General Medicine Wards Research Articles

An Assessment of an Inpatient Robotic Nurse Assistant: A Mixed-Method Study

The worldwide nursing shortage has led to the exploration of using robotics to support care delivery and reduce nurses’ workload. In this observational, mixed-method study, we examined the implementation of a robotic nurse assistant (RNA) in a hospital ward to support vital signs measurements, medication, and item delivery. Human–robot interaction was assessed in four domains: usability, social acceptance, user experience, and its societal impact. Patients in a general medicine ward were recruited to participate in a one-time trial with the RNA and a post-trial 75-question survey. Patients’ interactions with the RNA were video recorded for analysis including patients’ behaviours, facial emotions, and visual attention. Focus group discussions with nurses elicited their perceptions of working with the RNA, areas for improvement, and scalability. Sixty-seven patients aged 21–79 participated in the trial. Eight in 10 patients reported positive interactions with the RNA. When the RNA did not perform to expectations, only 25% of patients attributed fault to the RNA. Video analysis showed patients at ease interacting with the RNA despite some technical problems. Nurses saw potential for the RNA taking over routine tasks. However, they were sceptical of real time savings and were concerned with the RNA’s ability to work well with older patients. Patients and nurses suggested greater interactivity between RNA and patients. Future studies should examine potential timesaving and whether time saved translated to nurses performing higher value clinical tasks. The utility of improved RNA’s social capability in a hospital setting should be explored as well.

Assessment and Monitoring of Adverse Drug Reactions at a Tertiary Care Hospital

Background: Incidences of adverse drug reactions were reported through spontane-ous reporting at an ADR monitoring unit in a tertiary care hospital. Aims: This study was conducted to describe the distribution pattern of adverse drug reaction (ADR). Objective: The objective of this study was to monitor and report the adverse drug reactions (ADRs) occurring in a tertiary care hospital and to evaluate the incidence, causality, severity, and preventability of adverse drug reactions. Methods: A prospective, observational study was conducted at a tertiary care hospital in Punjab for 6 months. All patients admitted to the hospital above 18 years of age were included in the study. Results: A total of 103 ADRs were observed over the study period of 6 months. The majority of them were females (60), comprising of 58.25%. The therapeutic class of drug associated with most of the ADRs was antibiotics 18 (17.5%). Maximum number of ADRs occurred in the gen-eral medicine ward with frequency of 27 (26.2%) and were of type b 58 (56.3%). Causality was assessed using the Naranjo scale, and most of the ADRs came out to be probable 64 (62.1%) in nature. Severity was assessed using Hartwig’s severity assessment scale, and most of the cases, 66 (64.1%), were moderate in intensity. ADR preventability was assessed using the Schumock and Thornton preventability scale, and it was observed that most of the cases, 82 (79.6%), were not preventable. Conclusion: This study seeks to strengthen the ADR database through analysis of spontaneous reporting patterns of ADRs from various clinical departments of a tertiary care teaching hospital, thereby increasing awareness and improving the reporting culture among health care practition-ers. It can be concluded that continuous medication monitoring and a well-organized and com-mitted pharmacovigilance system led by a clinical pharmacist in a hospital setting would un-doubtedly lower the incidence of adverse drug reactions.

FI-lab in the emergency department and adverse outcomes among acutely hospitalized older adults

BackgroundThe emergency department is treating a growing number of older patients with frailty, which has been linked to poorer outcomes. Urgency is generally emphasized in the emergency department based on indicators such as triage scores and early warning scores for decision-making. However, this approach may not be sufficient for frail older people. The Frailty Index-laboratory (FI-lab) has been used as a simple assessment tool for frailty, but it may also reflect disease severity and predict adverse outcomes in the emergency care setting. Therefore, we aimed to evaluate the association between FI-lab in the emergency room and adverse outcomes during hospitalization through comparison with assessments using triage and early warning scores. MethodsThis was a retrospective cohort study conducted in a tertiary hospital. The study included patients aged 65 years or older who were admitted to the general internal medicine ward after being initially evaluated in the emergency department. FI-lab was calculated using 24 laboratory parameters from blood tests. The National Early Warning Score (NEWS), the Japan Triage and Acuity Scale (JTAS), and the modified JTAS were also used as prognostic indicators, and their association with adverse outcomes was compared with that of FI-lab. ResultsIn total, 872 patients (mean age, 80.9 years; male, 52.6 %) were analyzed. Patients who died during hospitalization had a higher FI-lab than those who survived. In multiple regression analysis, FI-lab, NEWS, and the modified JTAS were significantly associated with in-hospital death and prolonged length of hospital stay. In contrast, none of these indices were associated with in-hospital falls. The FI-lab was independently associated with the likelihood of discharge to home. ConclusionsFI-lab evaluated in the emergency department reflected the severity of illness in acutely hospitalized older adults, similarly to NEWS and JTAS, and was a useful indicator for predicting adverse outcomes. These results may indicate the value of FI-lab for older adults in the acute care setting.

Exploration of drug therapy related problems in a general medicine ward of a tertiary care hospital of Eastern Nepal

BackgroundInpatients are at higher risk of Drug Therapy Related Problems (DTRPs), and early identification and management of these DTRPs is crucial for optimal treatment outcomes and ensuring rational drug therapy. ObjectiveThis study aims to assess DTRPs in a general medicine ward of a tertiary care hospital in eastern Nepal. MethodsA three-month prospective observational study was conducted on inpatients admitted to the general medicine ward of the hospital. Pharmacists routinely performed patient drug therapy reviews, by which suspected DTRPs were identified and recorded as per the Pharmaceutical Care Network Europe Association (PCNE) v.9.1 guidelines. Binary logistic regression analysis was used to determine the influence of predictor variables on the occurrence of DTRPs. ResultsA total of 301 inpatients were enrolled, out of which 233 (77.4%) had one or more DTRPs. Altogether, 528 DTRPs with an average of 2.27 ± 0.92 DTRPs per patient were identified. The primary causes of the DTRPs were drug selection (40.47%), treatment duration (16.71%), dispensing (15.75%), and dose selection (13.12%). Antimicrobials were involved in 55.18% of the DTRPs. DTRPs were more prevalent in elderly, comorbid patients, patients with longer hospital stay days, and polypharmacy, which was statistically significant (p<0.05). Furthermore, multivariate binary logistic regression analysis showed that geriatric patients had a higher risk of experiencing DTRPs, with an adjusted odds ratio of 1.832 (1.021-3.286) at p-value < 0.05. ConclusionDTRPs are frequently prevalent in hospital wards, emphasizing the crucial role of clinical pharmacists in identifying, resolving, and preventing DTRPs in inpatient settings for optimal treatment outcomes.

Streamlining Communication: "Resident Huddle" on General Medicine Wards at a Veterans Affairs Hospital.

Background Orienting medical trainees to new practice environments is essential. Huddles have been shown to improve communication and safety outcomes. However, their use in orienting trainees to systems processes and changes on inpatient general medicine (GM) wards remains unexplored. Objective Implement a weekly inpatient huddle between residents and hospital leaders to improve dissemination of information around health system operations. Methods In 2019, we established "Resident Huddle," a weekly 20-minute huddle for senior internal medicine residents rotating on GM wards at a US Department of Veterans Affairs Hospital led by the site leads. Resident Huddle content included system updates, rotation updates, process reminders, performance feedback, and systems and patient safety concerns raised by trainees. Reactions to the huddle were assessed via survey. Behavioral change was assessed by rates of complete trainee admission medication reconciliation documentation before and after huddle implementation. Results Resident Huddle started in October 2019 and continues to this day. Between October 2019 and June 2022, 136 of 205 participants completed surveys (66% response rate). Respondents agreed or strongly agreed that the huddle provided useful information for care delivery (94%, 128 of 136), improved work engagement (73%, 99 of 136), provided feedback on practice patterns (90%, 121 of 135), and that issues they experienced were acknowledged and acted upon (86%, 114 of 133). Retrospective medical record analysis demonstrated improvement in admission medication reconciliation completion rate by trainees from pre-intervention (32%, 19 of 60) to post-intervention (73%, 44 of 60). Conclusions A weekly huddle between hospital leaders and residents strengthened communication and equipped trainees with operational health systems knowledge to enhance patient care outcomes while fostering a greater sense of engagement with their work environment.

A Study of the Clinical Profiles of Patients With Hepatorenal Syndrome.

Background and objective Hepatorenal syndrome (HRS)is a systemic disorder that affects both the kidneys and the liver. HRSrefers to the occurrence of kidney failure in individuals with advanced liver cirrhosis, portal hypertension, and ascites, without any underlying kidney disease. The interplay of systemic and portal hemodynamics causes severe constriction of blood vessels in the kidneys, which defines HRS. The study aims to illuminate the demographic profiles, etiology, and outcomes of patients with HRS. Material and methods The study was designed as a prospective, cross-sectional, hospital-based observational studyconducted at Dr. D.Y. Patil Medical College, Hospital, and Research Centre in Pimpri, Pune. The study period spans from September 2022 to June 2024. Before commencement, approval was obtained from the institutional ethics committee, and informed written consent was secured from all participating patients. The sample size consists of 100 patients diagnosed with HRS, selected from the general medicine outpatient department, wards, and ICU of Dr. D.Y. Patil Hospital and Research Centre. A comprehensive clinical history was recorded for all patients, focusing on the symptoms of cirrhosis and HRS, followed by a thorough examination for related signs and symptoms. Results Among the 100 patients included in this study on HRS, 25% (N=25) fell within the age range of 18-30 years, and 76% (N=76)were identified as male. Alcoholic cirrhosis accounted for 78% (N=78)of cases, with hepatitis B infection being the subsequent leading cause. The mortality rate was 12% (N=12)while the survival rate was 88% (N=88). Conclusion This study provides insights into the demographic profile, etiology, and outcomes of HRS. The results of this study contribute valuable insights into the complex nature of HRS, highlighting the importance of early detection and monitoring to optimize patient care.

Impact of the COVID-19 Pandemic on Pharmacist Interventions: A Retrospective Study with Inpatients in a University Hospital.

Despite growing interest in understanding the challenges faced by multidisciplinary health teams during the COVID-19 pandemic, there is a lack of studies specifically focusing on changes in pharmacist interventions and drug-related problems. To analyze and compare the interventions performed by pharmacists during comprehensive medication management in the adult intensive care unit and general internal medicine ward of the University Hospital of the University of São Paulo, Brazil, for defined periods before the onset of the COVID-19 pandemic and during the pandemic itself. All pharmacist interventions performed in relation to inpatient prescriptions from March to December 2019 (before the pandemic) and from March to December 2021 (during the pandemic) were collected and tabulated. These interventions were then classified according to the Pharmaceutical Care Network Europe (PCNE) system, version 9.1, and categorized based on first-level codes of the Anatomical Therapeutic Chemical classification system. The analysis revealed substantial changes in the patterns of pharmacist interventions and the therapeutic classes of drugs for COVID-19-positive and COVID-19-negative patients during the pandemic relative to patients in the pre-pandemic period. Among COVID-19-positive patients, interventions were predominantly related to enhancing patient safety (PCNE code P2), drug selection (C1), dose selection (C3), prescribing and dispensing processes (C5), the drug-use process (C6), and patient transfers between different levels of care (C8). The drug-related problems addressed by pharmacist interventions primarily involved COVID-19-positive patients in the pandemic period and were related to systemic hormonal preparations (excluding sex hormones and insulins), anti-infective agents for systemic use, nervous system and drugs for the blood and blood-forming organs. The results of this study highlight the adaptability and competence of pharmacists in responding to critical scenarios such as the COVID-19 pandemic. These scenarios are characterized by new work dynamics, the hiring of additional professionals, an increase in the number of beds, the rapid evolution of evidence-based information, and drug shortages that necessitate the use of alternative medications. Pharmacists play a crucial role in ensuring patient safety during these difficult times.

Impact of a codesigned and coproduced patient-centred discharge form on communication and understanding.

Adverse clinical outcomes and patient dissatisfaction with care often have elements of poor communication. Factors such as illness and pharmacotherapy can affect cognition, and overestimation of patients' health literacy may contribute to suboptimal communication with patients regarding their hospitalisation and post-discharge instructions. Improved patient understanding and recall of their diagnoses and treatment is critical for adherence to treatment, follow-up and optimal clinical outcomes. The aim of the study was to assess whether a coproduced and codesigned patient-centred discharge form (PCDF) improves patients' understanding of their discharge diagnosis, in-hospital treatment and post-discharge plan. A sample of 111 patients was enrolled through simple randomisation by admission to one of two identically operating general medicine wards. Over a 3-month period, 59 patients received the coproduced and codesigned form and 52 patients were controls. Assessment of patients' understanding of diagnosis, in-hospital management, post-discharge instructions and overall experience of care was undertaken by a blinded phone survey conducted approximately 6 days after discharge. Patients who received PCDF were significantly more likely to report adequate understanding of their hospital management (P < 0.001) and the post-discharge plan (P < 0.001). There was no statistically significant difference between the intervention and control groups in terms of understanding of diagnosis. Patients who received PCDF reported better understanding of care and recall of admission. The use of PCDF is associated with improved patient understanding with respect to their hospital management and post-discharge instructions. It is also associated with high levels of satisfaction as assessed by measures of patient experience.

Assessment of Health-Related Quality of Life of Epileptic Patients within the Indian Population at a Tertiary Care Teaching Hospital

Background: Epilepsy is one of the most limiting chronic disorders. There is a notable social stigma attached to epilepsy and is often associated with a decline in the overall quality of life of affected patients. It is crucial to identify and manage factors that affect the health-related quality of life of an epileptic patient and plan therapy to improve the same. Aim: The study aimed to evaluate the health-related quality of life in individuals with epilepsy and examine the various factors influencing the same. Materials and Methods: A prospective cross-sectional study was conducted in the general medicine wards of a tertiary care teaching hospital for six months. A total of 111 epileptic inpatients of both genders, above 18 years of age were included in the study. SF-36 questionnaire was used to assess the quality of life of the patients. Results: The study found that multiple detrimental factors affect the quality of life of epileptic patients such as age, gender, marital and employment status, presence of comorbidities, seizure frequency, alcohol intake and duration of alcohol intake. Conclusion: Management of epilepsy concerning these key factors is just as essential as lowering the stigma surrounding the disease in India.

Analysis of factors affecting in-hospital emergency response capability based on objective assessment

To analyze the factors affecting the quality of cardiopulmonary resuscitation (CPR) performed by medical staff in hospital and to explore the training methods to enhance their in-hospital emergency response capabilities. A cross-sectional study was conducted, involving medical staff of intensive care unit (ICU) and general internal medicine wards in China-Japan Friendship Hospital in December 2021. The American Heart Association (AHA) resuscitation quality improvement (RQI) model was used to evaluate the skills of the subjects in performing external chest compressions and bag-mask ventilation on adult and infant simulators. While ICU subjects were undergoing RQI model objective assessment, two instructors also provided subjective scoring for their operations. The study compared the differences in RQI model objective assessment scores between ICU and general internal medicine ward subjects, between doctors and nurses, in the RQI model objective scoring for adult and infant resuscitation, in the scoring differences of different positions for chest compressions, and the differences between traditional subjective scoring and RQI objective scoring when ICU subjects were assessed for compression and ventilation. A total of 75 medical staffs were enrolled, consisting of 50 from the ICU (including 24 doctors and 26 nurses) and 25 from the general internal medicine wards (including 10 doctors and 15 nurses). The ICU medical staff's scores for adult resuscitation skills were significantly higher than those of the general internal medicine ward medical staff [adult compression score: 82.5 (66.0, 96.5) vs. 65.0 (52.5, 74.5), adult ventilation score: 82.0 (68.8, 98.0) vs. 61.0 (48.0, 82.0), both P < 0.01]. The nursing group's compression scores for both adult and infant were significantly higher than those of the doctor group [adult compression score: 77.0 (68.5, 89.5) vs. 63.0 (40.8, 90.3), infant compression score: 54.4±25.1 vs. 41.5±18.5, both P < 0.05]. The compression and ventilation scores for the infant were significantly lower than those for adult resuscitation [compression score: 48 (29, 65) vs. 76 (58, 90), ventilation score: 56 (42, 75) vs. 76 (60, 96), both P < 0.01]. When the rescuer was positioned on the right side of the model, the compression score for the adult significantly increased [79.0 (65.0, 92.0) vs. 65.0 (51.3, 77.0), P < 0.05]. The ICU medical staff's traditional subjective scores of compression and ventilation assessments for adult were significantly higher than the RQI model objective scores [adult compression score: 88.8 (79.4, 92.5) vs. 82.5 (66.0, 95.5), adult ventilation score: 95.0 (80.0, 98.1) vs. 82.0 (68.8, 98.0), both P < 0.01]. Rich experience in emergency rescue is related to the improvement of CPR skills, and performing chest compressions from the right side of the adult model is more effective. Objective scoring of resuscitation skills based on the RQI model may more accurately reflect the performance of the trainees.

Do you really drink a single glass of wine a day? A cross-sectional study on self-reported and next-of-kin observed alcohol consumption

ABSTRACT Objective To evaluate the difference between self-reported and patients’ relative’s appreciation of alcohol consumption for patients with risky alcohol use. Methods Patients with risky alcohol use, admitted to general internal medicine wards, completed a questionnaire on drinking habits at hospital admission and 3 days later. The questionnaire contained the preceding week’s number of standard units (SU) alcohol consumption and the AUDIT C screening tool. A close relative completed a similar questionnaire about the patient’s drinking habits. The difference between self-report and proxy observed consumption was tested through Wilcoxon signed-rank test; differences in AUDIT C score were tested through paired t-test. Results Between March 2017 and May 2019, 46 patients were included. There was a significant difference between median self-reported (23.9 SU/week; IQR: 13.0–39.0) and relative’s (46.3 SU/week; IQR: 25.3–70.0) estimations of consumption (median difference of 12.4 SU/week; IQR 0–33.4, p < .001), and mean self-reported (6. 9; 95% CI:6.0–7.8) and relative’s (8.9, 95% CI: 8.0–9.7) estimations of the AUDIT-C Score (mean difference of 2.0; 95% CI: 1.1–2.8, p < .001). Conclusions Relative’s reported alcohol consumption is around two-fold higher than self-reported. Taking a history from a close relative could strengthen the confidence in the actual drinking habits of a patient.

Understanding Bardet-Biedl Syndrome: Unveiling the Complexities of this Rare Genetic Disorder and its Systematic Review to Identify its Various Variants with Genetic Analysis.

Background: There are a variety of clinical features associated with Bardet-Biedl Syndrome (BBS), a rare genetic disorder affecting several organ systems. First identified in the early 20th century, BBS has since been the subject of extensive research to understand its underlying genetics, clinical presentation, and management. This article provides a comprehensive background on BBS, highlighting its clinical manifestations, genetic basis, and current research efforts. Introduction: BBS is a multisystem, genetic, autosomal recessive heterogeneous cilia structural and functional disorder (occurs when one gene influences two or more seemingly unrelated phenotypic traits) characterized by structural and functional abnormalities of organ and tissues with diverse embryonic derivation. It was first described by Laurence and Moon in 1866. It is caused by loss of proteins coding by the BBS gene. It is characterized by retinal degeneration, post-axial polydactyly, obesity, cognitive deficit, hypogonadism, and cognitive dysfunction. Associated features are diabetes mellitus, hypertension, congenital heart disease, speech defects, dental anomalies, and hepatic fibrosis. In order to diagnose the BBS, molecular genetic tests, such as whole-exome sequencing or whole-genome sequencing is considered useful. Case: A 16 year old girl presented to us in the general medicine ward through the Emergency department with the complaints of dyspnea for six months, fever for three days, and dysuria for three days. Her fever was associated with rigors and chills. On further questioning, her urine was reported to have a bad smell. Past medical history was positive for otitis media and falls. She needed walking support as she was unable to see at night time. On physical examination a young lady was laying in the supine position. She was pale, obese and had high respiratory rate. There was no lymphadenopathy. Extra digits were noted in her upper and lower limbs. Rest of the physical examination was normal. The patient was started on 2 liters of oxygen and blood samples were taken for laboratory investigations. Conclusion: As this was diagnosed on time, so it helped both the family and physcians to check on her weight, respiratory functions, skeletal abnormalities, sexual development, visual acquity, cardiac functioning, hepatic functioning and hematologic stability such as hemoglobin. Being a very rare disease a therefore this disease awareness is necessary among physicians to diagnose the disease early and treat the complications of the disease so that the complications do not progress to the stage where it is irreversible. Early detection of renal problem, visual problems, obesity, and learning disabilities is necessary to be treated on time by involving multidisciplinary approaches.

Clinical audit on management of suspected meningoencephalitis patients at lady reading Hospital, Peshawar

Objective: The purpose of this study was to observe management and empiric treatment of meningitis/encephalitis without doing initial investigation CSF-RE or delaying it, at Department of Emergency Medicine, General Medicine and Neurology wards. Method: It is an observational retrospective study this study was carried out at the General medicine, Neurology and Emergency units from July 2023 to Dec 2023.Total of 54 patients were included. Before conduction of study Ethical Review Committee permission was sought to access patient Data. We studied their hospital stored data on HMIS such as admission Date, start of empiric antibiotics, CT Scans, Blood Culture and CSF-REs. Results: 98% of patients were started on empiric Antibiotics without doing CSF-RE/LP on initial presentation at the hospital. In 64% patients CSF-RE was delayed and subsequently performed. In 34% CSF-RE was never carried out. Conclusion: We did presentations, Information campaigns, to follow standard Guidelines for Suspected meningitis /encephalitis to limit potential side effects, Development of Resistance to Antibiotics and to limit treatment costs.

Effect of a person-centred goals-of-care form and clinical communication training on shared decision-making and outcomes in an acute hospital: a prospective longitudinal interventional study.

Patients with a life-limiting illness (LLI) requiring hospitalisation have a high likelihood of deterioration and 12-month mortality. To avoid non-aligned care, we need to understand our patients' goals and values. To describe the association between the implementation of a shared decision-making (SDM) programme and documentation of goals of care (GoC) for hospitalised patients with LLI. A prospective longitudinal interventional study of patients admitted to acute general medicine wards in an Australian tertiary hospital over 5 years was conducted. A SDM programme with a new GoC form, communication training and clinical support was implemented. The primary outcome was the proportion of patients with a documented person-centred GoC discussion (PCD). Clinical outcomes included hospital utilisation and 90-day mortality. 1343 patients were included. The proportion of patients with PCDs increased from 0% to 35.4% (adjusted odds ratio (aOR), 2.38; 95% confidence interval (CI), 2.01-2.82; P < 0.001). During this time, median hospital length of stay decreased from 8 days (interquartile range (IQR), 4-14) to 6 days (IQR, 3-11) (adjusted estimate effect, -0.38; 95% CI, -0.64 to -0.11; P = 0.005) and rapid response team activation from 28% to 13% (aOR, 0.87; 95% CI, 0.78-0.97; P value = 0.01). Documented treatment preference of high-dependency unit care decreased from 39.7% to 24.4% (aOR, 0.81; 95% CI, 0.73-0.89; P value < 0.001), and ward-based care increased from 31.9% to 55.1% (aOR, 1.24; 95% CI, 1.14-1.36; P value < 0.001). The implementation of a SDM programme was associated with increased documentation of person-centred GoC, changed patient treatment preference to lower intensity care and reduced hospital utilisation.

Impact of a general medicine consultant-led ward round in the emergency department.

Patients requiring admission to the general medicine wards in a public hospital are usually assessed by a medical registrar. This study is based at a metropolitan public hospital in Melbourne where the majority of general medicine patients in the emergency department (ED) are not seen by a consultant physician until they are transferred to the ward. To assess the impact of general medicine consultant-led ward rounds (CWRs) in the ED on patient length of stay (LOS). One-month audit was conducted of all patients admitted to general medicine and awaiting transfer to ward from ED at a metropolitan public hospital in Melbourne. A general medicine CWR was then implemented in the ED, followed by another 1-month audit, with the primary outcome being LOS and the secondary outcome being 30-day readmission rate. Additionally, admitting medical registrars were invited to complete a survey before and after the implementation of CWRs to assess satisfaction rate. Data from electronic medical records were analysed for 162 patients (90 preimplementation group and 72 postimplementation group). The median LOS was 6 days in the preimplementation group and 4 days in the postimplementation group (P = 0.014). There was no significant difference in 30-day readmission rates. Surveys showed admitting medical registrars reported a reduced level of stress and fewer barriers to seeking consultant input following implementation. A CWR in the ED has led to decreased LOS for general medicine patients and improved satisfaction among junior medical staff.

Hygienic aspects of general medicine ward operation: problems and solutions

The existing problems in the field of healthcare and prevention create new challenges and difficulties in various parts of the national public health system. Today, there is an effective set of new sanitary rules and regulations important for competent organization and stable functioning of general medicine wards. In 2023, this set is SanPiN 2.1.3678-20, developed to ensure safe and effective work in medical facilities. There are special bodies tasked with controlling compliance with the standards, including Rospotrebnadzor. The COVID-19 pandemic revealed a number of problems in the organization of work of inpatient departments, which required revision of the ways of rendering medical assistance. This article considers current sanitary and hygienic aspects of organization of operations at a general medicine ward, as well as the approaches to infection prevention in the context of medical care.

Molecular Analysis of Carbapenem and Aminoglycoside Resistance Genes in Carbapenem-Resistant Pseudomonas aeruginosa Clinical Strains: A Challenge for Tertiary Care Hospitals.

Carbapenem-resistant Pseudomonas aeruginosa (P. aeruginosa) strains have become a global threat due to their remarkable capability to survive and disseminate successfully by the acquisition of resistance genes. As a result, the treatment strategies have been severely compromised. Due to the insufficient available data regarding P. aeruginosa resistance from Pakistan, we aimed to investigate the resistance mechanisms of 249 P. aeruginosa strains by antimicrobial susceptibility testing, polymerase chain reaction for the detection of carbapenemases, aminoglycoside resistance genes, extended-spectrum beta-lactamases (ESBLs), sequence typing and plasmid typing. Furthermore, we tested silver nanoparticles (AgNPs) to evaluate their in vitro sensitivity against antimicrobial-resistant P. aeruginosa strains. We observed higher resistance against antimicrobials in the general surgery ward, general medicine ward and wound samples. Phenotypic carbapenemase-producer strains comprised 80.7% (201/249) with 89.0% (179/201) demonstrating genes encoding carbapenemases: blaNDM-1 (32.96%), blaOXA48 (37.43%), blaIMP (7.26%), blaVIM (5.03%), blaKPC-2 (1.12%), blaNDM-1/blaOXA48 (13.97%), blaOXA-48/blaVIM (1.68%) and blaVIM/blaIMP (0.56%). Aminoglycoside-modifying enzyme genes and 16S rRNA methylase variants were detected in 43.8% (109/249) strains: aac(6')-lb (12.8%), aac(3)-lla (12.0%), rmtB (21.1%), rmtC (11.0%), armA (12.8%), rmtD (4.6%), rmtF (6.4%), rmtB/aac(3)-lla (8.2%), rmtB/aac(6')-lla (7.3%) and rmtB/armA (3.6%). In total, 43.0% (77/179) of the strains coharbored carbapenemases and aminoglycoside resistance genes with 83.1% resistant to at least 1 agent in 3 or more classes and 16.9% resistant to every class of antimicrobials tested. Thirteen sequence types (STs) were identified: ST235, ST277, ST234, ST170, ST381, ST175, ST1455, ST1963, ST313, ST207, ST664, ST357 and ST348. Plasmid replicon types IncFI, IncFII, IncA/C, IncL/M, IncN, IncX, IncR and IncFIIK and MOB types F11, F12, H121, P131 and P3 were detected. Meropenem/AgNPs and Amikacin/AgNPs showed enhanced antibacterial activity. We reported the coexistence of carbapenemases and aminoglycoside resistance genes among carbapenem-resistant P. aeruginosa with diverse clonal lineages from Pakistan. Furthermore, we highlighted AgNP's potential role in handling future antimicrobial resistance concerns.

1808 QIP to improve the board round process on a general geriatric medicine ward

Abstract Introduction Effective board rounds improve the patient’s experience and reduce the risks associated with a prolonged hospital stay. Ward C54 at Queen’s Medical Centre is a 30-bedded ward dedicated to the provision of care for older, frail (CFS ≥ 6) patients. Board round on C54 was unstructured and could take over an hour. The project team set out to reduce the duration of board round, improve the quality of information handed over and improve staff satisfaction with board round. Method Pre- and post-intervention data on the daily duration of board round were collected by the junior doctors on the ward. PDSA methodology was then used to test the following interventions: 1. Nerve centre updated daily by the junior doctor responsible for that bay 2. Junior doctors to present information using 4Q approach 3. Staff nurse in each bay highlighting any issues for that bay. Pre- and post-intervention surveys were also distributed to staff working on C54. Results The duration of board round was reduced from an average of 52 minutes to an average of 38 minutes post-intervention. Over 90% of survey respondents believed the board round to be more efficient and over 80% were either satisfied or very satisfied with board round duration. Conclusions The findings have shown it is possible to improve the duration of and staff satisfaction with board round by giving MDT members a framework to help structure handover of written and verbal information. Future considerations include providing teaching sessions to staff on the board round process.

ASSESSMENT OF ANTIBIOTICS PRESCRIPTION PATTERN BY USING WHO PRESCRIBING INDICATORS IN GENERAL MEDICINE WARD OF A TERTIARY CARE HOSPITAL

Objective: Antibiotics encompass a great extent of the important cornerstone in clinical medicine. Antibiotics are being used more often for treatment, prophylaxis, and diagnosis as the diversity of infectious illnesses grows. Irrational prescribing of antibiotics leads to antibiotic resistance, ineffective treatment, polypharmacy, and an increase in treatment cost. This study is to assess prescribing pattern of antibiotics in the general medicine ward of a tertiary care hospital, Chitradurga.&#x0D; Methods: A prospective observational study was carried out for a period of six months. A self-designed data collection form was used to collect the data from the prescriptions. The collected data was entered and analysed using Microsoft Excel.&#x0D; Results: In 300 prescriptions, a total of 2,468 drugs were prescribed, with an average of 8.2 drugs per prescription. A total of 719 antibiotics were prescribed, with an average of 2.3 per prescription. Percentage of antibiotics prescribed by generic name was 6% and prescribed according to EDL was 74%. About 96% of prescriptions containing antibiotics are in injection form. Ceftriaxone (30.32%) was the most frequently prescribed antibiotic. Cephalosporins (44.51%) were the most frequently prescribed class of antibiotics.&#x0D; Conclusion: This study indicate that prescription pattern was not optimal compared to the recommended values of the WHO core prescribing indicators. The prescribing practices were not appropriate as they consisted of polypharmacy, lesser prescription by generic name, and parenteral route of administration more than the oral route. Hence, there is a need to implement the standards of antibiotic guidelines prescribed rational therapy.

Evaluation of Articular Manifestations in Hepatitis C Virus Infected Patients and its Association with Liver Fibrosis: A Cross-sectional Study from Rural Indian State of Manipur

Introduction: Hepatitis C Virus (HCV) is the main culprit for liver diseases worldwide. In Manipur its incidence is increasing, mainly due to blood borne transmission through intravenous drugs users. Among the extrahepatic manifestations of HCV infection-arthropathy (joint pain, swelling and stiffness) is most common. Exact mechanism of arthropathy are not well elucidated but are probably connected with the participation of the immune system and due to the replicating virus in the affected tissues, organ systems. Aim: To determine the articular manifestations in HCV infected patients and to study the association between articular manifestations and liver fibrosis. Materials and Methods: This cross-sectional study enrolled 100 hepatitis C infected patients above 18 years of age who attended Medicine OPD, gastroenterology and liver clinic or admitted in the General Medicine wards, Regional institute of Medical Sciences (RIMS), Imphal, Manipur, India. Blood samples were collected for Complete Blood Count, Erythrocyte Sedimentation Rate, C Reactive Protein, Liver function test, Renal function test, HCV, Rheumatoid Factor (RF), Antinuclear Antibody (ANA), anti-ds DNA. Ultrasound (USG) whole abdomen and X-rays of involved joints were done when indicated. Markers for liver stiffness/fibrosis, {Aspartate Aminotransferases (AST) to Platelet Ratio Index (APRI)} score, The fibrosis-4 (FIB-4) score and AST/Alanine Transaminase (ALT) ratio were calculated and compared. The Statistical Package for Social Sciences(SPSS) (IBM) version 21.0 was used for statistical analysis. Chi-square and Fischer’s-exact test were used. Results: A total of 100 hepatitis C infected patients were enrolled in the present study. Majority of the study subjects were males (63%) under 40 years of age (69%). Eighty-four (84%) patients were intravenous drug users. Joint pain, swelling and stiffness was present in 37 (37%), 31 (31%) and 24 (24%), respectively. Around 36 (36%), 45 (45%) and 29 (29%) of the participants had significant fibrosis with respect to FIB 4 score, APRI and USG finding, respectively. Conclusion: The prevalence of joint pain was 37% in this study. Females and younger age group were more associated with articular manifestation. The present study concluded that patient with articular manifestation were seen to have significant fibrosis with respect to FIB 4 score, APRI and USG finding, AST/ALT.