Hospital Experience Research Articles

ArGLP-1: our experience in a tertiary hospital in southern spain

arGLP-1: our experience in a tertiary hospital in southern spain

Primary hyperparathyroidism due to parathyroid cancer or atypical adenoma. a third-level spanish hospital experience

Primary hyperparathyroidism due to parathyroid cancer or atypical adenoma. a third-level spanish hospital experience

Cerebral hemodynamics and optic nerve sheath diameter acquired via neurosonology in critical patients with severe coronavirus disease: experience of a national referral hospital in Peru.

We aimed to describe the neurosonological findings related to cerebral hemodynamics acquired using transcranial Doppler and to determine the frequency of elevated ICP by optic nerve sheath diameter (ONSD) measurement in patients with severe coronavirus disease (COVID-19) hospitalized in the intensive care unit of a national referral hospital in Peru. We included a retrospective cohort of adult patients hospitalized with severe COVID-19 and acute respiratory failure within the first 7 days of mechanical ventilation under deep sedoanalgesia, with or without neuromuscular blockade who underwent ocular ultrasound and transcranial Doppler. We determine the frequency of elevated ICP by measuring the diameter of the optic nerve sheath, choosing as best cut-off value a diameter equal to or >5.8 mm. We also determine the frequency of sonographic patterns obtained by transcranial Doppler. Through insonation of the middle cerebral artery. Likewise, we evaluated the associations of clinical, mechanical ventilator, and arterial blood gas variables with ONSD ≥5.8 mm and pulsatility index (PI) ≥1.1. We also evaluated the associations of hemodynamic findings and ONSD with mortality the effect size was estimated using Poisson regression models with robust variance. This study included 142 patients. The mean age was 51.39 ± 13.3 years, and 78.9% of patients were male. Vasopressors were used in 45.1% of patients, and mean arterial pressure was 81.87 ± 10.64 mmHg. The mean partial pressure of carbon dioxide (PaCO2) was elevated (54.08 ± 16.01 mmHg). Elevated intracranial pressure was seen in 83.1% of patients, as estimated based on ONSD ≥5.8 mm. A mortality rate of 16.2% was reported. In the multivariate analysis, age was associated with elevated ONSD (risk ratio [RR] = 1.07). PaCO2 was a protective factor (RR = 0.64) in the cases of PI ≥ 1.1. In the mortality analysis, the mean velocity was a risk factor for mortality (RR = 1.15). A high rate of intracranial hypertension was reported, with ONSD measurement being the most reliable method for estimation. The increase in ICP measured by ONSD in patients with severe COVID-19 on mechanical ventilation is not associated to hypercapnia or elevated intrathoracic pressures derived from protective mechanical ventilation.

Frequency of Post-Cholecystectomy Syndrome Among Patients Undergoing Cholecystectomy: A Teaching Hospital Experience

Background and Objectives: Post-cholecystectomy syndrome is defined as upper abdominal pain or dyspepsia that persists after the cholecystectomy. Some studies show its incidence is about 40%. This study aims to find out the frequency of early post-cholecystectomy syndrome at our hospital and its possible cause.Methods: It was an observational study conducted at POF Hospital Wah Cantt from January 2018 to January 2022. 505 patients who underwent cholecystectomy were included in this study to find the incidence and cause of post-cholecystectomy syndrome. All the data were noted in a predesigned proforma and entered in SPSS version 24.0.Results: Out of 505, 59 patients were diagnosed as cases of post cholecystectomy syndrome with an incidence of 11.68%. 40(67.7%) were female, 19(32.2%) were male. The mean age of the patient was 38.43±8years. In 36(61%) patients, no cause of pain was found. In 12(20%) patients the cause was acid- peptic diseases. Three(5%) patients have CBD stones, 2(3.3%) patients have the remnant of the gallbladder, 2(3.3%) patients had a fluid collection, 2(3.3%) patient had pancreatitis, 1(1.6%) patient had scar pain (hypertrophic scar) and 1(1.6%) patient had periampullary growth.Conclusion: The incidence of post-cholecystectomy syndrome is significant. Any patient presenting with pain postoperatively should be examined and thoroughly investigated for possible treatable causes.Keywords: Post-cholecystectomy syndrome, Acid peptic diseases, jaundice, laparoscopic cholecystectomy.

Perspectives and Recommendations from Hospitalized Patients with Substance Use Disorders: A Qualitative Study.

Individuals with substance use disorders (SUDs) are hospitalized in growing numbers. Stigma is pervasive among their hospital providers, and SUD management during medical admissions is often inadequate. However, little is known about how these patients perceive their care quality. In particular, few studies have explored their positive care perceptions or recommendations for improvement. To explore perspectives on positive aspects, negative aspects, and consequences of care, as well as recommendations for improvement among hospitalized patients with SUDs. We conducted semi-structured, in-depth bedside interviews (n = 15) with patients who have been diagnosed with a SUD and were admitted to medical or surgical floors of an urban academic medical center. Interviews explored patients' hospital experiences and recommendations for improvement. The interviews were audio-recorded, transcribed verbatim, and imported into NVivo software. Two reviewers independently coded the transcripts using interpretative phenomenological analysis and inductive thematic analysis according to grounded theory, and recurring themes were identified from the data. Patients' demographic and clinical data were analyzed with descriptive statistics. Perceived clinical and emotional proficiency were the most important components of positive experiences, whereas perceived bias and stigmatized attitudes, clinical improficiency, and inhumane treatment were characteristic of negative experiences. Such care components were most consequential for patients' emotional well-being, trust, and care quality. Recommendations for improving care included specific suggestions for initiating and promoting continued recovery, educating, and partnering in compassionate care. Hospitalized patients with SUDs often experience lower quality and less compassionate care linked to pervasive stigma and poor outcomes. Our study highlights under-recognized perspectives from this patient population, including socioemotional consequences of care and recommendations grounded in lived experiences. By striving to advance our care in accordance with patients' viewpoints, we can turn hospitalizations into opportunities for engagement and promoting recovery.

Home care practice behavior and its influencing factors of primary care providers: a multicenter cross-sectional study in Sichuan Province, China

BackgroundPrimary care providers play an important role in home health care, and their practice behavior is significant for care quality and patient outcomes. This study aimed to assess the home care practice behavior of Chinese primary care providers and to explore the factors associated with the practice behavior.MethodsA multicenter cross-sectional design with a convenience sample was used to survey 863 registered primary care providers from 62 primary health care settings in Sichuan Province, China. Descriptive statistics, t-test or ANOVA for one-way analysis, and Pearson’s correlation analyses were used to compare the differences and examine the relationships between participants’ demographics and experience of home care services and practice behavior. Multiple linear regression models were performed to identify salient variables associated with the practice behavior from among demographic and home care experience.ResultsThe score of home care practice behavior questionnaire was 97.25 ± 21.05. The average scores for the dimensions of home visit preparation, assessment, medical care behavior and safety practice were 3.70 ± 0.95, 3.76 ± 1.02, 3.66 ± 1.03, and 3.20 ± 0.46, respectively. Home care practice behavior was associated with working years, working experience in general hospitals, work area, home care experience such as client types of home care, service frequency and willingness, explaining 21.5% of the total variance.ConclusionChinese primary care providers had a medium to high level of home care practice behavior but poor implementation of safety practice. The results may provide clues to increased focus and implementation of safety practice, as well as providing targeted measures based on influencing factors.

HOSPITALIZATION IN THE PANDEMIC: Perspectives of undiagnosed patients with covid-19

The Covid-19 pandemic has impacted the world since it was decreed in March 2020. As a result, studies have been produced with people who had the disease. However, there are gaps about the repercussions of the pandemic for people who had to be hospitalized for health treatments. Therefore, the objective of the study was to describe the perspective of patients, without a diagnosis of Covid-19, on the hospitalization experience, during the pandemic, marked by the absence of vaccines. Therefore, a qualitative-descriptive study was carried out, with a social constructionist methodological orientation, in which semi-structured interviews were carried out with 10 patients who were hospitalized in a public university hospital. The content of the interviews resulted in the construction of the themes: repercussions of hospitalization and the hospital as a place of care. The results show that the participants experienced feelings of fear and a sense of isolation, which were alleviated with the support between patients, professionals and religiosity/spirituality, presenting social support as an important coping resource. In addition, the suffering experienced by the participants seems to have been amplified and intensified by the pandemic, drawing attention to mental health care.

An Amish Family's Hospital Experience at End-of-Life: The Importance of Culturally-Sensitive Visitation Policies

An Amish Family's Hospital Experience at End-of-Life: The Importance of Culturally-Sensitive Visitation Policies

Reducing general anaesthetic episodes: 'piggyback' procedures - Birmingham Children's Hospital experience.

Introduction Birmingham Children's Hospital (BCH) has a well-established care pathway for joint procedures - 'piggybacks' - under general anaesthetic (GA). The premise behind these joint procedures is that dental treatment is undertaken at the same time as another planned GA, usually completed by the patient's primary medical or surgical specialty, or another speciality attending a dental GA list.Aim The aim of this paper is to share the recent BCH experience of joint procedures and provide a model for secondary and tertiary care providers across the UK to develop their own collaborative working approaches.Method Data were collected retrospectively from May 2021 to May 2023 on the department of paediatric dentistry at Birmingham Children's Hospital. Patients were included if they had any joint procedure undertaken.Results In total, 93 patients were treated as a 'piggyback' procedure during this period. The average age of patient treated was nine years and three months. A total of 39 patients had extractions only during this period, while 19 had scaling only and 12 had both scaling and extractions. Additionally, 269 primary teeth and 22 permanent teeth were extracted during this period.Conclusion BCH has a well-established pathway of care for 'piggyback' procedures. Future workforce planning and patient care pathways should consider joint procedures and further explore this initiative to continue to streamline patient care and reduce waiting lists and risks associated with GA.

Individualized Care Delivery for Children With Autism and Related Disabilities Undergoing Overnight Video Electroencephalography (EEG): One Hospital's Experience With a Coordinated Team Approach.

Background and Purpose: Children with developmental disabilities have increased risk of epilepsy and need for overnight video electroencephalographic (EEG) monitoring. However, video EEGs have historically been considered difficult to complete for this population. An autism support service at a pediatric tertiary care hospital implemented a coordinated team approach to help children with developmental disability tolerate overnight video EEGs. The project included completion of a caregiver-report preprocedure questionnaire that then was shared with the multidisciplinary team and used to create individualized care plans. The current study aims to describe rates of video EEG completion and need for lead placement under general anesthesia among children with autism and related disabilities who received these supports. Methods: Rates of video EEG completion and general anesthesia use were analyzed for children referred to the support service between April 2019 and November 2021. Results: A total of 182 children with developmental disability (mean age = 10.3 years, 54.9% diagnosed with autism) met inclusion criteria. 92.9% (n = 169) of children successfully completed EEG (leads on ≥12 hours). Only 19.2% (n = 35) required general anesthesia for video EEG lead placement. The majority (80.2%) of parents (n = 146) completed the preprocedure questionnaire. Video EEG outcomes did not differ based on completion of the questionnaire. Parent-reported challenges with communication and cooperation were associated with shorter video EEG duration and greater use of general anesthesia. Conclusions: These findings suggest that most children with developmental disability can complete video EEG with sufficient support. Preprocedure planning can identify children who would benefit from additional accommodations. Further research is necessary to clarify which supports are most helpful.

201: Cadaveric training for H&N brachytherapy: The Tata Memorial Hospital and BrachyAcademy experience

201: Cadaveric training for H&N brachytherapy: The Tata Memorial Hospital and BrachyAcademy experience

Surviving economic crisis in a perspective of biochemistry laboratory: Sri Lankan tertiary care hospital experience

Surviving economic crisis in a perspective of biochemistry laboratory: Sri Lankan tertiary care hospital experience

Multidisciplinary approach to patients with lymphatic conduction disorders

Patients with lymphatic disorders are remarkably complex and require a wide variety of medical and surgical services. Establishing a multidisciplinary program improves the efficiency of the patients’ hospital experience minimizing the compartmentalization of their care. Offering a clear intake process guarantees that patients will be seen promptly by all the required teams. Additionally, having regular multidisciplinary meetings allows all participating teams to learn from each other and gain experience in the care of a population that is extraordinarily heterogeneous. Additionally, establishing a solid program allows for long-term data collection, research and education.

A comparative retrospective analysis on robot-assisted laparoscopic surgery compared to conventional laparoscopy in case of myomectomy: experience in a third-level hospital of Southern Italy

Uterine myomas are the most common gynecological disease in reproductive-aged women, present several symptoms, and require effective medical and/or surgical strategies. This study aimed to compare robotic-assisted laparoscopic myomectomy (RALM) with laparoscopic myomectomy (LM) in terms of operative times, intraoperative estimated blood loss, pre- and post-hemoglobin levels drop, and length of hospital stay. Data from 50 clinical records (25 RALM in Group A and 25 LM in Group B) of patients with uterine fibroids were collected from December 2022 to December 2023 at Gynecological Unit of DAI Materno-Infantile Federico II in Naples, Italy. Patients aged 30–49 years with symptomatic fibroids were included. Data on peri-operative outcomes, including operative time for myomectomy (OTM), overall operative time (OOT), intraoperative estimated blood loss (EBL), pre- and post-operative hemoglobin levels, and length of hospital stay were analyzed. The OTM in the presence of > 5 myomas was 59 [52–65] vs 69 min [61–96] (p < 0.001) for RALM and LM groups, respectively. Moreover, also in presence of ≤ 5 myomas, a difference was observed in the RALM group 48[43–55] compared to the LM group 53[50–61] min (p = 0.07). The OOT was also statistically significant for Group A compared to Group B (83[65–93] vs 72[56–110] min, p < 0.001). There were no significant differences between the two groups in terms of pre- and post-operative hemoglobin levels and EBL (p = 0.178). Group A demonstrated a notably shorter hospital stay 1.2 [1–2] days compared to Group B 2.9[3–3.75] days (p = 0.007). Our study suggests potential advantages of RALM over LM in terms of reduced operative times and shorter hospital stays. The standardized approach and extensive surgical experience likely contributed to the favorable outcomes of RALM.

Perinatal Outcomes of High Risk Pregnancies: Experience of a Tertiary Care Hospital

High Risk Pregnancy (HRP) denotes a condition where the mother, the fetus, or both are predisposed to complications during the gestation period, at birth, or postnatally, which is affected by several factors. Objective: To analyze the perinatal outcomes of high-risk pregnancies, focusing on the experience of a tertiary care hospital. Methods: A longitudinal study over two years, from October 1, 2020, to December 31, 2022, was conducted on 213 high-risk pregnant women, via purposive sampling, who attended the antenatal clinic Liaquat University Hospital, Hyderabad and Jamshoro. After obtaining informed written consent, interviews were conducted with the participants to collect data about their sociodemographic, obstetric, and gynecological histories. Perinatal outcomes were evaluated on the 8th day post-delivery, during which details concerning maternal and fetal complications in terms of morbidity and mortality, were documented. Results: Rh-negative pregnancy was found to be the most high-risk factor with 24.4% (52) of the cases, followed by teenage pregnancy at 12.2% (26), and short stature at 10.9% (23). Additionally, severe anemia was found in 21 women (9.8%), Pregnancy Induced Hypertension (PIH) in 18 women (8.6%), and obesity was also seen in 18 women (8.6%). Other noted risk factors included grand multigravida in 13 women (6.1%), thyroid disorder 4.9% (10), twin pregnancy 3.7% (8) and congenital fetal anomaly, polyhydramnios, oligohydramnios each with 2.4% (5). Conclusions: This study significantly contributes to the body of knowledge on high-risk pregnancies and their outcomes.

Surgical strategies in Ebstein anomaly: 28 years' experience in a pediatric hospital

Ebstein anomaly is a congenital defect characterized by a lack of delamination and apical displacement of the tricuspid valve, tricuspid insufficiency, right atrial enlargement, and ventricular dysfunction. To analyze the results and evolution of the different surgical strategies, data were collected from 45 patients operated on during 1990-2018. Twenty-six patients were included with a median age at initial surgery of 11.3 years (range: 13 days-18.6 years). Procedures were plastic 10 patients (38%), cone technique reconstruction 11 (42%), and replacement 5 (19%). Additional interventions were required in 7 patients: cavo-pulmonary anastomosis 4 and Cox-maze 4. Nine patients (34.6%) required reoperation due to severe tricuspid insufficiency. Six had previous plastic, two bioprothesis, and one, cone. Overall mortality was 11.5% (3)at a median of 10.1 years post-surgery (range: 5.7-10.12) associated with arrhythmias (p = 0.05), right (p = 0.008), left (p = 0.0001) ventricular dysfunction and reoperations (p = 0.03). None were previous conus. Median follow-up was 6.5 years (range: 1-29.1). Ninety-one-point-six percent were in functional class I/II and 79.2% in sinus rhythm. The results of the different classic techniques were similar, although not free of complications and reoperations. Cone reconstruction proved to be effective, with low surgical mortality, less need for reoperations, and durability in the medium term.

Factors that influence young people’s experiences of emergency suicide care in Australia: a qualitative study

Young people in Australia are increasingly presenting to the emergency department in suicide crisis, where their experiences influence present and future treatment outcomes. Previous research on emergency suicide care has predominantly focused on adults’ experiences. This qualitative study aims to identify the factors that influence perceived positive and negative experiences of emergency suicide care for young people. Semi-structured interviews were conducted with 17 young people aged 16-24 years old (mean age = 18.4 years) who presented to an Australian hospital in the past 12 months for a suicide crisis. Young people reflected on the care they received in the emergency department, and the factors that influenced the quality of care. Data underwent reflexive thematic analysis. Most young people reported a negative hospital experience, attributed to resource constraints and invalidating staff responses, reflecting underlying stigma around suicide. Conversely, when young people reported positive experiences, this was largely attributed to empathetic connections with staff. Our findings highlight the importance of compassionate care from hospital staff for young people’s experience of emergency suicide care. Future research with young people is needed to co-design and trial interventions that promote compassionate care and address the barriers with resource constraints in hospitals.

Prevalence of Para-Pneumonic Effusion and the Associated Factors among Children: A 3-Year Experience in a Single Tertiary Hospital

Background: Previous studies have highlighted the significant morbidity associated with para-pneumonic effusions in pediatric populations. However, comprehensive data on the prevalence and associated factors in children remain limited, particularly in tertiary care settings. Methods: A retrospective cohort study was conducted over a three-year period at a single tertiary hospital. Medical records of pediatric patients diagnosed with pneumonia were reviewed to identify cases of para-pneumonic effusion. The study analyzed demographic data, clinical presentations, laboratory findings, and management approaches to determine factors associated with the development of para-pneumonic effusions. Results: 150 patients were identified with para-pneumonic effusions. The majority of patients with effusions were male (60%) and under five years of age (70%). Factors significantly associated with the development of effusions included the presence of comorbidities (p&lt;0.01), higher CRP levels (p&lt;0.05), and hospital-acquired pneumonia (p&lt;0.001). The length of hospital stay was notably longer in patients with effusions than those without (p&lt;0.001). Conclusion: The study found a considerable prevalence of para-pneumonic effusions among children with pneumonia in a tertiary hospital setting. Notably, associated factors were underlying comorbidities, elevated inflammatory markers, and hospital-acquired infections. These findings underscore the need for heightened surveillance and tailored management strategies in high-risk pediatric populations to mitigate the impact of effusions.

Active Tuberculosis Risk Associated with Malignancies: A 4-Year Retrospective Study in a Tertiary Care Hospital

Background Tuberculosis (TB) remains an important public health problem worldwide. Risk of acquiring TB in patients diagnosed with cancers remains high and can result due to reactivation or reinfection. We share the experience in a large tertiary care hospital. Materials and Methods Clinical samples from presumptive TB patients while on cancer therapy were tested by smear Ziehl–Neelsen (ZN) staining, GeneXpert MTB/RIF (Gx), TB polymerase chain reaction (PCR), and liquid culture (MGIT 960) from January 1, 2019, to December 31, 2022. Statistical Analysis Stata 14.0 software was used for statistical analysis. The p-value calculation was done by Pearson's chi-square test. Results Of 906 patients investigated, 42 (4.64%) tested positive for TB. Seven (1.37%) tested positive by ZN staining, 10 patients (6%) had culture positive by MGIT, 20 (10.53%) and 5 (13.51%) samples were positive by Gx and PCR, respectively. Maximum number of TB-positive patients were found to be suffering from carcinoma lung (28%) followed by leukemia (25%), gastrointestinal cancer (13%), and genitourinary cancer (13%), respectively. Seven of the 42 patients succumbed to the disease; the cases belonged to Hodgkin's lymphoma (75% mortality), leukemia (30% mortality), and genitourinary cancer (20% mortality). Conclusion The incidence of active TB is high in cancer patients, especially lung cancer, leukemia, gastrointestinal, and genitourinary cancers. Mortality was high in Hodgkin's lymphoma patients who developed TB. Screening for TB at the time of diagnosis of a high TB risk cancer would help initiate early treatment. We recommend targeted screening for TB in patients with these high-risk cancers, at the time of diagnosis and periodically through cancer treatment.

Analysing the patient experience of COVID-19: Exploring patients' experiences of hospitalisation and their quality of life post discharge.

We sought to gain an understanding of the patient experience during their hospital stay for COVID-19, and the impact of COVID-19 on quality of life post discharge. Symptoms of COVID-19 include a persistent cough, dyspnoea and fatigue. Individuals with comorbidities such as cardiovascular disease have a higher risk of contracting COVID-19 and approximately 20% of those diagnosed with COVID-19 are admitted to hospital. Following discharge from hospital, 40% of patients report a worsened quality of life and up to 87% of those discharged from hospital have experienced 'long COVID'. A qualitative design was used to understand patient experience of hospitalisation following a diagnosis of COVID-19, and their experiences following discharge from hospital. Ten patients with a previous diagnosis of COVID-19 took part in semi-structured interviews regarding their experiences of hospitalisation and the impact on quality of life post-discharge. The results identified three key themes from the interviews: communication and the inpatient experience, symptoms following discharge and regaining independence. Patients discussed their experience of hospitalisation and how this continued to impact their emotional well-being post-discharge. However, patients appeared to push themselves physically to improve their health, despite continued COVID-19 symptoms. Patients hospitalised following a diagnosis of COVID-19 experienced psychological distress during their hospital stay, as well as 3-months post-discharge. We suggest the use of psychosocial interventions to support patients post-discharge. The results of this study provide a greater understanding of the patient experience during their hospital stay, which can support nursing staff practice. Additionally, the study provides in depth knowledge of personal experiences of patients diagnosed with COVID-19 and the impact following hospital discharge. Patient's took part in semi-structured interviews via telephone to support the aims and objectives of this study.