General Patients Research Articles

Clinical Characteristics Associated With Secondary Generalization in Patients With Ocular Myasthenia Gravis: A Systematic Review and Meta-analysis.

Ocular myasthenia gravis (OMG) is an autoimmune disorder resulting in ocular symptoms such as diplopia and ptosis. The proportion of patients who convert to secondary generalized myasthenia gravis (SGMG) reported in the literature has been varied. The aim of this systematic review was to determine the clinical characteristics of patients with OMG and the proportion of SGMG conversion. We conducted an electronic database search for randomized controlled trials, prospective nonrandomized studies, observational studies, and retrospective studies in EMBASE, CENTRAL, MEDLINE, and Web of Science. We included studies with patients with OMG who initially presented with ocular symptoms and signs only and were seen in clinical practice, reporting on the characteristics and outcomes of SGMG. We excluded studies with pediatric and congenital myasthenia gravis populations. Eligible studies included articles written in any language and containing data on patients with OMG. The main outcome measured was the proportion of patients with OMG who converted to SGMG and risk factors associated with secondary generalization of OMG. Two independent reviewers screened titles and abstracts and extracted data from full texts, reporting findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The methodology was evaluated using the Joanna Briggs Institute critical appraisal forms. PROSPERO registration number: CRD2021285257. Thirty-one studies were included in the quantitative and qualitative analysis. The proportion of generalization ranged from 11% to 84%. The pooled proportion was 39% (95% CI 32%-47%, I 2 = 95.86%, p < 0.001 unweighted, low certainty). The pooled risk ratio of female sex for conversion to SGMG was 1.06 (95% CI 0.96-1.17, I 2 = 0% p = 0.614, 21 studies included, very low certainty), and the pooled risk ratio of acetylcholine receptor (AChR) positivity was 1.30 (95% CI 1.05-1.56, I 2 = 0% p = 0.455, 16 studies included, very low certainty). Risk factors such as female sex and anti-AChR positivity have been identified to have possible associations with SGMG, but there are not enough quality observational studies. There is a need for a prospective global database of patients with OMG, including all countries with different populations.

Prediction of complications associated with general surgery using a Bayesian network

BackgroundNumerous attempts have been made to identify risk factors for surgery complications, but few studies have identified accurate methods of predicting complex outcomes involving multiple complications. MethodsWe performed a prospective cohort study of general surgical inpatients who attended 4 regionally representative hospitals in China from January to June 2015 and January to June 2016. The risk factors were identified using logistic regression. A Bayesian network model, consisting of directed arcs and nodes, was used to analyze the relationships between risk factors and complications. Probability ratios for complications for a given node state relative to the baseline probability were calculated to quantify the potential effects of risk factors on complications or of complications on other complications. ResultsWe recruited 19,223 participants and identified 21 nodes, representing 9 risk factors and 12 complications, and 55 direct relationships between these. Respiratory failure was at the center of the network, directly affected by 5 risk factors, and directly affected 7 complications. Cardiopulmonary resuscitation and sepsis or septic shock also directly affected death. The area under the receiver operating characteristic curve for the ability of the network to predict complications was >0.7. Notably, the probability of other severe complications or death significantly increased when a severe complication occurred. Most importantly, there was a 141-fold higher risk of death when cardiopulmonary resuscitation was required. ConclusionWe have created a Bayesian network that displays how risk factors affect complications and their interrelationships and permits the accurate prediction of complications and the creation of appropriate preventive guidelines.

FTP6.1 A little respect! A closed-loop audit increasing awareness of ReSPECT forms in a busy general surgical department

Abstract Aims ReSPECT forms have been introduced by Resuscitation Council UK to provide recommendations for patients’ emergency care. The primary aim of the audit was to assess the completion rate of ReSPECT forms on a busy surgical ward. Secondly, the audit aimed to both increase the awareness and the completion rate of ReSPECT forms. Methods Data was collected in the form of random spot-checks of completed ReSPECT forms for all general surgical inpatients at our general hospital. The first intervention involved the addition of a column to the surgical ‘take’ list to highlight the presence or absence of ReSPECT forms. Team education using a novel poster, prioritising the urgency of completion of ReSPECT forms dependent on patient’s co-morbidities, and a teaching session was the intervention for the second cycle. Results The initial completion rate of accurate ReSPECT forms was 31%. Following the first intervention the ‘ReSPECT column’ on the list had been completed for 15% of inpatients and the overall completion rate of ReSPECT forms was 35%. After the ReSPECT poster and teaching the usage of the ‘ReSPECT column’ increased to 39% and overall completion rate was 33%. Conclusions The addition of a column to the acute, surgical list was a simple and effective way of increasing awareness of completed ReSPECT forms. Increased compliance may be achieved by finding more efficient methods of monitoring completion. Overall completion of ReSPECT forms had improved with the interventions, however, due to the high turnover of surgical patients, there are still further improvements possible.

Emergency Department Use Across Income Groups Following an Increase in Cost-Sharing

To encourage the appropriate utilization of emergency care, cost-sharing for emergency care was increased from HK$100 (US $12.8) to HK$180 (US $23.1) per visit in June 2017 in all public hospitals in Hong Kong. However, there are concerns that this increase could deter appropriate emergency department (ED) visits and be associated with income-related disparities. To examine changes in ED visits after the fee increase. This retrospective cohort study used administrative data from June 2015 to May 2019 from all public hospitals in Hong Kong. Participants included all Hong Kong residents aged 64 years and younger, categorized into low-income, middle-income, and high-income groups according to the median household income in their district of residence. Data analysis was performed from May to June 2023. The primary outcome was the ED visit rate per 100 000 people per month, categorized into 3 severity levels (emergency, urgent, and nonurgent). Secondary outcomes include general outpatient (GOP) visit rate, emergency admission rate, and in-hospital mortality rate per month at public hospitals. Segmented regression analyses were used to estimate changes in the level and slope of outcome variables before and after the fee increase. This study included a total of 5 441 679 ED patients (2 606 332 male patients [47.9%]; 2 108 933 patients [38.5%] aged 45-64 years), with 2 930 662 patients (1 407 885 male patients [48.0%]; 1 111 804 patients [37.9%] aged 45-64 years) from the period before the fee increase. The fee increase was associated with an 8.0% (95% CI, 7.1%-9.0%) immediate reduction in ED visits after June 2017, including a 5.9% (95% CI, 3.3%-8.5%) reduction in urgent visits and an 8.9% (95% CI, 8.0%-9.8%) reduction in nonurgent visits. In addition, a 5.7% (95% CI, 4.7%-6.8%) reduction of emergency admissions was found, whereas no significant changes were observed in in-hospital mortality. Specifically, a statistically significant increase in GOP visits (4.1%; 95% CI, 0.9%-7.2%) was found within the low-income group, but this association became insignificant after controlling for the social security group, who were exempted from payment, as a control. In this cohort study, the fee increase was not associated with changes in ED visits for emergency conditions, but there was a negative and significant association with both urgent and nonurgent conditions across all income groups. Considering the marginal increase in public GOP services, further study is warranted to examine strategies to protect low-income people from avoiding necessary care.

Vital signs and medical emergency response (MER) activation predict in-hospital mortality in general surgery patients: a study of 15 969 admissions.

The applicability of the vital signs prompting medical emergency response (MER) activation has not previously been examined specifically in a large general surgical cohort. This study aimed to characterize the distribution, and predictive performance, of four vital signs selected based on Australian guidelines (oxygen saturation, respiratory rate, systolic blood pressure and heart rate); with those of the MER activation criteria. A retrospective cohort study was conducted including patients admitted under general surgical services of two hospitals in South Australia over 2 years. Likelihood ratios for patients meeting MER activation criteria, or a vital sign in the most extreme 1% for general surgery inpatients (<0.5th percentile or > 99.5th percentile), were calculated to predict in-hospital mortality. 15 969 inpatient admissions were included comprising 2 254 617 total vital sign observations. The 0.5th and 99.5th centile for heart rate was 48 and 133, systolic blood pressure 85 and 184, respiratory rate 10 and 31, and oxygen saturations 89% and 100%, respectively. MER activation criteria with the highest positive likelihood ratio for in-hospital mortality were heart rate ≤ 39 (37.65, 95% CI 27.71-49.51), respiratory rate ≥ 31 (15.79, 95% CI 12.82-19.07), and respiratory rate ≤ 7 (10.53, 95% CI 6.79-14.84). These MER activation criteria likelihood ratios were similar to those derived when applying a threshold of the most extreme 1% of vital signs. This study demonstrated that vital signs within Australian guidelines, and escalation to MER activation, appropriately predict in-hospital mortality in a large cohort of patients admitted to general surgical services in South Australia.

Risk factors for device-related pressure injuries in general ward inpatients of a tertiary general hospital: A case-control study

AimsTo identify the characteristics of device-related pressure injuries (DRPI) in general ward inpatients, and to confirm the DRPI risk factors by examining differences between a DRPI and non-DRPI group. MethodsThis study is a retrospective case–control study. High-risk adult patients for pressure injuries (rated at 16 points or less on the Braden scale) who were admitted to a general ward of a tertiary general hospital in South Korea from January 1 to September 30, 2021 were enrolled in this study. Among them, participants were selected by matching the patients with DRPI (n = 50) to the non-DRPI patient group (n = 100) in a ratio of 1:2. ResultsAs for risk factors, longer hospitalization periods and the presence of oedema increased DRPI risk. In blood tests, higher glucose levels increased the risk by 1.03 times, and lower albumin levels increased the risk by 0.08 times. Furthermore, the risk of developing DRPI was 7.89 times higher when sedatives were administered. ConclusionsBased on the DRPI risk factors identified in this study, patients who have oedema, who have long hospital stays, use sedatives and devices, have a low albumin level, and whose blood glucose is not well controlled should be recognized as having a high risk of developing DRPI. In order to prevent the development of DRPI, it is necessary to recognize risk factors at an early stage, increase actively preventive interventions. The results of this study contribute to recognizing the risk of DRPI in patients and evaluating risk factors for DRPI prevention.

Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients

ObjectiveTo characterise the extent of unnecessary care in general surgery inpatients using a triple bottom line approach.DesignPatients with uncomplicated acute surgical conditions were retrospectively evaluated for unnecessary bloodwork according to...

Structure and replicability of oral health-related quality of life networks across patients with schizophrenia and the general community.

Schizophrenia is a disabling mental disorder associated with severe social dysfunction. Individuals with long-term mental conditions have poorer Oral Health-Related Quality of Life (OHRQoL) compared to the general population, but little is known about the measurement properties of OHRQoL instruments in this group of patients. This study aimed to examine the replicability of OHRQoL networks across samples of the general community (GC) and patients with schizophrenia (PWS). Data were obtained from 603 community-dwelling participants and 627 patients with schizophrenia. OHRQoL was measured using the short form of the Oral Health Impact Profile (OHIP-14) questionnaire. A regularized partial correlation network was estimated for each sample. The number of dimensions and structural stability were assessed using Exploratory Graph Analysis. Global strength, edge weights and centrality estimates were compared. Network replicability was examined fitting the PWS data to the GC network structure. A single OHIP-14 dimension was identified in the GC sample, whereas three dimensions were detected in the PWS sample. Structural consistency was perfect in the network of GC participants (1), and considerably low in at least two dimensions of the PWS network (0.28; 0.65; 0.16). A moderate correlation for node strength estimates was observed (τ: 0.43; 95% CI: 0.13, 0.72), although edge weights were not correlated (τ: 0.025; 95% CI: -0.11, 0.16). The fit of the PWS data to the GC network structure was deemed unacceptable. Network models of OHRQoL did not replicate across samples of the general community and outpatients with schizophrenia. Prudent use of OHIP-14 to compare measures of OHRQoL between groups with significant cognitive impartment and the general population is recommended.

Hospice Capacity to Provide General Inpatient Care: Emergency Department Utilization and Live Discharge Among Cancer Patients

General inpatient (GIP) hospice care is used only minimally for hospice patients, and more than a quarter of Medicare hospice facilities do not provide GIP care. To determine the impact of hospices' capacity to provide on emergency department use during hospice enrollment and live discharge from hospice, we used Surveillance, Epidemiology, and End Results-Medicare linked data and CMS Provider of Services data from 2007 to 2013 from ten states and two metropolitan regions. Grouping hospices into three GIP care provision categories: 1) no-GIP; 2) GIP-contract; and 3) GIP-IHF where hospices directly provide GIP care in their own inpatient hospice facility (IHF), we built a multilevel logistic model that accounted for unobserved hospice characteristics. Nearly 9% of the study sample received GIP care, of which 82% received such care in the last week of discharge. GIP-IHF hospices had lower live discharge rates than no-GIP hospices (AOR: .61; 95% CI: .47-.79; P < .001) and GIP-contract hospices (AOR: .84; 95% CI: .70-1.00; P < .05). Similarly, GIP-contract hospices were also associated with a decreased risk of live discharge, compared to no-GIP hospices (AOR: .76; CI: .62-.92; P < .05). There was no difference in emergency department use between no-GIP hospices and hospices with such capacity. Our results suggest that hospices capable of providing GIP care have lower live discharge rates than their counterparts. However, the fact that GIP care tends to be provided too close to death limits its effectiveness in preventing avoidable emergency department use.

Core Roles and Responsibilities of Physicians in Hospice Care: A Statement by and for U.S. Hospice and Palliative Care Physicians.

Physicians are integral members of hospice interdisciplinary teams (IDTs). This statement delineates the core roles and responsibilities of hospice medical directors (HMDs) and hospice physicians who are designated by the hospice program to fulfill core HMD responsibilities. In addition, we describe the basic elements of hospice programs' structure and function required for hospice physicians to fulfill their roles and responsibilities. Finally, we call attention to hospice program characteristics and circumstances of the work environment that should raise a hospice physician's concerns that hospice patients and families are at risk of receiving low-quality care. Such factors include lack of a functioning IDT, minimal physician involvement in direct patient care and clinical IDT meetings, inadequate responses to symptom emergencies in patients' homes, and no or limited access to general inpatient and continuous home hospice care. We write as individual physicians who are concerned about troubling variability in access to and quality of U.S. hospice care. This statement arises from the need to protect the safety and well-being of vulnerable seriously ill people with their families from low-quality hospice care. This statement is primarily intended to be a resource to hospice physicians in negotiating employment agreements and justifying staffing and programmatic resources necessary to perform their jobs well. This statement may also serve as a resource and reference for patient advocacy groups, hospice industry leaders, health services oversight organizations, accountability agencies, and legislatures in efforts to ensure the safety, quality, and reliability of hospice care in the United States.

Delirium Mediates Incidence of Hospital-Associated Disability Among Older Adults.

To examine whether delirium predicts occurrence of hospital-associated disability (HAD), or functional decline after admission, among hospitalized older adults. Retrospective cross-sectional study. General inpatient (non-ICU) units of a large regional Southeastern US academic medical center, involving 33,111 older adults ≥65years of age admitted from January 1, 2015, to December 31,2019. Delirium was defined as a score ≥2 on the Nursing Delirium Screening Scale (NuDESC) during hospital admission. HAD was defined as a decline on the Katz Activities of Daily Living (ADL) scale from hospital admission to discharge. Generalized linear mixed models were used to examine the association between delirium and HAD, adjusting for covariates and repeated observations with multiple admissions. We performed multivariate and mediation analyses to examine strength and direction of association between delirium and HAD. One-fifth (21.6%) of older adults developed HAD during hospitalization and experienced higher delirium rates compared to those not developing HAD (24.3% vs 14.3%, P < .001). Age, presence of delirium, Elixhauser Comorbidity Score, admission cognitive status, admission ADL function, and length of stay were associated (all P < .001) with incident HAD. Mediational analyses found 46.7% of the effect of dementia and 16.7% of the effect of comorbidity was due to delirium (P < .001). Delirium significantly increased the likelihood of HAD within a multivariate predictor model that included comorbidity, demographics, and length of stay. For dementia and comorbidity, mediation analysis showed a significant portion of their effect attributable to delirium. Overall, these findings suggest that reducing delirium rates may diminish HAD rates.

Taiwan National Health Insurance and Proportional Physician Fee of Psychiatrist in General Hospital during the COVID-19 pandemic : Case Report

IntroductionIn Taiwan, National Health Insurance has been implemented for 27 years and continues to receive international recognition. People pay part of the quota at the time of medical treatment, and the rest of the medical expenses will be paid by the national health insurance. In this study, the researcher, a psychiatrist in the general hospital, investigated the correlation between service and revenue. He has started to work in this hospital since November 1st, 2021, without any other psychiatrist peers.ObjectivesThis study used proportion of PPF as performance indicator and aimed to observe the changes of PPF unit from November 1st, 2021, to January 31st, 2022, examining the trend of PPF growth. The purpose is to figure out an appropriate model to optimize medical services and performance outcomes.MethodsDemographic data were collected through PPF projects, consisting of 17 inpatient ward items and 14 outpatient items from November 1st, 2021, to January 31st, 2022, and items with no performance or related to physiological examination has been excluded. In addition, items with a ratio of greater than 1.5% are presented in the bar graphs, as shown in Figure 2 and 3. The performance proportion of inpatient ward and outpatient were calculated separately.Results Demographic data found PPF rises significantly over time (Figure 1). The 2nd month PPF unit (27.09%) was 2.5 times the 1st month PPF unit (10.70%), and the 3rd month PPF unit (62.21%) was 2.2 times the 2nd month PPF unit (27.085%). The highest proportion of PPF items were general hospital bed inpatient consultation fee for inpatient ward item (Figure 2) and psychiatric outpatient consultation fee for outpatient item (Figure 3). Furthermore, only the proportion of psychiatric outpatient consultation – more than two consecutive transfers increased continuously and the proportion of psychiatric outpatient consultation – adjusted by the hospital decreased, the other items has not changed significantly.Image:Image 2:Image 3:ConclusionsIn the first three months of the psychiatrist employment, the performance showed an increasing trend. These findings may suggest that the psychiatrist could be competent in a general hospital with patients’ confidence. In addition, under an optimal model of PPF and medical service, psychiatrists would more like to work in the general hospital, to serve acute psychiatric patients in need.Disclosure of InterestNone Declared

The Influence of Service Quality on Outpatient General Satisfaction at the Regional General Hospital (RGH) Dr. H. Andi Abdurrahman Noor Tanah Bumbu District, South Kalimantan Province

The research aims to examine the influence of service quality on outpatient general patient satisfaction at the Regional General Hospital (RGH) dr. H. Andi Abdurrahman Noor, Tanah Bumbu Regency. A correlational study with a quantitative approach was adopted to describe the influence of service quality on general outpatient patient satisfaction at RGH dr. H. Andi Abdurrahman Noor, Tanah Bumbu Regency. The research was conducted on 97 general outpatients and was carried out for a month. It is such a long sentence that is hard to understand. Try to simplify it. My suggestions: The study shows the following results: (1) service quality ( such as tangibles, reliability, responsiveness, assurance, and empathy) had a significant effect simultaneously on general outpatient patient satisfaction; (2) service quality ( such as tangibles, reliability, assurance) had a partially significant effect on general outpatient patient satisfaction; (3) quality services (covering responsiveness and empathy) do not have a partially significant effect on outpatient general patient satisfaction, and; (4) assurance has a dominant effect on outpatient general patient satisfaction.

Knowledge, Attitudes, and Practice to COVID 19 Infection Among Outpatients Attending a General Medicine Department

Background and Objectives: We aimed to assess the knowledge, attitudes, and practices regarding COVID-19 among general medicine outpatients. Materials and Methods: We recruited people attending a general medicine outpatient department of a tertiary hospital. We assessed knowledge, attitudes, and practices toward COVID-19 using a specially designed questionnaire. Results: Two hundred and sixty-eight participants were recruited. The study documented high knowledge, positive attitude, and good practice among patients and their relatives. Knowledge was significantly associated with higher education (odds ratio [OR] = 2.87; 95% confidence interval [CI] = 1.127.36; P = 0.029) and the use of the Internet as a source of information about COVID-19 (OR = 5.17; 95% CI = 2.2611.85; P = 0.000). However, Internet use (OR = 0.23; 95% CI = 0.100.54; P = 0.001) was associated with a more negative attitude. Good practice was associated with high levels of knowledge (OR = 2.20; 95% CI = 1.223.96; P = 0.009), a positive attitude (OR = 2.31; 95% CI = 1.134.71; P = 0.022), and a professional or semi-professional occupation (OR = 2.80; 95% CI = 1.077.32; P = 0.036). Residence outside of the district (OR = 2.79; 95% CI = 1.077.32; P = 0.036) was associated with better practice related to COVID-19 suggesting people who travel greater distances for health care may be more motivated at maintaining better practice. Conclusion: The study found that good practice in relation to COVID-19 was associated with higher levels of knowledge, a positive attitude, professional occupation, and distance traveled to reach hospital.

Determinants of atopic dermatitis among children in a general out-patient clinics of a tertiary hospital in North central, Nigeria.

Atopic dermatitis (AD) is a chronic, inflammatory, and itchy skin condition that develops in early childhood in the majority of cases. The objective of this study is to determine factors associated with atopic dermatitis among children aged 6 months to 14 years seen at the General Out-Patients Clinics of a tertiary hospital in north central Nigeria as well as predictors of having AD. This was a descriptive cross-sectional study of 490 eligible children recruited using the systematic random sampling technique. The data collected were analyzed using statistical package for social sciences, version 22. Descriptive and inferential statistics was performed to determine the relationship between independent variables and having AD. The factors significantly associated with AD from this study include: male sex (χ = 4.78, P = 0.029), Being in nursery school (χ = 77.60, P = 0.000), Nupe ethnicity (χ = 49.06, P = 0.000), mothers and fathers Educational level (χ = 27.80, P = 0.000), having personal or family history of atopy (χ = 31.30, P = 0.000). After all variables that are significant was adjusted; Nursery level of education (OR = 4.076, 95% CI = 1.679-9.891, P = 0.002), Mother's Level of education (OR = 0.664, 95% CI = 0.442-0.998, P = 0.049), and personal or family history of atopy (OR = 5.585-E12, 95% CI = 5.585-E12-5.585-E12, P = 0.000) were independent predictors of AD. Our data suggest that AD has a specific pattern of inheritance in children and this was predicted by: nursery level of education, mother's level of education, and family or personal history of atopy. Knowledge of this will provide a better caring strategy for predicting and preventing AD earlier in at risk children.

Correlation Between Patients with Wounds and Isolated Pseudomonas aeruginosa and Staphylococcus aureus at Barau Dikko Teaching Hospital, Kaduna, Nigeria

This study was carried out to determine the correlation between patients with wounds and isolated Pseudomonas aeruginosa and Staphylococcus aureus in clinics at Barau Dikko Teaching Hospital, Kaduna, Nigeria. The Socio-demographic, medical and drug histories and characteristics of the wounds from each consented patient were taken using a questionnaire along with sixty samples of the patient’s wound swab samples. Isolation of Pseudomonas aeruginosa and Staphylococcus aureus from the wound swab samples was carried out using standard phenotypic and genotypic procedures. Out of the 60 samples collected, 30 (50.0%) each were from general out-patient and inpatients. The higher percentage 12 (20.0%) and 39 (65.0%) were patients in the age group between 61 and above and male patients respectively. Regarding the patient’s occupations, the higher percentage 20 (33.3%) of the patients were businessmen and women. The patient’s wound location indicated that a higher percentage of 38 (63.3%) wounds were located on the leg. Also, only 13 (21.7%) patients had diabetes and 44 (73.3%) of the wound patients were receiving antimicrobials; the commonest being metronidazole 11 (18.33%), followed by mupirocin/Supirocin 9 (15.6%). A total of eleven isolates each of Pseudomonas aeruginosa and Staphylococcus aureus were isolated from the sixty wound swab samples of the in-and out-patients. Association between antimicrobial agents use and the organisms showed significant difference (P &lt; 0.05), while the association between sex, diabetes status, duration of the wound and the isolation of Pseudomonas aeruginosa and Staphylococcus aureus from the wound of patients showed no statistically significant difference (P &gt; 0.05).

Characteristics of Male Perpetrators of Intimate Partner Violence in South-South Nigeria

Aims: This study was done to identify personal characteristics of men that may be associated with partner abuse in order to provide a basis for offering counseling services, to prevent, as well as appropriately manage cases of existing abuse.&#x0D; Study Design: Cross sectional survey.&#x0D; Place and Duration of Study: The study was done at the General Outpatients Clinic of University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria; between August and November 2007.&#x0D; Methodology: The examiner administered pre-tested questionnaire on adult females attending the clinic within the duration of the study. Every second patient seen by the investigator on the waiting line of a regular medical consultation visit that consented to the study was recruited until the desired sample size was got. Socio-demographic as well as drug use information of adult subjects’ partners aged between 18 to 59 years was obtained.&#x0D; Results: Of the 384 females investigated, age 21 – 67 years with a mean age of 31.31±8.61 years: physical abuse 41.9%, verbal/emotional abuse 49.0%, and a combined (physical/verbal) abuse 29.9%. Partners’ education had statistically significant relationship with physical abuse, P=0.018; partners’ tobacco uses with verbal abuse (P=0.000), and between combined abuse and use of tobacco or cannabis, P=0.003 and 0.048 respectively.&#x0D; Linear multiple regression model of physical abuse parameters: throw something at, being pushed, slapped, kicked, hit at, beaten-up, threatened or weapon used, and forced sex; P-value was 0.000, with sum of squares 60.263 and degree of freedom 9. Whereas for verbal abuse: cajoled, derogatory statements made at, name calling, and shout at, as abuse parameters; P-value was 0.000, sum of squares 72.763 and degree of freedom, 4. Both of these were statistically significant.&#x0D; Conclusion: This study demonstrates a higher perpetration of verbal/emotional violence than that of physical violence (or both) by males on their partners with lack of formal education, with tobacco and/or cannabis use, as aggravating factors.

‘Put in a room and left’: a qualitative study exploring the lived experiences of COVID-19 isolation and quarantine among rehabilitation inpatients

Background The SARS-CoV-2 (COVID-19) pandemic has resulted in significant changes to health care delivery and the patient’s experience in hospital. Changes for those who contracted COVID-19 or were close contacts included isolation and quarantine, visitor restrictions and changes to usual models of care to reduce viral transmission. Traditional models of inpatient rehabilitation utilise communal spaces (e.g. shared gyms and dining rooms) and involve a multidisciplinary team interacting with the patient daily. Objectives To report the experience of COVID-19 related isolation and quarantine among rehabilitation inpatients and their family members who experienced a nosocomial outbreak and to make recommendations for rehabilitation units. Methods A qualitative phenomenological methodology using semi-structured telephone interviews. Results 19 semi-structured interviews were conducted comprising of 13 general rehabilitation inpatients and 6 family members. Five themes were established: (1) the impact of social and physical isolation; (2) boredom and limited access to therapy; (3) the impact of technology; (4) inadequate information sharing and (5) positive experiences and things done well. Several novel insights were identified including: the desire for increased social interaction from staff to compensate for a lack of visitors; the impact of physical and cognitive deficits on a patient’s ability to reach basic items around their room or call for help, and the unique impact of isolation and quarantine on individuals who have a history of trauma, discrimination or mental illness. Conclusions This study establishes key areas that should be considered by rehabilitation units globally to adjust traditional models which are not suitable in this pandemic. Strategies to mitigate the impact of isolation include providing training to increase use of technologies such as tablet devices, increased staff social engagement to reduce isolation and tailoring the environment to suit specific patient groups. KEY MESSAGES COVID-19 related isolation and quarantine has a significant and unique impact on patients with cognitive and physical impairments such as those in inpatient rehabilitation. Patients who are required to isolate in inpatient settings expressed a desire for compensatory increased social interaction from staff and required specific assistance with basic daily tasks while isolated. The study makes key recommendations for other rehabilitation units to integrate into their approach for managing patients required to isolate or quarantine.

Development of a Clinical Prediction Model for 1-Year Mortality in Patients With Advanced Cancer

To optimize palliative care in patients with cancer who are in their last year of life, timely and accurate prognostication is needed. However, available instruments for prognostication, such as the surprise question ("Would I be surprised if this patient died in the next year?") and various prediction models using clinical variables, are not well validated or lack discriminative ability. To develop and validate a prediction model to calculate the 1-year risk of death among patients with advanced cancer. This multicenter prospective prognostic study was performed in the general oncology inpatient and outpatient clinics of 6 hospitals in the Netherlands. A total of 867 patients were enrolled between June 2 and November 22, 2017, and followed up for 1 year. The primary analyses were performed from October 9 to 25, 2019, with the most recent analyses performed from June 19 to 22, 2022. Cox proportional hazards regression analysis was used to develop a prediction model including 3 categories of candidate predictors: clinician responses to the surprise question, patient clinical characteristics, and patient laboratory values. Data on race and ethnicity were not collected because most patients were expected to be of White race and Dutch ethnicity, and race and ethnicity were not considered as prognostic factors. The models' discriminative ability was assessed using internal-external validation by study hospital and measured using the C statistic. Patients 18 years and older with locally advanced or metastatic cancer were eligible. Patients with hematologic cancer were excluded. The risk of death by 1 year. Among 867 patients, the median age was 66 years (IQR, 56-72 years), and 411 individuals (47.4%) were male. The 1-year mortality rate was 41.6% (361 patients). Three prediction models with increasing complexity were developed: (1) a simple model including the surprise question, (2) a clinical model including the surprise question and clinical characteristics (age, cancer type prognosis, visceral metastases, brain metastases, Eastern Cooperative Oncology Group performance status, weight loss, pain, and dyspnea), and (3) an extended model including the surprise question, clinical characteristics, and laboratory values (hemoglobin, C-reactive protein, and serum albumin). The pooled C statistic was 0.69 (95% CI, 0.67-0.71) for the simple model, 0.76 (95% CI, 0.73-0.78) for the clinical model, and 0.78 (95% CI, 0.76-0.80) for the extended model. A nomogram and web-based calculator were developed to support clinicians in adequately caring for patients with advanced cancer. In this study, a prediction model including the surprise question, clinical characteristics, and laboratory values had better discriminative ability in predicting death among patients with advanced cancer than models including the surprise question, clinical characteristics, or laboratory values alone. The nomogram and web-based calculator developed for this study can be used by clinicians to identify patients who may benefit from palliative care and advance care planning. Further exploration of the feasibility and external validity of the model is needed.

Assessment of a single-pass venous phase CT chest, abdomen and pelvis and dual-energy CT in general oncology outpatients.

This study assessed replacing traditional protocol CT-arterial chest and venous abdomen and pelvis, with a single-pass, single-bolus, venous phase CT chest, abdomen and pelvis (CAP) protocol in general oncology outpatients at a single centre. A traditional protocol is an arterial phase chest followed by venous phase abdomen and pelvis. A venous CAP (vCAP) protocol is a single acquisition 60s after contrast injection, with optional arterial phase upper abdomen based on the primary tumour. Consecutive eligible patients were assessed, using each patient's prior study as a comparator. Attenuation for various structures, lesion conspicuity and dose were compared. Subset analysis of dual-energy (DE) CT scans in the vCAP protocol performed for lesion conspicuity on 50 keV virtual monoenergetic (VME) images. One hundred and eleven patients were assessed with both protocols. Forty-six patients had their vCAP scans using DECT. The vCAP protocol had no significant difference in the attenuation of abdominal structures, with reduced attenuation of mediastinal structures. There was a significant improvement in the visibility of pleural lesions (p< 0.001), a trend for improved mediastinal nodes assessment, and no significant difference for abdominal lesions. A significant increase in liver lesion conspicuity on 50 keV VME reconstructions was noted for both readers (p< 0.001). There were significant dose reductions with the vCAP protocol. A single-pass vCAP protocol offered an improved thoracic assessment with no loss of abdominal diagnostic confidence and significant dose reductions compared to traditional protocol. Improved liver lesion conspicuity on 50 keV VME images across a range of cancers is promising.