Accident And Emergency Department Research Articles

2008 Improving the documentation of Treatment Escalation Plans in patients >65yo admitted under the care of orthopaedics

Abstract Introduction Treatment Escalation Plans (TEPs) are helpful tools that reduce un-necessary treatment burden, improve patient experience and follow the principles of realistic medicine. This is relevant in orthopaedics where a high percentage of the patients are frail, co-morbid, and would benefit from clear and realistic care plans. We aim to improve TEP completion to >50% of orthopaedic patients, over the age of 65yrs old, in three trauma wards at the Royal Infirmary of Edinburgh by August 2023. Methods We sampled three patient notes on each ward twice weekly from May – August 2023, noting whether TEPs were present, if it was consultant endorsed or provisional, and what key sections were completed (resuscitation, treatment goals and communication). To be included, the patient had to ≥65 and under orthopaedics. Process mapping demonstrated 2 key targets- admission clerk-in and registrar review. PDSA 1 involved creating a prompt for documenting TEPs on FY1 clerk-in which was added to the admission proforma folder and displayed as posters. PDSA 2 was a teaching session designed for orthopaedic registrars and other team members about TEP conversations. Results Pre-intervention data, demonstrated a median of 28% of orthopaedic patients ≥65yo have a TEP. Of the completed TEPs: 88% solely consisted of a resuscitation decision; 33% had treatment goals, 33% communication; and 0% of TEPs were endorsed. After PDSA 2; median TEP completion increased to 33%. Of the completed TEPs; none had only a resus decision, 100% have treatment goals; 100% communication, and 67% are endorsed. Conclusions Our studies have demonstrated that education and proforma changes have increased TEP documentation rate, although not to our projected target. However importantly, the percentage of TEPs that contain goals, document communication and consultant endorsement has improved significantly. This project is ongoing with planned further PDSA cycles.

Documentation Completeness and Nurses' Perceptions of a Novel Electronic App for Medical Resuscitation in the Emergency Room: Mixed Methods Approach.

Complete documentation of critical care events in the accident and emergency department (AED) is essential. Due to the fast-paced and complex nature of resuscitation cases, missing data is a common issue during emergency situations. This study aimed to evaluate the impact of a tablet-based resuscitation record on documentation completeness during medical resuscitations and nurses' perceptions of the use of the tablet app. A mixed methods approach was adopted. To collect quantitative data, randomized retrospective reviews of paper-based resuscitation records before implementation of the tablet (Pre-App Paper; n=176), paper-based resuscitation records after implementation of the tablet (Post-App Paper; n=176), and electronic tablet-based resuscitation records (Post-App Electronic; n=176) using a documentation completeness checklist were conducted. The checklist was validated by 4 experts in the emergency medicine field. The content validity index (CVI) was calculated using the scale CVI (S-CVI). The universal agreement S-CVI was 0.822, and the average S-CVI was 0.939. The checklist consisted of the following 5 domains: basic information, vital signs, procedures, investigations, and medications. To collect qualitative data, nurses' perceptions of the app for electronic resuscitation documentation were obtained using individual interviews. Reporting of the qualitative data was guided by Consolidated Criteria for Reporting Qualitative Studies (COREQ) to enhance rigor. A significantly higher documentation rate in all 5 domains (ie, basic information, vital signs, procedures, investigations, and medications) was present with Post-App Electronic than with Post-App Paper, but there were no significant differences in the 5 domains between Pre-App Paper and Post-App Paper. The qualitative analysis resulted in main categories of "advantages of tablet-based documentation of resuscitation records," "challenges with tablet-based documentation of resuscitation records," and "areas for improvement of tablet-based resuscitation records." This study demonstrated that higher documentation completion rates are achieved with electronic tablet-based resuscitation records than with traditional paper records. During the transition period, the nurse documenters faced general problems with resuscitation documentation such as multitasking and unique challenges such as software updates and a need to familiarize themselves with the app's layout. Automation should be considered during future app development to improve documentation and redistribute more time for patient care. Nurses should continue to provide feedback on the app's usability and functionality during app refinement to ensure a successful transition and future development of electronic documentation records.

Discharge against medical advice in pediatric wards at tertiary center in Addis Ababa, Ethiopia: A retrospective cross-sectional survey.

Background: Children are at high risk of problems related to discharge against medical advice (DAMA). Because they are not part of the decisions their best interests may be violated. This study is aimed to determine the prevalence, clinical outcomes, and factors associated with discharge against medical advice. 
 Methods: We cross-sectionally described 123 admissions in which caretakers decided to discharge against medical advice. A mixed data collection method from the patient's charts and telephone interviews was employed. A pretested semi-structured questionnaire tool was used. The data was manually cleaned and analyzed using SPSS software version 25, USA. The frequency and percentage of categorical data were calculated, as well as the mean, median, SD, and IQR of the continuous variable. A multivariate regression analysis was performed, with an adjusted odds ratio of 95% CI and a statistical significance of 0.05. 
 Results: Hospital prevalence of DAMA was 1.42%. The median age was 11(±59) months—eighty-one percent of the caretakers signed before leaving the hospital. The median hospitalization was 7 days (IQR=13 days). The majority of the caretakers were discharged during working hours (71%). Discharge was registered in all seasons: winter (31%), spring (28%), summer (23%), and autumn (18 %). Hemato-oncologic conditions, infectious, and neonatal problems were common. Most of the cases were reported from pediatric emergency and neonatology wards. Patients’ poor clinical response and the caretaker's financial constraints were the main reasons for signing DAMA. Death was significant when the DAMA occurred in fast-improving cases and infants; (AOR=6.909, 95% CI-2.191-21.782), and AOR=1.3, 95% CI -0.48-3.3) respectively. 
 Conclusion: DAMA in the Pediatric wards of Tikur-Anbessa Specialized Hospital was similar to the reported data elsewhere. However, death was very high which could be due to insufficient fol-low-up after DAMA.

Substance Use in Patients Admitted to the Psychiatric Emergency Department in Northern Iran

Background: Acute psychiatric problems are increasingly observed following substance abuse in emergency departments. To address this significant societal issue, it is essential to understand its various dimensions in order to develop comprehensive control policies. Objectives: This study aimed to evaluate substance use and its related factors in patients admitted to a psychiatric emergency ward in Sari, Mazandaran, Iran. Methods: In this cross sectional investigation, all patients who were admitted to the emergency department of Zare referral psychiatry hospital during the previous one year were studied. A checklist of demographic and psychiatric factors was completed for each patient based on their medical records. Urine rapid tests were routinely conducted in this department to screen for drug consumption. Descriptive statistics, central and dispersion indices, and the chi-square test were used to analyze the data. Results: A total of 578 cases, comprising 406 males (70.2%) and 172 females (29.8%), were examined. The mean age of patients was 34.7 ± 11.2 years. The most common symptoms reported were aggression (50.5%), insomnia (11.2%), paranoia (10.7%), and self-talk (8.1%), respectively. The most frequent final clinical diagnosis was bipolar disorder in 145 cases (25.1%), followed by schizophrenia in 131 cases (22.7%), and substance-induced psychotic disorder in 63 cases (10.9%). In the substance use screening among patients, the urine test was positive for morphine in 17.6% of the patients. Methamphetamine, methadone, and cannabis tests were positive in 16.1%, 9.5%, and 3.5% of cases, respectively. Among patients with positive urine tests (for methamphetamine, methadone, or morphine), the most common clinical diagnosis was substance-induced psychotic disorder, followed by schizophrenia. Schizophrenia and substance-induced psychotic disorder were the two most common diagnoses in patients with positive cannabis urine tests, respectively. Conclusions: The high rate of substance abuse among psychiatric emergency patients, often co-occurring with other psychiatric disorders, the high prevalence of psychosis, and the behavioral risks associated with these patients emphasize the need for special attention to this biopsychosocial problem.

The Pattern of Respiratory Diseases among Children Admitted in the Children Emergency Ward, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria

Aim: Respiratory diseases are common causes of childhood morbidity and mortality worldwide. Variations in the pattern of respiratory diseases exist globally, due to environmental conditions, poverty, hygiene and so on. This study sought to determine the pattern of respiratory diseases among children admitted into the emergency ward of the University of Port Harcourt Teaching Hospital.
 Study Design: Retrospective cross-sectional study.
 Setting and Duration of Study: Children Emergency Ward of the University of Port Harcourt Teaching Hospital, between January 2019 and January 2021.
 Methodology: This was a retrospective cross-sectional study. Data were collected from case notes of 3,851 children, aged two months to 18 years, admitted to the University of Port Harcourt Teaching Hospital, over three years.
 Results: Respiratory diseases accounted for 500 (13%) of the total admissions, and was more common among males than females (M: F = 1.3:1). The mean age of children with respiratory illnesses was 2.27±4.6 years. Infectious causes {443 (88.6%)} were significantly higher than non-infectious causes {57 (11.4%)}, p<0.001. Bronchopneumonia, bronchial asthma and bronchiolitis were the commonest morbidities seen, accounting for 394 (78.8%), 34 (6.8%) and 22 (4.4%) of cases respectively.
 Conclusion: The prevalence of respiratory diseases is high. Infectious causes are still prevalent with cases presenting more during the dry season. Measures to reduce environmental pollution and enhance immunization can greatly reduce respiratory diseases among children.

Identified Factors in COVID-19 Patients in Predicting Mortality.

The coronavirus disease 2019 (COVID-19) pandemic has led to a significant increase in global mortality rates. Numerous studies have been conducted to identify the factors associated with mortality in COVID-19 cases. In these studies, overall mortality was evaluated in patients, and no distinction was made as ward or intensive care mortality. This study aims to determine mortality-related factors in patients who died while in the ward. This could enable us to review the indications for intensive care hospitalization in possible pandemics. This retrospective study was conducted on a cohort of 237 patients who applied to our institution between January 2020 and December 2021 with the diagnosis of COVID-19. Demographic characteristics, length of stay, type of admission (emergency ward or outpatient clinic), presence of comorbidities, thoracic computerized tomography (CT) findings, and laboratory findings were extracted from the hospital database. The demographic and laboratory results of both deceased and recovered patients were compared. While many demographic and laboratory findings were statistically significant in the initial analysis, multiple logistic regression analysis showed that decreased albumin levels (adjusted OR = 0.23, 95% CI = 0.09 - 0.57), increased troponin (adjusted OR = 1.03, 95% CI = 1.02 - 1.05), and procalcitonin (adjusted OR = 3.46, 95% CI = 1.04 - 11.47) levels and higher partial thromboplastin time (PTT) (adjusted OR = 1.18, 95% CI = 1.09 - 1.28) values, presence of diabetes mellitus (DM) in patients (adjusted OR = 2.18, 95% CI = 1.01 - 4.69, P = 0.047), and admission to hospital from the emergency department (adjusted OR = 5.15, 95% CI = 1.45 - 18.27, P = 0.011) were significantly associated with mortality when adjusted for age. When a predictive model is constructed with these variables, this model predicted mortality statistically significant (AUC = 0.904, 95% CI = 0.856 - 0.938, P < 0.001), with a sensitivity of 77.2% (95% CI, 67.8 - 85), a specificity of 91.2% (95% CI, 85.1 - 95.4), a positive predictive value (PPV) of 86.7% (95% CI, 72 - 85.3), and an negative predictive value (NPV) of 84.4% (95% CI, 79.4 - 89.6). In this study, we may predict mortality among COVID-19-diagnosed patients admitted to the ward via this model which has the potential to provide guidance for reconsidering the indications for intensive care unit (ICU) admission.

Incidence and characteristics of ligamentous knee injuries accompanying a femur shaft fracture and their association with injury mechanism and fracture characteristics: A prospective-observational study in a low-middle-income country.

This study aims to elaborate the incidence, types, and characteristics of ligamentous knee injuries accompanying femoral-shaft fractures and their association with demographic data, fracture characteristics, and injury mechanism. This multi-center-prospective-observational study examined patients in the Shaheed Mohtarma Benazir Bhutto Institute of Trauma and Civil Hospital orthopedic wards. Using the consecutive sampling technique, 146 patients with femoral-shaft fractures were recruited, and scrutinized to determine the presence of ligamentous knee injury, through an evaluation form encompassing patients' demographic data, fracture characteristics, knee examinations, and confirmed through magnetic resonance imaging. Knee injuries were detected intra-operatively under regional/general anesthesia and post-operatively utilizing diagnostic maneuvers (varus/valgus stress, Lachman, anterior/posterior drawer, external rotation recurvatum, and McMurray tests) by 2-3 surgeons and confirmed through magnetic resonance imaging. Magnetic resonance imaging was exclusively employed in suspected false positive/negative cases, and when a titanium implant was utilized, that is, 131 cases (89.7%). Chi-square test was used to assess the relationship between incidence and type of ligamentous knee injury with demographic data, injury mechanism, and fracture characteristics. Among the 146 patients with femoral-shaft fractures, 78% and 22% were males and females, with 37% experiencing associated ligamentous knee injury. Medial collateral ligament and anterior cruciate ligament were the commonest types of ligamentous injuries accompanying femoral-shaft fractures, at 44% and 33%. The Chi-square revealed a statistically significant association between the incidence of ligamentous knee injury accompanying femoral-shaft fracture with demographic data, injury mechanism, and fracture characteristics (p-value < 0.05), and was noted to be higher among males (55.6%), participants aged 18-25 years (66.7%), involved in a road traffic accident (88.9%), resulting in a complex (77.8%) and close fracture (88.9%). A similar association was seen between medial collateral ligament and anterior cruciate ligament injuries with age, injury mechanism, and fracture characteristics (p-value < 0.05). Our study revealed the unaddressed fact that Pakistan has a significant incidence of ligamentous knee injuries accompanying femoral-shaft fractures. These insights can empower clinicians/surgeons to understand and manage this condition effectively.

Wernicke Encephalopathy in a Patient of Acute Gastroenteritis: A Case Report

An acute neurological disease known as Wernicke Encephalopathy (WE) is characterised by the clinical triad of symptoms: ophthalmoparesis with nystagmus, ataxia, and disorientation. Thiamine deficiency is the underlying cause of this potentially fatal condition, which mainly affects the central and peripheral nervous systems. Hereby, the authors present a case of a 47-year-old male who presented with multiple episodes of loose stools and altered consciousness to the emergency ward. He had hyperchloremic metabolic acidosis suspected to be due to acute gastroenteritis, which may have caused his altered consciousness. Despite correction of his metabolic acidosis, his sensorium did not improve. Later, he was diagnosed with WE using Magnetic Resonance Imaging (MRI) brain findings, which showed symmetrical subtle hyperintensities in the medial part of the thalami and periaqueductal grey matter, suggestive of WE; his consciousness improved after thiamine supplementation. There should be a high suspicion of WE for timely diagnosis and treatment. Prompt treatment would be rewarding as WE is reversible, if treated in time.

A Perforated Meckel's Diverticulum Simulating Appendicular Peritonitis : Case report

Meckel's diverticulum results from the partial persistence of the omphalomesenteric duct and its complications are rare. Diagnosis is often made intraoperatively. We present the case of a 46-year-old patient admitted to the emergency ward with symptoms suggestive of peritonitis. Clinical examination revealed tenderness in the right iliac fossa. Abdominal and pelvic ultrasound revealed a swollen appendix located laterocecally, measuring 9.2 mm in maximum thickness, with an associated oval collection containing finely echogenic contents measuring 32 × 14 mm, without evidence of effusion.During surgery, a perforated Meckel's diverticulum was discovered as the cause of the peritonitis. The patient underwent segmental bowel resection with ileostomy formation. Postoperative recovery was uneventful, and the patient was discharged on the third postoperative day. Anatomopathological examination of the surgical specimen showed inflammatory changes without signs of malignancy. One month after the operation, the patient underwent ileal continuity restoration.

Potential Drug-Drug Interactions among Geriatric Patients in Medicine Department at a Tertiary Care Teaching Hospital - A Prospective Observational Study

Background Drug-drug interactions occur when therapeutic effect of one drug is altered by another drug during co-administration. These effects may result in increase or decrease in the action of either of the substances or it may cause adverse effect that is abnormally associated with either of the drugs. Data was collected from patients admitted in the Emergency Department.Aim The objective of the study was to identify evaluate and analyze the drug-drug interactions found in the prescriptions of elderly patients visiting the Medical department at a tertiary care teaching hospital.Methods This prospective observational study was undertaken in an Emergency ward for a period of six months to identify evaluate and analyze the drug-drug interactions. Ethical clearance was obtained from the Institutional Ethical Committee of SCS College of Pharmacy Harapanahalli. A total of three hundred and fifty cases were reviewed and details such as demographics past medical and medication history prescribed drugs and drug interactions were recorded.Results The data of 350 patients was included in the study. In our study a total of 405 drug-drug interactions were seen in 191 patients. The most commonly involved drugs were hydrocortisone and furosemide. Increased polypharmacy was observed in patients with co-morbid conditions leading to increased risk of potential drug-drug interactions PDDI.Conclusion Our study revealed that geriatric patients have higher risk for polypharmacy due to the presence of co-morbid conditions. Overall the incidence of PDDI was high and most interactions were pharmacodynamic in nature.nbsp

Left Side Obturator Hernia With Multiple Ileal Diverticula : A Rare Case Report In A 72 Year Old Female

Obturator hernia is an extremely rare type of hernia that presents with signs and symptoms of intestinal obstruction. Its early diagnosis is difficult because the signs and symptoms are non-specific. A 72-year-old woman was admitted to our hospital in the emergency ward with complaints of intermittent abdominal colicky pain, abdominal distension, and bilious vomiting from last six days. The abdomen skiagram showed an obstructed loop of the bowel in the pelvis. After initial resuscitation, an exploration of the abdomen was planned. The patient also had multiple ileal diverticula in the terminal ileum. The only treatment for the obturator hernia is surgery.&#x0D;

Studying the level of hospital contamination with Staphylococcus aureus

Background and Objectives. Staphylococcus aureus bacteria is one of the most important types of antibiotic-resistant bacteria that cause hospital-acquired infections, so the source of this bacteria in the hospital must be determined for the purpose of controlling it and preventing its spread. Materials and Methods. The study included collecting (296) samples from operating lobbies and wards in Al-Hussein Teaching Hospital. The isolates were distributed by (73) isolates out of (177) samples from wards and (64) isolates out of the original (119). A sample from operating theaters and from different locations for the period between October 2016 and until February 2017. Bacterial isolates were diagnosed. This was confirmed with the use of CHROM agar Staphylococcus aureus media. Results. The results showed that the highest prevalence of bacteria was in the surgical ward by 64% and the lowest prevalence in the nose, ear and throat ward by 25%, while the prevalence rate was recorded at 40% in the urinary ward, 36.8% in the esotericism ward, and 36% in the fractures ward. Bacteria recorded a prevalence rate of 34.48% in the emergency ward. The highest prevalence of bacteria was on the floors of the wards by 51.16%. Conclusions. The high rates of pollution in operating theaters compared to wards, and this may be due to the failure of patients and companions to follow the procedures imposed by the hospital, lack of commitment to attention to the number of companions and visiting times, or to the commitment to wearing bras, head covers and sterile shoes.

Rapunzel Syndrome in A 13-Year-Old Girl with Abdominal Pain Presenting to The Pediatric Emergency Department: A Case Report

Trichobezoar is a rare form of bezoar characterized by the accumulation of swallowed hair in the stomach. An unusual form of bezoar, in which the bezoar spreads from the stomach to the small intestine or beyond, is called Rapunzel syndrome. This syndrome is mainly seen in females and is often associated with psychiatric disorders. Trichobezoar usually presents with abdominal pain, early satiety, and nausea. However, it may also present as an asymptomatic abdominal mass or obstruction and pe rforation of the gastrointestinal tract. This diagnosis should be considered in young women with abdominal pain, an epigastric mass, and malnutrition, especially in patients with a history of trichophagy or psychiatric disorder. The case of a 13-year-old girl with Rapunzel syndrome is described. She presented to the emergency ward with a history of abdominal pain, non-bilious vomiting after meal and fluid intake, halitosis, decreased appetite, and weight loss. The patient was treated successfully by laparotomy.

Correlation of the COVID-19 Infection and Outcomes with Workload among Emergency Healthcare Workers in an Iranian Referral Hospital.

The immediate spread of COVID-19 posed a great deal of strain on healthcare personnel, particularly emergency personnel. Considering the critical role of frontline health care personnel (HCPs) during the pandemic and the life-threatening effects of COVID-19 on them, the present study aimed to evaluate the hospital database among frontline emergency personnel, and to assess the factors affecting the health status of the emergency HCPs. In the current study, we collected data on coronavirus clinical features from 58 HCPs with confirmed COVID-19 who worked in the emergency ward of Baqiyatallah Hospital, Tehran, one of the most referral hospitals in Iran. We also assessed the factors affecting the health status of the emergency HCPs from February 2020 to November 2020. All of the 58 HCPs infected with COVID-19 were the personnel of the emergency ward with an age range of 20-59 years old. The median (interquartile range) of hospital length of stay (LOS) among all patients was 8 days. Length of stay is a critical factor in predicting hospital resource needs. Twelve (21.8%) patients had ground-glass opacity (GGO) alone, and 20 (35.7%) patients had patchy GGO. In our multivariable analysis, high levels of patient liver enzymes (P=0.04) and lymphopenia (P=0.01) were significantly associated with the LOS. In our study, there was an association between high levels of patient's ESR and CRP and longer LOS. We also found that age and gender had no effect on LOS. Nurses contributed to the highest number of COVID-19 infection. It was also found that HCPs who had more working shifts were more infected, and the intensive care unit of the emergency ward was the most infected area of the Emergency Room.

Trends of number of patient visits, demographic, and patient diagnosis at a dental hospital during the COVID-19 pandemic: a descriptive study

ABSTRACTIntroduction: The long-standing COVID-19 pandemic had resulted in the implementation of service restrictions and the emergence of patients' fear of coming to health facilities, which could have caused changes in patient visit trends. The aim was to determine trends in the number of visits, demographic characteristics and patient diagnoses during the COVID-19 pandemic. Method: the descriptive and population research used secondary data from medical records of new visiting patients and existing patients at the general dental clinic, pavilion clinic, and emergency ward at the Universitas Padjadjaran Dental Hospital (RSGM UNPAD) from April 2019 to March 2021. Sample for number of patient visits before and during the pandemic, the total sampling was 12,714 and the characteristics and diagnosis of patients during the pandemic were 3,625 medical records, while non-probability sampling technique with purposive sampling was used. Univariate analysis used frequency distribution, line charts, bar charts. Result: The number of patient visits at RSGM UNPAD during the pandemic decreased by around 60% (from 9,089 to 3,625 visits) compared to before the pandemic. The patient demographics during the pandemic at RSGM and at its three polyclinics were relatively the same: adults (26-45 years), female, domiciled in the city of Bandung, private employees, Moslem, Sundanese, unmarried, and past patient status.The most common diagnosis at RSGM was pulpitis 914 (61%); in general dental polyclinic was pulpitis 751 (33%); in the pavilion clinic was malocclusion 428 (32%) and in the emergency ward was pulpitis, necrosis of pulp and impacted each 4 (16%). Conclusion: During the COVID-19 pandemic, patient visits to the dental hospital decreased more than half, the demographic characteristics of the three polyclinics were relatively the same and the most common patient diagnosis was pulpitis.KEYWORDS : Demographics; dental hospital; oral diagnosis; the COVID-19 pandemic; trend of patient visits

Implementation of a shared oncologic intermediate and acute care unit in times of COVID. Has it come to stay?

With aging population and improvement of cancer treatments, the growing number of complex cancer survivors’ challenge the delivery of quality and affordable care. Health care systems need innovate to improve care coordination, patients’ outcomes and experiences and to contain costs. The aim of this study was to evaluate the implementation of an oncology care unit shared between an acute and an intermediate care ward. The shared unit was launched as a response to the COVID-19 pandemic situation that overwhelmed hospital resources and put the quality of care for non-COVID pathologies at risk. The unit is formed by a multidisciplinary team, including oncologists, geriatricians, specialized nurses, therapists and social and psychological support. It is located in a ward with dedicated spaces and activities for oncologic patients. Patients are derived from the emergency ward of the acute hospital after triage or a short stay, when they need specialized oncologic care but without need of complex acute procedures. &#x0D; We conducted a pre-post implementation evaluation using mixed-methods. We analyzed system-level longitudinal data from electronic health records before (historical controls) and during implementation. We performed quantitative and qualitative analysis of patients’ surveys, focus groups with professionals, and interviews with patients and caregivers.&#x0D; From January 2018 to June 2020 there were a mean of 160 discharges/month from the acute ward. Since the setup of the Unit in July 2020 until April 2022, approximately 45% (1551; 69 discharges/month) of patients were discharged from the subacute ward. Most patients (75.5%) were derived directly from the emergency unit of the acute care hospital or after a 1 day stay or less, thus avoiding acute hospitalization. During the implementation period patients attended in the subacute ward were older (67.9 vs 63.5), had higher comorbidity weight (GMA: 15.2 vs 13.5) and higher complexity (patients with complex chronic conditions due to health or social needs: 9.4 vs 7%; patients with advanced chronic conditions due to limited life expectancy or end of life situation: 20.7 vs 15%). Consequently, the number of complex patients in the acute ward decreased while the total capacity of the system increased.&#x0D; The focus group with professionals (n=15) revealed different arquetypes of patients: subacute care, symptoms control, end of life care and social problems; and caregivers: adjusted/unadjusted to the situation. Positive and negative aspects perceived by professionals were contrasted with those of patients. Professionals highlighted multidisciplinary and availability of adequate spaces and activities as positive values, patient valued the professionalism and humane treatment. Some improvement actions are taking place to improve the provision of information to patients.&#x0D; In conclusion, the shared intermediate oncology unit increases the total capacity of the oncologic care system and avoids acute hospitalization to complex patients due to age, comorbidity and social needs. Experiences of professionals, patients and caregivers are mostly positive. "

Novel diagnostic approach for amoebic liver abscess using cell free (cf) DNA: a prospective study

Background Amoebic liver abscess (ALA) is commonly seen in tropical countries and diagnosis of ALA relies mainly on non-specific serological and imaging techniques as well as PCR from pus. Objective This study evaluated the potential of using cell free DNA (cfDNA) from serum and urine for diagnosing ALA. Methods We prospectively evaluated quantitative PCR (qPCR) for detection of cf DNA in serum and urine sample in all liver abscess patients. The samples were collected from patients reporting to emergency ward of Postgraduate Institute of Medical Education and Research, Chandigarh, India with symptoms suggestive of liver abscess. Real time PCR was done to detect cf DNA in serum and urine by targeting 99-bp unit of small subunit rRNA of Entamoeba histolytica and conventional PCR for pus. Results A total 113 samples (serum and urine) and 100 pus samples were analysed. A total of 62 ALA patients were confirmed; with maximum 57 patients detected by qPCR for cfDNA in the serum, 55 patients by PCR on pus aspirate and 50 ALA patients by qPCR for cfDNA in urine sample. Therefore, the sensitivity of qPCR for detection of cf DNA in serum was 91.94% and for urine was 80.65%. Conclusion A total of 11.2% of ALA patients were diagnosed only through detection of E. histolytica cf DNA in their serum and urine. Detection of cfDNA from serum, urine of ALA has a potential role in future especially for developing countries as it is a rapid, sensitive and patient friendly diagnostic approach.

Demographic Profile and Outcome of Pediatric Intensive Care Unit.

Pediatric intensive care provides better observation as well as an intensive treatment, which helps to cure, support, and provide better outcomes for sick children. This study aimed to describe the demographic profile and the outcome of PICU patients, and evaluate the relationship of diagnostic categories with treatment and outcome. This retrospective cross-sectional study was conducted in a six-bedded PICU from 1 March 2021 to 1 March 2022. Bivariate analysis was used to identify the association between dependent and independent variables. The infants admitted below 6 months of age were 63 (22.3%) and had male predominance accounting for 64%. The main portal of entry of the admitted cases was emergency ward 214(75.6%). Most of the patients 153(54.1%) were admitted for intensive monitoring of their abnormal vitals along with critical care according to our PICU protocol. Respiratory illness 122(43.1%), neurosurgical illness 59(20.8%), and primary infectious disease 52(18.3%) were the common reason for PICU admission. Post-major surgery 2(66.7%), hematological illness 3(37.5%), and cardiac disorders 1(20%) had high mortality rates. Among the portal of admission, the majority of the children (80.0 %) who were admitted to the PICU through the emergency ward died before exiting from the PICU (p<0.0001). Respiratory illness was the most common cause of admission and post-major surgery had the highest mortality rate. Portal of entry was statistically associated with patient characteristics and had a significant relationship with the outcome. Similar studies in other health institutions are required to further analyze the demographic profile and outcome of pediatric critical care in Nepal.

Prevalence of Sick Building Syndrome and Its Related Factors in Medical Staff in Iran: A Cross-sectional Study

Background: Data on the prevalence of sick building syndrome (SBS) and its components in medical staff working at the Semnan University of Medical Sciences are limited. Objectives: The present study investigated the prevalence of SBS and its related factors in the medical staff in Semnan, Iran. Methods: A cross-sectional study was done on 300 medical staff in Kausar Hospital in Semnan, Iran, in 2020. A standard questionnaire was used to obtain information about SBS and indoor air quality. In order to measure environmental factors, random sampling was taken from different parts of the hospital, including building inspection, dust samples, and indoor and outdoor air measurements. The condition of physical factors, including temperature, humidity, and ventilation, was checked using relevant devices. The NIOSH 0800 method was used to measure the biological status of the working spaces in terms of fungal and bacterial contamination. Data analyses were performed using SPSS 26. Results: The mean age of the participants was 32.23 ± 5.34 years, of whom 81% were women. The prevalence of SBS was 65%, with the highest prevalence in the emergency ward (18%), followed by internal (16%), intensive care unit (13%), and cardiac care unit (12%). Sleep disorder (65%), tiredness (59%), feeling heavy (47%), headache (46%) and stress (45%) were the most common components of the SBS. There was a statistically significant relationship between the presence of harmful environmental factors, including noise, static electricity, unpleasant smell, and infection, and the prevalence of SBS (all P-values &lt; 0.05). Conclusions: Considering the high prevalence of SBS in hospital employees, re-engineering the hospital environment and improving the air quality and ventilation systems may be useful in preventing SBS.

Effect of early antibiotic treatment strategy on prognosis of acute pancreatitis

BackgroundAntibiotic use in the early stages of acute pancreatitis is controversial. The purpose of this study was to investigate the effect of early antibiotic application on the prognosis of acute pancreatitis (AP).Materials and methodsClinical data of patients with primary AP admitted to our emergency ward within 72 hours of onset were retrospectively collected from January 2016 to December 2020. We classified patients with acute pancreatitis according to etiology and disease severity, and compared the differences in hospital stay, laparotomy rate, and in-hospital mortality among AP patients who received different antibiotic treatment strategies within 72 hours of onset.ResultsA total of 1134 cases were included, with 681 (60.1%) receiving early antibiotic treatment and 453 (39.9%) not receiving it. There were no significant differences in baseline values and outcomes between the two groups. In subgroup analysis, patients with biliary severe acute pancreatitis (SAP) who received early antibiotics had lower rates of laparotomy and invasive mechanical ventilation, as well as shorter hospital stays compared to those who did not receive antibiotics. In logistic regression analysis, the early administration of carbapenem antibiotics in biliary SAP patients was associated with a lower in-hospital mortality rate. Early antibiotic use in biliary moderate-severe acute pancreatitis (MSAP) reduced hospital stays and in-hospital mortality. Quinolone combined with metronidazole treatment in biliary mild acute pancreatitis (MAP) shortened hospital stays. Early antibiotic use does not benefit patients with non-biliary AP.ConclusionStrategies for antibiotic use in the early stages of AP need to be stratified according to cause and disease severity.