General Medical Department Research Articles

Impact of the COVID-19 pandemic on care-quality outcomes in older adults admitted to hospital with altered mental status.

During the coronavirus disease (COVID-19) pandemic, patients with altered mental status (AMS: dementia, delirium and delirium superimposed on dementia) were profoundly affected by an abrupt transformation in healthcare systems. Here, we evaluated quality-care outcomes, including length of stay (LOS), in-hospital mortality, early readmission and mortality after hospital discharge, in older adults admitted for AMS during the pandemic and compared them to patients admitted prior to the pandemic. Chi-squared and Fisher's exact tests were used to examine changes to admissions for AMS before and during the pandemic, and their outcomes. Logistic regression analyses, with reference to pre-pandemic data, were conducted to examine the impact of the pandemic on outcomes. Prospective data of 21,192 non-COVID admissions to an acute general medical department in a Surrey (UK) hospital were collected from patients admitted before (1st April 2019 to 29th February 2020) and during the pandemic (1st March 2020 to 31st March 2021). There were 10,173 (47.7% men) from the pre-pandemic and 11,019 (47.5% men) from the pandemic periods; overall mean age = 68.3yr. During the pandemic AMS patients had significantly higher admission rates (1.1% vs 0.6%, P < 0.001). However, median LOS in hospital was shorter (9.0 days [IQR=5.3-16.2] vs 15.5 days [IQR = 6.2-25.7], P < 0.001) and thus were less likely to stay in hospital >3 weeks: adjusted OR = 0.26 (95%CI = 0.12-0.57). In-hospital mortality and readmission within 28 days of discharge did not change during the pandemic, but were less likely to die within 30 days of discharge: adjusted OR=0.32 (95%CI=0.11-0.96). This combination of higher admission rate, shorter LOS, and an unchanging early readmission suggests a higher admission-discharge turnover of different patients with AMS and provides important insights into the potential impact of the COVID-19 pandemic on healthcare delivery to individuals with AMS.

Treatment response for nocturnal enuresis in Taiwanese children: A comparison of medical departments

Purpose: This retrospective study aims to evaluate the medical treatment response, treatment choice, and medication adjustment during a clinical follow-up in Taiwanese children with nocturnal enuresis (NE). Materials and methods: A total of 287 children diagnosed with NE were included in the study. Patients’ characteristics, treatment response, and medication adjustment after the second clinic visit were analyzed. The study also compared treatment options chosen by different medical departments. Results: Of the 287 children analyzed, 56.8% received medical treatment, 68.8% were older than 7 years (P &lt; 0.001), and 45.6% were initially treated with desmopressin. The presence of daytime symptoms did not significantly affect the prescription of medication at the first clinic visit (P = 0.817). However, 76.9% of children with daytime symptoms who were initially treated with desmopressin needed medication adjustment during their second clinic visit (P = 0.01). Urologists were more likely to prescribe medications than other medical departments at the first clinic visit (P &lt; 0.001). Conclusion: Almost half of the Taiwanese children with NE (46%) in this study had a satisfactory treatment response after the initial treatment. Urologists were more likely to use medications as their initial treatment strategy. The limitation included bias from heterogeneous study population and limited information of pretreatment urodynamic or imaging studies. Further education is required for both general public and medical departments to improve the treatment outcomes of children with enuresis.

Construction and Development Strategy of General Medicine in Hospitals

This paper starts from the necessity and importance of the construction of general medical department in medical institutions, puts forward the basic ideas and strategies for the construction and development of general medical department in medical institutions, and briefly discusses the content of its construction.

Depressive symptoms and malnutrition are associated with other geriatric syndromes and increase risk for 30-Day readmission in hospitalized older adults: a prospective cohort study

BackgroundReadmission in older adults is typically complex with multiple contributing factors. We aim to examine how two prevalent and potentially modifiable geriatric conditions – depressive symptoms and malnutrition – relate to other geriatric syndromes and 30-day readmission in hospitalized older adults.MethodsConsecutive admissions of patients ≥ 65 years to a general medical department were recruited over 16 months. Patients were screened for depression, malnutrition, delirium, cognitive impairment, and frailty at admission. Medical records were reviewed for poor oral intake and functional decline during hospitalization. Unplanned readmission within 30-days of discharge was tracked through the hospital’s electronic health records and follow-up telephone interviews. We use directed acyclic graphs (DAGs) to depict the relationship of depressive symptoms and malnutrition with geriatric syndromes that constitute covariates of interest and 30-day readmission outcome. Multiple logistic regression was performed for the independent associations of depressive symptoms and malnutrition with 30-day readmission, adjusting for variables based on DAG-identified minimal adjustment set.ResultsWe recruited 1619 consecutive admissions, with mean age 76.4 (7.9) years and 51.3% females. 30-day readmission occurred in 331 (22.0%) of 1,507 patients with follow-up data. Depressive symptoms, malnutrition, higher comorbidity burden, hospitalization in the one-year preceding index admission, frailty, delirium, as well as functional decline and poor oral intake during the index admission, were more commonly observed among patients who were readmitted within 30 days of discharge (P < 0.05). Patients with active depressive symptoms were significantly more likely to be frail (OR = 1.62, 95% CI 1.22–2.16), had poor oral intake (OR = 1.35, 95% CI 1.02–1.79) and functional decline during admission (OR = 1.58, 95% CI 1.11–2.23). Malnutrition at admission was significantly associated with frailty (OR = 1.53, 95% CI 1.07–2.19), delirium (OR = 2.33, 95% CI 1.60–3.39) cognitive impairment (OR = 1.88, 95% CI 1.39–2.54) and poor oral intake during hospitalization (OR = 2.70, 95% CI 2.01–3.64). In minimal adjustment set identified by DAG, depressive symptoms (OR = 1.38, 95% CI 1.02–1.86) remained significantly associated with 30-day readmission. The association of malnutrition with 30-day readmission was no longer statistically significant after adjusting for age, ethnicity and depressive symptoms in the minimal adjustment set (OR = 1.40, 95% CI 0.99–1.98).ConclusionThe observed causal associations support screening and targeted interventions for depressive symptoms and malnutrition during admission and in the post-acute period.

Diagnostic Accuracy of Point-of-Care Tests Measuring Glycosylated Haemoglobin (HbA1c) for Glycemic Control: A Field Study in India.

ObjectivesThis study was performed to estimate diagnostic accuracy of the two commercially available point-of-care tests to identify poor glycemic control defined by HbA1c levels, with high-performance liquid chromatography (HPLC) as a reference.SettingsThe study was carried at two locations, general medical outpatient department of a teaching medical college in Bhopal (urban), and a primary health care centre in a rural area in the state of Madhya Pradesh, India.ParticipantsAll individuals with diabetes mellitus who presented to the health care facility for assessment of glycemic control. We compared HbA1c estimated from two index tests (Hemocue Hb 501, Sweden; SD Biosensor, South Korea) from capillary blood samples with HPLC performed from venous blood, as a reference standard.Primary and secondary outcome measuresDiagnostic properties of index tests such as sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for identifying poor glycemic control were primary outcome measures. Lin’s concordance correlation coefficient (CCC) was secondary outcome measure.ResultsOut of 114 patients, all received reference standard - 103 patients received Hemocue A1C test and 110 patients received SD Biosensor test. Overall both the index tests had similar diagnostic accuracy estimates. The area under the Receiver Operating Curve for SDA1c device was 0.935 (95% CI 0.886-0.983), and for Hemocue device was 0.938 (95% CI 0.893-0.984). The Hemocue device HbA1c value of above 7.0 (positive) correctly predicted poor glycemic control 92% times (81.58% for SD device). There were 4 vs. 11 device failures and 14 vs. 12 failures with SD and Hemocue, respectively. Ambient air temperatures were no different for the device test failures.ConclusionsCommercially available point-of-care tests evaluated in this study are comparable and an acceptable alternative to HPLC-based measurements for the assessment of glycemic control. Tests and device failure rates of both the index tests are similar.

Проактивний психосоматичний підхід до терапії постковідної депресії

Background. Recently a proactive model of psychosomatic medicine has been widely implemented in the world, namely a new way of providing psychiatric services in general medical departments, based on the principles of initiative, focus, intensity, and integration with general care. Postcovid depression is a major challenge for the mental health system, so the introduction of such a proactive model to provide specialized care to patients with depressive disorders within the ward of multidisciplinary hospitals is promising. During the COVID-19 pandemic, the proportion of depressed patients in somatic hospitals tripled compared to the previous period. Early diagnosis and treatment of postcovid mental disorders, including depression, already in inpatient COVID-19 therapy period should increase the effectiveness of therapy and improve the quality of life of patients. Research is needed to study how the proactive psychosomatic medicine model implementation can reduce the negative burden of postcovid mental problems, including depressive disorders. Objective. The study was to evaluate the effectiveness of proactive psychosomatic intervention in the form of 8-week escitalopram monotherapy in patients with postcovid depression. Materials and methods. The proactive psychosomatic intervention consisted of early diagnosis and subsequent treatment (first inpatient, then outpatient) of depressive disorders in 44 patients with COVID-19. After obtaining informed consent, the Hospital Anxiety and Depression Scale (Depression Subscale, HADS-D≥11) was used to screen for depression. The Hamilton Depression Scale (HAM-D), the Somatic Symptom Scale (SSS-8), and Chaban's Quality of Life Scale (CQLS) were used to assess symptoms and dynamics. The pharmacological intervention consisted of escitalopram (Medoprami, Medochemi Ltd) 10 mg per day for mild to moderate depression, and 20 mg per day with severe depression. Results. According to the proactive model of counseling-liaison psychiatry, patients who were hospitalized with COVID-19were screened for signs of active mental health problems, namely depression. 65.7% of them had clinically significant depression (≥11 on Depression Subscale of Hospital Anxiety and Depression Scale) and they were to be treated with pharmacotherapy. Significant reductions in mental and somatic symptoms of depression and improved quality of life were observed in patients with postcovid depression after an 8-week course of escitalopram therapy. At the beginning of the study, 12 (28.58%) people had a mild degree of depression, 15 (35.71%) - moderate, and 15 (35.71%) - severe. At the end of the 8th week of taking the drug, 24 (57.14%) people had no signs of depression on the HAM-D scale, 18 people had subclinical depressive features. There were improvements in quality of life and the reduction of somatic symptoms. Changes in the mean scores were: on HADS scale  = -7.90, on HAM-D scale  = -14.21, on SSS-8 scale  = -2.38, on CQLS scale  = + 11.31 points. Conclusions. Proactive psychosomatic medicine model implementation in the multidisciplinary hospital for patients with depressive disorders was timely and appropriate because it provided early screening for depression and early escitalopram treatment for postcovid depression. Escitalopram (Medopram, Medochemi Ltd) may be a promising drug for the psychopharmacotherapy of depressive symptoms in patients with COVID-19. Further study of its effectiveness in the treatment of postcovid depression is needed.

Nursing Staff Awareness Regarding Challenges for Applying Total Quality Management

Background: Total Quality Management represents a modern management philosophy, established due to the development in all aspects of life in today's world. Aim: To assess nursing staff awareness regarding challenges for applying Total Quality Management at Assuit University Hospital. Research design:A descriptive study convenience sample design with a sample contains all nurses working in General Surgical, Special Surgical, General Medical, and Special Medical departments at Assiut University Hospital with a total number of n= 219. Tools: Total Quality Management Challenges questionnaire is used. Results: Show that above one-third of them agree about all items of challenges for applying total quality management. Conclusion: No statistically significant differences between quality management challenges with personal and occupational characteristics of the studied nurses at Assuit University Hospital. Recommendations: Conduct an awareness sessions about total quality management between nurses at Assuit University Hospital; Conduct a total quality management training or program to all nurses at Assuit University Hospital, And the availability of quality assurance coordinator nurse in each department who works to implement quality policies in the departments and act as a link between the department and the Quality Committee.

Impact of Buerger-Allen Exercises on Foot Perfusion and Pain Level for Diabetic Patients Risk with Peripheral Arterial Disease

Abstract The risk of peripheral arterial disease is markedly increased among individuals with diabetes. The current study aimed to evaluate diabetic patients' foot perfusion and their pain level after applying Buerger-Allen exercises. Subjects & methods: Quasi-experimental research design was used on a purposive sample of 100 type II diabetic patient in the General medical department and diabetic out-patient clinic, at Minia university hospital. Patients' interview questionnair, Ankle-brachial Index test and Numerical pain rating scale were used as tools for data collection. Results: There were highly statistically significant differences between the study group and control group regard Ankle-brachial Index measurements only post-application of Buerger-Allen exercises for six weeks (p ≤ 0.004). Moreover, results stated that the highest percentage (54.0%) among the study group who had moderate pain pre-application exercises but after they were performed exercises, their pain description became mild or no pain constituted (50.0% & 20.0%) respectively with highly statistical significant. Conclusion: Buerger-Allen exercise was efficient for improvement of lower peripheral arterial perfusion and there are highly statistically significant improvements in pain level among the study group. Recommendations: Diabetic patient must attend health education sessions based on evidence guidelines regard Buerger-Allen exercise which had a positive effect on the improvement of lower peripheral circulation.

THE RELATIONSHIP OF DIABETIC CONTROL WITH SERUM ALANINE AMINOTRANSFERASE LEVELS IN PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE (NAFLD) AND TYPE 2 DIABETES MELLITUS (T2DM)

ABSTRACT&#x0D; Objectives&#x0D; This study is aimed to find out the relation of Diabetic control with serum Alanine aminotransferase in patients with Non Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus.&#x0D; Material and methods&#x0D; This cross sectional descriptive study was conducted from August to October 2019 in general medical outpatient department of Khyber Teaching Hospital Peshawar, a tertiary care hospital in Khyberpakhtunkhwa, Pakistan. Patients with non Alcohohol Fatty Liver Disease and T2DM were categorized into two groups. Group A with HbA1c from 6.5-8% and group B with HbA1c of more than 8%. Serum Alanine aminotransferase levels were correlated in these groups with the level of HbA1c. Data was collected through a specially designed proforma and was analyzed through statistical package for social sciences, SPSS version 23.&#x0D; Results&#x0D; Amongst 452 patients with T2DM, 289 were females and the rest of 163 were males, NAFLD was present in 197 patients. Amongst these 197 patients Serum Alanine aminotransferase was raised in 17 (27.86%) patients in Group A but was raised in 64 (47.05%) patients in Group 2.&#x0D; Conclusions&#x0D; Diabetic control was positively correlated with serum Alanine aminotransferase level in our patients with Non Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus.&#x0D; Keywords&#x0D; Type 2 Diabetes Mellitus, Non Alcoholic Fatty Liver Disease, Serum Alanine Aminotransferase.

Junior doctor perceptions of education and feedback on ward rounds.

The literature suggests that feedback is wanted and needed in clinical medicine and specifically on ward rounds, yet it is often lacking. This study aimed to examine junior doctor perceptions of education and feedback on ward rounds in one clinical department at a tertiary paediatric hospital and the key influences on these perceptions. Six semi-structured focus groups were conducted over a period of 9 months comprising of 20 participants (post-graduate year 1-5) in a general medical department of a tertiary paediatric hospital. Qualitative analysis was performed on focus group transcripts using an inductive approach and codes and themes were generated in an iterative fashion with checking of themes between two researchers. Feedback experiences were largely positive compared to previous rotations. Three overarching themes were identified which influenced trainee perceptions of education and feedback on ward rounds. These were: consultant influences (e.g. educational engagement), trainee influences (e.g. active seeking of feedback), and structural factors (e.g. organisational constraints). Despite positive feedback experiences, the need to improve feedback for our junior doctors is clear, but how to do this remains challenging when navigating work-learning tensions. The notion of the educational alliance between the consultant and trainee is a potential useful solution, but it requires deliberate effort and dedicated time to establish given our increasingly complex and busy clinical environments.

The Application Effect of Regional Family Doctor Contract Service Based on Internet Platform in the Management of Hypertensive Patients in Primary Hospital

Objective: To analyze the application effect of regional family doctor contract service based on Internet platform in the management of hypertension patients in community hospitals. Methods: Since June 2017, the Yetang Health Center has established a model of family doctors contracted chronic disease management based on the Internet platform under the guidance of the General Medical Department of the First People’s Hospital of Changshu City. The Internet platform for patient management was developed, and a regional data sharing center for hypertensive patients was established. The combination with the family doctor contract model enabled the effective management of hypertensive patients. In the 12 months before the model was implemented, 525 patients with hypertension were selected, and 2173 patients with hypertension after 12 months of implementation were included in the control group and the observation group. The differences in treatment compliance, selfmanagement rate and other indicators between the two groups were compared to analyze the application effect of the model. Results: Compliance, compliance rate, self-management rate and awareness rate of hypertensionrelated knowledge in the observation group were higher than those in the control group, and the difference was statistically significant (P &lt; 0.05). The total management cost, unit management cost and standard management cost of hypertension patients in the observation group were lower than those in the control group. The satisfaction rate of hypertension management in the observation group was 96.87% (2105/2173), which was higher than 63.05% (331/525) in the control group (P &lt; 0.05). The awareness rate of diagnostic criteria, risk factors, hazards and treatment methods of hypertension in the observation group was higher than that in the control group, and the difference was statistically significant (P &lt; 0.05). Conclusion: The regional family doctor contract service based on Internet platform can significantly improve the effectiveness and efficiency of community hospital management of hypertension patients, and it is also an effective way to reduce management costs and ensure patient satisfaction, which is worth further optimization and promotion.

Effectiveness of PD-L1 inhibitors in metastatic or recurrent squamous cell carcinoma of head and neck: An observational, indirect comparison.

e18503 Background: The prognosis for recurrent or metastatic Squamous Cell Carcinoma of Head and Neck (HNSCC) remains dismal and its treatment poses a challenge for oncologists. Agents against programmed cell death ligand 1 (PD-L1) have shown beneficial effects on overall survival (OS) for HNSCC. The aim of the present study was to compare differential effects of PD-L1 inhibitors on recurrent and metastatic HNSCC. Methods: In an indirect comparison of patients with recurrent HNSCC were matched to patients with metastatic HNSCC. All patients were treated with PD-L1 inhibitors at the general medical oncology department of UZ Leuven. Kaplan-Meier methods and Cox regression models were used to calculate the overall survival. Results: From December 2013 to July 2019, 68 patients with metastatic and 59 with recurrent HNSCC were enrolled and evaluable. A significant difference in OS was found between recurrent and metastatic groups (p &lt; 0.02). The mean OS was 7.6 months (95% CI: 2.4-11.3 months) for the recurrent group, while in the metastatic group the mean OS was 13.7 months (95% CI: 5.7-16 months). Conclusions: As a second-line therapy, PD-L1 inhibitors were associated with longer overall survival in metastatic compared to recurrent HNSCC.

Medication Treatment and Health Care Use Among Adolescents With Opioid Use Disorder in Ohio

PurposeThe opioid epidemic impacts both adolescents and adults, and overdose deaths continue to rise. Two medication treatments (buprenorphine and naltrexone) are effective for treating opioid use disorder (OUD) in office-based settings but are seldom prescribed to adolescents. The present study describes medication treatment for OUD and other care received by adolescents with OUD in a state at the center of the opioid epidemic. MethodsThis retrospective cohort study included adolescents (aged 12–18 years) enrolled in Ohio Medicaid with an index OUD diagnosis (August 1, 2012, to May 31, 2016). Analyses describe the proportion of adolescents who received medication for OUD, health care (general medical outpatient, behavioral health, hospitalization, and emergency department), and other medications (attention deficit/hyperactivity disorder, antidepressants, antipsychotics, benzodiazepines, and opioid analgesics) within 3 months after OUD diagnosis. The results are compared by age group (12–15 and 16–18 years). ResultsAmong 626,508 adolescents enrolled in Medicaid, 2,097 met inclusion criteria. Overall, 4.6% received medication for OUD, whereas 9.8% received an opioid analgesic, within 3 months after OUD diagnosis. The proportion of older adolescents receiving medication for OUD was significantly higher than younger adolescents (5.9% vs. 1.2%; p < .001), whereas a higher proportion of younger adolescents received attention deficit/hyperactivity disorder medications, antidepressants, and antipsychotics. Low proportions of adolescents in both age groups received benzodiazepines (2.4% and 3.6%). During the 3 months after OUD diagnosis, 48.5% of adolescents had general medical outpatient visits, and 29% received outpatient behavioral health services. ConclusionsAlthough a large proportion of adolescents with OUD have subsequent visits in outpatient settings, few receive medications to treat OUD.

The Role of General Medical Department Belonging to Psychosomatic Medicine Course

The Role of General Medical Department Belonging to Psychosomatic Medicine Course

The Mediating Effect of Patient Satisfaction on the Patient's Perception of Healthcare Quality and Patient Trust

Background: Patients‟ experiences with quality of care and patient satisfaction in hospital are considered to be important elements in quality improvement of work in hospitals, and are also seen as indicators of quality of healthcare. The Aim of this study was to investigate the impact of patient satisfaction in the patients‟ perceptions of healthcare quality and patient trust Research design: A descriptive study was used. Setting: the study conducted in Minia General Hospital. Subjects: Includes all patients (200 patients) admitted to general Medical and Surgical Departments. Tools of study: three tools were used include personal characteristics data, SERVQUAL questionnaire, patient satisfaction questionnaire, and patient trust questionnaire. Results: more than half of the studied subjects strongly disagree toward prompt services (no waiting time), services provided as expected, efficiency of admitting procedure, friendly and courteous staff/doctors, and healthy, neat and clean environment. Also, there were positive correlations between patient satisfaction, patient trust and healthcare quality items with highly statistically significant differences. Conclusion: the patients are not satisfied about healthcare quality and they haven't trust and satisfaction about their services. Recommendation: Hospitals have to running a study on managers/doctors/staff perceptions of hospitals' services.

Risk Factors for Hospital-Acquired Venous Thromboembolism in Children: Findings from the Children's Hospital-Acquired Thrombosis (CHAT) Registry

IntroductionPediatric hospital-acquired venous thromboembolism (HA-VTE) rates are increasing along with associated mortality, short- and long-term morbidity, and healthcare costs. National process improvement efforts are underway to decrease HA-VTE in children, but risk-stratified prevention strategies will be safest and most effective if informed by robust risk factor data. The objective of this work was to identify risk factors for HA-VTE in children via a multicenter studyMethodsThe Children's Hospital-Acquired Thrombosis (CHAT) Registry is a multi-institutional pediatric HA-VTE registry that we created to generate a risk-prediction model for future use in clinical trials of thromboprophylaxis. Designed as a retrospective case-control study, CHAT Registry data has been entered by 7 U.S. pediatric institutions for subjects admitted between January 1, 2012 and December 31, 2016. Cases (aged 0-21 years) that developed HA-VTE during the admission were matched by institution and admission year with 1:1 frequency to randomly sampled non-HA-VTE controls.Univariate analyses tested associations between risk factors and the development of HA-VTE. Analyses utilized weighted logistic regression, in which controls were weighted by the inverse sampling probability in order to recreate the population from which the controls were sampled. Year of admission and hospital sites were included in the assessment of each predictor to control for effects of time and treating hospital.Results825 HA-VTE cases and 841 controls from participating hospitals comprise the analytical cohort (total 1,666 hospital admissions). HA-VTE cases showed a male predominance (58%). The majority, 73%, were related to central venous catheters (CVCs). HA-VTE most commonly occurred in the lower extremity (32%) followed by upper extremity (16%), thorax/neck (16%), cerebral sinovenous (5%), abdomen (5%), lung (3%), cardiac (2%), and other (22%). VTE were asymptomatic or identified incidentally in 21% of cases. Subjects were most commonly located in an intensive care unit (ICU) (58%) when diagnosed with a VTE, followed by general medical ward (23%), hematology/oncology unit (13%), surgical unit (3%), emergency department (1%), and other (1%).Significant association with HA-VTE incidence (Table 1) was found with infancy compared to other age groups, prior hospitalization within 1 month (Odds Ratio [OR] 3.6, 95% Confidence Interval [CI] 2.7-4.8) compared to no recent prior admission, admission to ICU (cardiac/pediatric ICU OR 10.1, 95% CI 6.0-17.1 and NICU OR 9.0, 95% CI 5.2-15.7) or hematology/oncology units (OR 2.7, 95% CI 1.6-6.0) compared to admission to general pediatric ward, complete immobility acutely (OR 32.3, 95% CI 13.2-79.2 ) compared to no loss of mobility from baseline, chronic bed-bound/wheelchair-bound immobility (OR 2.2, 95% CI 1.4-3.6), and a past medical history of protein-losing state (OR 34.6, 95% CI 4.1-290.9), inflammatory/autoimmune disease (OR 31.8, 95% CI 3.9-262.1), congenital heart disease (OR 28.5, 95% CI 12.7-64.2), central venous catheter placed on the day of admission (OR 22.0, 95% CI 14.2-34.1) or prior to admission (OR 5.2, 95% CI 3.4-7.9) thrombophilia/VTE (OR 9.7, 95% CI 2.6-35.5), TPN dependence (OR 8.0, 95% CI 1.6-39.3), or history of cancer (OR 1.5, 95% CI 1.0-2.4) compared to the absence of past medical history. Additionally, active cancer conferred an overall odds ratio of 2.0, with the recurrent/metastatic subtype conferring an OR of 3.4 compared to other active cancer subtypes.ConclusionsThe multi-institution CHAT Registry contains a larger dataset of pediatric HA-VTE cases and controls than any similar collection published to date. Key demographic and clinical factors associated with HA-VTE include infant age, male sex, ICU admission, central venous catheter, decreased mobility, cancer, use of certain medications, or certain past medical history (protein-losing state, congenital heart disease, inflammatory/autoimmune condition, thrombophilia or history of VTE, and TPN dependence).Further analysis is being performed on these and other risk factors to develop a pediatric-specific HA-VTE risk-prediction model for future validation in an even larger multi-institutional cohort. This validated risk model will then be used to identify children at high risk of HA-VTE to guide preventative strategies to decrease the incidence in the pediatric population. [Display omitted] DisclosuresJaffray:CSL Behring: Consultancy, Research Funding; Octapharma: Consultancy; Bayer: Consultancy. Croteau:Tremeau Pharmaceuticals: Consultancy; Baxalta/Shire: Consultancy, Research Funding; Biomarin: Consultancy; Bioveritiv: Consultancy; Catalyst Biosciences: Consultancy; CSL-Behring: Consultancy; Genetech: Consultancy, Research Funding; Novo Nordisk: Consultancy; Octapharma: Consultancy, Honoraria, Research Funding; Pfizer: Research Funding; Spark Therapeutics: Research Funding; Bayer: Consultancy. Silvey:Bayer: Honoraria; Pfizer: Honoraria; CSL Behring: Honoraria; Octapharma: Honoraria. Young:Bioverativ: Consultancy, Honoraria; Bayer: Consultancy; CSL Behring: Consultancy, Honoraria; Genentech/Roche: Consultancy, Honoraria; Kedrion: Consultancy; Novo Nordisk: Consultancy, Honoraria; Shire: Consultancy, Honoraria. Mahajerin:Genentech Inc.: Consultancy.

Analysis of tuberculosis incidence among health workers in the Dnepropetrovsk region.

The purpose of our study was to conduct a comparative analysis of tuberculosis incidence among healthcare workers in the general medical service departments and anti-tubercular departments in the Dnipropetrovsk region for the period from 2008 to 2017, analysis of the professional, clinical structure of tuberculosis cases for 2015-2017. Despite the decrease in the incidence of tuberculosis inUkraine, the incidence of morbidity among medical workers in the Dnipropetrovsk region remains unfavorable. Over the past 3 years, 155 employees of health facilities have been infected with tuberculosis, including 134 from the institutions of the general medical profile and 21 employees of the anti-TB clinics. The risk group consists of representatives of scrub staff and nursing staff, as well as auxiliary (other) personnel, regardless of the profile of the medical institution. It was established that the morbidity of the staff of the institutions of the community network and the clinical structure of cases of tuberculosis is unfavorable with a high proportion of destructive changes in the lungs, bacterial discharge, less specific gravity of cases detected during prophylactic examinations.

Opening the black box: An observational study of teaching and learning interactions for paediatrics trainees on consultant ward rounds.

Ward rounds are complex activities in which education must be balanced against service. Limited evidence exists regarding how to optimise ward round education. In order to improve the educational experience, we aimed to understand the teaching and learning interactions on ward rounds with a particular focus on the experience of paediatric trainees. We conducted an initial quantitative survey as a needs assessment regarding learning and teaching in clinical settings using a structured survey of 21 trainees. This was followed by an observational study using focused ethnography of 20 consultant ward rounds in a general medical department of tertiary paediatric hospital. We used a structured observation form to document ward round characteristics and educational interactions. Data were analysed using inductive content analysis to understand key influences on teaching and learning interactions. Trainees reported a discrepancy between the actual educational value of ward rounds (mean rating 2.7/5) and what they desired (mean 4.3/5). Ward round ethnography revealed examples of excellent education and practice alongside missed opportunities. Explicit education on rounds was dominated by technical content with little focus on other aspects of professionalism. Major influences on educational interactions were the ward round model - consultant-as-expert versus learner-centred - and the hidden curriculum. There are many examples of excellence in ward round education, yet there remains substantial scope to better harness the education potential of rounds. This requires us to challenge assumptions, enable feedback and reflection and make learning explicit - while putting the learner at the centre of educational opportunities.

Validation of mental health screening instruments in the Kashmir Valley, India.

The present study aimed to culturally adapt, translate, and validate the Hopkins Symptom Checklist-25 (HSCL-25) and the Harvard Trauma Questionnaire-Posttraumatic Stress Symptoms Checklist (HTQ-16) prior to use in a cross-sectional mental health population survey in the Kashmir Valley. Cultural adaptation and translation of the HSCL-25 and the HTQ-16 employed multiple forms of transcultural validity check. The HSCL-25 and HTQ-16 were compared against a "gold standard" structured psychiatric interview, the Mini International Neuropsychiatric Interview (MINI). Interviews were conducted with 290 respondents recruited using consecutive sampling from general medical outpatient departments in five districts of the Kashmir Valley. Receiver operating characteristics (ROC) analysis was used to estimate the cut point with optimal discriminatory power based on sensitivity and specificity. Internal reliability of the HSCL-25 was high, Cronbach's alpha (α) = .92, intraclass correlation coefficient (ICC) = 0.75, with an estimated optimal cut point of 1.50, lower than the conventional cut point of 1.75. Separation of the instruments into subscales demonstrated a difference in the estimated cut point for the anxiety subscale and the depression subscale, 1.75 and 1.57, respectively. Too few respondents were diagnosed with posttraumatic stress disorder (PTSD) during structured psychiatric interview, and therefore the HTQ-16 could not be validated despite the fact that high internal reliability was demonstrated (α = .90). This study verified the importance of culturally adapting and validating screening instruments in particular contexts. The use of the conventional cut point of 1.75 would likely have misclassified depression in our survey, leading to an underestimate of this condition.

An evaluation of patient safety culture in a secondary care setting in Kuwait.

ObjectivesTo improve patient safety outcomes, it is considered essential to create a positive culture of patient safety. This study carried out an initial evaluation of the patient safety culture in a secondary care setting in Kuwait.MethodsThis cross-sectional questionnaire study was conducted in a general hospital medical department in Kuwait, using the Hospital Survey on Patient Safety Culture (HSPSC). Multiple linear regression analyses were used to identify patient safety culture predictors. Both an ANOVA and a Kruskal Wallis test were carried out to assess the differences between participants' total scores and the scores they achieved in each dimension, categorized by nationality.ResultsA total of 1008 completed questionnaires were received, yielding a response rate of 75.2%. Three dimensions of patient safety culture were found to be priority areas for improvement: non-punitive responses to errors, staffing, and communication openness. Teamwork within units and organizational learning with continuous improvement were identified as areas of strength. Respondents from Kuwait and the Gulf State countries had a less positive perception of the hospital's patient safety culture than did Asian respondents. A regression analysis showed that the respondents' countries of origin, professions, age, and patient safety course/lecture attendance were significantly correlated with their perceptions of the hospital's patient safety culture.ConclusionThis study demonstrates that patient safety is perceived differently by medical staff members from different countries of origin, professional groups, and age groups. These variables must be acknowledged and addressed when planning or evaluating patient safety initiatives.