Inpatient Medical Wards Research Articles

Impact of a Delirium Protocol on Deliriogenic Medication Use in Hospitalized Older Veterans.

Background The Southern Arizona VA Health Care System (SAVAHCS) implemented a delirium prevention and treatment protocol in 2019. Objective The primary objective of this study was to determine if the implementation of a delirium protocol influenced deliriogenic medication use in hospitalized geriatric veterans. The secondary objectives were to compare the rates of delirium diagnosis, hospital length-of-stay, and rates of newly started deliriogenic medications during admission pre- and post-protocol. Methods This study was a retrospective, secondary data analysis study. Veterans 65 years of age and older who were admitted to an inpatient medical ward at the SAVAHCS for 24 hours or more between January 1, 2018 and December 31, 2018 (pre-protocol) or January 1, 2021 and December 31, 2021 (post-protocol) were included. Patients were excluded if they had a diagnosis of alcohol or benzodiazepine withdrawal upon admission. Results A total of 5491 patients were included in this study; 2940 (53.5%) in the pre-protocol group and 2551 (46.5%) in the post-protocol group. Patients received at least one deliriogenic medication during their admission in the post-protocol group (36.2%) compared with the pre-protocol group (34.1%), but there was no statistically significant difference (P = 0.098). There were also no significant differences in the rates of documentation of delirium as a diagnosis at discharge, hospital length-of-stay, or the rates of newly started deliriogenic medications during admission between the groups. Conclusion Implementation of a delirium prevention and treatment protocol at the SAVAHCS did not significantly impact the use of deliriogenic medications in hospitalized geriatric veterans.

Prevalence, Risk Factors, and Result Features in the Detection of Latent Tuberculosis Infection in Thai Healthcare Workers Using QuantiFERON-TB Gold Plus.

Introduction Latent tuberculosis infection (LTBI) is an enormous reservoir for tuberculosis (TB), and healthcare workers (HCWs) are at high risk for TB infection. QuantiFERON-TB Gold Plus (QFT-Plus) is an alternative to the tuberculin skin test for LTBI detection, but data on its application and LTBI detected by QFT-Plus in high TB burden countries are limited. This study aimed to determine the prevalence of LTBI and its risk factors, and to investigate the QFT-Plus results in Thai HCWs. Methods A cross-sectional analytical study was conducted among HCWs at a secondary care hospital in Health Region 5, Thailand. Eligible HCWs were enrolled and underwent QFT-Plus testing. Interferon-gamma (IFN-γ) values in tubes were analysed. The prevalence and associated risk factors for LTBI were assessed based on laboratory and sociodemographic data. Logistic regression analyses were applied to calculate odds ratios (OR, aOR) reported with 95% confidence intervals (CI). Results Of the 269 participants enrolled, their median age was 42 years and 93.31% (n = 251/269) were female. The majority (n = 178/269, 66.17%) were nurses or nurse assistants and 42.75% (n = 115/269) worked in the inpatient medical wards. Overall, the QFT-Plus results showed 110 (40.89%) positive with good agreement (93.68%; κ 0.87) and high correlation (Spearman's ρ 0.91) of IFN-γ concentrations in the two antigen tubes. A true difference inIFN-γ values for predicting a recent infection was found about 7.81% (n = 21/269). By univariate and multivariate analyses, the participants' age > 40 years (OR = 3.21, 95% CI: 1.84-5.64%; aOR = 2.05, 95% CI: 1.07-3.96%), and employment duration > 10 years (OR = 3.19, 95% CI: 1.66-6.37%; aOR = 2.34, 95% CI: 1.05-5.21%) were significantly associated with the increased risk of LTBI (p-value < 0.05). Conclusions The prevalence of LTBI among these HCWs was high, and the increased risk factors for LTBI according to QFT-Plus positivity were age over 40 years and working time in the hospital for more than 10 years. It is important to screen HCWs in this setting for LTBI, particularly those with long employment durations and older ages. The high prevalence of LTBI suggests that LTBI management, such as regular screening and treatment, should be considered together with strengthening preventive measures, especially in high-risk groups.

EXERCISE INTERVENTIONS ON THE ACUTE MEDICAL WARD: A SYSTEMATIC REVIEW AND META-ANALYSIS

INTRODUCTION &amp; AIMS An acute hospital stay is associated with high proportions of sedentary time, and bed rest, with low physical activity participation for the stay duration. Exercise prescription on the acute inpatient medical ward can prevent decline, or at least maintain, physical outcomes in the adult population. The purpose of this systematic review with meta-analyses was to evaluate the effectiveness of exercise intervention on the acute inpatient medical ward on physical outcomes of muscle strength, aerobic capacity and balance in adults, compared with usual care. METHODS Medline, CINAHL and EMBASE were searched from inception to 20th April 2023. Randomised controlled trials in English, which reported muscle strength, aerobic capacity or balance outcomes for adults who received an exercise intervention on an acute medical ward were included. Studies were excluded if they did not have a control group receiving usual care. Study quality was assessed using the PEDro and TESTEX scales. The GRADE rating assessed quality of evidence to evaluate certainty of effect. Where studies with continuous data used different measures of assessment, and reported post-test outcomes, standardised mean differences with a random effects model was used. For studies with continuous data that used different measures of assessment, and reported change from baseline scores, a weighted mean difference with a random effects model was used. Significance was set at p&amp;lt;0.05. RESULTS Twelve studies were included, with 1,273 unique participants, which compared exercise intervention with usual care. Low quality evidence demonstrated a significant difference between groups for aerobic capacity (p=0.02) and maximum isometric strength (p=0.001). A meta-analysis of balance outcomes could not be performed. CONCLUSION Exercise prescribed during an acute medical ward stay may improve participants’ aerobic capacity and maximum isometric strength.

Prognostic awareness and prognostic information preferences among advanced cancer patients in Kenya.

Cancer is the third leading cause of death in Kenya. Yet, little is known about prognostic awareness and preferences for prognostic information. To assess the prevalence of prognostic awareness and preference for prognostic information among advanced cancer patients in Kenya. Outpatient medical oncology and palliative care clinics and inpatient medical and surgical wards of Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. The authors surveyed 207 adults with advanced solid cancers. The survey comprised validated measures developed for a multi-site study of end-of-life care in advanced cancer patients. Outcome variables included prognostic awareness and preference for prognostic information. More than one-third of participants (36%) were unaware of their prognosis and most (67%) preferred not to receive prognostic information. Increased age (OR = 1.04, 95% CI: 1.02, 1.07) and education level (OR: 1.18, CI: 1.08, 1.30) were associated with a higher likelihood of preference to receive prognostic information, while increased symptom burden (OR= 0.94, CI: 0.90, 0.99) and higher perceived household income levels (lower-middle vs low: OR= 0.19; CI: 0.09, 0.44; and upper middle- or high vs low: OR= 0.22, CI: 0.09, 0.56) were associated with lower odds of preferring prognostic information. Results reveal low levels of prognostic awareness and little interest in receiving prognostic information among advanced cancer patients in Kenya.Contribution:Given the important role of prognostic awareness in providing patient-centred care, efforts to educate patients in Kenya on the value of this information should be a priority, especially among younger patients.

1899 Early intervention by physiotherapy and occupational therapy in older inpatient population

Abstract Background Currently, on inpatient medical wards at University Hospitals of Leicester NHS Trust, first contact by physiotherapy and occupational therapy is made when patients become medically optimised for discharge. This is due to a number of reasons such as staffing and resource shortages. Aim Analyse the effects of early intervention by therapy on patients on a geriatric medicine inpatient ward. It is hypothesised that earlier intervention can improve patient and service outcomes. Method A data sheet was created to capture baseline information including mobility/care needs prior to admission, date of initial contact by therapy, mobility/care on discharge, length of stay and discharge destination. Data was collected over two phases; initial therapy contact at point of patient being medically optimised, and then with the planned intervention of proactive therapy input early in a patient’s admission. Results The data shows an improvement in all measured patient outcomes in the intervention group. The average time from admission to therapy first contact reduced from 7 days to 2 days. The average length of stay reduced from 14.5 days to 7 days in the intervention group. 70% of patients left the hospital with a reduction in their mobility status in the control group, whereas only 32% of patients left with worse mobility in the intervention group. 41% of patients in the control group left with new or increased care provision compared to 36% in the intervention group. The data also showed that a higher proportion of patients were mobilised by ward staff and less patients were discharged to 24-hour care settings in the intervention group. Conclusion Therapy (with the help of the multi-disciplinary team) should proactively identify patients in need of therapy input as soon as safely possible. This research shows that adopting this approach leads to improvements for our patients and our service.

Psychological impact of first admission with cardiovascular disease in a tertiary hospital in Oman

Background and objectivesCardiovascular diseases (CVD) are associated with substantial psychological effects that can adversely influence long term prognosis. The aim of this study was to determine the psychological effect of the first hospital admission for acute coronary syndrome (ACS) or congestive heart failure (CHF) in an adult Omani population. MethodsThis cross-sectional questionnaire based study used the Hospital Anxiety and Depression Scale. Patients were recruited from the in-patient cardiology and medical wards of our institution. Patients with a prior hospital admission for CHF and ACS were excluded. The questionnaire was administered between days 3 and 7 after admission once patients were clinically stable. ResultsThe study included 116 patients (mean age 60.3 + 13.8 years; 78 (67.8%) men), comprising 52 patients with ACS and 64 patients with CHF. Based on the scores, a total of 45 (38.8%) patients had moderate to severe anxiety, and 32 (27.6%) had moderate to severe depression. Patients with severe anxiety tended to be younger, and no other factors predicted anxiety or depression. The proportion of patients with severe depression was higher among patients with CHF (31.4%), and no other differences were observed between patients with ACS or CHF. ConclusionA substantial proportion of patients admitted to our institution in Oman with CVD had severe anxiety and depression. Treating physicians and caregivers should be more open to identifying these patients, and steps should be taken to address their psychological wellbeing along with the medical management of their illness.

Eosinophilia: Clinical experience from a tertiary care center in India

Objectives: Eosinophilia is a prevalent laboratory abnormality that we encounter in day-to-day practice both in outpatient and inpatient settings. The causes range from primary to secondary spanning from an allergic response to clonal neoplastic proliferations. Identifying an etiology may be challenging in many cases and may sometimes require extensive evaluation. We aimed to find the clinical and etiological profile of patients with eosinophilia and the association of eosinophilia with end-organ involvement and IgE levels. Material and Methods: The study was designed as a cross-sectional study over a period of two years (2019 to 2020). The study setting was outpatient and inpatient medical wards of a tertiary care center in north India. A detailed history and clinical examination were done on patients with eosinophilia detected in blood counts. Standard diagnostic protocols guided by positive clinical and diagnostic tests were followed to find etiologies in patients with eosinophilia. Results: In our study, the most common cause overall and in each category of eosinophilia was parasitic infections (35%) followed by allergic disorders (29.3%). The most frequent symptoms were cough (32%), generalized weakness (25.5%), dyspnoea (24%), and a history suggestive of atopy (21%). On clinical examination, the most common finding was rhonchi or wheeze (24.5%). The most commonly affected end-organ was the lungs (13.2%) followed by the skin (4.7%). Conclusion: Parasitic infections are the most common cause of eosinophilia in our population. IgE levels correlate with a diagnosis of atopy or asthma and do not show a correlation with AEC. The lungs were the most frequently involved as end-organ in eosinophilia followed by the skin. We found no significant association between end-organ involvement and the degree of eosinophilia which highlights the importance of working up symptomatic patients for end-organ damage irrespective of the eosinophil count.

COVID-19 and Cardiomyopathy in African Americans: An Early Single-Center Experience.

Introduction The 2019 coronavirus pandemic has taken a toll on our society. Although most patients report minimal symptoms, a small proportion of patients have reported significant respiratory symptomsthat led to admission to the inpatient medical ward or even the intensive care unit. Complications and long-term sequela of COVID-19 are still being reported and studied. The presence of cardiomyopathy, whether established or new-onset and its effect on inpatient mortality, admission to the intensive care unit or length of stay hasn't been studied. Methods All inpatient hospitalizations in our database between March 1, 2020, and April 30, 2020, due to COVID-19 were reviewed. Patients who had at least a limited echocardiogram during this time were included in the study if they were above the age of 18. Patients were then assigned to three groups. The first group had patients with normal left ventricular systolic function. The second group had established cardiomyopathy that persisted throughout admission. The third group had patients who were found to have new-onset cardiomyopathy during admission. Results The inpatient mortality, although high and variable, wasn't significantly different between the three groups. Also, there was no significant difference between admission to the intensive care unit, disposition at discharge, or oxygenation status at 24 hours between the three groups. The length of stay in the established cardiomyopathy group was markedly lower, and we suspect that could be due to more aggressive discussions about end-of-life care. Conclusion Early COVID-19 experience at our center revealed a relatively high mortality rate that was primarily due to respiratory failure. The presence of established or new cardiomyopathy didn't appear to alter the outcomes significantly early in the pandemic.

Clinical Presentation, Complications and Outcome of Measles in Pediatric Population at Tertiary Care Hospital

Measles is highly contagious infection with person-to-person transmission through droplet infection in developing countries, which can lead to death in complicated cases. Bronchopneumonia, encephalitis, gastroenteritis with renal failure and electrolyte imbalance are common complications in pediatric age group. Objective: To determine complications of measles in hospitalized children at Tertiary Care Children Hospital. Methods: This cross-sectional study conducted at inpatient medical wards of National Institute of Child Health from July-Dec 2022. All patients hospitalized in study duration with the diagnosis of measles from 6 months till 12 years of age were enrolled. History, examination, laboratory tests, treatment and outcome were recorded and analyzed. Results: Children enrolled were 185, the mean age ± SD of presentation was 26.7 ± 27.1 months, with 56.8% males. Mean weight of patients was 10.48 ± 9.7kg. Common measles complications were bronchopneumonia 160(86.5%), acute diarrhea 64(34.6%) encephalitis 24(13%), myocarditis 16(8.6%), acute kidney injury 11(5.9%), and otitis media 18(9.7%). Conclusions: Most common clinical features were fever, maculopapular rash, cough and coryza. Bronchopneumonia was the main reason of hospitalization in majority of patients and leading cause of death in 13.5% of patients along with encephalitis and myocarditis. Additional strategies are required by government for elimination of vaccine preventable measles from Pakistan.

Prevalence and Risk Factors of Potential Drug-Drug Interactions in the In-Patient Medical Wards: A Hospital-Based Cross-Sectional Study

Evidence shows that half of the Adverse Drug Reactions (ADRs) resulting from Drug-Drug Interactions (DDI) are predictable and preventable. Hospitalized patients are more expected to develop DDI. The current study aims to assess the prevalence, risk factors, and severity of PDDIs among hospitalized patients. This is a cross-sectional study that was conducted in medical wards of a NGO charity hospital located in Bathalapalli, Anantapur district. Patients aged 18 years or more, and admitted to the in-patient medical wards taking more than one medication have been selected for the study. A total of 310 subjects who met the study criteria were enrolled in the study after taking oral and written informed consent. Patient demographics, a list of medications, and clinical characteristics were collected from admission to discharge by the review of medical records and patient interviews. The collected data were subjected to identify and grade the severity of PDDI by using IBM Micromedex® Drug Interaction Checker. Among 310 in-patients, 82 cases had 127 PDDI with a prevalence of 26.45%. The majority of the PDDI are moderate (57; 44.9%) in severity level. Factors like the advanced age group of more than 40 years, more than one comorbidity, staying in the hospital for more than four days, and more than five drugs per prescription were positively associated with having PDDI with a P value less than 0.05. Clinical pharmacists need to work with the healthcare team to provide interventions to reduce clinically significant interactions and improve clinical outcomes.

Improving the quality of care for adolescents and young adults on an adult medical ward

Adolescents and young adults have health needs that are distinctly different from children and adults. A lack of education and training is reported by clinicians to be one of the main barriers to providing comprehensive developmentally appropriate care to young people, including the provision of confidential healthcare and taking a holistic approach. This study documents the current provision of care to young people on an adult inpatient medical ward at a large tertiary teaching hospital in Auckland. Forty-three staff and 40 patients aged 16-24 years on an adult medical ward completed surveys, which were based on the Northern Regional Alliance, Northern Regional Youth Health Network Standards for Quality Care for Adolescents and Young Adults in Secondary or Tertiary Care. Few (12%) staff had completed any specific training in looking after adolescent and young adult patients. Confidentiality was not routinely discussed with young people by 50% of clinicians, and only 23% of staff reported that they see a young person alone as part of their consultation or admission. Less than half of young people reported receiving a comprehensive psychosocial assessment that included sexual health, mental health and suicide, and safety. Key components of comprehensive developmentally appropriate healthcare were not regularly carried out by staff on an adult medical ward. These findings suggest that further education and training, and service improvements are needed in tertiary adult hospital settings.

How Pediatric Hospitals Must Adapt to the Adolescent Mental Health Crisis.

How Pediatric Hospitals Must Adapt to the Adolescent Mental Health Crisis.

146 Provision of Adolescent Confidential Care in a Tertiary Care Setting

Abstract Primary Subject area Adolescent Medicine Background Adolescents are more likely to seek care and disclose sensitive health information if confidentiality is assured. Several national societies endorse the need for confidential care at all health-related encounters with adolescents. Many adolescents have infrequent contact with the medical system other than unscheduled urgent care in pediatric hospitals. Little is known regarding the effectiveness and feasibility of providing confidential care to adolescents in a tertiary pediatric hospital setting. Objectives We sought to evaluate the frequency, quality and factors associated with the provision of confidential care to adolescent patients at a pediatric teaching hospital. Design/Methods We undertook a cross-sectional survey of adolescents presenting to an urban tertiary pediatric hospital from December 2019 to December 2020. Adolescents eligible for confidential care under Quebec legislation (aged 14-18) were recruited from a convenience sample either when presenting to the Emergency Department (ED) for low acuity visits (CTAS 3-5) or when hospitalized on the pediatric inpatient medical ward. Participants completed a standardized, self-administered electronic questionnaire regarding the confidential care provided at their initial ED or inpatient medical encounter. Multivariable logistic regression was used to identify factors associated with the provision of confidential care. Results A total of 406 adolescents completed the survey (335 ED; 71 inpatient). The majority of respondents identified as female (233, 57.4%), white/Caucasian (260, 64.0%) and presented to the hospital with a parent (367, 90.4%). Overall, confidential care was offered to 137 (33.7%) respondents, with 95 (69.3%) accepting confidential time alone with their doctor. Among participants receiving confidential care, 43.2% endorsed that the limits of confidentiality were not reviewed, 24.2% reported that their private issues were still discussed in front of family members and 15.8% had private information that they had wished to discuss but were not asked. When offered, there was no difference between hospitalized and ED patients declining confidential care (32/100 vs. 10/37; p=0.73). The most common reasons identified for declining private time were that it was deemed unnecessary (29/42, 69.0%), perceived risk of parental conflict (8/42, 19.0%), or concerns for violation of trust by the medical team (5/42, 11.9%). Multivariable analysis found inpatient location (aOR 2.28, 1.04-5.01), female gender (aOR 2.02, 1.21-3.38), age (aOR 1.67, 1.03-2.69), psychiatric diagnosis (aOR 8.10, 1.47-44.6), resident involvement (aOR 1.96, 1.09-3.53) and overnight assessment (aOR 0.23, 0.06-0.90) were all associated with the provision of confidential care, after adjusting for patient- and hospital-level covariates. Conclusion Survey results suggest inadequate provision of confidential care in an academic pediatric hospital. Adolescents receiving confidential care were not consistently explained to regarding the limits of confidentiality, and breaches were reported in a quarter of all cases. Confidentiality-specific education initiatives are necessary to improve the frequency and quality of confidential care for adolescents in tertiary care settings.

Adaptation of Adult Pathways to Improve the Care of Adult Patients at Pediatric Hospitals.

Adaptation of Adult Pathways to Improve the Care of Adult Patients at Pediatric Hospitals.

Chest X-ray interpretation does not complement Xpert MTB/RIF in diagnosis of smear-negative pulmonary tuberculosis among TB-HIV co-infected adults in a resource-limited setting

BackgroundChest X-ray (CXR) interpretation remains a central component of the current World Health Organization recommendations as an adjuvant test in diagnosis of smear-negative tuberculosis (TB). With its low specificity, high maintenance and operational costs, utility of CXR in diagnosis of smear-negative TB in high HIV/TB burden settings in the Xpert MTB/RIF era remains unpredictable. We evaluated accuracy and additive value of CXR to Xpert MTB/RIF in the diagnosis of TB among HIV-positive smear-negative presumptive TB patients.MethodsHIV co-infected presumptive TB patients were recruited from the Infectious Diseases Institute outpatient clinic and in-patient medical wards of Mulago Hospital, Uganda. CXR films were reviewed by two independent radiologists using a standardized evaluation form. CXR interpretation with regard to TB was either positive (consistent with TB) or negative (normal or unlikely TB). Sensitivity, specificity and predictive values of CXR and CXR combined with Xpert MTB/RIF for diagnosis of smear-negative TB in HIV-positive patients were calculated using sputum and/or blood mycobacterial culture as reference standard.ResultsThree hundred sixty-six HIV co-infected smear-negative participants (female, 63.4%; hospitalized, 68.3%) had technically interpretable CXR. Median (IQR) age was 32 (28–39) years and CD4 count 112 (23–308) cells/mm3. Overall, 22% (81/366) were positive for Mycobacterium tuberculosis (Mtb) on culture; 187/366 (51.1%) had CXR interpreted as consistent with TB, of which 55 (29.4%) had culture-confirmed TB. Sensitivity and specificity of CXR interpretation in diagnosis of culture-positive TB were 67.9% (95%CI 56.6–77.8) and 53.7% (95%CI 47.7–59.6) respectively, while Xpert MTB/RIF sensitivity and specificity were 65.4% (95%CI 54.0–75.7) and 95.8% (95%CI 92.8–97.8) respectively. Addition of CXR to Xpert MTB/RIF had overall sensitivity and specificity of 87.7% (95%CI 78.5–93.9) and 51.6% (95%CI 45.6–57.5) respectively; 86.2% (95%CI 75.3–93.5) and 48.1% (95%CI 40.7–55.6) among inpatients and 93.8% (95%CI 69.8–99.8) and 58.0% (95%CI 47.7–67.8) among outpatients respectively.ConclusionIn this high prevalence TB/HIV setting, CXR interpretation added sensitivity to Xpert MTB/RIF test at the expense of specificity in the diagnosis of culture-positive TB in HIV-positive individuals presenting with TB symptoms and negative smear. CXR interpretation may not add diagnostic value in settings where Xpert MTB/RIF is available as a TB diagnostic tool.

AHA telemetry guidelines improve telemetry utilization in the inpatient setting.

Overuse of telemetry among hospitalized patients results in poor patient care and wasted health care dollars. Guidelines addressing telemetry use have been developed by the American Heart Association (AHA) and are effective when applied to specific clinical practices and high-value care. The purpose of our intervention was to facilitate more effective utilization of telemetry in our hospital. We aimed to reduce patient days on telemetry through use of AHA guideline criteria for telemetry. We used Plan-Do-Study-Act cycles with chart review for pre- and postintervention measurement collection. We included patients hospitalized at The Brooklyn Hospital Center on inpatient general medical wards from January 1, 2017, through July 31, 2018. The intervention consisted of a standard process of reviewing patients on telemetry based on AHA guidelines, educating teams on the guidelines, and changes to telemetry order sets. The primary outcome measured was the total number of days that patients remained on telemetry. Secondary measures included the daily number of telemetry downgrades and total number of patients on telemetry. Diagnosis-related group and case mix index were also noted. Patient average days on telemetry changed from 7.20 days preintervention to 3.51 days post intervention (P < .0001). The number of patients on telemetry with a diagnosis meeting AHA guidelines for telemetry increased. The stated intervention resulted in more effective use of telemetry, evidenced by fewer patient days on telemetry and increased numbers of patients on telemetry meeting AHA guidelines for telemetry.

Level of Anxiety among the Elderly Adults at Western Regional Hospital, Pokhara, Nepal

Anxiety disorders are abnormal states in which most striking features are mental and physical symptoms of anxiety, whichare not caused by organic brain disease or any other psychiatric disorder. This study aimed at exploring the level of anxietyamong the elderly adults in inpatient and outpatient departments of western regional hospital, Pokhara, Nepal.This is a hospitalbased cross-sectional study conducted in the outpatient as well as inpatient departments, medical and geriatric ward of westernregional hospital, Pokhara. We interviewed 318 respondents purposively using structured interview schedule. Geriatric Anxiety Scale (GAS) – Version 2.0 was used to assess anxiety symptoms. It was found an overall 68% had anxiety. The highestfrequency 209 (65.7%) respondents had moderate anxiety whereas only 7(2.2%) had high anxiety. Sex, religion and monthlyfamily income were significantlyassociated with level of anxiety (p&lt;0.05). The burden of anxiety among elderly patients visiting tertiary level health care suggestsfocusing on evidence-based interventions by health authority.&#x0D; Key words : Anxiety, Elderly, Magnitude, Nepal

1193. Assessing Sustainability of Hand Hygiene Adherence 5 Years after a Contest-Based Intervention in 3 Japanese Hospitals

BackgroundTo evaluate the 5-year sustainability of a multimodal intervention which included a prize to the hospital with the highest overall hand hygiene adherence rates among healthcare workers.MethodsDesign: An observational study using direct observation of hand hygiene adherence performed by a trained observer coupled with a survey of healthcare workers about their knowledge of hand hygiene practices. Setting: Three Japanese tertiary care hospitals. Study Population: Physicians and nurses working on an inpatient medical or surgical ward, an intensive care unit (ICU), or the emergency department. Outcome Measures: Hand hygiene adherence rates before patient contact using unobtrusive direct observation. Secondary outcomes were survey responses on a World Health Organization (WHO) questionnaire on hand hygiene.ResultsData for the current study were collected between September and December 2017 at the 3 participating hospitals. An additional 2,485 observations were conducted during this 5-year post-intervention assessment. These observations were compared with 2,679 observations from the pre-intervention period, and 2,982 observations from the 6-month post-intervention period. Hand hygiene adherence rates had previously improved significantly after the introduction of a multimodal intervention – based on principles recommend by the WHO – in 2012 and 2013 in 3 Japanese hospitals (18.0% pre-intervention to 32.7% 6-months post-intervention; P < 0.001). No significant changes were found in hand hygiene adherence in these hospitals 5 years after the original intervention (31.9% 5-years post-intervention; P = 0.53); however, substantial variability in hand hygiene adherence by unit and healthcare worker type was noted.ConclusionA multimodal hand hygiene initiative achieved sustained improvement in hand hygiene adherence in 3 Japanese hospitals 5 years after the original intervention. Disclosures All authors: No reported disclosures.

Afternoon ward rounds: bad for patients, bad for doctors?

Hospital medicine in the UK is under unprecedented pressure, with increasing demand on physicians as well as challenges in recruiting new doctors into the physicianly specialties. We sought to assess the prevalence of the afternoon ward round and its effect on those undertaking them. We sampled each hospital within our postgraduate region, surveying junior doctors working on inpatient medical wards. We surveyed roughly two-thirds of eligible doctors, -finding that 30% of juniors had some commitment, of varying frequency, to ward rounds beginning after 1.00pm. Of the -doctors involved in afternoon ward rounds, the majority felt they contributed to late finishes, delayed discharge of -patients, reduced team efficiency and reduced job -satisfaction. Just under 80% felt they were less likely to consider a career in hospital medicine as a result The afternoon ward round lives on, and we should not -underestimate its effect. Low junior doctor morale coupled with high work intensity can lead to burnout as well as -impairing the effectiveness of the clinical service. Clinical -leaders should consider leaving this practice in the past so we can cope with the challenges of the future.

SAT-538 A Dedicated Inpatient Bone Health Team Improves Screening Rates for Osteoporosis

BACKGROUND: Published reports continue to indicate osteoporosis is under-diagnosed in the United States and most significantly in men, with published rates of screening in primary care settings repeatedly below 20%; this despite that fact that men have been shown to have higher rates of fracture-related morbidity and mortality when compared to women (Cheng N, Green ME.. We have previously published how an interdisciplinary Bone Health Team (BHT) improves screening rates in the outpatient setting. Here we describe the results of identifying individuals for screening in the inpatient setting. METHODS: Over the course of 3 months, on 5 of 7 days per week, all patients on the inpatient medical wards of our hospital were reviewed for age-based screening eligibility (aged 70 years of over in men, aged 65 or over in women) based upon current National Osteoporosis Foundation and Endocrine Society guidelines. All individuals felt clinically appropriate for DXA and/or treatment recommendations were also earmarked for outpatient BHT follow-up. RESULTS: Of the 203 individuals identified as meeting age-based criteria, 200 (98.5%) were men and 3 (0.015%) were women, with ages ranging from 70 to 98, and with 48 (23.6%) having had dual energy x-ray absorptiometry (DXA) studies in the 2 years prior to identification (28 (58.3%) of which were performed by our outpatient program) and 13 (6.4%) with DXAs >2 years prior (range 3-11 years). Two had previously received recommendations for DXAs but had refused. Charts of all 155 (76.4% of the 203) without recent DXAs were reviewed: DXA was not felt to be clinically useful but treatment recommendations based upon fracture history were made in 7 (4.5% of the 155); 33 (21.2%) did not have DXA recommended related to goals of care; 18 (11.6%) received inpatient DXA recommendations and a post-hospital contact but declined the study; 5 (3.2%) were not local and would not have had follow-up; 4 (2.6%) did not get the recommended DXA for unclear reasons; 1 (0.6%) died during the hospitalization. Notably, of the 155 age-eligible without a DXA in the last 2 years, 87 (56.1% (42.9% of the total age-eligible)) went on to complete a DXA within the next 3 months. CONCLUSION: When compared to published rates for primary care, a dedicated inpatient BHT results in higher rates of DXA screening completion in those meeting age-based criteria.