimicrobials with 100% in vitro antibacterial activity against S. aureus isolates. The Multiple antimicrobials resistance (MAR) index revealed 73 isolates (38.9%) with a MAR index greater than 0.2, and 115 (61.1%) less than 0.2. The D-test showed that of MLSb phenotypes among S. aureus, 22 (11.7%) strains were D-test positive (MLSbi phenotype), 53 (28.2%) strains were constitutive MLSc phenotypes, and 17 (9%) strains were shown to have MSb phenotypes. All VRSA isolates (n=5) were found to be positive for vanA, and no vanB positive isolates were detected in the study.

Conclusion

Regular monitoring and an antimicrobials stewardship program should be in place to provide critical information that can be utilized for empirical therapy and future prevention strategies.

Adherence to Follow-Up and the Related Factors of Paediatric Glaucoma at a Tertiary Care Centre in Western Saudi Arabia

INTRODUCTION

Glaucoma is a main cause of blindness globally. In Saudi Arabia, congenital glaucoma is believed to affect 1 in every 2500 live births. In this study, we identified the adherence and evaluated the factors associated with non-compliance (non-adherence) to recommended follow-up appointments at King Abdulaziz University Hospital, a tertiary centre in Jeddah, Saudi Arabia.

METHODS

The medical records of paediatric patients diagnosed with glaucoma between 2009 and April 2022 were reviewed retrospectively. Demographic information, visit dates, scheduled follow-ups, and specific patients' glaucoma histories were all extracted from the records. Patients were categorized as adherent, non-adherent, or lost to tertiary follow-up (LTTF).

RESULTS

Of 91 patients, 52 (57.1%) were adherent, 20 (22%) were non-adherent, and 19 (20.9%) were LTTF. Most adherent patients were Saudi (59.3% adherent, 26.5% non-adherent, 14.2% LTTF) (P = 0.02). Adherent patients were far likelier to live further away from the ophthalmology clinic (P = 0.03). The frequency of clinical encounters was statistically significantly different between adherence statuses. The non-adherent group had a higher average number of prescribed ocular medications (P = 0.03). The adherent patients had more frequent visits with elevated intraocular pressure (P = 0.02).

CONCLUSION

A significantly high percentage of paediatric glaucoma patients were non-adherent to follow-up visits. When determining the non-compliance risk among paediatric glaucoma patients, physicians must consider the factors contributing to adherence status, which include nationality, distance to the ophthalmology clinic, and number of prescribed ocular medications.

Incidence of Surgical Site Infection Despite Preoperative Cefazolin Administration in Total Knee Arthroplasty Patients: A Tertiary Hospital Experience

INTRODUCTION

Surgical site infection (SSI) is an infection that occurs after surgery on the incision site. Cefazolin is an old-generation antibiotic that decreases the risk of SSI. This study aimed to determine the relationship between the incidence of SSI, cefazolin administration, and the factors contributing to the relationship between them.

METHODS

This is a retrospective study that used a data collection sheet to collect variables from the medical records of patients who underwent total knee arthroplasty (TKA) between 2016 and 2020. We looked mainly for the type of antibiotics given preoperatively, the number of doses given, discontinuation of antibiotics postoperatively, length of hospital stay, intensive care unit (ICU) admission, and SSI occurrence.  Results: A total of 195 patients were included. The majority (87.8%) were given two grams of cefazolin. Patients who have taken one gram of cefazolin had a slightly higher hospital stay than those who took two grams. However, all the patients did not develop an SSI.

CONCLUSION

There was no incidence of SSI despite preoperative cefazolin administration in TKA patients. Patients who received higher doses of cefazolin had a shorter length of hospital stay.

Spectrum of ocular disease in children aged between 0 and 3 years at an Australian paediatric tertiary hospital

BACKGROUND

Childhood ocular disease can be a significant health burden to the child, family and society. Previous studies have examined the spectrum of paediatric ocular disease presenting to tertiary hospitals; however, these studies have broader age ranges, smaller sample sizes, and are largely based in developing countries. This study aims to assess the spectrum of ocular disease in the first 3 years of life presenting to the eye department of an Australian tertiary paediatric hospital.

METHODS

The records of 3337 children who had their initial presentation at the eye clinic between the age of 0 and 36 months were reviewed, spanning 6.5 years from 1st July 2012 to 31st December 2018.

RESULTS

The most common primary diagnoses overall were strabismic amblyopia (6.0%), retinopathy of prematurity (5.0%) and nasolacrimal duct obstruction (4.5%). Bilateral visual impairment was more common in younger children, while unilateral visual impairment was more common in older children. The proportion of all children presenting with visual impairment was 10.3%, with 5.7% of all children presenting with bilateral visual impairment and 4.6% presenting with unilateral visual impairment. In children with visual impairment, the most common sites of primary abnormality were lens (21.4%), retina (17.3%), and cerebral and visual pathways (12.1%). The most common primary diagnoses in children with visual impairment were cataract (21.4%), strabismic amblyopia (9.3%) and retinoblastoma (6.5%).

CONCLUSIONS

The spectrum of eye disease and vision impairment presenting in the first 3 years of life facilitates health care planning, greater community education about vision impairment and importance of early intervention, and guidance for appropriate resource allocation. Health systems can apply these findings to aid in early identification and intervention to reduce preventable blindness and institute appropriate rehabilitation services.

Assessment of Oral Health Knowledge of Pharmacists in Two Tertiary Hospitals in Enugu, Nigeria

Introduction

Oral health is defined as a state of being free of mouth and facial pain, oral infections and sores, and other diseases that limit an individual's capacity for biting, chewing, smiling, speaking, and psychosocial well-being. This study assessed the knowledge, barriers, and facilitators of oral health knowledge among Pharmacists in Enugu, Nigeria.

Methods

This was a cross-sectional study of 163 pharmacists in two tertiary hospitals in Enugu, South East, Nigeria. Data on sociodemographic profiles, knowledge of oral health care, barriers, and facilitators of oral health knowledge was collected. Data were analyzed using SPSS version 26 and P < 0.05 was considered significant.

Results

There were more female 96 (58.9%) than male pharmacists 67 (41.1%). Their mean age was 32.98 ± 8.33 years. The majority of respondents, 56 (34.4%) graduated between 2010 and 2019, and 44 (27%) had additional qualifications. Many of the pharmacists 88 (54%) believed that oral health is part of general health. Also, 107 (65.6%) of the respondents had a good knowledge of oral health while 56 (34.4%) had poor knowledge. There was a significant association between academic qualification (P = 0.04) and having good knowledge of oral health care among pharmacists with those with additional qualifications having better knowledge than the others. Poor creation of oral health awareness by dentists 106 (65.0%) was considered as the main barrier to having good oral health knowledge by the pharmacists.

Conclusion

More than half of the pharmacists had good knowledge of oral health and academic qualification was associated with having a good knowledge of oral health care among pharmacists in the study population.

Knowledge and Awareness About Diabetes Mellitus Among Urban and Rural Population Attending a Tertiary Care Hospital in Haryana

BACKGROUND

Diabetes mellitus (DM) is one of the fastest-growing public health problems in the twenty-first century. The ignorance among people about their disease may be related to their low socioeconomic status and lack of quality education available to them about the disease. It is a serious condition leading to several complications if the individual does not follow up regularly for check-ups and blood sugar monitoring. Lifestyle modifications such as a healthy diet, regular exercise, reducing weight, stress management, and smoking cessation can play a critical role in managing diabetes and improving the health and well-being of diabetic patients. Thus, through this study, we want to assess and create awareness among diabetic patients.

METHODOLOGY

It is a hospital-based cross-sectional study conducted at a tertiary care hospital on diagnosed cases of DM. The patients aged 18 years or above of either gender who had already been diagnosed with DM type 1 and type 2 were included, and patients with gestational DM were excluded from the study. Informed consent was taken from the patients, and all the required details were obtained using a well-structured questionnaire. After obtaining all the answers, the level of knowledge and awareness was analyzed, and the data was entered into an MS Excel sheet (Microsoft, Redmond, Washington) and analyzed by Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM Corp., Armonk, NY).

RESULTS

In our study, the maximum prevalence of diabetes was seen in males (55.5%) than females (44.5%), and the mean age of our study population was 53.3 ± 16.4 years. In our study, participants from rural areas made up the majority (59%) compared to those from urban areas (41%), and the majority of participants had a high school education. Among 211 diabetics, about 84%, 79%, and 41% of the patients knew about diabetes, symptoms of diabetes, and complication of diabetes. Only 18% of the patients were aware of the symptoms of hypoglycemia, and 38% of the patients possess their own glucometers and monitor their blood sugar levels on a regular basis. Merely 38% of the diabetics were aware of the various DM treatment choices. About 52% of patients had some awareness of insulin therapy. Out of 211 patients, about half skipped their antidiabetic prescriptions, and of those, 22% took a double dose the next day. A total of 121 patients (57%) combined the use of alternative and allopathic medications, and among these, 22% of patients had replaced the allopathic with alternative medicines. Almost 53% of patients had a positive family history of diabetes; 54% of patients believe that obesity is unrelated to diabetes, and 79% of diabetics are aware of the lifestyle changes that must be done for diabetes. Almost 67% of the patients believed that diabetes could be permanently treated, and 84% of patients believed that eating too much sugar caused their diabetes.

CONCLUSION

In our study, a significant number of patients suffering from diabetes had less knowledge and awareness about it. The prevalence of myths about the onset of diabetes was noticeably higher among diabetic patients. It was observed that a greater number of patients were shifting to alternative medications instead of allopathic ones, and in the long run, it can lead to various complications. Therefore, there is an immediate need to promote awareness about diabetes among the general population.

Peritoneal Dialysis Care in Mainland China: Nationwide Survey

BACKGROUND

Peritoneal dialysis (PD) care in mainland China has been progressing in the past 10 years.

OBJECTIVE

To complement information from the dialysis registry, a large-scale nationwide survey was conducted to investigate the current infrastructure and management of PD care at hospitals of different tiers.

METHODS

A web-based multiple-choice questionnaire was distributed through the National Center for Nephrology Medical Quality Management and Control to PD centers of secondary and tertiary hospitals in October 2020. The 2-part survey collected the information of PD centers and the clinical management of patients on PD. A total of 788 effective surveys from 746 hospitals were voluntarily returned, and data were extracted and analyzed.

RESULTS

The effective survey data covered 101,537 patients on PD, with 95% (96,460/101,537) in the tertiary hospitals. The median number of patients per PD center was 60 (IQR 21-152); this number was 32 (IQR 8-65) and 70 (IQR 27-192) for secondary and tertiary hospitals, respectively. There was a discrepancy in the availability of designated physical areas for different functions of PD care between the secondary and tertiary hospitals. The proportion of tertiary hospitals with PD training (P=.01), storage (P=.09), and procedure area (P<.001) was higher compared to secondary hospitals. PD catheter placement was performed in 96% (608/631) of the PD centers in tertiary hospitals, which was significantly higher compared to 86% (99/115) in secondary hospitals (P<.001). Automated PD was available in 55% (347/631) of the tertiary hospitals, which was significantly higher than that in secondary hospitals (37/115, 32%) according to the survey (P<.001). The most commonly performed PD module was continuous ambulatory peritoneal dialysis (772/788, 98%), followed by intermittent peritoneal dialysis (543/788, 69%). The overall reported nocturnal intermittent peritoneal dialysis was 31% (244/788); it was 28% (220/788) for continuous cycling peritoneal dialysis and 15% (118/788) for tidal peritoneal dialysis. Comparisons between the secondary and tertiary hospitals revealed no significant differences in prophylactic antibiotic use for PD catheter placement and therapeutic use for peritonitis. The first peritoneal equilibrium test was conducted in 58% (454/788) of patients at 4-6 weeks after initiation of PD, and 91% (718/788) reported at least one peritoneal equilibrium test per year. Overall, 79% (570/722) and 65% (469/722) of PD centers performed assessment for dialysis adequacy and residual kidney function, respectively; and 87% (685/788) of patients on PD were followed every 1 to 3 months for laboratory and auxiliary examinations.

CONCLUSIONS

This national survey reflects the current status and disparities of PD center management in mainland China. The study results suggest that the PD care needs to be more conveniently accessible in secondary hospitals, and quality management and staff training in secondary hospitals are still in high demand.

Patient healthcare experiences of cancer hospitals in China: A multilevel modeling analysis based on a national survey

Importance

Patient satisfaction is a crucial indicator for assessing quality of care in healthcare settings. However, patient satisfaction benchmark for cancer hospitals in China is not established.

Objective

To examine patient satisfaction levels in tertiary cancer hospitals in China, and inter-hospital variations after case-mix adjustment.

Design

A nationwide cross-sectional hospital performance survey conducted from January to March 2021.

Settings

At 30 tertiary cancer hospitals in China.

Participants

A total of 4,847 adult inpatients consecutively recruited at 30 tertiary cancer hospitals were included.

Exposures

Patient characteristics included demographic characteristics (sex, age, education, and annual family income), clinical characteristics (cancer type, cancer stage, self-reported health status, and length of stay), and actual respondents of questionnaire.

Main outcomes and measures

Patient satisfaction was measured using 23 items covering five aspects, administrative process, hospital environment, medical care, symptom management, and overall satisfaction. Responses to each item were recorded using a 5-point Likert scale. Patient satisfaction level for each aspect was described at individual and hospital levels. Using multilevel logistic regression, patient characteristics associated with patient satisfaction were examined as case-mix adjusters and inter-hospital variation were determined.

Results

The satisfaction rates for symptom management, administrative process, hospital environment, overall satisfaction, and medical care aspects were 74.56, 81.70, 84.18, 84.26, and 90.86% with a cut-off value of 4, respectively. Significant predictors of patient satisfaction included sex, age, cancer type, cancer stage, self-reported health status, and actual respondent (representative or patient) (all P < 0.05). The ranking of the hospitals' performance in satisfaction was altered after the case-mix adjustment was made. But even after the adjustment, significant variation in satisfaction among hospitals remained.

Conclusions and relevance

This study pointed to symptom management as a special area, to which a keen attention should be paid by policymakers and hospital administrators. Significant variation in satisfaction among hospitals remained, implying that future studies should examine major factors affecting the variation. In review, target interventions are needed in low-performing hospitals.

Utility and impact of early diagnostic assessment of sepsis on mortality in an emergency department of a tertiary hospital in Lagos, Nigeria

CONTEXT

Currently, little is known about the timely application of clinical screening tools and blood sampling for decision-making in the management of patients with suspected sepsis in the accident and emergency units of hospitals in Nigeria.

AIM

The aim of the study was to ascertain the association between the time taken for the conduct of serum lactate and blood culture investigations following a clinical suspicion of sepsis, and the mortality of patients admitted to a Nigerian tertiary hospital.

METHODS

Over a 6-month period (November 2021 to April 2022), 119 patients hospitalised for sepsis or septic shock at the Lagos University Teaching Hospital were followed until discharge or death. The proportion of patients whose serum lactate, serum procalcitonin and blood culture samples was taken was also determined. Predictors of mortality were determined using bivariate analysis and logistic regression. Kaplan-Meier plots were used to predict survival using sepsis diagnostic criteria.

RESULTS

Eighty (67%) of 119 sepsis patients met systemic inflammatory response syndrome or quick sequential (sepsis-related) organ failure assessment criteria. Only 3 (2.5%) patients had blood cultures and serum procalcitonin and 0 (0%) had serum lactate tests. Forty-one (34.5%) patients died, but clinical and laboratory procedures for sepsis management were not linked to death. A shorter hospital stay increased the death risk (χ² = 14.83, P = 0.002).

CONCLUSION

This study revealed low compliance with sepsis care guidelines and no impact of timely clinical and laboratory procedures on sepsis mortalities. Further study is needed to explore patient care models that can improve the objective assessment and treatment of sepsis patients in emergency departments of busy tertiary hospitals.

Factors Associated with Outpatient Satisfaction in Provincial Tertiary Hospitals in Nanchang, China: A Structural Equation Modeling Approach

Outpatient satisfaction is important in evaluating the performance of tertiary public hospitals in China. However, only a few studies have examined the interaction between outpatient satisfaction and its related factors. This study aimed to explore the relationship between patient satisfaction and its related factors in provincial tertiary hospitals. Six hundred outpatients in three provincial tertiary hospitals in Nanchang, China, were randomly selected. Structural equation modeling was used to analyze the relationship of the factors associated with outpatient satisfaction. The conceptual model fitted the data well (χ2/df = 4.367, CFI = 0.951, TLI = 0.937, SRMR = 0.055, RMSEA = 0.075), with all the path coefficients being statistically significant (p < 0.001). The environment and facilities showed the most significant influence on outpatient satisfaction (standardized total effect = 0.389), followed by the quality of diagnosis and treatment (standardized total effect = 0.235). The waiting time for medical services showed a partial mediation effect of 0.077 between the environment and facilities and outpatient satisfaction. The study indicates that targeted measures should be taken to improve the amenities of hospitals and shorten the waiting time for medical services, thus further improving outpatients’ medical experience.

The Impact of COVID-19 on Cancer Care in a Tertiary Hospital in Korea: Possible Collateral Damage to Emergency Care

Objectives

We investigated the impact of the COVID-19 pandemic on cancer care in a tertiary hospital of South Korea without the specific lockdown measures.

Methods

A retrospective cohort of cancer patients from one of the largest tertiary hospitals in South Korea was used to compare the healthcare utilization in different settings (outpatient clinic, emergency department (ED), and admission) between the period of January 1 and December 31, 2020 and the same time period in 2019. The percent changes in healthcare utilization between two periods were calculated.

Results

A total of 448,833 cases from the outpatient cohort, 26,781 cases from the ED cohort, and 14,513 cases from the admission cohort were reviewed for 2019 and 2020. The total number of ED visit cases significantly decreased in 2020 than in 2019 by 18.04%, whereas the proportion of cancer patients maintained. The reduction in ED visits was more prominent in cases with COVID-19 suspicious symptoms, with high acuity, and those who lived in non-capital city area. There were no significant changes in the number of total visits and new cases in the outpatient clinic between two periods. No significant differences in the total number of hospitalizations were observed between two periods.

Conclusion

During the pandemic, the number of ED visits significantly decreased, while the use of outpatient clinic and hospitalizations were not affected. Cancer patients' ED visits decreased after the COVID-19 outbreak, suggesting the potential for collateral damage outside the hospital if the ED could not be reached in a timely manner.

The Impact and Vaccination Coverage of Seasonal Influenza among Children Aged 6-59 Months in China in 2017-2018: An Internet Panel Survey

Seasonal influenza vaccination is highly recommended for 6-59-month-old children. To determine the impact of seasonal influenza and the factors affecting influenza vaccine uptake among children, we conducted an opt-in Internet panel survey of parents from 21 March 2018 to 1 April 2018. Overall, 40.5% (1913/4719) of children experienced influenza-like illness (ILI), 92.4% of parents sought medical care for children with ILI (outpatients: 61.2%, inpatients: 12.8%), 39.6% of parents preferred to take their sick child to a tertiary hospital, and 57.3% of family members requested leave to care for children with ILI. There was a median of three days of absenteeism (2, 5) per sick child, and 39.4% of children received the influenza vaccine during the 2017-2018 influenza season. Vaccine coverage among children aged 6-11 months and 48-59 months was lower than that among 12-47-month-old children. The top three reasons for not vaccinating were: the influenza vaccine was not recommended by healthcare workers (21.1%), no knowledge about the influenza vaccine (19.2%), and lack of confidence in the vaccine's effectiveness (14.3%). Our findings highlight the need for awareness about the severity of influenza, hygiene behavior, and effectiveness of the influenza vaccine among children and their family members in China.

Influence of Prolonged Visual Display Terminal Use on Physical and Mental Conditions among Health Care Workers at Tertiary Hospitals, Taiwan

This study aimed to examine the effects of prolonged VDT working time on physical and mental health disadvantages among health care workers (HCWs) in tertiary hospitals based on their work characteristics, age, and sex. Included in the study were 945 and 1868 participants in the non-doctor/nurse and doctor/nurse groups, respectively. The questionnaire included VDT usage-related information, the Nordic Musculoskeletal Questionnaire (NMQ), computer vision syndrome (CVS), perceived occupational stress, burnout, the Brief Symptom Rating Scale-5 (BSRS-5), and self-rated health (SRH). After adjustment, multiple logistical regression analysis revealed that the two groups showed that the longer the VDT working time, the higher the risk of muscle pain, severe headaches, severe job stress, and self-assessed bad sleep quality. This showed that the condition of the doctor/nurse group was more severe than that of the non-doctor/nurse group. According to the stratified analysis by sex and age, in the group of women under the age of 30, the adjusted odds ratio value of physical and mental conditions increased with longer VDT working time and was statistically significant. The result show that it is important to reduce daily VDT exposure for doctor, nurses, and women under 30.

Prevalence and antibiotic resistance of Klebsiella pneumoniae in a tertiary hospital in Hangzhou, China, 2006-2020

Objective

This study analyzed the characteristics and tendencies of resistance to common antibiotics for Klebsiella pneumoniae to provide a basis for clinical treatment and prevention.

Methods

A total of 71,743 isolates were collected from hospital clinical specimens following standard procedures from 2006 to 2020. Statistical analyses were conducted on laboratory test results.

Results

A total of 3054 isolates of K. pneumoniae were mainly isolated from sputum (53.77%), urine (14.70%), and blood (8.42%). Isolation rates of strains in the AIDS, hepatology, and intensive care wards were 9.72%, 12.52%, and 16.45%, respectively. Resistance rates of imipenem, cefazolin, gentamicin, tobramycin, ciprofloxacin, and ceftazidime respectively increased from 2.33%, 27.91%, 16.28%, 13.95%, 18.60%, and 9.30% to 12.83%, 40.82%, 21.57%, 25.07%, 44.61%, and 17.78%, while piperacillin–tazobactam resistance decreased from 13.95% to 13.70%. Differences in resistance rates to seven antibiotics were significant among specimen types. Detection rates of carbapenem-resistant K. pneumoniae were significantly different among blood, sputum, and urine specimens, and between wards.

Conclusions

The prevalence and drug resistance of K. pneumoniae showed an upward trend over time, and resistance varied according to ward and specimen source. The prevention of nosocomial infections and rational drug use must be emphasized to reduce antimicrobial resistance.

Burnout Syndrome in a Military Tertiary Hospital Staff during the COVID-19 Contingency

(1) Background: Burnout syndrome (BOS) is defined as a psychological state of physical and mental fatigue associated with work. The COVID-19 pandemic greatly impacted the physical and mental wellbeing of health professionals. The objective of this work was to determine the impact on personnel, monitoring the frequency of BOS throughout the pandemic. (2) Methods: The Maslach Burnout Inventory (MBI) was self-applied in four periods of the pandemic according to sociodemographic and employment characteristics. In this study, all hospital personnel were included; the association of BOS with sex, age, type of participant (civilian or military), military rank and profession was analyzed. (3) Results: The frequency of BOS was 2.4% (start of the pandemic), 7.9% (peak of the first wave), 3.7% (end of the first wave) and 3.6% (peak of the third wave). Emotional exhaustion (EE) was the most affected factor, and the groups most affected were men under 30 years of age, civilians, chiefs and doctors, especially undergraduate medical doctors and specialty resident doctors, and nursing personnel were less affected. (4) Conclusions: The low BOS levels show that the containment measures and military training implemented by the hospital authorities were effective, although the chief personnel were more affected in the first wave. It is probable that this combination allowed the containment of BOS, which was not observed in civilians.

Current Status of the Health Information Technology Industry in China from the China Hospital Information Network Conference: Cross-sectional Study of Participating Companies

Background

The China Hospital Information Network Conference (CHINC) is one of the most influential academic and technical exchange activities in medical informatics and medical informatization in China. It collects frontier ideas in medical information and has an important reference value for the analysis of China's medical information industry development.

Objective

This study summarizes the current situation and future development of China's medical information industry and provides a future reference for China and abroad in the future by analyzing the characteristics of CHINC exhibitors in 2021.

Methods

The list of enterprises and participating keywords were obtained from the official website of CHINC. Basic characteristics of the enterprises, industrial fields, applied technologies, company concepts, and other information were collected from the TianYanCha website and the VBDATA company library. Descriptive analysis was used to analyze the collected data, and we summarized the future development directions.

Results

A total of 205 enterprises officially participated in the exhibition. Most of the enterprises were newly founded, of which 61.9% (127/205) were founded in the past 10 years. The majority of these enterprises were from first-tier cities, and 79.02% (162/205) were from Beijing, Zhejiang, Guangdong, Shanghai, and Jiangsu Provinces. The median registered capital is 16.67 million RMB (about US $2.61 million), and there are 35 (72.2%) enterprises with a registered capital of more than 100 million RMB (about US $15.68 million), 17 (8.3%) of which are already listed. A total of 126 enterprises were found in the VBDATA company library, of which 39 (30.9%) are information technology vendors and 57 (45.2%) are application technology vendors. In addition, 16 of the 57 (28%) use artificial intelligence technology. Smart medicine and internet hospitals were the focus of the enterprises participating in this conference.

Conclusions

China's tertiary hospital informatization has basically completed the construction of the primary stage. The average grade of hospital electronic medical records exceeds grade 3, and 78.13% of the provinces have reached grade 3 or above. The characteristics are as follows: On the one hand, China's medical information industry is focusing on the construction of smart hospitals, including intelligent systems supporting doctors' scientific research, diagnosis-related group intelligent operation systems, and office automation systems supporting hospital management, single-disease clinical decision support systems assisting doctors' clinical care, and intelligent internet of things for logistics. On the other hand, the construction of a compact county medical community is becoming a new focus of enterprises under the guidance of practical needs and national policies to improve the quality of grassroots health services. In addition, whole-course management and digital therapy will also become a new hotspot in the future.

COVID-19 Vaccine Acceptance and Associated Factors among Unvaccinated Workers at a Tertiary Hospital in Southern Thailand

Background

Hospital workers are at high risk of COVID-19 infection which is now vaccine-preventable. However, vaccine refusals also occur among hospital workers, but the associated factors have not been described.

Objectives

To describe: (1) the level of COVID-19 vaccine acceptance, and; (2) the extent that history of pre-pandemic vaccine hesitancy and health beliefs regarding COVID-19 were associated with COVID-19 vaccine acceptance among workers at a tertiary hospital in southern Thailand.

Methods

We conducted a cross-sectional study using a paper-based self-administered questionnaire at a tertiary hospital in south Thailand in April 2021 and used multivariable logistic regression to identify psychological-behavioral factors associated with vaccine acceptance.

Results

Of 359 workers invited to participate, 226 participants returned the questionnaires, 67% of whom reported willingness to accept the vaccine. Vaccine acceptance was associated with perceived severity of disease (Adjusted OR = 2.07, 95% CI = 1.04, 4.10), perceived harm from non-vaccination (Adjusted OR = 2.51, 95% CI = 1.27, 4.96), and lower expectation of vaccine efficacy (Adjusted OR = 3.80, 95% CI = 1.87, 7.71).

Conclusion

Most workers in this study were willing to accept the COVID-19 vaccine, and such acceptance was associated with components of the health belief model. However, the cross-sectional study design did not allow causal inference, and study data were all self-reported with no probing of the responses. These limitations should be considered as caveats in the interpretation of the study findings.

Evaluating the Operational Efficiency and Quality of Tertiary Hospitals in Taiwan: The Application of the EBITDA Indicator to the DEA Method and TOBIT Regression

This study estimates the efficiency of 19 tertiary hospitals in Taiwan using a two-stage analysis of Data Envelopment Analysis (DEA) and TOBIT regression. It is a retrospective panel-data study and includes all the tertiary hospitals in Taiwan. The data were sourced from open information hospitals legally required to disclose to the National Health Insurance (NHI) Administration, Ministry of Health and Welfare. The variables, including five inputs (total hospital beds, total physicians, gross equipment, fixed assets net value, the rate of emergency transfer in-patient stay over 48 h) and six outputs (surplus or deficit of appropriation, length of stay, the total relative value units [RVUs] for outpatient services, total RVUs for inpatient services, self-pay income, modified EBITDA) were adopted into the Charnes, Cooper and Rhodes (CCR) and Banker, Charnes and Cooper (BCC) model. In the CCR model, the technical efficiency (TE) from 2015–2018 increases annually, and the average efficiency of all tertiary hospitals is 96.0%. In the BCC model, the highest pure technical efficiency (PTE) was in 2018 and the average efficiency of all medical centers is 99.1%. The average scale efficiency of all medical centers was 96.8% in the BBC model, meaning investment can be reduced by 3.2% and the current production level can be maintained with a fixed return to scale. Correlation coefficient analysis shows that all variables are correlated positively; the highest was the number of beds and the number of days in hospital (r = 0.988). The results show that TE in the CCR model was similar to PTE in the BCC model in four years. The difference analysis shows that more hospitals must improve regarding surplus or deficit of appropriation, modified EBITDA, and self-pay income. TOBIT regression reveals that the higher the bed-occupancy rate and turnover rate of fixed assets, the higher the TE; and the higher number of hospital beds per 100,000 people and turnover rate of fixed assets, the higher the PTE. DEA and TOBIT regression are used to analyze the other factors that affect medical center efficiency, and different categories of hospitals are chosen to assess whether different years or different types of medical centers affect operational performance. This study provides reference values for the improvable directions of relevant large hospitals’ inefficiency decision-making units through reference group analysis and slack variable analysis.

Behavioural abnormalities among school-age children living with HIV at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background: The human immunodeficiency virus infection has manifestations causing behavioural and cognitive abnormalities among children. The aim of this study was to assess the magnitude and correlates of behavioural abnormalities among school-age children living with HIV attending follow-up at the Pediatric Infectious Diseases Clinic of Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia.Methods: A sample of 251 children and their primary caregivers were included in this study. The Strengths and Difficulties Questionnaire was used to assess behavioural abnormalities. Descriptive statistics and bivariate analysis using logistic regression were done to assess the determinants of abnormal behaviour scores.Results: The overall prevalence of any form of behavioural abnormalities was 49%. The prevalence of emotional symptoms was 31.5%, peer problems 21.5% and hyperactivity deficit was 13.1%. Children residing out of Addis Ababa, the capital city (AOR 0.18; 95% CI 0.03-0.94), children having both parents (AOR 0.29; 95% CI 0.12-0.70) and children having either of their parents (AOR 0.39; 95% CI 0.18-0.83) were less likely to have behavioural abnormalities. Moreover, children whose primary caregivers had elementary education or lower were more likely to have any form of behavioural abnormalities (AOR 2.44; 95% CI 1.05-5.69)Conclusions: The magnitude of behavioural abnormalities among children living with HIV is substantial. We recommend that children living with HIV, particularly those with parental losses and those having less-educated primary caregivers, be closely monitored for behavioural problems.

Needlestick and sharps injuries among secondary and tertiary healthcare workers, Saudi Arabia

Aim

The study aimed to assess the incidence of needlestick and sharps injuries among healthcare workers (HCWs) in the Jazan region of Saudi Arabia, as well as to determine whether there exists an association between hospital level and needlestick and sharps injuries rate.

Design

A cross‐sectional survey was conducted among 609 randomly selected HCWs from nine general hospitals.

Methods

A self‐administered questionnaire, which covered the structure and process of injection safety, was used for data collection.

Results

The overall needlestick and sharps injuries incidence rate was 24%. The needlestick and sharps injuries rates were 30% and 14% in secondary and tertiary hospitals, respectively. HCWs working in tertiary hospitals were 61% less likely to have needlestick and sharps injuries than those employed in secondary hospitals. This was mainly the impact of better and continuous training. High safety level maintenance and health education provision are vital in such settings.

Doctors and social media: knowledge gaps and unsafe practices

INTRODUCTION

Easy access and availability of communication tools have facilitated doctors' communication, adding new challenges. Through this study, we aimed to determine the profile of the knowledge and practices of doctors in our institution, and to identify knowledge gaps in the use of social media accounts.

METHODS

An anonymous survey was sent by electronic mail in March-May 2018 to 931 doctors working in National University Hospital, Singapore. It included questions on demographics; use of social media; and case-based scenarios involving professionalism, patient-doctor relationship and personal practices of social media use.

RESULTS

The response rate was 12.8%. The majority of the respondents owned a social media account (93.3%), had not received education on social media use in medical school (84.0%), did not own a separate work phone (80.7%) and claimed to have no medical education on this as a doctor (58.8%). Unawareness of the institution's social media policy was reported by 14.3% of the respondents. Questions on knowledge of the privacy settings of their account were incorrectly answered. Only 75.6%-82.4% of the participants responded 'no' when asked if they would post pictures of patients or their results, even if there were no patient identifiers.

CONCLUSION

There is inadequate knowledge regarding institutional social media policy and privacy settings of social media accounts among doctors. Regarding practices in social media use, while most agree that caution should be exercised for online posts involving patients, ambiguity still exists. The emerging knowledge deficit and potentially unsafe practices that are identified can be addressed through continuing medical education and training on social media use.

Palliative Prognostic Index Validation in Hospitalized Advanced Cancer Patients in Indonesia Tertiary Hospitals

BACKGROUND

Accurate prediction of survival is important for advanced cancer patients to determine medical interventions plan the patient's lives and prepare for their death. The palliative prognostic index (PPI) is most popular scores used worldwide to predict life expectancy in advanced cancer palliative patients. The purpose of this study was to test validity and the performance of PPI in Cipto Mangunkusumo Hospital as a Tertiary Referral Nasional Hospital.

METHODS

This retrospective cohort study, uses total subject during study with consecutive sampling. Palliative prognostic index was assessed by a palliative care team (PCT). Demographic data were summarized as n (%) and Chi square for categorical variables and median or mean for continuous variables. Overall survival was calculated using the Kaplan-Meier method with hazard ratios. The performance of PPI analyzed using SPSS version 20.0, includes for Receiving Operator Characteristics (ROC) and Hosmer-Lemeshow calibration test.

RESULTS

160 patients were included in the PPI study. The subjects  have an average age of 50.08 years and are mostly women 68.10%. 28 (17.50%) had symptoms of dyspnoea, 22 (14.60%) pneumonia, and 19 (11.90%) had pain. The number of patients who died during hospitalisation was 83 (51.90%). PPI sum score >6  109 (68,10%). Calibration performance PPI score reached x2 = 8.915 (p = 0.259), and showed correlation  r 0.799 (p 0.000). The accuracy of PPI scores in predicting survival in advanced cancer patients in studies for survival <3 weeks 81%, with a sensitivity of 85%, specificity 70%, PPV 86%, and NPV 67%. Predictive accuracy of survival within 3-6 weeks had 76%, sensitivity 66%, specificity 88%, PPV 85% and NPV 70%. PPI score discrimination performance is had a AUC value of 0.822 (95% CI 0.749-0.895).

CONCLUSION

Palliative Prognostic Index (PPI ) is valid and has good performance in predicting the survival of advanced cancer patients and may  be used to help clinicians in palliative care consultation.

Who is willing to participate in and provide Family Doctor Contract Service?: A cross-sectional study based on the medical staff's perspective in China

China encourages medical staff from non-primary hospitals (higher-level hospitals) to participate in and provide Family Doctor Contract Service (FDCS) due to a lack of primary medical resources in community health service centers. This study aims to explore the factors affecting the willingness of family doctor contracting from the tertiary hospital medical staff's perspective. An anonymous self-administered survey was conducted among the medical staff from tertiary hospitals in Hangzhou, Zhejiang Province. Information of the socio-demographic characteristics, the willingness of participating in FDCS and its related reasons, and factors that might affect willingness were investigated. A multivariate logistic regression was used to identify the statistically significant variables associated with willingness. A total of 346 medical staff were recruited in the survey, and 37.86% of them were willing to participate in and provide FDCS. Medical staff with the following characteristics had stronger will: (1).. with higher education level; (2).. having better knowledge with family doctor; (3).. being more attracted by the national policy of FDCS; (4).. thinking it help for income increase. The majority of willing doctors (25.95%) believed that participating in FDCS could help them achieve their personal value, and the reason chosen most for unwilling reason was “low income and unrealized personal value (32.21%).” It is necessary for the government to establish the essential matching mechanisms to guarantee the development of the family doctor, including increasing the final financial support for primary health facilities, and developing the national incentive mechanism for family doctors.

[Outpatient Clinic Practice of Hospice and Palliative Care in Peking Union Medical College Hospital]

Objective To share the outpatient clinic practice of hospice and palliative care at the Department of Geriatrics,Peking Union Medical College Hospital.Methods We conducted a retrospective analysis on the consecutive clinic data of doctor N in Geriatric Outpatient Clinic,Peking Union Medical College Hospital from January 1,2016 to December 31,2019.The patients aged 85 years and older,as well as those with end stage malignant tumor,non-tumor dysfunction due to chronic diseases or primary diseases without effective treatment were defined as patients with palliative care need.The basic information,symptoms,consultation purposes and treatments of these patients were collected.Results Among the 2502 visits during the study period,1388 patients with palliative care needs were admitted and recorded,with an average age of(69.7±13.5)years(8-105 years),among which 73.3% were patients over 60 years old and 712(51.3%)were males.Among these patients,63.4% visited specifically to seek for palliative care service and 87.2% of the visits were due to distress caused by advanced malignant tumors.Of the 221 patients with non-tumor diseases,frailty and neurodegenerative diseases were the leading life-threating cause.Of the 5483 symptoms recorded,pain(21.2%),anorexia(13.1%),fatigue(11.6%),constipation(6.9%),insomnia(4.6%),and abdominal distension(4.6%)were the six common symptoms.In the 2502 visits,26.2% of the patients had mutiple visits,and 50.3% of the patients with multiple visits had more than three visits;38.6% of patients visited the clinic themselves,and 65.7% of visits were attended by two or more family members(including the patients).The average duration of visit was(19.6±8.5)min(2-85 min),and 13.5%,53.0%,25.6% and 7.9% of the patients completed the consultation within 10,11-20,21-30 and over 30 min,respectively.Conclusion There is strong demand of palliative care in the outpatient clinic of Department of Geriatrics in Peking Union Medical College Hospital and it is feasible to provide palliative care service for patients with serious diseases in geriatric outpatient clinics.

Patient satisfaction with outpatient care in China: a comparison of public secondary and tertiary hospitals

OBJECTIVE

The aims of this study were to investigate and compare patient satisfaction with outpatient care in public secondary and tertiary hospitals in China and to explore the factors affecting patient satisfaction for improving the quality of outpatient care in public hospitals.

METHODS

This cross-sectional study comprised a sample survey of 11 097 adults in 31 provincial cities in China from February to April 2018. A pretested structured questionnaire was used to collect outpatient experience data through a computer-assisted telephone interviewing system. Patient satisfaction was assessed using nine questions answered on a 4-point Likert scale. Multivariate regression models were employed to examine the relationships of patient satisfaction with outpatient services and healthcare provider level and to identify the factors associated with satisfaction.

RESULTS

Patient's overall satisfaction score with outpatient care was 27.3 (SD = 3.8), with lower scores observed in tertiary hospitals than in secondary hospitals (27.3 vs. 27.6, P < 0.05). The domain with the highest satisfaction was 'consulting environment', and the domain with the lowest satisfaction was 'patient waiting time in the hospital'. Patients who went to tertiary hospitals reported lower satisfaction in 'patient waiting time in the hospital', 'medical expenses', 'patient length of treatment time' and 'attitudes of other health workers' than patients who went to secondary hospitals (P < 0.05). In secondary hospitals, no significant difference in patient satisfaction was observed between different sociodemographic categories (P > 0.05). In tertiary hospitals, female and single respondents were more likely to have higher satisfaction (P < 0.05), whereas respondents with high school or junior college degrees were more likely to have lower satisfaction (P < 0.05).

CONCLUSION

The aforementioned results suggested that tertiary hospitals face larger challenges in patient satisfaction with outpatient care than secondary hospitals. Measures must be adopted to improve patient satisfaction with outpatient care in future healthcare reforms. Patient waiting time, medical expenses and treatment duration especially require improvements in tertiary hospitals.

Antimicrobial-Resistant Bacteria and Prescription of Antibiotics at a Tertiary Care Hospital in Riyadh, Saudi Arabia

Purpose The purpose of the study was to assess the bacterial resistance and annual antibiotic consumption at a tertiary care hospital in Riyadh, Saudi Arabia over a two-year period. Methods This retrospective cohort study was conducted at a tertiary care hospital in Riyadh, Saudi Arabia from January 1, 2016, to December 31, 2017. Results The results showed that there was no significant difference between 2016 and 2017 data regarding patient characteristics like bed occupancy rate, the average length of stay, and the number of admissions; the same was true for bacterial characteristics like the number of bacteria, percentage of isolates in the group, and multidrug resistance (MDR) percentage (p: >0.05). Between 2016 and 2017, there was a slight reduction in the sensitivity of Escherichia​​​ coli (E. coli) carbapenem-resistant Enterobacteriaceae (CRE) (97%, 86%) and Klebsiella pneumoniae (K. pneumoniae) CRE (80%, 76%) towards colistin. There was also a decrease in the sensitivity of Acinetobacter baumannii (A. baumannii) multidrug-resistant organism (MDRO) from 42% to 29% against tigecycline, but an increase in the sensitivity of K. pneumoniae CRE (33%, 50%) and E. coli CRE (76%, 82%). The percentage of MDR strains in gram-positive bacteria showed that more than half of Staphylococcus aureus (S. aureus) were methicillin-resistant (61%, 59%) in 2016 and 2017 respectively. There was a reduction in the percentage of MDR strains in some gram-negative bacteria like Pseudomonas aeruginosa (P. aeruginosa) MDRO (24%, 19%),E. coli extended-spectrum beta-lactamases (ESBL) (56%, 50%), E. coli CRE (4%, 1%), K. pneumoniae CRE (49%, 33%), A. baumannii CRE (90%, 76%), and Proteus mirabilis​​​​​​​ (P. mirabilis) ESBL (54%, 50%). Conclusion MDRO bacteria are very common in the hospital where the study was conducted. Immediate action is required to tackle this problem.

Patient Education and Medication Adherence among Hypertensives in a Tertiary Hospital, South Western Nigeria

Background

Hypertension is a global health issue among the adult population with high morbidity and mortality rates. Poor adherence to medication is associated with bad outcome of the disease and wastage of health resources. Therefore, this study aims to determine the role of patient education in medication adherence among hypertensives attending tertiary hospitals in Ekiti State, South Western, Nigeria.

Methods

This is a descriptive cross-sectional study involving 420 participants attending Family Medicine Department Clinic of Federal Medical Centre (FMC), Ido-Ekiti. Relevant data were collected using semi-structured questionnaire.

Results

The mean age of respondents was 60.97 ± 11.28 years, and a slight female preponderance (male: female = 1:1.7 over male). Three hundred and forty nine (83.1%) were married, 273(65.0%) were from a monogamous family and 375(89.2%) had family sizes of more than 4. Ninety four (22.4%) had good knowledge about hypertension, and 257(61.2%) were adherent to their medication. Increased medication adherence proportion was observed as knowledge about hypertension improves. The odds of adherence to treatment among subjects with good knowledge is 2 times (OR = 2.320, 95%CI = 1.164, 4.626) higher than among subjects with poor knowledge.

Conclusion

The proportion of respondents with good knowledge about hypertension is low. However, the adherence among them to medication is higher and statistically significant. Patient education about the disease and its treatment by primary care physicians can help to improve adherence to medication.

Chest CT features of patients under investigation for Covid-19 pneumonia in a Ghanaian tertiary hospital: a descriptive study

BACKGROUND

Coronavirus disease 2019 (COVID-19) has since December 2019 become a problem of global concern. Due to the virus' novelty and high infectivity, early diagnosis is key to curtailing spread. The knowledge and identification of chest Computerized Tomography (CT) features in Patients Under Investigation (PUI) for the disease would help in its management and containment.

OBJECTIVES

To describe the chest CT findings of PUI for COVID-19 pneumonia referred to the Department of Radiology of the Korle Bu Teaching Hospital; as well as to determine the relationship between symptom onset and severity of the chest CT findings.

METHODS

The study was retrospective and included 63 PUI for COVID-19 referred to the Department between 11th April, 2020 and 10th June, 2020, for non-enhanced chest CT imaging. Clinical data were obtained from patients' records and Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) results were acquired after the CT evaluation.

RESULTS

The mean age in years was 51.1±19.9 SD. More males (52.8%) than females (47.2%) tested positive for COVID-19 and the age range for positive cases was 7 months to 86 years, with a mean of 53.2±21 SD years. Common features of COVID-19 pneumonia were bilateral posterior basal consolidations, Ground Glass Opacities (GGO) and air bronchograms. Findings were worse in patients scanned 5-9 days after onset of symptoms.

CONCLUSION

Adequate knowledge of chest CT features of COVID-19 pneumonia, proves a valuable resource in triaging of symptomatic patients and consequent containment of the disease in the hospital setting.

FUNDING

None declared.

Understanding the influence of the COVID-19 pandemic on hospital-based mortality in Burundi: a cross-sectional study comparing two time periods

This study used hospital records from two time periods to understand the implication of COVID-19 on hospital-based deaths in Burundi. The place of COVID-19 symptoms was sought among deaths that occurred from January to May 2020 (during the pandemic) vs. January to May 2019 (before the pandemic). First, death proportions were tested to seize differences between mortality rates for each month in 2020 vs. 2019. In the second time, we compared mean time-to-death between the two periods using the Kaplan-Meier survival curve. Finally, a logistic regression was fitted to assess the likelihood of dying from COVID-19 symptoms between the two periods. We found statistical evidence of a higher death rate in May 2020 as compared to May 2019. Moreover, death occurred faster in 2020 (mean = 6.7 days, s.d. = 8.9) than in 2019 (mean = 7.8 days, s.d. = 10.9). Unlike in 2019, being a male was significantly associated with a much lower likelihood of dying with one or more COVID-19 symptom(s) in 2020 (odds ratio 0.35, 95% confidence interval 0.14-0.87). This study yielded some evidence for a possible COVID-19-related hospital-based mortality trend for May 2020. However, considering the time-constraint of the study, further similar studies over a longer period of time need to be conducted to trace a clearer picture on COVID-19 implication on hospital-based deaths in Burundi.

Scientific misconduct and associated factors: A survey of researchers in three Chinese tertiary hospitals

We designed a questionnaire to assess the prevalence of scientific misconduct and possible associated factors in tertiary hospitals in China. A total of 278 questionnaires were distributed to researchers in three tertiary hospitals, and 217 were returned. The top three influencing factors on scientific misconduct were individual morality (74.20%), pressure for promotion (65.90%), and pressure for publishing articles (63.59%). More than 50% of researchers thought the pressure for promotion, publication, and external funding were high or very high. Approximately 40% of researchers admitted having committed at least one of the nine listed forms of scientific misconduct, and 17.51% admitted having committed at least one of fabrication, falsification, or plagiarism. The most common scientific misconducts was inappropriate authorship (29.49%). Being a principal investigator or physician and higher pressure for promotion were associated with higher self-reported research misconduct severity score (RMSS) grade. Being female and better recognition of scientific integrity were related to lower RMSS grade. We recommend that the Chinese policy makers and hospitals pay more attention to increasing perceptions of scientific integrity, establish a more scientific evaluation system for promotion, and improve the auditing and surveillance of research.

Quality improvement study on early recognition and intervention of caregiver burden in a tertiary hospital

Background

Caregivers play a crucial role in taking over the important task of looking after patients post-hospitalisation. Caregivers who are unfamiliar with patients’ post-discharge care often experience caregiver stress, while patients may see deterioration in their condition. As caregivers are our core partners in healthcare, it is therefore necessary for patient navigators to recognise, assess and address caregivers’ needs or burden as early as on admission to hospital. Patient navigators are trained registered nurses whose main role is to provide patients and caregivers with personalised guidance through the complex healthcare system.

Objectives

This quality improvement study examined the efficacy of using the Zarit Burden Interview as a tool in helping patient navigators recognise caregiver burden early and the effectiveness of targeted interventions on caregiver burden.

Methods

Various quality improvement tools were used. Eighty-six patient-caregiver dyads who met the inclusion criteria were enrolled. Informal caregivers were assessed for caregiver burden using the Zarit Burden Interview during hospital admission (T0) and again at 30 days postdischarge (T1), post-intervention.

Results

There was significant improvement in the Zarit Burden mean scores from T0 to T1 reported for the 80 dyads who completed the study, even after adjusting for covariates (T0 mean=11.08, SD=7.64; T1 mean=2.48, SD=3.36, positive ranks, p<0.001). Highest burden identified by most caregivers were the personal strain; trying to meet other responsibilities and uncertain about what to do in caring for their loved one. By recognising the different aspects of caregiver burden early, patient navigators were able to focus their interventions.

Conclusion

Early recognition of caregiver burden and targeted interventions were found to be effective at reducing caregiver burden in a tertiary hospital.

Out-of-Pocket Expenditure and Opportunity Cost of Leptospirosis Patients at a Tertiary Care Hospital of Gujarat, India

INTRODUCTION

The study investigates the cost incurred by leptospirosis patients as either out-of-pocket expenditure (OOPE) or opportunity cost (OC) and recommends accordingly for the national program on leptospirosis in India.

OBJECTIVES

The objective of this study is to determine leptospirosis-related OOPE and OC at a government tertiary care hospital and to disaggregate the total OOPE into contributing cost domains.

MATERIALS AND METHODS

The OOPE data were collected by the personal interview of confirmed leptospirosis cases who took complete treatment at the hospital in year 2009 using a prestructured questionnaire. The patients were interviewed daily until discharge to know daily OOPE.

RESULTS

The mean OOPE per patient was Rs. 2157/-, Median: Rs. 1880/-, 25^th-75^th percentile: Rs. 1446 - Rs 2587.5). The lowest quintile for OOPE was Rs. 1330/- and the highest quintile was Rs. 2874/-. Loss of daily wages was 68% (Rs. 1458.9/-) of the total OOPE. Other major expenditure included cost of drugs Rs. 308.8/- (14%), expenditure on food Rs. 173/- (8%), and travelling expenses Rs. 204.4/- (9%).

CONCLUSIONS

Rs. 2157/- is significant OOPE, and hence, important factor in understanding health-seeking behavior and compliance of leptospirosis patients. The OC (loss of daily wages) amounts to 68% of total OOPE which has to addressed by the government to realize universal health coverage.

Protection and Response of a Tertiary Hospital in South Korea to the COVID-19 Outbreak

Objective:

Here, we present an overview of how a tertiary hospital responded to maintain necessary activities and protect patients and staff from the coronavirus disease (COVID-19) outbreak.

Methods:

Gil Medical Center, a tertiary hospital in Incheon, has operated a special response team since January 21, 2020. All visitors were assessed for body temperature and respiratory symptoms, and screened for recent overseas travel. Suspected COVID-19 patients were taken to a screening clinic. All febrile patients with or without respiratory symptoms were taken to a respiratory safety clinic. An isolation ward, which consisted of 10 negative-pressure rooms, was used to treat confirmed cases. More than 120 beds were prepared for the outbreak, and patients with pneumonia were preemptively isolated.

Results:

By May 5, 480 960 visitors were assessed at the control station, 3350 patients visited the triage center, and 1794 were treated in the respiratory safety clinic. Seventeen confirmed cases were admitted to the negative isolation ward, and 350 patients with pneumonia were preemptively isolated. A total of 2977 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction tests were performed.

Conclusions:

While tertiary hospitals play an important role in treating both COVID-19 patients and non-COVID-19 patients, hospital staff have to protect themselves from unexpected in-hospital transmission. A multifaceted response must be undertaken to protect tertiary hospitals and their staff during the COVID-19 epidemic.

Determinants of severe injury and mortality from road traffic accidents among motorcycle and car users in Southern Thailand

This study aimed to identify factors associated with severe injury and mortality from road traffic accidents (RTA) among motorcycle and car users in southern Thailand. The data were obtained from the Office of Disease Prevention and Control, Thailand, for years 2008-2013. Chi-squared tests were used to assess associations between determinants and outcomes and these associations were then estimated after adjusting for possible confounding with other factors using logistic regression. Severe injury and mortality contributed 11.6% and 5% to RTA of motorcycle users, and 14.3% and 7.5% for car users. Among motorcycle users, male gender, older age, and not wearing a helmet increased severe injury and mortality rates, whereas drivers had more severe injuries than passengers. Older car users had higher severe injury and mortality rates, whereas not fastening seat belts had higher mortality. Safety device use should be made mandatory for both drivers and passengers. Male motorcycle users and the elderly should be focused on.