Internal Wards Research Articles

Adjuvant chemotherapy-associated febrile neutropenia in a patient with breast malignancy: A case report

Adjuvant chemotherapy has been widely applied in patients with breast malignancy after surgery to prevent its recurrence and to improve survival comprehensively. Febrile neutropenia is one of the most life-threatening chemotherapy-associated toxicities. A 66 years old woman came to an emergency department of a secondary healthcare facility one week after her final chemotherapy with dose regimen of docetaxel and epirubicin, followed by having nausea, vomitus, and general fatigue with a fever of 38.2°C. Based on her medical record, she had experienced breast malignancy for almost two years and had already conducted mastectomy three months after her diagnosis. Her leukocyte number was only 300 cells per mm3, with 23% neutrophil, hypoalbuminemia, and hypokalaemia. She was then treated in an internal ward and was given intravenous ceftazidime, fluid, granulocyte colony-stimulating factor, albumin transfusion, intravenous potassium replacement, and symptomatic medication. After two days of inpatient care, she was referred to an oncology team in a tertiary healthcare facility. Febrile neutropenia is considered as a fever with a low neutrophil number as a result of bone marrow suppression. The neutrophil plays an essential role as the body’s first line of defence. This condition could make the patient more vulnerable to infections. The Patient was given broad-spectrum antibiotics and typically hospitalized to allow close monitoring until the neutropenia was resolved. Febrile neutropenia possesses a serious threat to patients with breast malignancy who are on cytotoxic chemotherapy. Urgent full blood count and immediate broad-spectrum antibiotic administration are significant to reduce morbidity and mortality.

Gray Transformation of Internal Medicine.

AimTo study the profile of patients hospitalized in an internal medicine facility of a public hospital and explore if there is a shift in the age distribution of hospitalized patients toward an older age group.MethodsThe study was conducted at a tertiary care hospital in Delhi where the department of medicine has six units and a particular unit is in charge of the emergency room one day a week and every sixth Sunday. A total of 716 patients hospitalized in the medicine ward through the emergency services each Wednesday and every sixth Sunday (i.e, admission days of a particular unit) during a period for six months (November 2017 to April 2018) were retrospectively identified and their name, age, sex, comorbidities, final diagnosis, duration of hospital stay, and the outcome were noted. This was compared with similar data collected from a previous study conducted in the same setting in the years 2010-2011. The data were analyzed using Stata version 13 software (StataCorp, College Station, Texas). Findings were compared using the chi-squared test or t-test, wherever applicable.ResultsThe mean age of patients hospitalized in 2010-2011 was 43.9 years, and this had increased to 48 years in 2018-2019 suggesting that the average patient being hospitalized in general medicine wards of a public hospital was now approximately five years older. Thirty-nine percent (39%) of the individuals admitted were more than 60 years of age in 2018-2019 as compared to 28.0% in 2010-2011. There was a significant rise in the cases of cardiovascular and gastrointestinal diseases and a decline in poisoning and infectious diseases from the year 2010-2011 to 2018-2019. A significantly higher prevalence of cardiovascular diseases, diabetes, and respiratory diseases was found in the current study among older adults.ConclusionThere has been a significant shift in the distribution of hospitalized patients in the internal medicine in-patient wards toward the older age group during the last decade. Also, there is a significant difference between the disease profiles of older and young patients. A comprehensive approach to geriatric medicine should be introduced and followed.

Personalized machine learning approach to predict candidemia in medical wards.

Candidemia is a highly lethal infection; several scores have been developed to assist the diagnosis process and recently different models have been proposed. Aim of this work was to assess predictive performance of a Random Forest (RF) algorithm for early detection of candidemia in the internal medical wards (IMWs). A set of 42 potential predictors was acquired in a sample of 295 patients (male: 142, age: 72 ± 15years; candidemia: 157/295; bacteremia: 138/295). Using tenfold cross-validation, a RF algorithm was compared with a classic stepwise multivariable logistic regression model; discriminative performance was assessed by C-statistics, sensitivity and specificity, while calibration was evaluated by Hosmer-Lemeshow test. The best tuned RF algorithm demonstrated excellent discrimination (C-statistics = 0.874 ± 0.003, sensitivity = 84.24% ± 0.67%, specificity = 91% ± 2.63%) and calibration (Hosmer-Lemeshow statistics = 12.779 ± 1.369, p = 0.120), markedly greater than the ones guaranteed by the classic stepwise logistic regression (C-statistics = 0.829 ± 0.011, sensitivity = 80.21% ± 1.67%, specificity = 84.81% ± 2.68%; Hosmer-Lemeshow statistics = 38.182 ± 15.983, p < 0.001). In addition, RF suggests a major role of in-hospital antibiotic treatment with microbioma highly impacting antimicrobials (MHIA) that are found as a fundamental risk of candidemia, further enhanced by TPN. When in-hospital MHIA therapy is not performed, PICC is the dominant risk factor for candidemia, again enhanced by TPN. When PICC is not used and MHIA therapy is not performed, the risk of candidemia is minimum, slightly increased by in-hospital antibiotic therapy. RF accurately estimates the risk of candidemia in patients admitted to IMWs. Machine learning technique might help to identify patients at high risk of candidemia, reduce the delay in empirical treatment and improve appropriateness in antifungal prescription.

The Influential Factors in the Medication Errors by the Nurses of the Internal Wards of the Teaching Hospitals Affiliated to Iran University of Medical Sciences (2019)

The Influential Factors in the Medication Errors by the Nurses of the Internal Wards of the Teaching Hospitals Affiliated to Iran University of Medical Sciences (2019)

Factors Associated with Step Numbers in Acutely Hospitalized Older Adults: The Hospital-Activities of Daily Living Study

ObjectivesTo determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge. DesignProspective observational cohort study conducted in 2015–2017. Setting and ParticipantsOlder adults (≥70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals. MethodsSteps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index. ResultsThe analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250–1146] at the last day of hospitalization. This increased to 1750 (IQR 675–4114) steps 1 day postdischarge, and to 1997 (IQR 938–4098) steps 7 days postdischarge. Age [β = −57.93; 95% confidence interval (CI) −111.15 to −4.71], physical performance (β = 224.95; 95% CI 117.79–332.11), and steps in hospital (β = 0.76; 95% CI 0.46–1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (β = −1400; 95% CI –2380 to −420; P = .005). Conclusions and ImplicationsAmong acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps postdischarge. The number of steps 1 week after discharge is a promising indicator of functional decline 1 month after discharge.

Early Point-of-Care Ultrasound Assessment for Medical Patients Reduces Time to Appropriate Treatment: A Pilot Randomized Controlled Trial

Numerous studies emphasize the diagnostic importance of point-of-care ultrasound (POCUS), but the level of evidence remains low as most data are gathered from observational studies. We conducted a pilot, randomized controlled trial to evaluate the effect of POCUS exam on medical patient's management and clinical outcomes. Patients presenting with chest pain or dyspnea were enrolled and randomly allocated to an early POCUS scan group and a control group. POCUS assessment, within 24 h of internal ward admission, was conducted only for the intervention group. The primary outcome was time to correct diagnosis. Secondary outcomes included time to appropriate treatment, POCUS-related rate of primary diagnosis alteration and new clinically relevant findings and time to hospital discharge. Sixty patients were enrolled. Thirty patients were randomly allocated to each study arm. The POCUS exam revealed clinically relevant findings among 79% of patients and led to alteration of the primary diagnosis among 28% of patients. Time to appropriate treatment was significantly shorter among patients in the POCUS group compared with the control group (median time of 5 h [95% confidence interval: 0.5–9] vs. 24 h [95% CI: 19–29] p = 0.014). The time needed to achieve correct diagnosis by the primary team was shorter in the POCUS group compared with the control group, yet it did not reach statistical significance (median time of 24 h [95% CI: 18–30] vs. 48 h [95% CI: 20–76], p = 0.12). These results indicate that POCUS assessment conducted early among patients with dyspnea or chest pain improves diagnostic accuracy and shortens significantly the time to appropriate treatment.

Does an antimicrobial stewardship program for Carbapenem use reduce Costs? An observation in Tehran, Iran.

Background:Inappropriate administering of antimicrobials has led to increased antibiotic resistance as well as burden of infectious diseases. Antibiotic stewardship programs (ASPs) help prevent resistance through improved utilization of antimicrobial agents while potentially decrease costs of treatment.Methods:We reviewed 186 infectious disease (ID) consultations from two internal disease wards in a tertiary center where ID specialists were asked to confirm carbapenem use in patients within 48 hours of initiation. The records were reviewed in terms of age, gender, and final decision about carbapenem use. The crude mortality rates during the 5-month period of the study (May to September 2016) as well as hospital spendings were compared with the same time of the year before the implementation of the ASP.Results:Of the 186 consultations conducted by the ID specialists, 28 (15%) consultations led to antibiotic change, 46 (25%) led to discontinuation, while 112 (60%) carbapenems were continued. An estimate of 14,000 € was saved based on the annual hospital costs during the 5-month period of the study. Although antimicrobial resistance patterns could not be evaluated, the crude mortality rate in the two IM wards was calculated to be 2.6% with no significant change compared to previous year (CMR: 2.9%).Conclusion:Based on findings of the present study, ASPs for carbapenems (as wide-spectrum agents) can lower costs with no increased mortality rates in a tertiary center located in a middle-income country.

Kemampuan mobilitas dan derajat luka tekan pasien rawat inap

The occurrence of pressure ulcer is directly related to the duration of immobility. If the suppression continues for a long time, small vascular thrombosis and tissue necrosis will occur. In bone protrusions that hold weight are more susceptible to pressure sores and are often found in people with limited movement because they are unable to change positions to remove pressure. Objective is to determine the relationship of mobility ability with the degree of pressure ulcer on inpatients at Wonosari Hospital in Gunungkidul Regency. This research was non-experimental research with cross-sectional design. The samples in this study were patients treated in the surgical, internal and neurological ward of Wonosari Hospital in Gunungkidul Regency. The sampling technique used the simple random sampling technique. While the statistical test used the Pearson test. Results showed that the average scale of mobility ability of inpatients was 3 scale (mean 2,70), while the average value of the degree of pressure ulcer in the inpatient ward of Wonosari Hospital was degree I (mean 1,32). Conclusion of this research was there was a significant correlation between mobility ability and the degree of pressure ulcer of the patient in the inpatient room at Wonosari Hospital in Gunungkidul Regency with a significance value of 0.000 (ρ &lt; 0,05).

Clindamycin stewardship: An opportunity for hospitalized patients in Razi Hospital, Rasht, Iran

Background: In hospitalized patients, the most common used drugs are antibiotics. Programs designed to rational use of antibiotics improve the quality of care and infection management, and reduce costs. Aims and Objectives: The objective of this study was to assess the rational use of clindamycin in Razi Hospital, Rasht, Iran. Materials and Methods: This retrospective cross-sectional study was performed in Razi Hospital, Rasht, Iran. All hospitalized patients who received clindamycin were included. Patient’s demographic, duration of use and dose of clindamycin therapy, and other concomitant antibiotics were collected from patients’ medical records. Rational clindamycin prescribing was evaluated based on recommendations of UpToDate software, version 21.6, Waltham, MA, United States. Analysis of data was performed by the Statistical Package for the Social Sciences software, version 16.0. Results: A total of 607 patients receiving clindamycin during 15 months of study were evaluated. The mean age of the patients was 51.51 ± 15.92 years (range: 16–87 years). The most hospitalized patients receiving clindamycin were in internal ward (86%). The most frequently coadministered antibiotics with clindamycin were third-generation cephalosporins (47.9%). The majority of patients admitted in the winter (40.4%). The most frequently primary and final diagnosis in patients receiving clindamycin was reported pneumonia, respectively, 33.1% and 32.1%. Indication, dose, and duration of clindamycin were appropriate in 583 (96%), 277(47.5%), and 208 (35.7%) patients, respectively. Conclusion: The rate of incorrect dose and duration of clindamycin in our hospital were significantly high. Also, the majority of its prescription were as off-label indications. Programs for more justified administration of clindamycin to improve quality of care and decrease antibacterial resistance and cost are necessary.

The utilization patterns of vancomycin, metronidazole, ceftriaxone, and ceftazidime in the ICU ward of a public hospital of Tehran Medical University: a cross-sectional study

Introduction Pharmacoepidemiology is a relatively new scientific topic, and it’s the concepts, methods, and implications are in line with the observations of health studies in the past few decades. It involves the postmarketing investigations, drug utilization review, and the monitoring of both adverse drug reactions and the clinical efficacy of drugs. The Anatomical Therapeutic Chemical classification system as a drug classification method and the defined daily dose (DDD) as a measurement unit have been recommended by WHO for drug utilization studies. Patients and methods This was a prospective cross-sectional study. It was done using the Anatomical Therapeutic Chemical/DDD system and by calculating DDD per 100 bed-days (BDs) for four antibiotics, namely, vancomycin, metronidazole, ceftriaxone, and ceftazidime, used in 78 patients admitted in the internal medicine ICU ward in a hospital of Tehran University of Medical Sciences from April to October 2018. Results The DDD/100 BDs for ceftazidime, ceftriaxone, metronidazole, and vancomycin was 5.96, 4.17, 9.65, and 28.02, respectively. Conclusion Comparing the results of the current study with those of similar studies, it was found that the DDD/100 BDs for ceftazidime, ceftriaxone, and metronidazole is within the normal range, whereas that of vancomycin was much higher than normal.

INCREASE THE COMPLETENESS OF THE NURSING DOCUMENTATION THROUGH THE IMPLEMENTATION OF THE NURSING INITIAL ASSESSMENT FORMS

Nu rse had limited time t o perform nursing documentation due to dense work load and limited number of nurse as well as the narrative format of documentation. Therefore, nursing assessment documentation was frequently incomplete. The study aim was to determine the effect of initial nursing assessment form aton the completeness of nursing assessment documentation in the internal ward of Padang Panjang District Hospital in year 2016. The study design was action research. Bivariate analysis was done by W ilcoxon ’s test and multivariate analysis was done by F riedman ’s test. R esult showed that the implementation of nursing initial assessment checklist form at increase the completeness of the nursing initial assessment documentation (p = <0.05). N ursing initial assessment checklist form at could be applied to improve the completeness of nursing assessment documentation. It is r ecomme nded to hospital management to set the nursing initial assessment checklist form at as the standard form at usedand provide supervision and evaluation of this program . Key w ords : checklist, in nitial a ssessment, d ocumentation

When perception is reality: Resident perception of faculty gender parity in auniversity-based internal medicine residency program.

IntroductionAlthough women have entered medical school and internal medicine residency programs in significant numbers for decades, women faculty remain underrepresented in senior and departmental leadership roles. How residents perceive this gender disparity is unknown. We sought to assess resident perception of gender parity among departmental leadership and teaching faculty in our internal medicine department, and to determine the actual gender distribution of those faculty roles.MethodsAn anonymous cross-sectional survey was distributed to evaluate resident perception of gender representation of various faculty roles. Using conference schedules, resident evaluations, and our department website, we determined the actual representation of women faculty in department leadership roles, and in clinical and educational activities.Results88 of 164 residents (54%) responded. Women residents were less likely than men to perceive that women faculty were equally represented in department leadership (45% men agreed vs. 13% women, p < 0.05), clinical teaching roles (55% men agreed vs. 28% women, p < 0.05), or facilitating educational conferences (45% men agreed vs. 28% women, p = 0.074). In 2017, the internal medicine department at our institution comprised 815 faculty members, 473 men (58%) and 342 women (42%). At that time, women faculty held 5% of senior departmental leadership positions and 21% of educational leadership positions. During the year preceding survey distribution, women faculty attended on internal medicine inpatient wards for 33% of the total number of weeks, staffed 20% of morning reports, and facilitated 28% of noon conferences.DiscussionWomen residents in our internal medicine training program perceived a gender disparity among faculty in leadership and educational positions to a greater extent than male residents. The perception of women trainees was accurate. In addition to disproportionate underrepresentation in leadership positions, women faculty were underrepresented in prominent educational positions, including attending on inpatient services and serving as discussants at educational conferences.Electronic supplementary materialThe online version of this article (10.1007/s40037-019-00532-9) contains supplementary material, which is available to authorized users.

Review nurses' skills in handover using SBAR tool in general ward

Patient's clinical handoff which is a critical organizational and clinical process is considered one of the fundamental responsibilities of nurses. In this regard, lack of tools and resources to be applied for this purpose threatens the life of patients. The present study aimed to investigate the nursing handoff skill among nurses using situation-background-assessment-recommendationquestionnaire. This observational research was carried out on 64 nurses in internal and surgical wards in selected hospitals affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran in 2018. The research population included the content of reports related to nursing handoff of nurses working in the hospitals. The reliability and validity of the questionnaire were confirmed, and descriptive statistics were applied to evaluate the data. It is worthy to note that the majority of participants were female (68.8%). After the evaluation, patient information was reported in areas of current situation (90.0%), clinical background (10.0%), assessment of systems’ status (57.5%), and recommendations (92.5%). Based on the results of the study, less attention was paid to mentioning clinical background and assessing patients’ systems during nursing handoff, which necessitates the training courses on accurate reporting for nurses to ensure patient safety.

Molecular Characterization Of Vancomycin-Resistant Enterococcus faecalis Among Inpatients At Iranian University Hospitals: Clonal Dissemination Of ST6 And ST422.

PurposeOver the past two decades, enterococci have emerged as an important opportunistic pathogen causing life-threatening infections in hospitals. The purpose of the present study was to examine the prevalence of genes encoding virulence factor and molecular characterization of vancomycin-resistant E. faecalis strains isolated from hospitalized patients in Isfahan, the central city of Iran.Patients and methodsA total of 53 vancomycin-resistant E. faecalis isolates (VRE) obtained from clinical samples of hospitalized patients were characterized by phenotypic and genotypic methods, and 25 selected VRE isolates from internal and ICU wards were typed by multilocus sequence typing.ResultsThe efa was the most prevalent virulence gene (100%) among isolates, followed by gelE (92.45%), asa1 (90.56%), ace (86.79%), esp (75.47%), cylA (39.62%), and hyl (18.86%). More than 80% of the isolates were HLGR. Multilocus sequence typing showed eight different sequence types including ST6, ST422, ST28, ST448, ST531, ST328, ST421, and ST495. STs were grouped into two clonal complex (CC) including CCA (ST6, ST422, ST448, ST531) and CCF (ST28, ST421) and two singletons (ST328, ST495).ConclusionOur data indicated a high prevalence of virulence genes among STs described in this study. In addition, the molecular analysis demonstrated a relatively high genetic diversity among selected VRE strains from the ICU in comparison with the internal ward. Therefore, in order to prevent the colonization of virulent strains in the hospital environment, infection control procedures should be performed.

The accuracy of a diagnosis of pneumonia in the emergency department

BackgroundAchieving a high degree of diagnostic accuracy of infections in the emergency department (ED) is crucial since a delay in diagnosis can lead to increased mortality, whereas overdiagnosis can lead to antibiotic overprescription. Limited data are available as to ED diagnostic accuracy of infections. The aim of this study was to demonstrate the degree of discordance of an ED diagnosis of pneumonia in relation to an internal medicine ward’s discharge diagnosis of hospitalized adults. MethodsWe reviewed the records of all adults hospitalized in internal wards from November 2017-January 2018 diagnosed with an acute infection by an ED physician. The primary outcome was the discordance degree of an ED pneumonia diagnosis compared to the internal ward discharge diagnosis. The influence comorbidities and clinical characteristics on the diagnostic discordance were also evaluated. ResultsThe study included 875 adults; 434 were admitted with an ED diagnosis of a specific infection. Pneumonia was the most frequent ED diagnosis (n = 195, 45%), of them, 56 (29%) were discordant diagnosis in the internal ward. ConclusionInterpretation of chest X-rays with the assistance of a radiologist might help in reducing overdiagnosis and minimize antibiotic overprescription, thus improving the ED diagnostic accuracy of pneumonia.

Determining frequency and pattern of infections associated with diabetes based educational hospitals in Ahvaz city; Iran

BackgroundDiabetes mellitus is a metabolic disease known as one of the most common illness in the world. It is believed that diabetic patients are at high risk of varied infections than non-diabetics. The aim of this study was to determine the frequency and pattern of infections in diabetic patients admitted to the internal wards of educational hospitals of Ahvaz Jundishapur University of Medical Sciences. MethodsThis descriptive cross-sectional study was performed on 700 diabetic patients from January 2014 to December 2015 in internal wards (general, endocrine, gastroenterology, lung, nephrology, cardiology, neurology and infectious diseases) of educational hospitals affiliated to Ahvaz JundishapurUniversity of Medical Sciences. Data includeddemographic information, type of diabetes treatment, duration of diabetes mellitus, final diagnosis, and blood sugar on admission that were analyzed statistically. ResultsOut of 700 patients, 374 (53.4%) women and 326 (46.6%) men were entered into this study. The number of non-infectious and infectious patients were 506 (72.3%) and 194 (27.7%). The mean of age,duration of diabetes, and glucose were 62.34 ± 14.38 years, 11.11 ± 7.18 years, and 271.98 ± 90 (mg/dl) in patients with infectious diseases respectively. The most common infectious illnesses were diabetic foot infections (32.5%), pneumonia (18%), soft tissue abscess(13.9%), and urinary tract infections (11.3%). ConclusionInfectious diseases are one of the most common factorsto hospitalize diabetic patients (27.7%), most of whom had diabetic foot infections, pneumonia, and soft tissue abscess.

Influence of historical use of antibiotics toward antibiotic resistance

A WHO’s Global Surveillance of Antibiotic Resistance showed there is an increase of antimicrobial resistance in Asia between 2013 until 2014. Many studies showed that there is a correlation between prior antibiotic use with antimicrobial resistance case. The primary objective of this study is to analyze the relationship between prior antibiotic use with antimicrobial resistance. İt was a retrospective and descriptive study conducted at Bangil Regional General Hospital. The data collected from the medical record and microbiological test from the patient at the internal ward. Chi-square analysis used for the statistic. This study showed that prior antibiotic use increased 0,399 bigger for antimicrobial resistance rate (p=0,001).

RAPID PROGRESSION OF CLAVICULAR SOLITARY PLASMACYTOMA TO MULTIPLE MYELOMA

Introduction: Solitary plasmacytoma is a monoclonal plasma cell malignancy restricted to one tumor. Fifty percents of cases can progress to multiple myeloma (MM). Median time to progression is 19 months. A case about plasmacytoma progressing rapidly to MM within 2 months from initial diagnosis is hereby described. Case: A 45-year-old male, attended the Surgery clinic with the chief complaint of progressive swelling on the left neck for two months. Physical examination revealed a fixed, solid, 8x8 cm mass on the left supraclavicular. FNAB showed plasmacytoma. Surgical biopsy and immunohistochemistry confirmed the diagnosis of plasmacytoma. Ki67 index was 80%. There was no abnormality in laboratory examination. Two months later he was admitted to the Internal ward with anemia and kidney disorder. Serum protein electrophoresis revealed M-spike. BMA showed plasma cell proliferation with 78% proportion, which confirmed the diagnosis of MM. Discussion: Solitary plasmacytoma can occur on any bone, mostly on axial bones. Solitary plasmacytoma on clavicle is very rare, with prevalence 0.45% of all primary bone tumors. Diagnosis of solitary plasmacytoma relies on tissue biopsy, laboratory, radiology and bone marrow aspiration. Progression of plasmacytoma to MM can be detected from CBC and clinical chemistry results. Serum protein electrophoresis and bone marrow aspiration results confirmed the diagnosis of MM. High proliferation index (Ki67&gt;8%) and tumor size(&gt;5cm) were the risk factors for rapid progression of plasmacytoma. Conclusion: Early detection of systemic symptoms is very important in the management of solitary plasmacytoma. Keywords: solitary plasmacytoma, multiple myeloma

The Relationship of Nurse’s Workload and Caring in Internal Disease Ward and Surgery Ward in Regional Public Hospital

Background: Caring is the efforts conducted by nurses to be close with the client to provide appropriate interventions in accordance with the problems experienced. One that causes bad nurses' caring behaviors is their workload that is not balanced. Workload is all activities undertaken by nurses during their duties in a nursing unit. Research Objective: To find out the correlation between workload and nurses' caring behaviors in internal disease ward and surgical ward of Dr. Tjitrowardojo Regional Public Hospital, Purworejo. Research Method: This research was a quantitative research using cross sectional design. The population in this study were all nurses working in Internal Disease Ward and Surgical Ward of Dr. Tjitrowardojo Regional Public Hospital, Purworejo. The total sample was 65 using total sampling technique. The research instruments for workload was using NASA-TLX questionnaire and for nurses' caring behaviors was using a questionnaire. The data processing was using Kendall's tau statistical test. Research Results: The results showed that the majority of respondents with a high workload implemented caring behaviors in the category of enough by 19 respondents (29.2%), while the respondents with very high workload implemented caring behaviors in the category of less by 9 respondents (13.8%). The Kendall's tau analysis showed the results of p = 0.000 (p &amp;lt; 0.05) and r = -0.618, meaning that there was a correlation between workload and nurses' caring behaviors in internal disease ward and surgical ward of Dr. Tjitrowardojo Regional Public Hospital, Purworejo with strong correlation and negative correlation, meaning that the higher the workload, then the lower the caring behaviors. Conclusion: There was a correlation between workload and nurses' caring behaviors in internal disease ward and surgical ward of Dr. Tjitrowardojo Regional Public Hospital, Purworejo

Molecular analysis and genotyping of pathogenicity locus in Clostridioides difficile strains isolated from patients in Tehran hospitals during the years 2007–2010

Background & AimsClostridioides difficile (C. difficile) has been identified as the leading cause of antibiotic associated diarrhea (AAD). Co-carriage of an intact pathogenicity locus (PaLoc) with binary toxin genes in C. difficile strains seems to be linked with severe disease outcomes in the infected patients. Epidemiology of C. difficile infection (CDI) in hospital setting and knowledge about their genetic context help us to decrease the morbidity, mortality, and costs associated with Clostridioides difficile infection. In the present study was aimed to characterize genetic diversity of PaLoc among different C. difficile strains isolated from hospitalized patients and carriage of cytolethal distending toxin gene (cdt) in different hospitals. MethodC. difficile strains were isolated from stool samples of inpatients referred to a reference laboratory from different hospitals and also outpatients with diarrhea, during 2008–2011. DNA was extracted from pure culture of the bacterium and PCR was performed for tcdA, tcdB, tcdE, tcdC, tcdD, and cdu2 genes. Carriage of two binary toxin genes cdtA, cdtB was also determined in these strains. To find clonal strains, similarity of genotypes and integrity of PaLoc among the isolates was compared in each hospital. ResultsThe intact PaLoc was found most frequently among the isolates in the outpatients (19/51, 37.2%, Group I), while incomplete PaLoc found mostly in patients who were hospitalized in the infectious diseases and internal diagnosis wards. tcdA and tcdB genes were detected in different combinations among the studied strains. These strains showed tcdA+B+, tcdA+B−, and tcdA−B+ genotypes in a frequency of 76.4% (39/51), 7.8% (4/51), and 17.6% (9/51), respectively. Analysis of gene composition of the PaLoc showed 19 distinct genotypes among the 51 strains. Accordingly, 38 strains were classified mainly into 6 regular groups, while the remaining strains showed heterogeneous patterns. tcdC−/tcdD− constituted the most common genotypic group among the strains with partial PaLoc (7/51, 13.7%). A hypertoxigenic genotype, tcdC−/tcdA+/tcdB+, was detected in 2 strains (2/51, 3.9%). The intact genotype was also detected in a C. difficile isolate from outpatients. Cdt encoding genes toxins was observed in low numbers of the strains (7/52, 13.5%). All of cdtA+B+ strains were belonged to PaLoc group 1 (intact genotype). Statistical analyses showed no correlation between particular genotypes and special wards of the hospitals (p value>0.05). ConclusionCollectively, our results showed diversity of C. difficile strains in most wards of the studied hospitals. Diversity of PaLoc genotypes in the strains that isolated from the same wards proposed endogenous routes of the infection, as common cause of CDI in these patients.