General Hospital Setting Research Articles

Patient expectations do matter - experimental evidence on antibiotic prescribing decisions

Abstract Inappropriate prescription of antibiotics remains a major contributor to the global antimicrobial resistance crisis despite clear linkages between antibiotic utilization and resistance spread. This study aims to better understand the simultaneous and independent effect of previous prescription behavior, patient expectation, and clinical uncertainty on antibiotic prescribing. This discrete choice experiment was embedded within a routine organizational climate survey administered to all physicians working in the Tuscany healthcare system administered between Nov 11 and Nov 20, 2019 (Qualtrics). Participants were provided with a patient encounter vignette and subsequently asked to in which of two alternatives they were more likely to prescribe antibiotics. The two alternatives varied in levels of clinical uncertainty, patient expectations, and the physician’s past behavior. We fitted a conditional logistic regression model. Respondents included 1,436 hospital-based physicians, of which 52% were female, 78% practiced in a general hospital setting, and 33% were between the ages of 50 and 59. Results show that the odds of prescribing antibiotics decrease when a patient requests it (OR = 0.80, 95%CI [0.72,0.89]) and increase when the physician has prescribed antibiotics to a patient under similar circumstances previously (OR = 1.15, 95%CI [1.03,1.27]). We found no significant effect of clinical uncertainty on the odds of prescribing antibiotics (OR = 0.96, 95%CI [0.87, 1.07]). We show that patient expectation has a significant negative association with antibiotic prescribing among hospital-based physicians. Our findings inform the design of antibiotic stewardship programs in Tuscany and highlight the importance of cultural context in shaping the physician’s disposition when confronted with patient expectations. We suggest shared decision-making to improve prudent prescribing without compromising on patient satisfaction. Key messages • Health administrators should address patient expectations when designing hospital antibiotic stewardship programs. • Physicians’ past prescribing behaviour influences antibiotic prescribing decisions and should be considered during intervention design.

Detecting DSM-5 somatic symptom disorder in general hospitals in China: B-criteria instrument has better accuracy-A secondary analysis.

This study investigates the diagnostic accuracy of the PHQ-15, SSS-8, SSD-12 and Whitley 8 and their combination in detecting DSM-5 somatic symptom disorder in general hospitals. In our former multicenter cross-sectional study enrolling 699 outpatients from different departments in five cities in China, SCID-5 for SSD was administered to diagnose SSD and instruments including PHQ-15, SSS-8, SSD-12 and WI-8 were used to evaluate the SSD A and B criteria. In this secondary analysis study, we investigate which instrument or combination of instrument has best accuracy for detecting SSD in outpatients. Receiver operator curves were created, and area under the curve (AUC) analyses were assessed. The sensitivity and specificity were calculated for the optimal individual cut points. Data from n = 694 patients [38.6% male, mean age: 42.89 years (SD = 14.24)] were analyzed. A total of 33.9% of patients fulfilled the SSD criteria. Diagnostic accuracy was moderate or good for each questionnaire (PHQ-15: AUC = 0.72; 95% CI = 0.68-0.75; SSS-8: AUC = 0.73; 95% CI = 0.69-0.76; SSD-12: AUC = 0.84; 95% CI = 0.81-0.86; WI-8: AUC = 0.81; 95% CI = 0.78-0.84). SSD-12 and WI-8 were significantly better at predicting SSD diagnoses. Combining PHQ-15 or SSS-8 with SSD-12 or WI-8 showed similar diagnostic accuracy to SSD-12 or WI-8 alone (PHQ-15 + SSD-12: AUC = 0.84; 95% CI = 0.81-0.87; PHQ-15 + WI-8: AUC = 0.82; 95% CI = 0.79-0.85; SSS-8 + SSD-12: AUC = 0.84; 95% CI = 0.81-0.87; SSS-8 + WI-8: AUC = 0.82; 95% CI = 0.79-0.84). In the efficiency analysis, both SSD-12 and WI-8 showed good efficiency, SSD-12 slightly more efficient than WI-8; however, within the range of good sensitivity, the PHQ-15 and SSS-8 delivered rather poor specificity. For a priority of sensitivity over specificity, the cutoff points of ≥13 for SSD-12 (sensitivity and specificity = 80 and 72%) and ≥17 for WI-8 (sensitivity and specificity = 80 and 67%) are recommended. In general hospital settings, SSD-12 or WI-8 alone may be sufficient for detecting somatic symptom disorder, as effective as when combined with the PHQ-15 or SSS-8 for evaluating physical burden.

AML-154 Induction Mortality of Acute Myeloid Leukemia Patients Treated With Purine Analogues-Cytarabine-Anthracycline at General Hospital

Despite the fact that purine analogs (fludarabine/cladribine) in combination with cytarabine and idarubicin (FIA/CLIA) have a higher CR rate than '3+7' (historically, 60%), cytarabine-anthracyclines (7+3) induction chemotherapy (IC) remains the standard acute myeloid leukemia (AML) IC. Cytarabine-anthracyclines (7+3) IC has been the mainstay therapy for over four decades, and it remains the standard AML IC regimen internationally. Triplet IC using FIA/CLIA is superior to the standard 7+3 regimen but is challenging to administer in general hospital settings due to myelosuppression. We reviewed the AML induction mortality (IM) rate in patients induced with (fludarabine/cladribine) combined with cytarabine and idarubicin (FIA/CLIA) at Memorial Hermann Hospital, Texas Medical Center. Of 44 AML patient records reviewed from January 2013 to January 2022, 40 received 5 days FIA/CLIA IC and four received 3-4 days due to age and comorbidities. Clinical characteristics analyzed included gender, race, ECOG PS, ELN risk stratification, molecular characteristics, and disease origin. The median age was 51.5 years (range: 18-68). Three patients died before assessment. The composite CR (CR+CRi) was 82.9% (34/41) after 1 cycle and 87.8% (36/41) after 2 cycles. MRD-negative composite CR was 92%. Four patients had adverse risk cytogenetics and primary induction failure (modified FIA). Thirty-seven percent had febrile neutropenia, 25% had bacteremia, 15% required ICU admission, and 4% required mechanical ventilation. The 30-day induction mortality was 9%. FIA/CLIA has a higher CR rate than '3+7' (historically, 60%). Given the fact that in AML, achieving CR is the most important factor to improve survival with adequate treatment expertise, a triplet IC regimen can be safely administered with low IM and superior results.

External validation and clinical application of the predictive model for severe hypoglycemia.

ObjectiveAn internally validated, one-year risk prediction model for severe hypoglycemia (SH) in type 2 diabetes was evaluated in a general hospital setting to externally verify and validate its performance.Research design and methodsBetween December 2017 to December 2019, 2,645 adult patients with type 2 diabetes who visited the diabetes center were enrolled. The receiver operating characteristics curve and Harrell C-statistics were compared to identify the discrimination of the model. The predicted and actual incidence of SH for one year in the development and validation cohorts were compared by ranking participants by deciles of predicted risk.ResultsThe concordance index was 0.878 in the external validation cohort. The sensitivity and specificity of the predictive model were 0.833 and 0.847, respectively. Based on the predicted risk, we stratified the groups into four categories: low (<0.05%), intermediate (0.05% to <0.5%), high (0.5% to <2.0%), and very high-risk group (≥2.0%). The actual annual incidence of SH gradually increased with the increased risk score level for the decile group (P for trend <0.001). The actual annual SH incidence significantly increased with increase in SH risk scores, which proportionately increased with age, duration of diabetes, glycated hemoglobin, and albuminuria and decreased with body mass index, renal function (p for trends <0.001 for all) in type 2 diabetes.ConclusionOn external validation, the novel one-year SH prediction model showed excellent discrimination in participants with type 2 diabetes and can effectively screen high-risk patients for SH, even in the general hospital setting.

The “GHU-Checkist”: Validity and acceptability of a 17-words checklist for rapid screening of depressive symptoms and anxiety

Background and objectivesEarly detection of psychiatric disorders in general hospital settings could facilitate a systematic assessment of anxiety and depression, and lessen their non-detection, misdiagnoses and subsequent negative impacts. We built a new short screening tool with simple Yes/No questions on anxiety and depression and examined its diagnostic capacity and acceptability. MethodsOur cross-sectional study included 608 patients examined in an emergency department at a Parisian general hospital. Their depressive and anxiety symptoms were assessed with the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder 7 (GAD-7). Participants also completed the ‘GHU-checklist’, a list of 17 words evoking moods or feelings. Sensitivity and specificity of the checklist were determined using receiver operating characteristic (ROC) analysis. Results22.7% of participants had depressive symptoms as measured by the PHQ-9, while 25.4% suffered from moderate or severe anxiety. Most participants perceived positively the GHU-checklist, which had a sensitivity of 81.5% in distinguishing patients with depressive symptoms. Sensitivity was 86.0% for moderate anxiety and 94.7% for severe anxiety. The specificity ranged from 64.3% to 71.1%. ConclusionsA short 17-words checklist is able to ultra-rapidly screen for depressive and anxiety symptoms in non-psychiatric medical settings, and was perceived positively by patients. Its systematic use could facilitate a rapid and systematic assessment of these symptoms, especially in crowded and under-staffed settings such as the emergency department.

Interventions for preventing and reducing the use of physical restraints of older people in general hospital settings.

Interventions for preventing and reducing the use of physical restraints of older people in general hospital settings.

Short-term low-intensity Early Start Denver Model program implemented in regional hospitals in Northern Taiwan.

The Early Start Denver Model is an evidence-based early intervention program for young and very young children with autism. This interdisciplinary model is used by many types of professionals, such as psychologists, occupational therapists, speech pathologists, early child special educators, and paraprofessionals, as well as by parents. Most previous studies on the Early Start Denver Model were conducted in the West, and there are scarce studies on the topics of generalization in culture and countries outside the Western world. In this study, we evaluated the effect of the Early Start Denver Model with some adaptations, including a lower intensity, shorter duration, and delivery in regional general hospitals in Northern Taiwan. In total, 45 young children with autism, aged 2-4 years, were divided into the Early Start Denver Model and community-based control groups. The children in the Early Start Denver Model group received one-on-one intervention for approximately 8-9 h per week for 6 months. The results revealed that compared with the control group, the Early Start Denver Model group showed greater gains in overall development ability and nonverbal development ability from pre- to post-intervention. However, these differences did not sustain at the 6-month follow-up after the completion of the intervention. Being mindful of some caveats in trial designs, this study provides preliminary evidence to support the effectiveness of the Early Start Denver Model intervention in the regional general hospital settings in the context of Han-Chinese-mainly culture. Our findings can provide helpful information to stakeholders and policymakers of early intervention service systems for children with autism in Taiwan, as well as in Asian countries.

173 Debridement, Antibiotics and Implant Retention (DAIR) in the Management of Prosthetic Joint Infections Following Primary Hip and Knee Arthroplaty: A DGH Experience

Abstract Aim Prosthetic joint infections (PJI) are a devastating complication of arthroplasty surgery. Current gold standard one or two-stage revision, poses sincere surgical challenges and carry significant patient morbidity. If diagnosed promptly, a debridement, antibiotics, and implant retention (DAIR) procedure can be performed. We report the results of our experience with the DAIR procedure in a District General Hospital setting. Method Our study comprises of a single centre retrospective review of a prospectively updated database. All patients who underwent a DAIR procedure following hip or knee arthroplasty from August 2012 to July 2019 were included in the study with no exclusions. Results Four total knee replacements, sixteen total hip replacements (THR), two revision THR and three hemiarthroplasties were included in the study. Average duration from onset of symptoms to DAIR was 22 days for immediate post-operative patients and 6 days in patients presenting later with an acute infection. All patients had exchange of modular components during the DAIR procedure. Out of 25 DAIR procedures, 23 identified a positive microbiology culture. Most common causative organisms identified were Staphylococcos aureus (23%) and Staphylococcus epidermidis (23%). Average follow up in clinic was 55 months. 76% of patients had a stable post-operative recovery with no recurrence of infection. One patient required a revision THR for aseptic loosening; one patient required a knee arthrodesis and four patients died. Conclusions Infection was successfully eradicated in 19 patients. The success reported within the literature stem predominantly from tertiary units. Our study reflects this success in a DGH setting.

Hospital nursing factors associated with decreased odds of mortality in older adult medicare surgical patients with depression

BackgroundDepression is common, costly, and has deleterious effects in older adult surgical patients. Little research exists examining older adult surgical patient outcomes and depression and the potential for nursing factors to affect these outcomes. The purpose of this study was to determine the relationship between hospital nursing resources, 30-day mortality; and the impact of depression on this relationship.MethodsThis was a retrospective cohort study employing a national nurse survey, hospital data, and Medicare claims data from 2006–2007. The sample included: 296,561 older adult patients, aged 65–90, who had general, orthopedic, or vascular surgery in acute care general hospitals from 2006–2007, 533 hospitals and 24,837 nurses. Random effects models were used to analyze the association between depression, hospital nursing resources, and mortality.ResultsEvery added patient per nurse was associated with a 4% increase in the risk-adjusted odds of mortality in patients with depression (p < 0.05). Among all patients, every 10% increase in the proportion of bachelor’s prepared nurses was associated with a 4% decrease in the odds of mortality (p < 0.001) and a one standard deviation increase in the work environment was associated with a 5% decrease in the odds of mortality (p < 0.05).ConclusionsFor older adult patients hospitalized for surgery, the risk of mortality is associated with higher patient to nurse ratio, lower proportion of BSN prepared nurses in the hospital, and worse hospital work environment. Addressing the mental health care needs of older adults in the general care hospital setting is critical to ensuring positive outcomes after surgery. Hospital protocols to lower the risk of surgical mortality in older adults with and without depression could include improving nurse resources.

TU2.13 Laparoscopic/robotic restorative proctectomy in the District General Hospital setting

Abstract Aims Ileal pouch anal anastomosis/restorative proctectomy is a standard surgical treatment for ulcerative colitis performed in a few specialist centres. We report the evolution of the service at our trust which originally carried out open pouch surgery but has moved practice towards laparoscopic and robotic-assisted pouch surgery. The aim of this study was to assess the surgical and functional outcomes of patients undergoing laparoscopic/robotic-assisted IPAA. Methods Data were prospectively collected from consecutive laparoscopic/robotic IPAA cases from 2014 to 2021. Patient demographics, operative details, postoperative complications, functional outcomes were collected. Patients were selected by IBD specialized surgeons and reviewed by a pouch nurse. Follow-up consisted of clinical examination and assessment of pouch function. Results 18 patients underwent laparoscopic or robotic IPAA during the study period, 13 (72.23%) were males. Median age was 28 years. Indication for surgery was ulcerative colitis. Median duration of surgery was 7 hours. Four patients (22.23%) developed postoperative intra-abdominal collection, managed conservatively in all except one, who required laparoscopic washout. The median duration of stay was 8 days. The rate of severe complications, Grade 3 and 4 on Clavien-Dindo classification was 11.12%. During a median follow up of 75 months, there were no pouch failures. The median stool frequency was 6 daily. Conclusion Our data suggests that with good patient selection and guidance from an experienced pouch nurse, laparoscopic/robotic IPAA is safe and feasible. Good perioperative outcomes and acceptable pouch function can be achieved in a DGH setting with a team to ensure consistent care of patients.

Anticoagulation for atrial fibrillation in people with serious mental illness in the general hospital setting

ObjectivePeople with serious mental illnesses (SMI) have an increased risk of stroke compared to the general population. This study aims to evaluate oral anticoagulation prescription trends in atrial fibrillation (AF) patients with and without a comorbid SMI. MethodsAn open-source retrieval system for clinical data (CogStack) was used to identify a cohort of AF patients with SMI who ever had an inpatient admission to King's College Hospital from 2011 to 2020. A Natural Language Processing pipeline was used to calculate CHA2DS2-VASc and HASBLED risk scores from Electronic Health Records free text. Antithrombotic prescriptions of warfarin and Direct acting oral anti-coagulants (DOACs) (apixaban, rivaroxaban, dabigatran, edoxaban) were extracted from discharge summaries. ResultsAmong patients included in the study (n = 16 916), 2.7% had a recorded co-morbid SMI diagnosis. Compared to non-SMI patients, those with SMI had significantly higher CHA2DS2-VASc (mean (SD): 5.3 (1.96) vs 4.7 (2.08), p < 0.001) and HASBLED scores (mean (SD): 3.2 (1.27) vs 2.5 (1.29), p < 0.001). Among AF patients having a CHA2DS2-VASc ≥2, those with co-morbid SMI were less likely than non-SMI patients to be prescribed an OAC (44% vs 54%, p < 0.001). However, there was no evidence of a significant difference between the two groups since 2019. ConclusionOver recent years, DOAC prescription rates have increased among AF patients with SMI in acute hospitals. More research is needed to confirm whether the introduction of DOACs has reduced OAC treatment gaps in people with serious mental illness and to assess whether the use of DOACs has improved health outcomes in this population.

Profiles of the Patients and Their Referral Patterns Visiting the Psychiatry Clinic of a General Hospital Setting Located in a Mental Health Resource Deficient Region of India: A Retrospective Observational Study.

Objectives Treatment for mental health problems is determined by cultural, health infrastructure, and illness-related factors. Literature is sparse from India, particularly from the mental health resources-deficient regions of the country such as central India. Therefore, the current study is aimed at assessing the profile of the patients visiting the psychiatry outpatient facility (OPF) of a tertiary-care general hospital setting (GHS), their referral patterns, and their determinants. Materials and Methods A retrospective chart review of the newly registered individuals (October 2019 to March 2020) in the psychiatry OPF of the GHS from Central India was used in the study. Data (sociodemographic profiles, illness characteristics, and referral patterns) were extracted as per the standard guidelines. Statistical Analysis Descriptive statistics were used to represent sociodemographic, illness-, and past treatment-related characteristics of the participants. Chi-squared test was used to compare the referral characteristics of the two groups (self-referred patients vs. those referred by others, dependent variable) with regard to characteristics of the patients (independent variables). Results A total of 418 individuals were registered in the clinic. Most individuals suffered from the neurotic, stress-related, and somatoform group of disorders ( n = 231, 39.5%). More than halves were self-referred; most were referred from the internal medicine and allied departments. Being male, having at least graduate degree (χ 2 df(1) = 4.25 to 6.79, p < 0.05), suffering from organic mental-, psychotic-, and recurrent affective-disorders, and positive family history (χ 2 df(1) = 4.91 to 21.76, p < 0.05 to <0.001) along with first treatment attempt or previous treatment from the traditional healers, and absence of co-occurring medical illness were associated with self-referral (vs. referred by others) (χ 2 df(1) = 4.64 to 17.6, p < 0.05 to <0.001). Conclusions GHS has a characteristic referral pattern. The referral patterns of the patients for various psychiatric problems are determined by their sociodemographic, illness, and cultural characteristics; particularly, poor mental health literacy (among the patients-caregivers), stigma related to mental disorders, and unavailability of the mental health services act as major determinants. Sensitizing the patients-caregivers and health-care professionals concerning this could facilitate an early engagement with the psychiatric treatment. Future research needs to explore this phenomenon in greater detail, maybe by qualitative methods.

Bereavement care provision and its associated factors among nurses in cancer care settings: a cross-sectional study.

The goals of this study were to (1) investigate bereavement care provision in practical settings, (2) examine the difference in care by nurses' affiliation (general hospital, hospice, or homecare setting), and (3) identify institutional and personal barriers associated with bereavement care provision. A cross-sectional survey was conducted using an online questionnaire. Nurses (n = 309) who had an experience of cancer patient care before death at least once in a previous year were included in the analysis. Kruskal-Wallis test and Mann-Whitney test were conducted to compare bereavement care provision by nurses' affiliation, and hierarchical logistic regression analysis was conducted to investigate the correlation between bereavement care provision and its associated factors. Less than 30% of nurses reported providing bereavement care in structured settings such as home visits, counseling at a hospital, or phone calls. The differences in bereavement care provision by nurses' affiliation were significant, and the nurses working in a hospital were less likely to provide bereavement care than those working in a hospice or homecare setting. Working in a palliative care setting (OR = 2.35, 95%CI 1.09-5.07, p < 0.05) and greater confidence (OR = 2.18, 95%CI 1.07-4.42, p < 0.05) and knowledge regarding bereavement care (OR = 12.46, 95%CI 5.69-27.29, p < 0.001) were significantly associated factors of bereavement care provision. This study indicated a lack of bereavement care provision, especially in general hospitals. Improving nurses' confidence and knowledge may encourage them to provide bereavement care provision.

Induction mortality (IM) of acute myeloid leukemia (AML) patients treated with purine analogues-cytarabine-anthracycline at a general hospital.

e19019 Background: Cytarabine-anthracyclines (7+3) induction chemotherapy (IC)) has been the mainstay therapy for over four decades and it remains the standard AML IC regimen internationally. Triplet IC using purine analogues (fludarabine/cladribine) in combination with cytarabine and idarubicin (FIA/CLIA) is superior to the standard 7+3 regimen, but challenging to administer in general hospital settings due to myelosuppression. We reviewed AML IM rate in patients induced with (fludarabine/cladribine) combined with cytarabine and idarubicin (FIA/CLIA) at Memorial Hermann Hospital, Texas Medical Center (MHH at TMC). Patients and Methods: Of 44 AML reviewed records from January 2013 to January 2022, 40 received 5 days FIA/CLIA IC, and four 3-4 days due to age and comorbidities. For clinical characteristics see Table. Results: Median age was 51.5 years (range: 18-68). Three died before assessment. After 1 cycle the composite CR (CR+ CR i) was 82.9% (34/41) and 87.8% (36/41) after 2 cycles. MRD negative composite CR was 92%. Four patients had adverse risk cytogenetics and primary induction failure (modified FIA). 37% had febrile neutropenia. 25% had bacteremia with 15% requiring ICU admission and 4% mechanical ventilation. The 30-day induction mortality was 9%. Conclusions: FIA/CLIA has a higher CR rate than ‘3+7’ (which historically is 60%). The 30-day induction mortality in non-academic centers is about 30%. Given the fact that in AML achieving a CR is the most important factor to improve survival, with adequate treatment expertise, triplet IC regimen can be safely administered with a low induction mortality. [Table: see text]

Does an embedded psychiatrist in an internal medicine team shorten length of stay in the general hospital setting?

Does an embedded psychiatrist in an internal medicine team shorten length of stay in the general hospital setting?

Tobacco Treatment Outcomes for Hospital Patients With and Without Mental Health Diagnoses.

BackgroundThe prevalence of mental health conditions is higher in cigarette smokers than nonsmokers. However, those with diagnosed mental health disorders are understudied within general inpatient hospital settings. This study seeks to evaluate how having a mental health diagnosis influences response to a brief opt-out inpatient tobacco treatment intervention.MethodsData included 4,153 admitted patients who completed a tobacco treatment visit. Post-discharge self-reported abstinence was obtained via response to an automated call 1-month after discharge. Mental health co-morbidities were assessed by reviewing electronic medical records. Logistic regression was used to assess associations between having a mental health diagnosis and patients' smoking history, interest in quitting smoking, and post-discharge abstinence.ResultsOverall 34.1% of patients were diagnosed with mental health disorders, most commonly depression or substance use disorders. Patients with a diagnosed mental health disorder were more likely to report a history of long-term heavy smoking and were less likely to express an interesting in remaining abstinent from smoking after hospitalization. An intent-to-treat analysis using logistic regression analysis found lower rates of self-reported smoking abstinence in those with a mental health disorder compared to those without (9 vs. 13.2%, p < 0.001).ConclusionsPatients with a history of mental health diagnoses, such as depression or substance use disorders, was associated with lower rates of smoking abstinence in patients after hospitalization. Hospital based opt-out smoking cessation programs have shown to be generally effective and efficient. However, certain subpopulations may require tailored intervention in order to improve treatment outcomes. Future research is needed to develop brief, effective tobacco treatment for hospital patients with comorbid mental health diagnoses.

Outcomes in open rectal cancer surgery; five-year local recurrence and survival rates in a District General Hospital setting, a retrospective cohort study

IntroductionFollowing treatment for rectal cancer, outcomes in the UK include a 5-year survival rate of around 60%, and a variable 5-year local recurrence rate. Surgical treatment involves Total Mesorectal Excision (TME), with laparoscopic and, more recently, robotic approaches gaining popularity over the open technique. The aim of this study was to compare outcomes of rectal cancer patients managed in a single District General Hospital to the documented UK averages for 5-year survival and 5-year local recurrence. MethodsA total of 64 consecutive patients undergoing open TME performed by a single surgeon at a single site between 2009 and 2015 were analysed retrospectively. Histopathological, radiological, and demographic data collected during 5 years of follow up were used to help establish a 5-year survival rate and a 5-year local recurrence rate. ResultsFor the 64 patients analysed, the 5-year survival rate was 74.6% and the 5-year local recurrence rate was 7.9%. ConclusionIn our cohort of patients undergoing open TME, the 5-year survival rate was higher than the documented UK average and the 5-year local recurrence rate lay within the published range. In addition, greater patient age and a shorter distance of the tumour from the anal verge were shown to have a significant correlation with increased mortality.

Why mental health service delivery needs to align alongside mainstream medical services.

There is significant individual human suffering and economic burden because of untreated mental health and substance use disorders. There is high psychiatric morbidity in primary and secondary medical care. At least one-fifth of patients attending primary care services in western countries pertain to mental health and one-third of patients attending general hospitals have a comorbid mental disorder. Patients with mental disorders have lower life expectancy than the general population due to various medical conditions and reduced access to physical healthcare. There is a suicide every 40 seconds and the vast majority of those who die by suicide have a diagnosable mental disorder. Despite this, most countries spend less than 2% of their health budgets on mental health. Effective treatments exist for mental disorders, however underfunding, poor integration of services, lack of trained health care professionals and stigma often prevent access to effective treatments. Stigma is a significant barrier to seeking help and receiving treatment. Geographical separation of mental health services from general hospital settings may be perpetuating the stigma of mental illness among the population. In this article, we review the key reasons why mental health services globally need to align with mainstream healthcare services and the longstanding reasons that necessitate the need to make mental health a public health priority.

Systematic Youth Suicide Screening in a General Hospital Setting

Abstract Objectives: Adolescent suicide rates have been rising since 1999, and efforts to identify youth at risk with systematic approaches are important in secondary prevention. The Columbia Suicide Severity Rating Scale (C-SSRS) screener is a tool that has demonstrated predictive validity in identifying youth at risk of attempting suicide. Health care settings are key venues where at-risk youth can be identified effectively. Methods: A tertiary hospital in the Northeast U.S. developed a suicide risk protocol, consisting of systematic screening of patients for suicidal ideation/behavior with a screening version of the C-SSRS and a response algorithm based on risk levels derived from the screen. A total of 840 nurses were trained on the C-SSRS Screener, with a response protocol addressing environmental safety and psychiatric consultation. Results: This report focuses on the screening results for adolescents (ages 12–17) within this cohort, occurring over a 11-year period. Posttraining inter-rater reliability on the C-SSRS Screener definitions of ideation and behavior were high and independent of level of education or mental health experience. Of 6126 patients screened in this age group, 9.6% were in the highest risk category, as compared to 0.93% of adults during a 12-month period. Middle adolescents, females, African American and Latino patients, patients with psychiatric diagnoses, and patients with some medical diagnoses were at significant risk. Conclusions: These findings suggest that a systematic screening and clinical response protocol using the C-SSRS screener can potentially enhance the ability to identify suicide risk in the adolescent population in medical surgical hospitals and can focus services on patients with the most need.

PD19-10 DOES POWER MATTER? A COMPARISON OF HOLMIUM LASERS IN AN AUSTRALIAN TERTIARY CENTRE

You have accessJournal of UrologyCME1 May 2022PD19-10 DOES POWER MATTER? A COMPARISON OF HOLMIUM LASERS IN AN AUSTRALIAN TERTIARY CENTRE Romy Mondschein, and Philip McCahy Romy MondscheinRomy Mondschein More articles by this author , and Philip McCahyPhilip McCahy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002557.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Holmium lasers are an effective endoscopic treatment for renal stones, with both high- and low-power lasers commonly in use in Australia. Laser settings for stone destruction are relatively limited when using 10-20W lasers. Basket extraction of fragments is often required. This can be time consuming and associated with ureteric injury. High-power lasers can deliver more energy (up to 120W) at higher frequencies. This allows more variation in laser settings, including the ability to dust stones with low-power high-frequency settings. Dusted stones may result in fewer large fragments and increase the likelihood of spontaneous passage of residual stone. In addition, laboratory studies have demonstrated reduced destruction times for high-power lasers, although clinical evidence is lacking. Clinical evidence for superior stone destruction based on operative times was the focus of this study – theatre times for URS were investigated comparing high and low power lasers in a general hospital setting. METHODS: An audited review was conducted of 354 patients who underwent URS over a two-year period at two hospital sites utilising high or low power laser. Operative time, stone characteristics, disposables equipment, use of dusting, complications and stone free rates were recorded. Linear regression was used to model the relationship between laser type and theatre time. Univariate analysis was performed to determine other factors associated with increased operative time. RESULTS: Mean operative time was 61.9 minutes. No significant difference between sites (0.40, p=0.88, CI -4.9-5.8) was found, including following exclusion of large stones (>20mm). Stone size categories analysed separately showed reduced operative times for larger stones when using high-power laser. Basket use (8.4, p=0.002, CI 3.06-13.65) and increasing stone size (6.9, p<0.005, CI 3.4-10.4) were associated with increased operative time. Complication and stone free rates did not vary between sites. CONCLUSIONS: High-power laser was not associated with reduced total operative time in this cohort, although there was a trend towards this for larger renal calculi. Further delineation by surgeon expertise would be useful to determine if high power laser is advantageous in the clinical setting generally. In training hospitals, any difference may be obscured by other factors. Source of Funding: No funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e353 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Romy Mondschein More articles by this author Philip McCahy More articles by this author Expand All Advertisement PDF DownloadLoading ...