General Medical Department Research Articles

Gatekeeper Suicide Training's Effectiveness Among Malaysian Hospital Health Professionals: A Control Group Study With a Three-Month Follow-Up.

There is a lack of suicide-related training in the nonpsychiatric health professional's basic education. We suggest that a continuing education through a brief gatekeeper suicide training program could be a suitable platform to improve suicide-related knowledge, self-efficacy, and attitudes. This study aimed at examining the effectiveness of the Question, Persuade, Refer gatekeeper program on improving the knowledge, self-efficacy in suicide prevention, and understanding of/willingness to help suicidal patients of Malaysian hospital health professionals. The Question, Persuade, Refer program materials were translated and adapted for implementation in the hospital setting for nonpsychiatric health professionals. There were 159 (mean age = 35.75 years; SD = 12.26) participants in this study. Most participants were female (84.9%), staff/community nurses (52.2%), who worked in the general medical department (30.2%) and had no experience managing suicidal patients (64.2%). Intervention participants (n = 53) completed a survey questionnaire at pretraining, immediately after training, and after three months. Control participants (n = 106) were not exposed to the training program and completed the same questionnaire at baseline and three months later. Significant improvement occurred among intervention participants in terms of perceived knowledge, self-efficacy, and understanding of/willingness to help suicidal patients immediately after training and when compared with the control participants 3 months later. Improvements in declarative knowledge were not maintained at the 3-month follow-up. This study confirmed the short-term effectiveness of the gatekeeper training program. Gatekeeper suicide training is recommended for implementation for nonpsychiatric health professionals nationwide.

The TRIAGE-ProADM Score for an Early Risk Stratification of Medical Patients in the Emergency Department - Development Based on a Multi-National, Prospective, Observational Study.

IntroductionThe inflammatory biomarker pro-adrenomedullin (ProADM) provides additional prognostic information for the risk stratification of general medical emergency department (ED) patients. The aim of this analysis was to develop a triage algorithm for improved prognostication and later use in an interventional trial.MethodsWe used data from the multi-national, prospective, observational TRIAGE trial including consecutive medical ED patients from Switzerland, France and the United States. We investigated triage effects when adding ProADM at two established cut-offs to a five-level ED triage score with respect to adverse clinical outcome.ResultsMortality in the 6586 ED patients showed a step-wise, 25-fold increase from 0.6% to 4.5% and 15.4%, respectively, at the two ProADM cut-offs (≤0.75nmol/L, >0.75–1.5nmol/L, >1.5nmol/L, p ANOVA <0.0001). Risk stratification by combining ProADM within cut-off groups and the triage score resulted in the identification of 1662 patients (25.2% of the population) at a very low risk of mortality (0.3%, n = 5) and 425 patients (6.5% of the population) at very high risk of mortality (19.3%, n = 82). Risk estimation by using ProADM and the triage score from a logistic regression model allowed for a more accurate risk estimation in the whole population with a classification of 3255 patients (49.4% of the population) in the low risk group (0.3% mortality, n = 9) and 1673 (25.4% of the population) in the high-risk group (15.1% mortality, n = 252).ConclusionsWithin this large international multicenter study, a combined triage score based on ProADM and established triage scores allowed a more accurate mortality risk discrimination. The TRIAGE-ProADM score improved identification of both patients at the highest risk of mortality who may benefit from early therapeutic interventions (rule in), and low risk patients where deferred treatment without negatively affecting outcome may be possible (rule out).

Temporal Patterns of In-Hospital Falls of Elderly Patients.

A potentially important factor yet to receive adequate study is the time when hospital falls occur. A prior study conducted before the system-wide introduction of preventive measures revealed a biphasic 24-hour pattern of hospital falls with major peak in the morning. The purpose was to identify the temporal patterning of falls among elderly patients in hospitals with comprehensive fall prevention programs in place. A 4-year observational study was conducted by the local health authority in the five nonteaching public hospitals located in the province of Ferrara, Italy. Fall records involving patients of ages ≥65 years hospitalized in the general medical departments were used. Single- and multiple-component cosinor (time series) analyses were used to explore 24-hour, weekly, and annual patterns of falls. A total of 763 falls were experienced by 709 different elderly hospitalized patients. Falls typically took place in the patient's hospital room (72%) and bathroom (23%). Major causes were patient instability (32%) and accident (13%), and most occurred when not wearing footwear (45%) or wearing inappropriate sling-back open-toe shoes (39%). Falls happened while standing (39%), while seated (21%), and while getting into, out of, or laying in bed (32%)-either with the bed rails raised or lowered. Fall outcome usually involved no injury (58%) or slight injury (35%), but some (7%) were disabling. Fall occurrence was higher during the night (46%) compared to either the morning (30%) or afternoon (24%) shift. Patterns across 24 hours were characterized by a single major and one or more minor peaks that seemed to be associated with a variety of scheduled patient, hospital, and nursing activities. Multiple-component cosinor analysis identified significant (p < .05) prominent day-night patterns according to fall location, patient position, cause, injury severity, and type of footwear. Falls were more frequent, but not significantly so, on Fridays, Sundays, and Mondays compared with Tuesdays, and were more frequent in winter and spring (p = .003). Documentation by cause and circumstance of these moderate- to high-amplitude temporal patterns in hospital falls of elderly patients advances the knowledge of fall epidemiology by identifying the times of day, week, and year and nursing shifts of elevated risk that is of critical importance to improving hospital patient safety programs.

Prevalence of unrecognized depression and associated factors among patients attending medical outpatient department in Adare Hospital, Hawassa, Ethiopia.

Depression is an illness that involves the body, mood, and thoughts and that affects the way a person eats, sleeps, feels about him or herself and thinks about things. Depression is one of the most common mental disorders affecting 121 million people in the world, and it frequently goes unrecognized among patients. It is estimated that 5%–10% of the population at any given time is suffering from identifiable depression needing psychiatric or psychosocial intervention. An institution-based cross-sectional study design was implemented to determine the magnitude and associated factors of unrecognized depression among patients attending the adult medical outpatient department in Adare Hospital, Hawassa, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, among 326 patients selected using systematic random sampling technique. Data were collected using the interviewer-administered technique. A structured questionnaire was used to collect data on sociodemographic characteristics and other independent variables. Depression was assessed using the Patient Health Questionnaire 9. Data were entered and ana-lyzed using SPSS 20. The level of significance was determined at P<0.05. About 326 patients were interviewed, of whom 186 (57.1%) were males. The mean age of participant was 34 with standard deviation of ±13.1 years. Current substance users accounted for 106 (32.5%) of the total participants. Of 326 respondents, 80 (24.5%) had significant depressive symptoms, while the detection rate of depression by the clinician was 0%. Depression was associated with female sex (adjusted odds ratio [AOR] =1.63 [1.14–2.34]), age >60 years (AOR =4.14 [1.87–9.14]), being divorced (AOR =3.13 [1.70–5.76]), and having an average monthly income <750 ETB (AOR =1.92 [1.119–3.195]). The findings of this study revealed that the prevalence of depression among patients attending general medical outpatient department was highly underrecognized and unmanaged. On the basis of these results, we recommended that health-care providers perform a thorough assessment to address common mental disorders, especially depression, and suggest that training to recognize and manage depression appropriately be given.

Knowledge, attitude and opinion of patients regarding the new German legislation on advance care planning : Results of a survey in a department of general internal medicine

In September 2009 a new legislation for advance care planning was introduced in Germany with the important characteristics of bindingness and unlimited validity for individual directives. Knowledge regarding this act and the attitude towards its characteristics among patients is unclear. Analysis of knowledge, attitude and opinion of patients in a general internal medical department regarding advance care planning in general and the recent German legislation. A total of 200 consecutive patients in an internal medicine ward were interviewed with the help of a questionnaire regarding their attitude to and knowledge on advance care planning in general and the current legislation. Approximately 40 % of the patients had issued some form of directive (either advance care directive or health care proxy) and only 7.5 % were advised by their physicians to make an advance directive. Patients with no directive were not willing to deal with dying and death, were not well-informed about directives or assumed that relatives or physicians would make an appropriate decision. Characteristics of the new legislation were controversially assessed; only 21 % of the patients wished to have a literal implementation of their directive. Regarding the content of an advance directive, more than 80 % of the patients voted for pain control in the palliative setting. The proportion of patients with a directive regarding advance care planning is only slowly increasing. Many patients are not well-informed, do not want to deal with dying or would like to delegate decisions to relatives and physicians. The present characteristics of the German legislation are controversially assessed and often do not represent the wishes of the patients.

Consultation–liaison psychiatric services in Dubai, UAE: a descriptive analysis study

Introduction Liaison psychiatry refers to the interface between psychiatry and general hospital patients. It involves psychiatrist’s intervention in the care of medically ill patients who present with psychiatric symptoms while in a general hospital setting. It may also involve the assessment of patients who have pre-existing psychiatric illness or those who develop psychiatric symptoms because of their medical or surgical illness. It is estimated that nearly 26.5–60% of the general medical inpatients suffer psychiatric comorbidity. Aim of the study The aim of this study was to evaluate the pattern and the characteristics of liaison referral to the psychiatric department from other general medical and surgical departments at Al Rashid Hospital, Dubai, and its association with clinical and diagnostic factors, and to study the quality and appropriateness of information presented in the referral letters to the psychiatric department. Patients and methods The patients included in the study were recruited from individuals who had been consecutively assessed and treated by the liaison psychiatric team at Rashid Hospital, Dubai, UAE, during the period of 6 months from 1 November 2012 to 30 April 2013. A specially designed data sheet was developed and a pilot analysis on 20 patients was undertaken using the designed data sheet to assess the applicability of data collection and tool arrangement of items, and to estimate the time needed and the feasibility of the study. The data sheet included demographic data, data of patterns of descriptive psychopathology, either physical or mental, before presentation, a mental state examination and cognitive assessment through the Mini Mental State Scale. We identified the following parameters to evaluate the referred letters from GP and other medical or surgical specialists or consultants: the degree of urgency − reason of referral, symptom-relevant life events or stresses, family history of psychiatric disorder, medical history, psychiatric history, treatment given, physical examination and any investigations that have been performed, mental state examination and psychiatric diagnosis. Results The number of referrals over the indicated period was 60 patients (6 months). Suicidal behaviour was the highest among the reasons for referral. The main comorbid physical disorders included 13 (21.7%) endocrine disorders, 11 (18.3%) gastrointestinal tract disorders, 10 (16.7%) central nervous system disorders, seven (11.7%) musculoskeletal system disorders, six (10%) respiratory system disorders, five (8.3%) coronary artery diseases, five (8.3%) urogenital disorders and three (5%) sensory deprivation. The medical history was not mentioned in 46 (76.7%) of the referral letters The action taken by the psychiatrist after assessments were admission to the psychiatric ward for 21 patients (35%), outpatient appointments for 24 (40%) and discharge from psychiatric service for 15 patients (25%). Psychiatrists agreed with the GP diagnosis in 15 cases (25%), but considered the diagnosis inaccurate in 27 (45%) of these cases. Replies of the psychiatrists to the GP referrals were made only in 18 patients (30%); no reply was written in 42 (70%) cases. Conclusion Future research is needed to understand how liaison service can be utilized and sustained most effectively as part of general hospital care. A comprehensive consultation–liaison unit that comprises a sufficient number of multidisciplinary mental health professionals (psychiatrist, psychologist, social worker) is vital in general hospital settings to address the unmet needs.

Connectedness and Perceived Burdensomeness among Adolescents at Elevated Suicide Risk: An Examination of the Interpersonal Theory of Suicidal Behavior

The interpersonal theory of suicidal behavior emphasizes the constructs of perceived burdensomeness, thwarted belongingness, and acquired capacity, which warrant investigation in adolescents at risk for suicide due to interpersonal stressors. This study examined one component of the interpersonal theory of suicidal behavior, “suicidal desire” (suicidal ideation), in 129 adolescents (12–15 years) recruited from a general medical emergency department who screened positive for bully victimization, bully perpetration, or low interpersonal connectedness. Greater perceived burdensomeness combined with low family connectedness was a significant predictor of suicidal ideation. This suggests the importance of addressing connectedness and perceptions of burdensomeness in prevention and early intervention efforts with at-risk adolescents.

EFFECTIVENESS OF STRUCTURED TEACHING PROGRAM ON KNOWLEDGE AND PRACTICE OF NURSES REGARDING BLOOD TRANSFUSION IN MEDICAL AND HEMOLYTIC DEPARTMENTS AT TANTA UNIVERSITY HOSPITAL

An understanding and knowledge of the path physiology of transfusion reactions, symptoms and treatment is essential to safely administer and monitor transfusion. Aim of the study: to evaluate the effectiveness of structured teaching program on knowledge and practice of nurses on blood transfusion. Material and methods: A quasi-experimental research design was utilized on a convenient sample of 30 nurses. The study was conducted in the general medical and hematological departments at TantaUniversityHospital. Three Tools used for data collection includetool I to assess sociodemographic nurses data and knowledge. Tool II Observation check list sheet:to assess nurse’s practice. ToolIII Construction of teaching program.Results: 43.3 % and 93.3% and 66.7 % respectively of the total sample of nurses pre program ,immediately and after one month of post program had correct answer about blood and blood transfusion. There was progress in information immediately after the program and after one month from the program than before the program (76.7%, 66.3% , 26.7% ) respectively . The finding indicated that there was statistical significant difference and improvement of nurses' performance in immediately and after one month of the program from pre the program. Conclusion:there was a great improvement in the knowledge and practice score levels obtained by nurses after implementation of nursing intervention program immediately and after one month of follow up. Recommendation: Nurses are in need for in-service training programs and refreshing courses to improve their knowledge which will reflect on their practice.

(Innovative Development of Medical Organizations in Reforming of the Health Care System)

Russian Abstract: Сложность и многофакторность задач анализа финансово-экономического состояния медучреждения, прогнозирования и планирования действий, направленных на его инновационное развитие, требуют создания специализированных инструментов поддержки принятия решений (ППР). В работе проведено исследование и параметризация определяющих финансово-экономических и нормативных факторов в их взаимосвязи с основными производственными показателями работы многопрофильного медицинского учреждения на примере группы федеральных учреждений в составе Главного медицинского управления (ГМУ) Управления делами Президента Российской Федерации. Разработана математическая модель финансовой устойчивости медучреждения, адекватная условиям проводимой реформы здравоохранения и методика анализа, прогнозирования и планирования инновационного развития многопрофильного медицинского учреждения в условиях реформирования с использованием инструментов интерактивного моделирования по принципу «что если». Описан создаваемый на базе модели программно-информационный инструмент – система поддержки принятия решений (СППР). Инструмент позволяет лицу, принимающему решения (ЛПР), в интерактивном режиме осуществлять оптимизацию финансовых и производственных ресурсов с учетом всех влияющих факторов, моделировать и оценивать влияние макроэкономических условий на финансово-экономическую устойчивость учреждения, проводить моделирование и планирование баланса доходов и расходов по видам оказываемых учреждением медицинских услуг.English Abstract: The complexity and multivariate analysis problems of financial and economic state medical institutions, forecasting and planning activities aimed at the development of its innovative, require the creation of specialized decision support tools (SPR). The paper studied and parameterization defining financial, economic and regulatory factors in their relationship with key performance indicators work diversified medical institutions at a group of federal agencies as part of the General Medical Department (LGU) Office of the President of the Russian Federation. A mathematical model of financial sustainability of health facilities, adequate conditions of health reform and methods of analysis, forecasting and planning of innovative development of diversified medical institution in the conditions of reforming using the tools of interactive simulation on the principle of what if. Described created based on the model and software information tool - Decision Support System (DSS). The tool allows the decision maker (LPR) in interactive mode to perform the optimization of financial and operational resources, taking into account all influencing factors, simulate and evaluate the impact of macroeconomic conditions on the financial and economic stability of the institutions to carry out simulation and planning the balance of income and expenditure by type of institution provided medical services.

Pattern of irritable bowel syndrome and its impact on quality of life: A tertiary hospital based study from Kolkata on newly diagnosed patients of irritable bowel syndrome attending general medical outpatient department

Background and Aims: Irritable bowel syndrome (IBS) is a highly prevalent functional gastrointestinal disorder long considered a diagnosis of exclusion. It is associated with decreased quality of life and significant economic burden to both the individual patient and society. To the best of our knowledge, this was the first study from this part of India assessing the relative impact on quality of life with respect to subtype of IBS. Subjects and Methods: The study was conducted between December 2011 and December 2013 among 1000 IBS patients attending general medical outpatient department of a tertiary care hospital in Kolkata (West Bengal, India). The Rome III criterion was used for diagnosis of IBS. IBS was further classified as diarrhea predominant (IBS-D), constipation-predominant (IBS-C) and mixed variety (IBS-M). This was a prospective, observational, cross-sectional study to assess the demographic and socioeconomic parameters, and impact of IBS on the quality of life of the patients by using short form-36 (SF-36) questionnaire. Results: The study found that IBS-D (67.6%) was the most common type, followed by IBS-M (30.4%) and IBS-C (2%). The majority of patients were males (59.2%). Overall none of the demographic and socioeconomic parameters analyzed in the study was found to have any significant bearing on the subtype of IBS affecting them. Eight scales of the SF-36 questionnaire were individually analyzed and correlated with the different subtypes of IBS. IBS-D group had the worst scores while IBS-M had the best score of quality of life. The difference between IBS-D and IBS-M was found to be statistically significant (P < 0.001) on every aspect. Conclusions: The study highlights that IBS is a bio-psychosocial disorder with poor quality of life. Most of the patients of IBS reporting to physicians have IBS-D. The socioeconomic and demographic factors do not appear to be significant determinants in this condition. IBS-D causes worst impact on quality of living among all subtypes.

Tuberculosis in health care workers in Belarus.

Tuberculosis (TB), including drug-resistant TB, is a serious problem in Belarus. To determine the prevalence of TB among health care workers (HCWs) along with patient characteristics, treatment outcomes and drug resistance patterns between 2008 and 2012. A retrospective national record review. There were 116 HCWs with TB. Case notification rates were higher among HCWs than in the general population (349 vs. 40/100 000 in 2012). Most HCWs with TB were nurses (n = 46, 40%) or nurse assistants (n = 37, 32%), female (n = 100, 86%) and aged 25-44 years (n = 84, 72%). Most common places of work for HCWs with TB were multidrug-resistant (MDR-) and extensively drug-resistant (XDR-TB) wards (n = 23, 20%), general medical (n = 26, 22%) and non-medical (n = 34, 29%) departments. All HCWs had pulmonary TB, 107 (92%) had new TB and 103 (89%) had negative sputum smears. Of the 38 (33%) with culture and drug susceptibility testing (DST), 28 (74%) had MDR-/XDR-TB. In 109 HCWs evaluated for final treatment outcomes, 97 (89%) were successfully treated, and their results were not affected by DST status. This study highlights the high prevalence of recorded TB in HCWs in TB health facilities in Belarus: there is a need to better understand and rectify this problem.

Are we following the guidelines for consenting? Prospective audit to determine whether the general medical council and department of health guidance on consent is being followed in an inner city hospital

Are we following the guidelines for consenting? Prospective audit to determine whether the general medical council and department of health guidance on consent is being followed in an inner city hospital

The effectiveness of health education using the teach-back method on adherence and self-management in chronic disease: a systematic review protocol

Review question/objective What is the effect of using the teach-back method for health education to improve adherence to treatment regimen and self-management in chronic disease? Inclusion criteria Types of participants This review will consider all studies that include adult patients (aged 18 years and over) in any healthcare setting, either as inpatients (eg acute care, medical and surgical wards) or those who attend primary health care, family medical practice, general medical practice, clinics, outpatient departments, rehabilitation or community settings. Participants need to have been diagnosed as having one or more chronic diseases including heart failure, diabetes, cardiovascular disease, cancer, respiratory disease, asthma, chronic obstructive pulmonary disease, chronic kidney disease, arthritis, epilepsy or a mental health condition. Studies that include seriously ill patients, and/or those who have impairments in verbal communication and cognitive function will be excluded. Types of intervention This review will consider studies that investigate the use of the teach-back method alone or in combination with other supporting education, either in routine or research intervention education programs; regardless of how long the programs were and whether or not a follow-up was conducted. The intervention could be delivered by any healthcare professional. The comparator will be any health education for chronic disease that does not include the teach-back method. Types of outcomes Primary outcomes of interest are disease-specific knowledge, adherence, and self-management knowledge, behavior and skills measured using patient report, nursing observation or validated measurement scales. Secondary outcomes include knowledge retention, self-efficacy, hospital readmission, hospitalization, and quality of life, also measured using patient report, nursing observation, hospital records or validated measurement scales.

Blood Transfusion :Impact of Implementing a Design Nursing Intervention Protocol to Minimize Patient's Complications

Blood transfusion generally refers to the therapeutic use of blood and components. There are several risks associated with blood transfusion. According to WHO (2009) more than 81 million units of blood are collected globally every year. Through 2010, units of blood for internal medicine and blood disease unit are more than 3168 units. The nurse plays a critical role in caring for patients undergoing blood transfusion. The aim of the study was 3 folds: the first is to assess the patient undergoing blood transfusion of physical and psychological needs; the second is to assess nurses' knowledge and practice before and after implementing the protocol and the third is to design nursing intervention protocol. Hypotheses: Hypotheses were formulated: (1) The post mean knowledge score of nurses who would be exposed to design nursing intervention protocol would be higher than their pre mean knowledge scores. (2)The post mean practice scores of nurses who will be exposed to design nursing intervention protocol will be higher than their pre mean practice scores.(3) A positive relationship would be exist between knowledge and practice score obtained by nurses receiving the designed nursing intervention protocol. (4) The incidence of complications of blood transfusion after protocol implementation would be lesser than that developed pre protocol. Research design: A quasi-experimental research design was utilized in this study on a convenient sample of 55 nurses and 30 patients control group and 30 study group patients. The study will be conducted in the general medical departments (B and C) and blood diseases unit at Assiut University Hospital. Tools utilize for data collection were a) pre and post nurses' intervention interview sheet. b) Construction of designed nursing intervention protocol. c) Patients' complications assessment sheet. Results: The first and the second hypotheses were supported as a good improvement in the mean knowledge & practice scores were found after the implementing of nursing intervention protocol. The third hypothesis was supported as was not able to extract the statistical significance of the relationship between knowledge and nursing practices before and after the study but extract a positive correlation by figure. The fourth hypothesis was supported as the complications of blood transfusion after protocol implementation were lesser than that developed pre protocol. Conclusion: Improved nurses' knowledge and practice can favorable affect the incidence of complications for patient undergoing blood transfusion. Recommendation: Nurses are in need for in-service training programs and refreshing courses to improve their knowledge which will reflect on their practice while providing care to patients.

Effect of a designed nursing protocol on nurse's knowledge and practice regarding Intravenous Therapy

Background: Peripheral venous cannulation is the commonest method used for intravenous therapy. There are numerous well recognized indications such as intravenous fluids, limited parenteral nutrition, blood and blood products, drug administration (continuous or intermittent). The aim of the present study is 3-folds: the first is to assess nurse's knowledge and practice regarding intravenous therapy, the second is to design nursing protocol for nurses about intravenous therapy and the third is to evaluate the effect of implementing the designed nursing protocol on nurse's knowledge and practice regarding intravenous therapy. Hypotheses: Three hypotheses were formulated: (1) the post mean knowledge scores of nurses who will be exposed to designed nursing protocol will be higher than their pre mean knowledge scores. (2) The post mean practice score of nurses who will be exposed to a designed nursing protocol will be higher than their pre mean practice scores. (3) A positive relationship will exist between knowledge and practice score obtained by nurses receiving the designed nursing protocol. Research design: Aquasi-experimental research design was utilized in this study on a convenient sample of 55 nurses. The study will be conducted in general medical departments (B and C) and blood diseases unite of Assiut university hospital. Tools: utilize for data collection were a) Questionnaire sheet. b) Observation checklist sheet. c) Construction of designed nursing protocol. Results: The first and the second hypotheses were supported as a good improvement in the mean knowledge & practice scores were found after the implementing of designed nursing protocol. The third hypothesis was supported as a negative relationship was found between nurse's knowledge and practice scores immediately after application of the designed nursing protocol. Conclusion: implementing the designed nursing protocol on nurse's knowledge and practice regarding intravenous therapy shows a significant improvement in nurses' knowledge and practice. Recommendation: Continued nursing education and in-service training programs should be well organized within Assiut University Hospital.

Assessment of Nutritional Status of patients with Liver Cirrhosis at Minia University Hospital

There is limited data on the nutritional status of Egyptians with various etiology of cirrhosis, this study aimed to, assess the nutritional status for patients with liver cirrhosis at Minia University Hospital. Patient and Methods: 100 adult patients with liver cirrhosis (63 male and 37 female with mean age (45.58, 45.11 years respectively) and 20 patients as controls with mean age 42.20 years, the study was conducted at the General Medical Department and outpatient clinic in Minia University Hospital. Assessment of nutritional status was done using (1) anthropometric measurements as mid-arm circumference, mid-arm muscle circumference, triceps skin fold thickness, (2) Biochemical measurements as serum albssessmentmin, hemoglobin, WBCs, total protein, and INR, also; Mini-Assessment sheet was used. Results: the cause of liver cirrhosis among study group was 77% HCV and 22% HBV and 1%Mixed HBV and HCV infection, they were Child Pugh Class B and C (66%, 34% respectively). The most common nutritional risk factors for patients are gastrointestinal problems such as dry mouth, taste alteration, anorexia, nausea, and flatulence Malnutrition was prevalent in 85% of patients in study group in comparison with control group none of them have malnutrition. There is a high statistical significant difference found between liver cirrhosis group and control group in all anthropometric measurements. Conclusion: the majority of patients with decompensated liver cirrhosis were malnourished regardless the etiology of liver cirrhosis. Identifying the patients that are approaching the state of malnutrition by simple and easily applied methods is necessary in order to provide nutritional support. Follow up and correction of the nutrient deficit is very important and can improve the clinical outcome.

Seizure, dysphasia, blindness and amnesia; what's the connection?

A 70-year-old right-handed man was admitted to the general medical department after his first ever generalised seizure. His past history included resection of a bowel carcinoid tumour in 2003 and...

The Relationship between Burnout and Organizational Commitment among Nurses at Tanta University Hospitals

Burnout is a familiar term for today's health care professionals with emotional, psychological, physical, and social consequences for those who experience it. It leads to job dissatisfaction, low organizational commitment, absenteeism, as well as inter personal conflict in teams and patient care. The commitment of nurses is a worldwide concern which is necessary to describe their commitment and what keep them committed in nursing and hospitals. it is an undeniable fact that organizations need workers with high commitment and low burnout levels more than ever before. Aim : The aim of the study was to explore the relationship between nurses burnout on organizational commitment among nurses in selected department (emergency and intensive care units of medical and surgical, , cardiovascular intensive care units,) and general medical surgical departments) at Tanta University Hospitals. Material and method: Correlation design was used. the study was conducted at Tanta University Hospitals, The sample consisted of (123) staff nurses from emergency and intensive care units N=75) and medical-surgical departments( N=48) at Tanta University Hospitals. Two tools were used for data collection, first; Maslach Burnout Inventory which included 22 questions cover areas of: 1- emotional exhaustion (8question), personal accomplishment ( 8 questions) and depersonalization (6questions), second organizational commitment questionnaire It included 39questions divided into eight categories namely: feeling experienced at work(2 questions) 1-2,perceived strategy(1questions) 3, perceived identification with hospital (9questions) 4-12 ,Equity(1questions)13 investment(9questions)14 -22,, trust(3questions) 23-25, resistance(4 questions) 26-30, grievance(1questions)31, compliance(2questions) 32-33and participation(7 questions)34-39. Results: two third of staff nurses (66.6% ) in general medical surgical departments experienced high level of total burnout compared to 60%of staff nurses in emergency or intensive care units have the same level of total burnout. Three fourth of staff nurses (75.6%) have moderate level of total organizational commitment. in emergency or intensive units and general medical surgical units. There were negative correlations between organizational commitment and Emotional Exhaustion (r = -0.36 ). Also, there is statistical significant negative correlations between organizational commitment and Accomplishment(r = -0.42). However, non-significant correlation was observed between organizational commitment and Depersonalization. Conclusion: High percent of staff nurses. in emergency or intensive units and general medical surgical units experienced high level of burnout and moderate level of organizational commitment. It recommended that work redesign plans as well as early assessment and intervention may be helpful in the reduction of job burnout in staff nurse working in hospitals. Key wards: Burnout , Nurses, Organizational commitment,

Nutritional Screening Model in Tertiary Medical Unit in Croatia

Background/Aims: Malnutrition of hospitalized patients is often undetected and untreated due to poor awareness and insufficient knowledge of the attending hospital staff. Nutritional screening has not been part of the daily routine in Croatian hospitals. Our aim was to implement nutritional screening as part of the routine medical examination and to assess the nutritional risk at admission for all hospitalized patients. Methods: All patients hospitalized in departments of internal medicine in tertiary hospitals in Croatia were screened at entry using the Nutrition Risk Screening 2002 (NRS 2002). Results: Between October and December 2010, 1,696 patients were screened and analyzed (948 males and 748 females). 329 (19.4%) had an NRS 2002 score ≥3 and were considered to be at nutritional risk. An NRS 2002 score ≥3 was identified as a significant predictor of the length of hospital stay (beta coefficient = 0.06, p = 0.027) and fatal outcome (OR = 6.18, p < 0.001). Only 32.8% of malnourished patients received some nutritional support. Conclusions: Every fifth patient hospitalized in a general medical department in Croatia is at nutritional risk and the majority of them does not receive nutritional support. More effort is needed to implement nutritional standards in daily clinical practice.

Completion of consent forms in colorectal surgery: are we getting it right?

The General Medical Council and Department of Health both recognise that although the acquisition of written informed consent for surgery is not a legal requirement, it remains a good practice.1...