Hospital Practitioners Research Articles

Knowledge of local anesthetics anaphylaxis among dental practitioners in a Nigerian tertiary hospital


 
 
 
 Background: Anaphylaxis is an acutely presenting life-threatening medical emergency. Studies have shown that dentists feel inadequately able to recognize and treat anaphylaxis. This study aims to determine the level of knowledge of local anesthetic (LA) anaphylaxis among dentists in a Nigerian Teaching Hospital.
 Methods: This cross-sectional, questionnaire-based study was conducted among dental practitioners at the Dental complex of the University of Benin Teaching Hospital, Nigeria from August 2020 to January 2021. The questionnaire consisted of 21 items divided into four main sections: (1) Demographic characteristics, (2) general knowledge on local anesthetic anaphylaxis, (3) knowledge on signs and symptoms of local anesthetic anaphylaxis, (4) knowledge on treatment of local anesthetic anaphylaxis. Data was analyzed using Statistical Package for Social Sciences version 20.0, IBM, Armonk, NY, USA.
 Results: The 101 respondents approached agreed to participate in the study. There were more males (64.4%) compared to females. Majority of the respondents were aged 30 -39 years. None of the respondents knew completely all the signs and symptoms of anaphylactic reaction from LA. None of the respondents got the complete drugs to be kept in the office for LA anaphylaxis. Less than half (43.6%) of the respondents knew that epinephrine is the drug of first choice for anaphylactic reactions. Only 50 (49.5%) of the respondents knew that the best route for epinephrine administration is intramuscular route.
 Conclusion: Adequate knowledge on anaphylaxis from local anesthesia is lacking among dental practitioners in our centre.
 
 
 

Initiation of buprenorphine for opioid use disorder in the hospital setting: Practice models, challenges, and legal considerations.

To provide health-system pharmacists with published examples of strategies utilized to offer buprenorphine to inpatients with opioid use disorder (OUD) along with information on challenges and legal considerations. Hospitals and emergency departments (EDs) are a constant source of healthcare for patients with OUD. As a result, hospital practitioners can screen, diagnose, begin treatment, and facilitate transfer of care to the outpatient setting. Offering sublingual buprenorphine in the hospital can bridge the gap before outpatient care is established. Multiple studies have shown that initiating treatment in the ED or during inpatient hospitalization results in 47% to 74% of patients utilizing medication-assisted treatment at day 30 of follow-up, statistically superior to the rates achieved with brief interventions or referral alone. Moreover, initiating buprenorphine treatment in the ED has been shown to decrease healthcare costs. Despite the benefits of offering buprenorphine in the inpatient setting, several challenges must be solved by hospital administration, such as achieving clinician readiness to prescribe buprenorphine, developing relationships with outpatient providers of buprenorphine, and creating an efficient workflow. Treatment of OUD with buprenorphine is heavily regulated on the federal level. Pharmacists can participate in the development of these programs and ensure compliance with applicable laws. As health systems continue to care for patients with OUD, starting buprenorphine in the inpatient setting can improve the transition to outpatient treatment. Several institutions have developed programs with positive results. With an understanding of the typical barriers and relevant laws when initiating buprenorphine in the hospital setting, health-system pharmacists can assist in the development and operation of these initiatives.

Review: Rise of the Modern Hospital: An Architectural History of Health and Healing, 1870–1940

Review: <i>Rise of the Modern Hospital: An Architectural History of Health and Healing, 1870–1940</i>

English

The burden of cardiovascular diseases is on the rise in resource-constrained developing countries. Cardiac rehabilitation (CR) is a constellation of multidisciplinary interventions designed to alleviate the burden of cardiovascular disorders. Qua litative data on barriers to the utilisation of cardiac rehabilitation services among healthcare personnel in Nigeria is not available. This research was undertaken to explore the barriers to implementation of cardiac rehabilitation services by healthcare practitioners in a tertiary hospital in Kano, North-Western Nigeria. A researcher-constructed guide with open-ended questions was used to obtain information qualitatively from a purposive sample of ten health professionals via interview. Themes generated included non-functional cardiac rehabilitation team, inadequate skills, inadequate funding, lack of awareness about the role of allied health care professionals, lack of collaboration and absence of enabling environment. Key words: Barriers, cardiac rehabilitation, implementation, Kano.

Analysis of UK eye casualty presentations

ABSTRACT Clinical relevance Optometrists upskilling and participating in enhanced optometric schemes has the potential to improve service accessibility and alleviate pressure on hospital eye services. Background There is a growing demand for eye care in the UK with rising hospital attendances thought to be due in part to an ageing population and a shift in behaviour to favour emergency secondary care. Methods Records of first-time presentations to the eye casualty department at the County Hospital (Wye Valley NHS Trust), Hereford, UK, over a month were analysed retrospectively and sequentially. The proportion of patients from optometrist referrals with conditions potentially requiring pharmacological intervention, that could have been retained within community optometry by an independent prescriber, was assessed. For general practitioner and self-referrals, the reasons for visit were compared to the Minor Eye Conditions Service criteria for inclusion. Patient conditions reviewed at the hospital following their initial presentation were grouped according to those who could have been discharged to a commissioned optometric service. Results The records of 421 patients were organised by the source of referral and condition diagnosed by the hospital practitioner. Thirty-three percent of optometrist referrals could have been managed by an independent prescribing optometrist. Ninety-two percent of patients presenting from general practitioner referrals and 83 percent of self-referrals could have been assessed via the local optometric scheme. Sixty-six percent of patients attending hospital for follow-up could have been seen within the community. Conclusion The present analysis highlights the value of commissioned local optometric community services to address acute ocular symptoms and the value of an independent prescribing qualification in helping to further alleviate the burden on hospital emergency eye services. The large number of self-referrals suggests that the general public needs to be further educated on services that are available at a community optometry level.

Clinical Communication Within Hospital Pharmacy Practice: Exploring Pharmaceutical Oncological Consultations

ABSTRACT This exploratory study aimed to identify communication trends typical of pharmacists’ clinical communication in the context of hospital consultations. A cross-sectional design was used to investigate the pharmacist-patient exchange, applying the Roter Interaction Analysis System (RIAS). Communication variables and RIAS composites were assessed, including therapeutic information complexity, estimated through the ad-hoc score CTICS (Cancer Therapy Information Complexity Score). The study comprised 13 consultations of cancer patients with one female pharmacist, of which 6 included a patient family member, lasting on average 22.74 minutes and presenting repeated or overlapping consultation phases. The pharmacist’s talk dominance reached 53.49%, slightly higher in dyadic consultations (U = 6.0, p = .032), and with an overall predominance of closed-ended questioning (W = 81.0, p = .013). Patients’ questioning on biomedical issues was higher in dyadic consultations. The level of the pharmacist’s rapport-building with the relative was higher when the patient’s age was ≥80 years. Several strong correlations, both positive and negative, were found between composites, including between patient positive rapport-building and relative lifestyle/psychosocial information giving (Rho = −0.971, p = .001). Pharmaceutical consultations seem to be lengthier than other hospital practitioners’ interviews, indicating a lack of clear organization and flow, thus challenging their efficiency regarding therapy management. Still, several positive communication features were found regarding the pharmaceutical care of older cancer patients. Further studies are needed, involving larger samples and other hospital consultation settings.

PrEP monitoring and HIV incidence after PrEP initiation in France: 2016-18 nationwide cohort study.

Clinical trials have demonstrated that oral pre-exposure prophylaxis (PrEP) has high efficacy in preventing HIV transmission. In many countries, HIV testing is recommended prior to PrEP initiation, 1 month after and quarterly thereafter. We assessed the uptake of HIV testing and estimated the incidence of HIV infections after oral PrEP initiation, by using the French national health database (SNDS). A historic cohort study included every adult person who started oral PrEP between 1 January 2016 and 30 June 2018 in France. HIV infection was tracked in the follow-up, from first PrEP dispensation up to 31 December 2018. Factors associated with adherence to HIV testing in PrEP follow-up were analysed using a generalized linear mixed model. PrEP users (9893) were followed for a median duration of 551 days (IQR 350-769). The first HIV test, 1 month after PrEP initiation, was performed by 64% of users. For subsequent tests, this rate exceeded 81% and remained stable over time. HIV testing was lower among PrEP users without prescription refill (OR 0.15; 99% CI 0.12-0.20), but higher if the last prescription was made by a hospital practitioner (OR 2.03; 99% CI 1.69-2.45). Twenty-nine HIV infections were identified, leading to an incidence of 0.19 cases per 100 person-years (99% CI 0.12-0.30). We confirmed good adherence to HIV testing and efficacy of PrEP in users, which should help in decreasing HIV incidence in France. This study also revealed that SNDS could be a powerful automated tool for the epidemiological monitoring of PrEP users.

Hospital Information System for Decision Making: A Qualitative Study

Abstract: Background: Information technology applications play a major role in improving the services provided to patients in healthcare settings. Hospital Information System HIS is expected to facilitate information management and decision making, thus enhancing patient services. Purpose of this study is to explore the obstacles that healthcare practitioners in PKU Muhammadiyah Bantul Hospital faces during using HIS for decision making. Method: This research is a qualitative study. Depth-interviews were carried out with six respondents (Two Clinicians, Three Managers, and One Director), interviews were recorded and transcribed for analysis, a list of codes has produced representing themes identified in the textual data. Results: Data in the HIS were not optimal due to the insufficiency of the system in generating the necessary information for decision-making. Raw data, not real time data, unstable connection, and incomplete data between units were the most obstacles that decision makers faced. Conclusion: One of the crucial keys of a good performance of healthcare providers is hospital information system that ensures the production, analysis, and providing a reliable and timely information, making it easy for managers and doctors to make managerial and clinical decisions more effectively. Upgrading HIS to enable data analysis is suggested.&#x0D; &#x0D; Keywords: Hospital Information System, Obstacles, Decision Making.

Gender inequality among medical, pharmaceutical and dental practitioners in French hospitals: Where have we been and where are we now?

IntroductionWomen are under-represented in senior academic and hospital positions in many countries. The authors aim to assess the place and the evolution of all appointed female and male health practitioners’ working in French public Hospitals.Materials and methodsData of this observational study were collected from the National Management Centre (Centre National de Gestion) from 2015 up to January 1, 2020. First, the authors described demographic characteristics and specialties of all appointed medicine, pharmacy, and dentistry doctors’ working as Hospital Practitioners, Associate Professors, and Full Professors in French General and University-affiliated Hospitals in 2020. Then, they retrospectively reported the annual incidence of new entrance according to gender and professional status from 1999 to 2019 thanks to the appointment date of all practitioners in activity between 2015 and 2020.ResultsIn 2020, 51 401 appointed practitioners (49.7% of female) were in activity in French public hospitals with a large majority being medical doctors (92.4%) compared to pharmacists (6%) and dentists (1.6%). Women represented 52.5% of the Hospital Practitioners, 48.6% of the Associate Professors, and 22.0% of the Full Professors (p < 0.001). There were disparities between the rates of female Full Professors in medicine (20.6%), pharmacy (36.1%), and dentistry (44.3%, p < 0.001). Women were appointed Hospital Practitioners and Associate Professors earlier than men (respectively 37.1 versus 38.8 years, p < 0.001 and 36.1 versus 36.5 years, p = 0.04), and at a later age among Full Professors (43.7 versus 41.9 years, p < 0.001). Compared to men, the annual proportion of appointed women varied significantly between 1999 and 2019 from 47.6% to 60.4% for Hospital Practitioners, from 50.0% to 44.6% for Associate Professors, and from 11.2% to 33.3% for Full Professors (p < 0.001 for trend).ConclusionsAlthough more and more women occupy positions in French hospitals, there is still a gender gap regarding access to Full Professor status in medicine and pharmacy, but not in dentistry. The disparity in numbers makes comparison difficult. Despite a trend towards gender equality during the last twenty years, it has not yet been achieved regarding access to the highest positions.

Discharge communication study: a realist evaluation of discharge communication experiences of patients, general practitioners and hospital practitioners, alongside a corresponding discharge letter sample

ObjectivesTo develop a programme theory for the intervention of patients receiving discharge letters.DesignWe used a realist evaluation approach and captured multiple perspectives of hospital discharge to refine our previously developed...

Cohort profile of Acutelines: a large data/biobank of acute and emergency medicine

PurposeResearch in acute care faces many challenges, including enrolment challenges, legal limitations in data sharing, limited funding and lack of singular ownership of the domain of acute care. To overcome...

Perinatal and infant outcome of fetuses with prenatally diagnosed hyperechogenic kidneys.

Hyperechogenic kidneys are a relatively rare antenatal finding, which can generate significant parental anxiety due to uncertain prognosis. We report on the perinatal and infant outcomes of a large cohort of fetuses with antenatally diagnosed hyperechogenic kidneys. This was a retrospective analysis of all cases diagnosed prenatally with hyperechogenic kidneys between 2002 and 2017 in a large tertiary fetal medicine unit. Hyperechogenicity was defined as kidney parenchyma with greater echogenicity than that of the liver. Pregnancy, pathological and postnatal outcomes were collected from hospital and general practitioner records up to 1 year of age. Abnormal renal outcome was defined as elevated creatinine beyond 6 months of age, hypertension requiring medication or major kidney surgery, such as nephrectomy. Severe abnormal renal outcome was defined as the need for dialysis or kidney transplant at any stage. Three-hundred and sixteen fetuses with hyperechogenic kidneys were identified at a mean gestational age of 21 (range, 13-37) weeks. The majority of cases (97%) had bilateral hyperechogenic kidneys. In the 265 cases with available follow-up data, other associated renal tract abnormalities were identified prenatally in 36%, concomitant extrarenal structural abnormalities in 39% and abnormal karyotype in 15% of cases. Of the 316 included cases, 139 did not survive, including 105 terminations of pregnancy, five intrauterine deaths and 29 early neonatal deaths. Only 4.3% (6/139) of these fetuses had isolated hyperechogenic kidneys while 28.1% (39/139) had associated multiple renal tract abnormalities alongside hyperechogenic kidneys and over two-thirds (67.6%; 94/139) had concomitant extrarenal abnormalities. Of the 177 cases that survived beyond 1 month of age, outcome data were available in 126. Of these, based on the antenatal findings, 60 (47.6%) cases had isolated hyperechogenic kidneys, 56 (44.4%) had associated renal structural abnormalities and 10 (7.9%) had additional extrarenal abnormalities. Considering renal outcome alone, kidney function was abnormal in 13 (21.7%), 10 (17.9%) and 0 (0%) infants in these three groups, respectively, although concurrent pathology clearly affected global outcome in the more complex cases. Neonatal mortality of 1.6% was observed in the isolated renal hyperechogenicity group. The presence of oligohydramnios or abnormal renal volume was not associated significantly with abnormal renal function (odds ratio (OR), 2.32 (99% CI, 0.54-10.02) and OR, 0.74 (99% CI, 0.21-2.59), respectively) in this group. Hyperechogenic kidneys are often complicated by associated renal tract and extrarenal abnormalities, aberrant karyotype and genetic disease, and these factors have a greater effect on overall outcome than does kidney echogenicity. The renal outcome of fetuses with isolated hyperechogenic kidneys is good generally, with over 70% of cases having normal renal function postpartum. Importantly, for prognostic counseling, all of the fetuses in this non-selected series with isolated hyperechogenic kidneys and normal amniotic fluid levels had normal renal outcome in infancy. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Scepticism and resistance to IoMT in healthcare: Application of behavioural reasoning theory with configurational perspective

The innovative application of smart devices in healthcare promotes real-time sensing, enables intelligent services, and accelerates medical progress, which ultimately boosts clinical trial efficiency, timely diagnostics, and effective patient-centred care. Despite its proven capabilities, the Internet of Medical Things (IoMT) can flourish only if users in the medical sector willingly use these devices in their daily routine work. Drawing on behavioural reasoning theory and its implication in explaining user behaviour, this study aims to shed light on hospital practitioners’ reasons for and against resistance to IoMT. We proposed an integrative theoretical framework that combines system, information, and individual positive and negative factors to understand and explain clinical users’ scepticism and resistance toward IoMT. We benefit from a multi-analytical approach including symmetrical (net effect) and configurational analysis to test this theoretical framework. Our study contributes to the literature by proposing new insights into IoMT users’ decision-making, considering a dual approach that simultaneously explains positive and negative pathways toward scepticism and resistance. Empirically, this study advances our knowledge of users’ resistance rationality that could lead to improved managerial policies for introducing and successfully implementing IoMT technologies in hospitals.

Immuno-Hormonal, Genetic and Metabolic Profiling of Newborns as a Basis for the Life-Long OneHealth Medical Record: A Scoping Review.

Holistic and life-long medical surveillance is the core of personalised medicine and supports an optimal implementation of both preventive and curative healthcare. Personal medical records are only partially unified by hospital or general practitioner informatics systems, but only for citizens with long-term permanent residence. Otherwise, insight into the medical history of patients greatly depends on their medical archive and memory. Additionally, occupational exposure records are not combined with clinical or general practitioner records. Environmental exposure starts preconceptionally and continues during pregnancy by transplacental exposure. Antenatal exposure is partially dependent on parental lifestyle, residence and occupation. Newborn screening (NBS) is currently being performed in developed countries and includes testing for rare genetic, hormone-related, and metabolic conditions. Transplacental exposure to substances such as endocrine disruptors, air pollutants and drugs may have life-long health consequences. However, despite the recognised impact of transplacental exposure on the increased risk of metabolic syndrome, neurobehavioral disorders as well as immunodisturbances including allergy and infertility, not a single test within NBS is geared toward detecting biomarkers of exposure (xenobiotics or their metabolites, nutrients) or effect such as oestradiol, testosterone and cytokines, known for being associated with various health risks and disturbed by transplacental xenobiotic exposures. The outcomes of ongoing exposome projects might be exploited to this purpose. Developing and using a OneHealth Medical Record (OneHealthMR) may allow the incorporated chip to harvest information from different sources, with high integration added value for health prevention and care: environmental exposures, occupational health records as well as diagnostics of chronic diseases, allergies and medication usages, from birth and throughout life. Such a concept may present legal and ethical issues pertaining to personal data protection, requiring no significant investments and exploits available technologies and algorithms, putting emphasis on the prevention and integration of environmental exposure and health data.

Flexibility and Bed Margins of the Community of Madrid's Hospitals during the First Wave of the SARS-CoV-2 Pandemic.

Background: The COVID-19 pandemic has had global effects; cases have been counted in the tens of millions, and there have been over two million deaths throughout the world. Health systems have been stressed in trying to provide a response to the increasing demand for hospital beds during the different waves. This paper analyzes the dynamic response of the hospitals of the Community of Madrid (CoM) during the first wave of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in the period between 18 March and 31 May 2020. The aim was to model the response of the CoM’s health system in terms of the number of available beds. Methods: A research design based on a case study of the CoM was developed. To model this response, we use two concepts: “bed margin” (available beds minus occupied beds, expressed as a percentage) and “flexibility” (which describes the ability to adapt to the growing demand for beds). The Linear Hinges Model allowed a robust estimation of the key performance indicators for capturing the flexibility of the available beds in hospitals. Three new flexibility indicators were defined: the Average Ramp Rate Until the Peak (ARRUP), the Ramp Duration Until the Peak (RDUP), and the Ramp Growth Until the Peak (RGUP). Results: The public and private hospitals of the CoM were able to increase the number of available beds from 18,692 on 18 March 2020 to 23,623 on 2 April 2020. At the peak of the wave, the number of available beds increased by 160 in 48 h, with an occupancy of 90.3%. Within that fifteen-day period, the number of COVID-19 inpatients increased by 200% in non-intensive care unit (non-ICU) wards and by 155% in intensive care unit (ICU) wards. The estimated ARRUP for non-ICU beds in the CoM hospital network during the first pandemic wave was 305.56 beds/day, the RDUP was 15 days, and the RGUP was 4598 beds. For the ICU beds, the ARRUP was 36.73 beds/day, the RDUP was 20 days, and the RGUP was 735 beds. This paper includes a further analysis of the response estimated for each hospital. Conclusions: This research provides insights not only for academia, but also for hospital management and practitioners. The results show that not all of the hospitals dealt with the sudden increase in bed demand in the same way, nor did they provide the same flexibility in order to increase their bed capabilities. The bed margin and the proposed indicators of flexibility summarize the dynamic response and can be included as part of a hospital’s management dashboard for monitoring its behavior during pandemic waves or other health crises as a complement to other, more steady-state indicators.

Situs inversus totalis: Anatomic study and radioanatomic aspects about one case

The term "Situs inversus" is a diminutive for "Situs inversus viscerum" which means in Latin: inverted position of the internal organs. It was first described in 1643 and has an incidence of approximately 1 / 10,000 births. A mirror image of the original anatomical configuration represents the situs inversus totalis. Several authors described anomalies in the rotation and fixation of viscera during their development. These developmental anomalies are not necessarily the cause of functional problems. The clinical and surgical implications can be significant, as several authors reported a situs inversus totalis over the most conventional surgical procedures. The technical difficulties represent the main challenge. Because even though many patients are known to have situs inversus totalis, surgeons need an adaptation time to get used to the mirror image of viscera. Iatrogenic injuries and an increase in operative time are not uncommon.We report a case of situs inversus totalis in a 68-years-old patient, accidentally discovered during investigations for an adenocarcinoma of the prostate. We remind in detail the anatomical presentation and morphological aspects found in our patient. Several hypotheses have been mentioned to explain the pathogenesis of situs inversus. Even if the anatomical inversion of many organs has been genetically studied, it appears a predominance for the viscera whose positional abnormalities are the most obvious (heart, liver, stomach). For other naturally "symmetrical" organs the inverted position is much less obvious, if not controversial, as is the case with the brain.The term "situs inversus totalis" is used to describe the transposition of all organs of the body to the opposite side, its incidence is relatively low. Situs inversus totalis is a rare pathological condition, but with important clinical and surgical implications. Even if its discovery is most often fortuitous, hospital practitioners (especially surgeons and radiologists) must take this possibility into account, especially for patients awaiting surgery.

Teleneuropsychology practice survey during COVID-19 within the United States

Objective Identify factors influencing service delivery changes during COVID-19 and examine barriers and provider satisfaction with teleneuropsychology (teleNP). Method Licensed clinical neuropsychologists within the United States recruited via neuropsychology-specific listservs (July–August 2020) to complete an online survey. Results A total of 261 individuals completed the survey. Most (76%) reported delivering in-person testing in some capacity at the time of our survey. Relatively more private practitioners identified concerns with privacy/confidentiality (45.2% vs. 17.9%; χ 2(2) = 6.99, p < 0.05), legal issues (47.6% vs. 17.9%; χ 2(2) = 8.06, p < 0.05), and an undesirable precedent for legal/forensic cases (59.5% vs. 15.4%; χ 2(2) = 17.54, p < 0.001) compared to hospital or other medical (non-VA) practitioners. Multiple resources informed teleNP protocols, such as organization guidelines (87.6%), literature review (75.9%), webinars (72.4%), and consultation (68%). Several factors influenced test selection, including availability of normative data (70.1%), test familiarity (66.4%), administration time (63.5%), and evidence base (60.6%). Reported barriers to continuing teleNP after COVID-19 included need for improved teleNP norms (85.9%), domain coverage (84.7%), improved patient access to technology (74.1%) and further validation studies (84.1%). Conclusion TeleNP may not be feasible in all settings and/or referrals. Respondents employed multiple resources in aggregating teleNP protocols and considered several factors when selecting tests. Results highlight the complex and varied decision-making processes utilized by respondents to adapt to service delivery changes. Considering the many benefits of teleNP, future research addressing some of the potentially modifiable factors (e.g., technology access, attitudes regarding teleNP) and significant development needs for teleNP itself (i.e., improved teleNP norms, further validation studies, etc.) is warranted.

Trends in antibiotic resistance for over 700,000 Escherichia coli positive urinary tract infections over six years (2014-2019) from a university teaching hospital.

IntroductionAntibiotic microbial resistance (AMR) is a global health problem. Our aim was to review the resistance of Escherichia (E.coli) to antibiotics at our university hospital over a six-year period and see whether our protocol based antibiotic policy over this time led to any change in the resistance patterns.Material and methodsSensitivities of E.coli urine isolates between 2014–2019 (6-years) were sourced from the hospital and general practitioners in the community and collected from the microbiology department. Trends of resistance for amoxicillin, tazocin, cefalexin, ciprofloxacin, co-amoxiclav, gentamicin, nitrofurantoin, trimethoprim, amikacin, and pivmecillinam were examined using the Cochran-Armitage test.Results712,004 urine samples tested positive for E. coli. The overall resistance trends for cefalexin, nitrofurantoin and amikacin remained equivocal; increased for ciprofloxacin, co-amoxiclav, gentamicin, and tazocin; and decreased for fosfomycin, pivmecillinam, and trimethoprim.ConclusionsDespite our protocol based antibiotic policy, although the overall antibiotic resistance remained stable, there was an increasing trend in antibiotic resistance for more commonly used antibiotics including ciprofloxacin, co-amoxiclav, gentamicin, and tazocin reflecting their overall use for prophylaxis and treatment. We plan to continue our policy of reviewing our antibiotic usage and the prescribing protocol with the microbiology department to minimize antibiotic resistance.

Cooperation and spillovers in healthcare R&D: Theory and evidence

This study tests the hypothesis that the research and development activity that is taking place in medical schools will influence the research and development activity that is occurring in hospitals, and vice-versa. To do so, we present a game in which the flow (short run) and level (long run) of research and development activities in medical schools determines the flow and level of research and development endeavors in hospitals (and vice-versa). The division of labor that occurs in our game entails the specialization in basic research by medical schools that leads to application and refinement of the results from that work by hospital practitioners. In turn, the refinements made by hospital practitioners informs further medical school research. Empirical support for our hypothesis is provided using data from the Association of American Medical Colleges, the Association for Healthcare Philanthropy and the National Science Foundation.

Gender Inequality Among Hospital and University Practitioners in France in 2020: Where Have We Been and Where are We Now?

Backgrounds: Women are under-represented in senior academic and hospital positions in many countries. We aim to assess the place and the evolution of tenured female and male health practitioners’ working in French public Hospitals. Methods: Data of this observational study were collected from the National Management Centre (Centre National de Gestion) up to January 1, 2020. First, we describe demographic characteristics and specialties of all tenured medicine, pharmacy, and dentistry doctors’ working as Hospital Practitioners, Associate Professors, and Full Professors in French General and University-affiliated Hospitals in 2020. Then, we report the annual incidence of new entrance according to gender and professional status from 1999 to 2019. Findings: In 2020, 51 401 health practitioners (49·7% of female) are in activity in French public hospitals. Women represent 52·5% of the Hospital Practitioners, 48·6% of the Associate Professors, and 22·0% of the Full Professors. There are disparities between the rates of female Full Professors in medicine (20·6%), pharmacy (36·1%), and dentistry (44·3%). Women are nominated Hospital Practitioners earlier than men (37·1 versus 38·8 years), at a similar age among Associate Professors (36·1 versus 36·5 years), and at a later age among Full Professors (43·7 versus 41·9 years). Compared to men, the annual rates of appointed women varied between 1999 and 2019 from 47·6% to 60·4% for Hospital Practitioners, from 50·0% to 44·6% for Associate Professors, and from 11·2% to 33·3% for Full Professors. Interpretation: Although hospitals are becoming more and more feminised, there is still a gender gap to access the Full Professors status in medicine and pharmacy, but not in Dentistry. Despite a trend towards, gender equality has not yet been achieved regarding access to the highest positions. Funding Statement: None. Declaration of Interests: ALB, NA, CV, BH, FL, BL, MBM, AB, and JSA declare no competing interests.