Regional Hospital Research Articles

Effectiveness of Online Mindfulness Platform in Improving Anxiety, Depression, and Stress in Adults During the COVID-19 Pandemic: A Randomized Control Trial.

COVID-19 epidemic bring a great threat to human physical and mental health. This study aimed to investigate the effectiveness of an online mindfulness platform in improving mental status. Patients from a regional hospital were randomly divided into the experimental and control groups. The experimental group received online mindfulness interventions, and control group received general health education. There were no significant differences in the stress or depression scores between the two groups (P > 0.05). Intervention group had significantly lower anxiety scores than control group at fourth and eighth weeks (P<0.001). There was no significant difference in the emotion change over time in control group (P > 0.05). The anxiety in the intervention group was significantly improved at the 4th and 8th weeks (P<0.05). Moreover, the stress and depression in the intervention group were significantly improved at the 8th week (P<0.05). Online mindfulness intervention can effectively improve emotional status.

Clinical Characteristics and Outcomes of Hyperphosphatemia in Patients with Chronic Kidney Disease Stages 1-2.

There was limited research on the epidemiology of hyperphosphatemia in early-stage chronic kidney disease (CKD) patients. We aimed to explore the clinical characteristics and prognostic value of hyperphosphatemia in patients with CKD stages 1-2. We enrolled adult patients with CKD stages 1-2 from 24 regional central hospitals across China. Hyperphosphatemia was defined as a serum phosphate level exceeding 1.45 mmol/L. The study outcomes included all-cause and cardiovascular (CV) mortality. Cox proportional hazard models were used to investigate the association of hyperphosphatemia with all-cause and CV mortality. Among 99,266 patients with CKD stages 1-2 across China, the prevalence of hyperphosphatemia was 8.3%. The prevalence of hyperphosphatemia was increased with the level of urinary protein and was higher in younger and female patients. Among 63,121 patients with survival information, during a median of 5.2 years follow-up period, there were 436 (8.0%) and 4,695 (8.1%) deaths in those with and without hyperphosphatemia, respectively. After adjusting for potential confounders, compared with patients without hyperphosphatemia, patients with hyperphosphatemia were associated with a higher risk of all-cause mortality (hazard ratio: 1.28, 95% CI: 1.16-1.41). Although nearly 60.3% of hyperphosphatemia could be relieved without phosphate-lowering drug therapy among patients with CKD stages 1-2, transient hyperphosphatemia was also associated with an increased risk of all-cause mortality (p = 0.048). Hyperphosphatemia was not rare in patients with CKD stages 1-2 and was associated with an increased risk of mortality. Clinicians should closely monitor serum phosphorus levels in patients with CKD, even in those with normal kidney function.

Use Mobile Apps to Link to Google Forms to Conduct Online Surveys.

The study aimed to evaluate changes in anxiety levels in patients with coronary artery disease before and after cardiac catheterization. The mobile applications LINE and GOOGLE were used to collect online data. A total of 188 patients participated in the study conducted at a regional teaching hospital in eastern Taiwan, and 51 of them completed the questionnaire twice, with a response rate of 27.1%. Although the second study noted the problem of incomplete data and low response rates, this study shows that online research methodology can still be improved and that using electronic questionnaires for data collection and statistical analysis reduces the risk of errors in online research and saves time in documentation. It is recommended to provide clear and detailed instructions when conducting online surveys and to review them carefully upon completion to ensure the completeness of the data collected.

FOXP3 serum concentration; a likely predictor of CIN and cervical cancer: Secondary analysis from a case control study at a clinic in South western Uganda

Biomarkers including Forkhead/winged-helix transcription factor box P3 have been proposed in immunohistochemical techniques to diagnose cervical lesions, but can be objectively quantified and measured in blood using methods that can be standardised. In this study we quantified the serum FOXP3 concentrations and assessed their association with cervical lesions at the cervical cancer clinic of Mbarara Regional Hospital (MRRH) Southwestern Uganda.We performed secondary analysis on archived serum samples from a previous unmatched case control study in which we recruited 90 cervical cancer (CC) cases, 90 cervical intraepithelial neoplasia (CIN) cases before any form of treatment and 90 controls. Clinical and demographic data were recorded. We measured FOXP3 concentrations using quantitative ELISA. We performed descriptive statistics and logistic regression in STATA 17 and took P-values of < 0.05 as statistically significant.The mean concentration of FOXP3 was higher in serum samples from CC cases compared with CIN cases and controls, and this difference was statistically significant (P value < 0.001). More than half (52/90,58 %) of serum samples from CC cases had FOXP3 concentrations greater than 0.0545 ng/ml (P value < 0.001). Increase serum FOXP3 expression was not associated with CIN. Increase in serum FOXP3 concentrations were observed to increase the chances of CC by 2 times (OR: 2.094, P value 0.038, 95 % CI: 1.042–––4.209).Serum FOXP3 is likely associated with cervical lesions especially CC in our study population. Serum FOXP3 testing may be useful in resource limited settings to aid detection of such lesions given the challenges associated with cytology and VIA. We recommend diagnostic utility studies for circulating FOXP3 as a biomarker for detection of cervical cancer.

Knowledge, attitudes, and practices of orthopedic operating room personnel regarding the use of pneumatic tourniquets.

Pneumatic tourniquets (PTs) play a crucial role in hemostasis during orthopedic surgery. This study aimed to investigate the current knowledge, attitudes, and practices (KAP) of orthopedic operating room personnel concerning the use of PTs. This cross-sectional study was conducted from Jul. 2023 to Aug. 2023. An online questionnaire was used to collect demographic information and KAP score data of the orthopedic operating room personnel from Hangzhou Regional Hospitals. A total of 336 participants included orthopedic physicians (37.8%), orthopedic nurses (31.5%), anesthesiologists (8.9%), operating room nurses (19.9%) and medical students (1.8%). The median knowledge score was 28.5 (24, 32), with a maximum score of 38; the median attitude score was 31 (28, 35), of a maximum of 35; the median practice score was 41 (36, 44), of a maximum of 45. Correlation analysis showed links between knowledge and attitude (r = 0.388, p<0.001), knowledge and practice (r = 0.401, p<0.001), and attitude and practice (r = 0.485, p<0.001). Multivariate logistic regression analysis confirmed that female gender (OR = 0.294, 95% CI: 0.167-0.520; p<0.001), working in a specialized hospital (OR = 0.420, 95% CI: 0.219-0.803; p = 0.009), and occupation as a surgical anesthesiologist (OR = 3.358, 95% CI: 1.466-7.694; p = 0.004) were associated with better knowledge scores. A higher educational degree (OR = 0.237, 95% CI: 0.093-0.608; p = 0.003) was associated with better practice scores. No previous training was associated with lower knowledge (OR = 0.312, 95% CI: 0.187-0.520; p<0.001) and practice (OR = 0.325, 95% CI: 0.203-0.521; p<0.001) scores. Orthopedic personnel in this study had acceptable knowledge, attitude, and practice concerning the use of PTs; additional training and guidance might enhance proficiency.

The Impact of Value-based Purchasing on Rural and Urban Healthcare Systems in the United States

Since the 2010s, the U.S. government has adopted value-based purchasing, and many states has utilized this program to reduce hospital readmission rates and improve performance of urban hospitals. Nonetheless, the lack of participation in this program among rural hospitals has contributed to the growing urban-rural health disparities. This paper aims to identify policy solutions to improve health outcomes of vulnerable populations who reside in resource-poor at-home healthcare agencies, nursing homes, and hospitals in rural regions. This paper finds that rural health outcomes are significantly worse than urban parts. At the same time, it also shows that African Americans and Hispanics have higher mortality and morbidity rates than that of their White counterparts, demonstrating the need for policymakers to further address the unmet medical needs of vulnerable populations, such as racial minorities and those with chronic conditions. Therefore, this paper proposes that the government allocates more healthcare funding toward resource-poor urban hospitals. Moreover, insurers should not penalize rural hospitals with a higher proportion of high-risk patients for having higher-than-average hospital readmission rates.

Hubungan Peran Keluarga Dengan Keberhasilan Pengobatan Tuberculosis Paru Pada Anak Pra-Sekolah Di Rumah Sakit Wilayah Bogor

Introduction: Pulmonary Tuberculosis is an infectious disease and is latent. Nearly 40% of children with pulmonary Tuberculosis are transmitted by their families. Pulmonary Tuberculosis can develop into miliary Tuberculosis or meningitis. Methods: This study used a cross-sectional quantitative descriptive method, with a correlation type. The sampling technique used was total sampling, namely patients with pulmonary tuberculosis in preschool children at the Bogor Regional Hospital totaling 30 respondents. The instruments used were family role questionnaire sheets based on Friedman's theory (questionnaire of medical outcomes study, social support survey) and a questionnaire on the success rate of pulmonary Tuberculosis treatment. The dependent and independent variables in this study are the role of the family and the success rate of pulmonary Tuberculosis treatment in preschool children. Results: It was found that the role of a good family with the highest number was 19 respondents (63.3%), and the success of pulmonary Tuberculosis treatment was in the complete category of 26 respondents (86.7%). The results of the Correlation Test for the p-value were 0,012 (&lt; 0,05). Discussion: This study aims to determine whether there is a relationship between the role of the family and the success of pulmonary Tuberculosis treatment in preschool children at Bogor Regional Hospital.

Correlation Between the Hepatitis C Virus NS3 Protein and CD30 Expression in Diffuse Large B-cell Lymphoma.

One of the etiologies of non-Hodgkinlymphoma (NHL) is chronic infection related to lymphoma pathogenesis, with a high prevalence ofhepatitis C virus (HCV) infection seen. In determining the treatment and prognosis of NHL, cluster of differentiation 30 (CD30) immunohistochemical staining plays an important role. High levels of CD30are found in patients with HCV infection. This study aimed to determine the prevalence of CD30 and HCV expression and its correlation with clinicopathological characteristics of Indonesian diffuse large B-cell lymphoma (DLBCL) patients. A total of 86 formalin-fixed paraffin-embedded (FFPE) samples of DLBCL cases were collected over the course of two years from the Anatomical Pathology department at Dr. Sardjito General Hospital in the special region of Yogyakarta, Indonesia. Immunohistochemistry was performed to detect the two markers (CD30 and HCV). Chi-square tests were used to investigate the correlations between CD30 expression and clinicopathological features in DLBCL patients. The positivity rate of CD30 expression in 86 DLBCL samples was 25.6% (22/86) when using a 0% cut-off, and 7.0% (6/86) while using a 20% cutoff. The positivity rate of HCV expression in DLBCL samples was 34.9% (30/86). Positive CD30 expression, HCV expression and clinicopathological features (age, sex, Ann Arbor stage, extranodal involvement, and morphological variations) did not have statistically significant relationships (p>0.05). There was no statistically significant correlation between CD30 immunoreactivity (cut-off >0% or >20%) and HCV NS3 expression and clinicopathological features (age, sex, Ann Arbor stage, extranodal involvement, lactate dehydrogenase, Eastern Cooperative Oncology Group status and morphological variants) in DLBCL.

Chronic invasive fungal rhinosinusitis with septal perforation: a case report

Background: Chronic Invasive Fungal Rhinosinusitis (CIFRS) is a sub-entity of fungal rhinosinusitis, with the most common causes being Aspergillus and Mucor. Non-specific symptoms such as nasal obstruction, headaches, face pain, rhinorrhea, and epistaxis are frequently observed in patients with CIFRS. Extension to the nasal septal is a scarce case. This case report aims to present a rare case report of a 50-year-old female considered immunocompetent with chronic invasive fungal rhinosinusitis with septal perforation at our hospital who underwent Functional Endoscopic Sinus Surgery (FESS). Case Presentation: Fifty-year-old female was referred to the Otorhinolaryngology Department, Mangusada Regional Hospital, with a blocked nose, especially on the right side, with frequently purulent nasal discharge, headache, and she had a foul smell in the nose for about 5 years, then in the last few months, the symptoms became worse, and she frequently had bloody discharge and anosmia. The patient came to our hospital due to failure of previous medical therapy. She denied any history of underlying systemic disease, relevant trauma, and nasal surgery. A large polypoid mass with an obstructed right middle meatus was detected on nasal endoscopy. A dark-brown substance resembling clay was found in the right posterior nasal cavity, close to the posterior nasal septum. The same material was seen in the left posterior nasal cavity, close to the posterior nasal septum. Computed Tomography (CT)-scan demonstrated a soft tissue density in the right maxillary sinus. The density extended into the left nasal cavity through a septal defect. The patient was done surgically with FESS to restore the drainage of the nasal cavity and paranasal sinuses. It is crucial to remove all the debris and infected tissue altogether. After the surgery, the patient was given nasal irrigation therapy with physiological saline solution 2 times a day and the condition improved. Conclusion: Diagnosing invasive fungal rhinosinusitis can be challenging due to its non-specific clinical presentation. Awareness, early diagnosis, and intervention help prevent permanent complications.

Assessment of antimicrobial stewardship programmes and antibiotic use among children admitted to two hospitals in Sierra Leone: a cross-sectional study

IntroductionAntimicrobial resistance (AMR) is a global public health concern and irrational use of antibiotics in hospitals is a key driver of AMR. Even though it is not preventable, antimicrobial stewardship (AMS) programmes will reduce or slow it down. Research evidence from Sierra Leone has demonstrated the high use of antibiotics in hospitals, but no study has assessed hospital AMS programmes and antibiotic use specifically among children. We conducted the first-ever study to assess the AMS programmes and antibiotics use in two tertiary hospitals in Sierra Leone.MethodsThis was a hospital-based cross-sectional survey using the World Health Organization (WHO) point prevalence survey (PPS) methodology. Data was collected from the medical records of eligible patients at the Ola During Children’s Hospital (ODCH) and Makeni Regional Hospital (MRH) using the WHO PPS hospital questionnaire; and required data collection forms. The prescribed antibiotics were classified according to the WHO Access, Watch, and Reserve (AWaRe) classification. Ethics approval was obtained from the Sierra Leone Ethics and Scientific Review Committee. Statistical analysis was conducted using the SPSS version 22.ResultsBoth ODCH and MRH did not have the required AMS infrastructure; policy and practice; and monitoring and feedback mechanisms to ensure rational antibiotic prescribing. Of the 150 patients included in the survey, 116 (77.3%) were admitted at ODCH and 34 (22.7%) to MRH, 77 (51.3%) were males and 73 (48.7%) were females. The mean age was 2 years (SD=3.5). The overall prevalence of antibiotic use was 84.7% (95% CI: 77.9% – 90.0%) and 77 (83.8%) of the children aged less than one year received an antibiotic. The proportion of males that received antibiotics was higher than that of females. Most (58, 47.2 %) of the patients received at least two antibiotics. The top five antibiotics prescribed were gentamycin (100, 27.4%), ceftriaxone (76, 20.3%), ampicillin (71, 19.5%), metronidazole (44, 12.1%), and cefotaxime (31, 8.5%). Community-acquired infections were the primary diagnoses for antibiotic prescription.ConclusionThe non-existence of AMS programmes might have contributed to the high use of antibiotics at ODCH and MRH. This has the potential to increase antibiotic selection pressure and in turn the AMR burden in the country. There is need to establish hospital AMS teams and train health workers on the rational use of antibiotics.

The Impact of Continuous Labor Support on Cesarean Section Rates among Nulliparous Women: A Randomized Controlled Trial

Cesarean section (CS) rates are increasing globally, raising concerns about maternal and neonatal morbidity. Continuous labor support (CLS) has been shown to reduce CS rates in some settings, but its impact in Indonesia remains understudied. This study aimed to evaluate the effect of CLS on CS rates among nulliparous women in Purwakarta Regency, Indonesia. A randomized controlled trial was conducted at the Purwakarta Regional Hospital from January 2022 to December 2023. Eligible nulliparous women in labor were randomized to receive either CLS (n=210) from a trained midwife or standard care (n=205). The primary outcome was the rate of CS. Secondary outcomes included duration of labor, use of analgesia, maternal satisfaction, and neonatal outcomes. The CS rate was significantly lower in the CLS group (18.1%) compared to the standard care group (29.3%) (p=0.02). Women in the CLS group also reported higher satisfaction with their birth experience. No significant differences were found in other secondary outcomes. Continuous labor support provided by a trained midwife significantly reduces CS rates among nulliparous women in Purwakarta Regency, Indonesia. Implementing CLS as a routine practice may help address the rising CS rates and improve maternal birth experiences in this setting.

Two-year mortality and seizure recurrence following status epilepticus in Auckland, New Zealand: A prospective cohort study

PurposeTo document the 2-year mortality and seizure recurrence rate of a prospective cohort of patients identified with status epilepticus (SE). MethodsPatients presenting to any hospital in the Auckland region between April 6 2015, and April 5 2016, with a seizure lasting 10 min or longer were identified. Follow up was at 2 years post index SE episode via telephone calls and detailed review of clinical notes. ResultsWe identified 367 patients with SE over the course of one year. 335/367 (91.3 %) were successfully followed up at the 2-year mark. Two-year all-cause mortality was 50/335 (14.9 %), and 49/267 (18.4 %) when febrile SE was excluded. Two-year seizure recurrence was 197/335 (58.8 %). On univariate analyses, children (preschoolers 2 to < 5 years and children 5 to < 15 years), Asian ethnicity, SE duration <30 mins and acute (febrile) aetiology were associated with lower mortality, while older age >60 and progressive causes were associated with higher mortality on both univariate and multivariate analyses. Age < 2 years and acute aetiology were associated with lower seizure recurrence, while non convulsive status epilepticus (NCSE) with coma and a history of epilepsy were associated with higher seizure recurrence. On multivariate analyses, a history of epilepsy, as well as having both acute and remote causes were associated with higher seizure recurrence. ConclusionsAll-cause mortality in both the paediatric and adult populations at 2 years was lower than most previous reports. Older age, SE duration ≥30 mins and progressive aetiologies were associated with the highest 2-year mortality, while febrile SE had the lowest mortality. A history of epilepsy, NCSE with coma, and having both acute and remote causes were associated with higher seizure recurrence at 2 years. Future studies should focus on functional measures of outcome and long-term quality of life.

Evaluasi Rasionalitas Insulin Pada Pasien Diabetes Mellitus Tipe 2 Rawat Jalan di RSUD Kota Madiun Periode 2022

Diabetes mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia that occurs due to defects in insulin secretion, insulin action or both. Diabetes mellitus (DM) is currently a global health threat. Various epidemiological studies have shown an increase in the incidence and prevalence of DM in the world. Based on data from the profile of the East Java Health Office in 2021, it is estimated that DM patients in Madiun City rank fourth in the East Java region. . Objective: This research was conducted to determine the evaluation of the rationality of insulin in type 2 DM patients in the Outpatient Hospital of Madiun City Hospital for the period 2022. Methods: This research method is in the form of an observational research, retrospective data collection in the form of medical records of history of type 2 diabetes mellitus patients at Outpatient Hospital at RSUD Madison City. The total population in this study in the period January - December 2022 was 165 patients. Results: From the 62 type 2 DM patients who were outpatients at Madiun City Regional Hospital, it was found that 14.52% using single insulin and 12.90% used Detemir insulin. The use of the insulin combination was 85.48% and the Detemir – Aspart insulin combination was 58.06%. Conclusion: Evaluation of the rationality of insulin use showed that the correct drug was 100% and the correct dose was 93,55%.

Characteristics of low, moderate and high severity trauma hospitalisations in a health region of Aotearoa New Zealand-10-year review.

To describe the incidence, characteristics, outcomes and hospital costs of patients admitted to hospital following trauma in a health region in Aotearoa New Zealand over a 10-year period. A retrospective, observational study used data from the Te Manawa Taki (TMT) regional trauma registry to identify patients of all ages and injury severities that were admitted to hospital following injuries from 2013 to 2022, inclusive. This study reports on incidence of injuries with regard to age, gender, ethnicity, injury severity score (ISS), injury characteristics and direct cost to TMT facilities. Searches identified 60,753 trauma events leading to patient admission to hospitals in the TMT region. Of these, 81.9% were low-severity trauma, 10.2% were moderate-severity trauma and 7.9% were high-severity trauma. There were statistically significant relationships between gender, ethnicity and ISS category. Males were more likely to be hospitalised for any traumatic injuries. High-severity trauma is dominated by road traffic injuries and low-severity trauma is dominated by falls. Advanced age was associated with higher injury severity. The direct cost of trauma care to TMT hospitals increased by 122% during the 10-year period. The study has identified the incidence, demographic features, severity, costs and outcomes for trauma patients admitted to hospitals in the TMT region of Aotearoa New Zealand over a continuous 10-year period. The volumes and costs of injury represent a significant burden on the health system, individuals and communities. Detailed understanding of the causes and costs of injuries of all severities will inform prevention activities, clinical quality improvement and health service planning.

Occurrence and environmental risk assessment of pharmaceuticals in the Mondego river (Portugal)

In this case study pharmaceuticals were analysed in the Mondego river (Portugal) and their environmental risk assessed by means of risk quotients based on an extensive retrieval of ecotoxicological data for freshwater and saltwater species. The Mondego river crosses Coimbra, the most populated city in the Portuguese Centro Region hosting a complex of regional hospitals. Environmentally relevant and prioritised pharmaceuticals were investigated in this study and their potential hazards were evaluated by conducting a separate risk assessment for the freshwater and estuary parts of the examined river section.A target analysis approach with method detection limits down to 0.01 ng L−1 was used to determine pharmaceuticals. Twenty-one prioritised target analytes out of seven therapeutical classes (antibiotics, iodinated X-ray contrast media (ICM), analgesics, lipid reducers, antiepileptics, anticonvulsants, beta-blockers) were investigated by applying ultra-high pressure liquid chromatography coupled to a triple quadrupole mass spectrometer equipped with an electrospray ionisation source.The relative pattern of pharmaceuticals along the middle to the lower Mondego showed a quite uniform picture while an approximately 40fold increase of absolute concentrations was observed downstream of the wastewater treatment plant (WWTP) discharge of Coimbra. The most frequently measured substance groups were the ICM, represented by the non-ionic ICM iopromide (βmin: 3.03 ng L−1 - βmax: 2,810 ng L−1). Environmentally more critical substances such as carbamazepine, diclofenac, and bezafibrate, with concentrations up to and 52.6 ng L−1, 59.8 ng L−1, and 10.2 ng L−1 respectively, may potentially affect aquatic wildlife. Carbamazepine revealed elevated risk quotients (RQs >1) along the middle and lower Mondego with a maximum RQ of 53 downstream of Coimbra. Especially for saltwater species, carbamazepine and clarithromycin pose high potential risks.Especially in periods of low water discharge of the Mondego river, other pharmaceuticals as diclofenac and bezafibrate may pose additional risks downstream of the WWTP.

Healthcare workers’ knowledge, attitude and practices on infection prevention and control in the context of the COVID-19 pandemic at the Faranah regional hospital and associated healthcare centers, Guinea

BackgroundIn response to the COVID-19 pandemic, WHO launched a strategic preparedness and response plan, outlining public health measures to support countries worldwide. Healthcare workers have an increased risk of becoming infected and their behaviour regarding infection prevention and control (IPC) influences infection dynamics. IPC strategies are important across the globe, but even more in low-resource settings where capacities for testing and treatment are limited. Our study aimed to assess and implement COVID-19 pandemic preparedness and response measures in Faranah, Guinea, primarily focusing on healthcare workers’ IPC knowledge, attitude and practice (KAP).MethodsThe study was conducted between April 2020 and April 2021 assessing IPC pandemic preparedness and response measures such as healthcare workers’ KAP, alcohol-based handrub (ABHR) consumption and COVID-19 triaging in the Faranah Regional Hospital and two associated healthcare centres. The assessment was accompanied by IPC training and visual workplace reminders and done in pre- and post- phases to evaluate possible impact of these IPC activities.ResultsThe overall knowledge score in the Faranah Regional Hospital was 32.0 out of 44 at baseline, and did not change in the first, but increased significantly by 3.0 points in the second follow-up. The healthcare workers felt closer proximity to SARS-CoV-2 overtime in addition to higher stress levels in all study sites. There was significant improvement across the observed triaging practices. Hand hygiene compliance showed a significant increase across study sites leading to 80% in Faranah Regional Hospital and 63% in healthcare centers. The average consumption of ABHR per consultation was 3.29 mL with a peak in February 2020 of 23 mL.ConclusionDespite increased stress levels among HCWs, the ongoing IPC partnership well prepared the FRH in terms of triaging processes with a stronger impact on IPC practice than on theoretical knowledge. Throughout the pandemic, global shortages and surges in consumption did not affect the continuous ABHR provision of the FRH. This highlights local ABHR production as a key pandemic preparedness strategy.

High prevalence of diabetes in a regional Australian hospital highlights the need to prioritise inpatient diabetes care.

Regional centres have smaller workforces in acute diabetes care compared to their metropolitan counterparts. A cross-sectional audit performed at Albury Hospital identified a high prevalence (34%) of diabetes for inpatients compared with metropolitan centres. The high prevalence highlights the need for all healthcare services to consider appropriate resources for the management of diabetes in people admitted to hospital.

Effectiveness of bedside staplers in bariatric robotic procedures

BackgroundFew studies have evaluated the use of laparoscopic staplers in robotic procedures (bedside stapling, BS). This study aims to evaluate the effectiveness of BS compared with robotic staplers (RS) in bariatric robotic procedures.MethodsPatients who underwent robotic sleeve gastrectomy or gastric bypass elective procedures between 1/1/2021 and 12/31/2021 were extracted from PINC AI™ Healthcare Data. The following clinical outcomes were compared: blood transfusion, bleeding, anastomotic leak, intensive care unit (ICU) visit, and 30-day readmission, operating room (OR) time, inpatient costs, and length of stay. We evaluated baseline balance in BS and RS and bivariate association between covariates and outcomes using Chi-square or Fisher exact test and t-test or ANOVA. Multivariable general linear mixed models (GLMMs) with respective gamma or binomial distribution and log-link function were used to obtain adjusted outcomes variations between BS and RS.ResultsTotal of 7268 discharges were included with 1603 (22.1%) BS and 5665 (77.9%) RS cases. RS cases consisted of a higher number of patients who were Hispanic (17.0% vs. 9.4%), had Medicaid (26.9% vs. 19.4%) and underwent sleeve gastrectomy (68.4% vs. 53.5%). Higher proportions of RS cases were done by providers in Northeast region (35.5% vs. 24.3%), smaller size (< 500 beds; 71.1% vs. 52.3%), and teaching hospitals (59.4% vs. 39%). The adjusted outcomes variations demonstrated that patients that had RS were significantly more likely to have blood transfusions, ICU stays, increased ORT (19 min) and costs ($1273). Sensitivity analysis showed similar results, except no significant differences in blood transfusion rates in both groups.ConclusionsBedside staplers significantly reduce healthcare resource utilization with equivalent effectiveness and fewer ICU stays compared to robotic staplers.Graphical abstract

Retrospective study on suicide attempts among psychiatric emergencies admitted to the emergency department of a Regional hospital in Turkey

IntroductionThe aim of this study was to determine the sociodemographic characteristics of psychiatric emergencies presenting to emergency departments (ED), the provisional diagnoses and reasons for consultation by emergency physicians, and to determine the rate of suicide attempts among patients presenting to emergency departments for psychiatric emergencies.MethodsThe records of all patients aged 18 years and older admitted to the emergency department of the Department of Emergency Medicine, a tertiary hospital, with either a pre-existing psychiatric diagnosis or a new psychiatric provisional diagnosis made by emergency physicians between January 2020 and December 2023 were reviewed.ResultsAccording to the data obtained in the study, it was determined that the most common provisional diagnoses made by emergency physicians in psychiatric emergencies were suicide attempts (41.88%), agitation (21.94%), schizophrenia (8.44%), psychosis (7.91%) and manic attack (6.54%). It was found that 49.3% of psychiatric emergencies resulted in discharge and 25.5% resulted in hospitalisation. Among the provisional diagnoses, depression, mutism and sleep disorders were most commonly associated with refusal of treatment, while depression and suicide were the most common reasons for hospitalisation. Among psychiatric emergency patients who attempted suicide, medication, sharp objects and chemicals were the most common substances ingested.DiscussionIn this study, it was determined that a great portion of the emergency psychiatric cases admitted to the emergency department consisted of patients who attempted suicide. However, due to the crowdedness and fast pace of emergency departments, it is understood that in psychiatric emergencies, epidemiological profile data are missing in the files of the cases and detailed medical history cannot be obtained from the patients We think that recording better data of patient who admitted a psychiatric condition to the emergency department will provide better information about the patients in future visits and improve the care to be provided. Psychiatrists and psychiatric nurses recommend the implementation of emergency department-based rehabilitation programs for these patients.

PENGARUH KUALITAS PELAYANAN, FASILITAS DAN CITRA PERUSAHAAN TERHADAP LOYALITAS PASIEN RAWAT INAP PADA RSUD ASEMBAGUS DENGAN KEPUASAN SEBAGAI VARIABEL INTERVENING

This research aims to determine the role of satisfaction in mediating service quality, facilities, and company image in the loyalty of inpatients at Asembagus Regional Hospital. The population in this study were all inpatients at Asembagus Regional Hospital. The sampling technique used in this research is the probability sampling method, which uses a random sampling technique. Data analysis and hypothesis testing in this research used the Partial Least Square - Structural Equation Model (PLS-SEM). The research results show that service quality has a positive and significant effect on satisfaction, facilities have a positive but not significant effect on satisfaction, company image has a positive and significant effect on satisfaction, company image has a significant effect on satisfaction, company image has a positive but not significant effect on patient loyalty, facilities has a positive and significant effect on patient loyalty, service quality has a positive and significant effect on patient loyalty, satisfaction has a positive and significant effect on patient loyalty, service quality has a positive but not significant effect on patient loyalty through satisfaction, facilities have a positive but not significant effect on patient loyalty through satisfaction, company image have a positive and significant effect on patient loyalty through satisfaction.