Large Public Teaching Hospital Research Articles

ASSISTÊNCIA AO POTENCIAL DOADOR DE ÓRGÃOS EM MORTE ENCEFÁLICA EM PRONTO-SOCORRO ADULTO: PERSPECTIVA CONVERGENTE-ASSISTENCIAL

ABSTRACT Objective: to investigate situations that interfere with health professionals’ performance, in the identification and maintenance of potential brain-dead donors in an Adult Emergency Care Unit, and to indicate actions, from the health team’s perception, that can promote care for these patients. Method: this is a qualitative, convergent care research, carried out with health professionals from an adult emergency unit, a large public teaching hospital located in southern Brazil. Data were collected between February 2020 and January 2021 through structured participant observation, semi-structured interview and convergence group. Data analysis was performed according to the stages of gathering, synthesis, theorization and transfer. Results: based on data analysis, the difficulties in caring for brain-dead persons, lack of information, inadequate structure and difficulties in the work process were identified as situations that interfere with health professionals’ performance in relation to brain-dead potential donors. Actions were signaled to promote care for these people through continuing education activities on the subject, dissemination of information, construction of technologies/protocols, organization of infrastructure and the work process with support for professionals who assist these people. Conclusion: it was evidenced that professional education, the organization of the donation process and systematized actions to improve the work are fundamental factors for the effective care for brain-dead potential organ donors.

Limb-Girdle Muscular Dystrophy in Brazilian children: Clinical, histological and molecular characterization.

Limb-girdle muscular dystrophies (LGMD) are a heterogeneous group of genetic muscular disorders, involving autosomal recessive and dominant forms, that clinically are characterized by progressive muscular weakness of proximal predominance, generally starting in the pelvic girdle and, later, in the shoulder girdle, frequently associated with other clinical signs such as calf hypertrophy, joint retractions and skeletal deformities such as winging scapula and scoliosis. The distal muscles may be affected, but usually only late in the progression of the disease. Involvement of respiratory muscles and cardiac muscles is described in many forms of the disease. Different degrees of increase in the serum level of creatine kinase (CK) are observed and, sporadically, there is involvement of the central nervous system (CNS) and gastrointestinal tract . Autosomal recessive forms are far more common than autosomal dominant, particularly in children. Significant overlap of clinical phenotypes, with genetic and clinical heterogeneity, constitutes the rule for this group of diseases. Muscle biopsies are useful for histopathologic and immunohistochemical studies and the confirmatory toll is the molecular test . This retrospective study had the objective to investigate the frequency of different subtypes of limb-girdle muscular dystrophy in children from a population from a large public teaching hospital serving the country, describing the clinical and histological aspects of the different forms.

Impact of ‘Get it to 100%’, a hepatitis B vaccination campaign amongst the health-care workers: A 5-year multimodal interventional study in a large tertiary care public sector teaching hospital, India

Background: The World Health Organization recommends administering the hepatitis B virus (HBV) vaccine at least for high-risk adults including health-care workers (HCWs). Active intervention through hospital-wide vaccination campaign may be necessary to augment the vaccine coverage, instead of merely having a hospital vaccination policy. Materials and Methods: The study was an interventional type, where hepatitis B vaccination campaign ‘Get it to 100%’ was implemented in a tertiary care hospital for 5 years, through multimodal interventions. Subsequently, the impact of hospital-wide HBV vaccination campaign to improve compliance amongst HCWs was evaluated. Results: HCWs being ‘vaccinated’ were increased from 45.6% (4398) to 84.2% (8126); not-vaccinated reduced from 54.4% (5253) to 15.8% (1525) and HCWs protected against HBV improved from 2.5% (240) to 50.2% (4843) with significant yearly increase. Doctors (63.9%), followed by nurses (57.7%) were more compliant, while defaulters were observed maximum for other staff (78.8%) and housekeeping staff (64.5%). Discussion: The hospital infection control and prevention unit at our institute was earmarked as designated centre for HBV vaccination campaign, which was instrumental in implementing the various components of the multimodal interventions such as making the resources (vaccines and titre testing) available free-of-cost, mandatory induction vaccination of HCWs at the timing of joining, educational intervention and conducting several vaccination camps such as department-specific on-site camps and student camps (at the time of joining). Conclusions: The authors urge to implementation of a mandatory national policy for HBV immunisation amongst HCWs, which will result in their protection from contracting the virus from occupational exposures.

P641 Impact of lockdown period due to COVID-19 pandemic in patients with Inflammatory Bowel Disease

BackgroundThe lockdown period due to the coronavirus disease 2019 (COVID-19) in Spain was established from 16th March to 21th June 2020. Therefore, the authorities controlled personal movements and private and public non-essential activities were cancelled. It has probably had an important emotional impact on chronic patients and hence in those who are suffering from Inflammatory Bowel Disease (IBD) due to their high risk of emotional disorders.The aim of this study is to know how COVID 19 influenced to the patients suffering from IBD during the quarantine period, focusing heavily on the psychological distress through the Perceived Stress Scale-10 (PSS-10), and also the impact of the pandemic on therapeutic adherence using Visual Analogue Scale (VAS).MethodsThis is an unicentric and analytical observational study carried out in IBD unit of a large public teaching Hospital (University Hospital “Lozano Blesa”) during August 2020. Patients were contacted and interviewed by phone by two trained researchers not involved in the patient′s medical care. Inclusion criteria were age ≥ 18 years old and confirmed diagnosis of Crohn′s Disease (CD), Ulcerative Colitis (UC) or Indeterminate Colitis. A descriptive analysis was carried out and, subsequently, the factors associated with the loss of therapeutic adherence and higher-moderate levels of stress were analyzed through Logistic regression multivariate analyses.ResultsOf the 426 patients included, 217 (50.9%) were women, 249 (58.4%) had UC and 177 (41.6%) had EC. During the Spanish lockdown period, most of patients did not have symptoms related to their IBD (302; 72.1%). Among those who had symptoms, the most frequent was diarrhea and abdominal pain (11.5%). Most of subjects were not diagnosed of SARS-CoV2 infection (93%), whereas 2.1% suffered confirmed infection and 4.9% had compatible symptoms without test confirmation. Regarding economic situation of patients, most of them did not have economic difficulties (87.6%). Moreover, 74.4% of participants referred a very good physician-patient relationship and 21.8% a good relationship.People who participated in the study had a median PSS-10 score of 12 (10–16). A higher level of stress was reported between those who were not married, women, and those who experimented an increase of IBD related symptoms. Adherence to treatment was not associated with stress level based on PSS-10 questionnaire.ConclusionAlthough the lockdown period due to COVID-19 pandemic has probably had an important emotional impact on Spanish population, IBD patients had in general lower PSS-10 scores. It could be due to a good patient-physician relationship, which contributed to maintaining a good adherence to medications in those patients.

200 Homelessness in pregnancy is associated with adverse maternal and neonatal outcomes

The objective of this study was to evaluate the effects of homelessness in pregnancy on obstetrical, neonatal and postpartum outcomes. We conducted a retrospective cohort analysis of all deliveries at a large urban public teaching hospital between January 1st, 2017 and December 31st, 2017. Homeless women who delivered during this period were compared to age-matched controls. Data was collected on demographics, prenatal care, and obstetrical, neonatal and postpartum outcomes. There were 1425 total deliveries at our institution between January 1st, 2017 and December 31st, 2017. Ultimately 67 patients (4.7%) were identified as homeless; the majority, 39 (58.2%) were shelter-housed. Our final cohort included 67 homeless patients and 67 domiciled controls (4.9% of total domiciled patients). Homeless patients were less likely to have a vaginal delivery (61.2% vs 77.6%, p=0.017). Their neonates had longer NICU stays (27.3 days vs 7.5 days, p=0.008). The mean birthweight for neonates born to homeless patients was 2864g as compared to 3174g for controls (p= 0.006). Homeless patients were more likely to be evaluated by the Administration for Children’s Services (ACS) (15% vs 2%, p = 0.016). Homeless women were also less likely to exclusively breastfeed in the 6 weeks following delivery (28.3% vs 53.7%, p=0.005). Homeless women are less likely to have a vaginal delivery and to exclusively breastfeed during the immediate postpartum period, and more likely to be referred for evaluation by the Administration for Children’s Services. Their neonates have longer NICU stays and a lower average birthweight than that of their non-homeless counterparts. Homelessness should be considered as a social determinant of health that may have an unrecognized and severe impact on maternal and neonatal health, and warrants further exploration. We plan to evaluate our findings more in-depth to explore these associations.

Clinical Characteristics and Complications in Patients Undergoing Permanent Pacemaker Implantation

Abstract Background: Pacemakers are electronic impulse generators that are implanted to restore a regular heart rhythm in patients with symptomatic bradycardia. A large body of epidemiological data on permanent pacemaker implantation (PPI) originates from developed countries with minimal data from developing regions, especially sub-Saharan Africa. This study aims to describe patient demographics, clinical indications, short-term and long-term complications in patients undergoing PPI at the Charlotte Maxeke Johannesburg Academic Hospital, which is a large urban public teaching hospital in Johannesburg, South Africa. Methods: We retrospectively reviewed in-patient and out-patient medical records of consecutive patients who underwent index PPI over ten years (January 2009 to November 2018). Results: The study cohort comprised of 565 patients, of which 325 (57.52%) were female. The median age at first PPI was 71.8 [interquartile range: 61.7–78.8] years. The indications for pacemaker implantation were atrioventricular (AV) block in 417 (73.81%) and sinus node dysfunction in 114 (20.18%). A total of 40 (7.08%) patients experienced PPI-related complications. Lead dislodgement was the most common complication occurring in 16 (3.05%) patients. Females were 3.8 times more likely to experience a complication [odds ratio (OR): 3.80; 95% CI: 1.40–10.32, P = 0.009]. Conclusion: In this study, AV block was the most common indication for PPI, and the complication rate was found to be 7.08%. Furthermore, the risk of developing a complication was significantly higher in females.

Radiological profile of patients undergoing Chest X-ray and computed tomography scans during COVID-19 outbreak.

Background & Objective:Radiology has played a significant role in the diagnosis and quantifying the severity of COVID 19 pulmonary disease. This study was conducted to assess patterns and severity of COVID-19 pulmonary disease based on radiological imaging.Methods:A prospective observational study was conducted in a large tertiary care public sector teaching hospital of Karachi, Pakistan from June 2020 till August 2020. All confirmed and suspected COVID-19 patients referred for chest X-rays and computed tomography (CT) scans were evaluated along with RT-PCR results. Suspected patients were followed for RT-PCR. Radiological features and severity of imaging studies were determined.Results:Of 533 patients in whom X-rays were performed, majority had severe/critical findings, i.e., 304 (57.03%). Of 97 patients in whom CT scan was performed, mild/moderate findings were observed in 63 (64.94%) patients. Of 472 patients with abnormal X-rays, majority presented with alveolar pattern 459 (97.2%), bilateral lung involvement 453 (89.6%), and consolidation 356 (75.4%). Moreover, lobar predominance showed lower zone preponderance in 446 (94.5%) patients. Of 88 patients with abnormal CT findings, ground-glass opacity (GGO) 87 (98.9%) and crazy paving 69 (78.4%) were the most common findings. An insignificantly higher association of PCR positive cases was observed with severe/critical X-rays (p-value 0.076) and CT scan findings (p-value 0.431).Conclusion:Most common patterns on CT scans were GGO and crazy paving. While on chest radiographs, bilateral lung involvement with alveolar pattern and consolidation were most common findings. On X-rays, majority had severe/critical whereas CT scan had mild/moderate findings.

Single-arm prospective interventional study assessing feasibility of using gallium-68 ventilation and perfusion PET/CT to avoid functional lung in patients with stage III non-small cell lung cancer

BackgroundIn the curative-intent treatment of locally advanced lung cancer, significant morbidity and mortality can result from thoracic radiation therapy. Symptomatic radiation pneumonitis occurs in one in three patients and can...

Teaching Geriatrics and Transitions of Care to Internal Medicine Resident Physicians.

(1) Background: Internal medicine (IM) resident physicians need to be trained to care for older adults and transition them safely across care settings. Objective: The study purpose was to evaluate the efficacy of a curriculum in geriatrics assessment and communication skills for transitions of care (TOCs) to IM resident physicians. (2) Methods: IM residents rotated for 4 weeks on the geriatrics consult service at a large public teaching hospital, where they received didactic lectures and clinical experience in consultation and transitional care. The curriculum was designed to meet consensus guidelines for minimum geriatrics competencies expected of IM residents. Previously validated and published assessment tools were used for geriatrics knowledge and attitudes. Locally developed tools were used to directly observe and rate communication skills, and self-assess geriatrics assessment and health literacy skills. The curriculum was evaluated using a quasi-experimental, nonrandomized, single-group pre- and post-test observational design. Data on 31 subjects were collected over 18 months and analyzed using mixed-effects models. (3) Results: Average knowledge scores improved from 65% to 74% (Δ9%, 95% CI 4–13%, p < 0.001). Communication skills improved by an average of 1.15 points (95% CI 0.66–1.64, p < 0.001) on a 9-point scale. Attitudes did not change significantly. Self-rated confidence in geriatrics assessment and health literacy skills improved modestly. (4) Conclusions: The curriculum is effective in teaching basic geriatrics knowledge and communication skills, and increasing self-confidence in geriatrics assessment skills. In settings where an inpatient geriatrics consult service is feasible, the curriculum may be a model for combining geriatrics and TOC training.

Impact of place of residence, frailty and other factors on rehabilitation outcomes post hip fracture.

Following hip fracture surgery, patients from residential care are frequently excluded from inpatient rehabilitation. We aimed to assess the impact of place of residence and other factors such as frailty on rehabilitation outcomes after hip fracture surgery. Retrospective cohort study. Outcome measures included Functional Independence Measure efficiency, discharge destination and recovery of pre-fracture mobility. Univariable and multivariable linear or logistic regression analyses were performed. One general rehabilitation and two geriatric evaluation and management wards in a large public tertiary teaching hospital. A total of 844 patients who underwent inpatient rehabilitation after hip fracture surgery from 2010 to 2018. There were 139 (16%) patients from residential care. Being from residential care was not an independent predictor of poor outcomes. Premorbid frailty (Clinical Frailty Scale) was the strongest independent predictor of poorer Functional Independence Measure efficiency, inability to recover pre-fracture mobility and return to community dwelling. Dementia and delirium were also independently predictive of poor outcomes across all measures. Age > 90years was independently predictive of inability to recover pre-fracture mobility and return to community dwelling. Being from residential care is not independently associated with poor outcomes following inpatient rehabilitation after hip fracture surgery and should not be the basis for excluding these patients from rehabilitation. Major predictors of poorer outcomes include premorbid frailty, dementia, delirium and age > 90years. If able and motivated, those with potentially reversible functional limitations should be given the opportunity to participate in inpatient rehabilitation as even small gains can have a significant impact on quality of life.

Towards service quality measurement mechanism of teaching hospitals

ABSTRACT Quality is the principal concern of all organizations and their survival and prosperity directly depends, to a large part, on the quality of their services. Hospitals endeavor to deliver service with the acceptable quality to their clientele to maximize profit. Scholars are yet to develop consensus on definition and measurement of quality of service. Literature exhibits models to evaluate the quality of service; however, it does not present any mechanism to evaluate quality of services delivered by teaching hospitals. This study presents an exclusive model to evaluate service quality in teaching hospitals. In addition to healthcare services (cure and care), the model encompasses teaching aspect of hospital services. Thus this paper is a careful study of a large (2500 bedded) public sector teaching hospital. 400 patients, 250 employees, 200 general public and 250 students were administered with questionnaires followed by interviews. Hospital records were studied. In addition to this data was collected through observation. All that contribute to quality of services were classified into one of the three dimensions of the model. Since this model has been developed through inductive approach, it can safely be applied to evaluate quality of services of teaching hospitals with reliability and accuracy.

Saberes, desafios e perspectivas sobre a sistematização da assistência de enfermagem

OBJETIVO: compreender os saberes dos enfermeiros atuantes na unidade de clínica médica adulto de um hospital de ensino bem como os seus desafios e perspectivas sobre a Sistematização da Assistência de Enfermagem. MÉTODO: estudo de abordagem qualitativa, utilizando-se da análise de conteúdo de nove entrevistas com enfermeiros de um hospital público de ensino de grande porte. RESULTADOS: os enfermeiros, mesmo reconhecendo a importância da sistematização da assistência de enfermagem, apresentam um conhecimento superficial do tema; vivem desafiados pelas precárias condições de trabalho institucionais, somadas a sobrecarga de atividades, o que dificulta a implementação e continuidade do cuidado sistematizado; e, implementar e continuar o cuidado sistematizado constitui uma reafirmação do cunho científico da profissão bem como estratégia para melhora do cuidado prestado. CONCLUSÃO: a sistematização da assistência de enfermagem no cotidiano do enfermeiro perpassa por subsídios profissionais e institucionais, sendo o último o de maior impacto, o que desvela um cenário dificultador do cuidado de enfermagem que deve ser pensado e discutido para o avanço da qualidade assistencial.

Estratégias utilizadas por enfermeiras para minimizar a ocorrência de delirium em pacientes críticos

Objetivo: descrever as estratégias utilizadas por enfermeiras para minimizar a ocorrência de delirium em pacientes internados em unidade de terapia intensiva (UTI). Método: estudo exploratório-descritivo, de abordagem qualitativa, desenvolvido em um hospital de ensino, público, de grande porte da cidade de Salvador. Foi realizado nos meses de setembro e outubro de 2018, participaram do estudo 16 enfermeiras. Os dados foram coletados mediante entrevista semiestruturada e analisados por meio da “Técnica de Análise de Conteúdo Temática”. Resultados: da análise dos dados emergiram duas categorias temáticas, denominadas: “Desconhecimento sobre monitorização do delirium em UTI” e “Estratégias das enfermeiras para minimizar a ocorrência de delirium em UTI”. Conclusão: apesar do pouco conhecimento das enfermeiras sobre o delirium existe uma coerência quantos aos métodos de intervenções para preveni-lo. A implementação de protocolos e atividades educativas são imprescindíveis para empoderar o enfermeiro quanto às intervenções realizadas.

Management of patients with gout and achievement of target serum urate levels at a tertiary rheumatology service in Australia.

Gout is common crystal arthritis that is often managed sub-optimally. To determine what proportion of patients treated for gout by the tertiary level rheumatology service at the Royal Brisbane Hospital between 2014 and 2018 reached target serum urate (SU) levels. Secondary aims included exploring the demographic characteristics of those who did and did not reach target. The records of patients who were treated at least once either as in inpatient or outpatient by the rheumatology service at the Royal Brisbane Hospital between 1 January 2014 and 31 December 2018 were reviewed. Clinical status, treatment characteristics and outcome were recorded and analysed. There were 129 patients who met the inclusion criteria for the study, the majority of patients were male and 39% had tophaceous gout. Fifty-four (42%) had been intentionally discharged from clinic, 50 (85%) of those patients had reached their SU target, the remaining eight (15%) were discharged with a plan for other services to continue their therapy to reach SU target. Forty patients (31%) had ongoing follow up, with 16 (40%) of these at target and 24 (60%) not at target. Thirty-five (27%) were not attending, five (4%) had died and 30 (23%) had failed to attend follow-up appointments, none of these patients was at target at their last known SU level. Despite effective therapy the number of patients treated for gout at a large public metropolitan teaching hospital reaching SU target was low. Almost one-quarter of patients in the study discontinued contact with the clinic. The reasons for this are not clear and are likely multifactorial.

Evaluating the impact of a mass gathering (2018 Commonwealth Games) on emergency department presentations with communicable diseases: A retrospective cohort study

ObjectiveTo identify the impact of a mass gathering event (MGE) on emergency department (ED) patient presentations with communicable diseases and underpinning syndromic indicators (SIs). MethodsThis retrospective observational cohort study was undertaken in one large public teaching hospital ED in Queensland, Australia. Routinely collected ED data for patient presentations with an ICD-10 diagnosis corresponding to a communicable disease were used to compare demographic characteristics, clinical characteristics, and outcomes before (March 23 to April 3), during (April 4 to April 15), and after (April 16 to April 27) the 2018 Commonwealth Games. ResultsOver the study period, there were 10 595 patient presentations to the ED; 14.2% (n = 1503) were diagnosed with a communicable disease. The median age of those with a communicable disease was 8 years, 50.5% (n = 759) were female, and 24.8% (n = 373) arrived by ambulance. The most common communicable disease profile was respiratory in nature (51.4%, n = 772). The most common SI was altered breathing (24.0%, n = 185). ED length of stay (LOS) increased over the study period (pre: 160 min; during: 163 min; post: 180 min, p < 0.001). ConclusionsThe 2018 Commonwealth Games had an impact on ED presentations with communicable diseases, in terms of LOS. A longer LOS and higher percentage of patients with a LOS of more than 4 hrs in the ED were noted following the MGE period. This outcome indicates a potential need to continue with up-scaled services. Future research is required to understand the broader impact on other EDs in the area, and longitudinal patient follow-up is needed to determine the potential spread of communicable diseases.

CROSS-SECTIONAL SURVEY ASSESSING A CULTURE OF SAFETY AT A LARGE PUBLIC HOSPITAL

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: High-risk industries with a narrow tolerance for errors such as healthcare pay considerable attention to studying safety. Such research has expanded from focus on morbidity and mortality to recognition of ways in which organizational structure, team dynamic, and working conditions impact a climate of patient safety within an institution. The Safety Assessment Questionnaire (SAQ) solicits employee perceptions of teamwork, safety, job satisfaction, stress recognition, management, and working conditions. Validation studies suggest this tool is reliable and responsive to interventions. This study was designed to identify baseline gaps in safety culture among various provider disciplines within our institution. METHODS: The study was conducted in a large public teaching hospital. We used the abbreviated Short Safety Assessment Questionnaire (sSAQ), which explores the same domains as the SAQ via 36 questions graded on a 5-point Likert scale. The survey was distributed over a month-long period to all housestaff rotating on the inpatient medicine floor and in the medical and cardiac intensive care units (MICU and CCU respectively), as well as to medicine floor attendings, MICU and CCU nurses, and inpatient respiratory therapists. Response to the survey was voluntary and anonymous. RESULTS: Responses were obtained from 86% of the rotating housestaff, 91% of floor attendings, 41% of MICU nurses, 24% of CCU nurses, and 33% of respiratory therapists. Housestaff overall responded positively to job satisfaction, stress recognition, and working conditions, while ICU-based housestaff were additionally positive regarding teamwork and patient safety climate. Attendings answered favorably to job satisfaction and stress recognition. CCU nurses scored highest in the domains of safety climate and job satisfaction, while MICU nurses were most satisfied with stress recognition. Nursing units also differed in negative perceptions; CCU nurses expressed that communication breakdown commonly interfered with delivery of patient care, and MICU nurses felt burdened by insufficient staffing for patient volume. Respiratory therapists scored low in stress recognition, perception of management, and working condition domains. They looked favorably on collaboration with nurses but were neutral toward collaboration with physicians. CONCLUSIONS: Responses to the sSAQ revealed discrepancies between provider disciplines regarding perception of safety culture across six different domains. CLINICAL IMPLICATIONS: Improvement in scores across domains in the SAQ has shown association with shorter ICU stays, decreased rates of ventilator-associated pneumonias and blood-stream infections, and lower mortality. Our survey demonstrates a clear opportunity within our institution for targeted quality improvement initiatives which can be tailored to different provider disciplines in order to improve safety culture and optimize patient outcomes. DISCLOSURES: My spouse/partner as a Advisory Committee Member relationship with CORECEPT Please note: $1001 - $5000 Added 03/15/2019 by Vikramjit Mukherjee, source=Web Response, value=Consulting fee No relevant relationships by Maria Sunseri, source=Web Response No relevant relationships by Amit Uppal, source=Web Response No relevant relationships by Brandon Walsh, source=Web Response

SAT-307 NORMAL FETAL KIDNEY VOLUME AND INFANT URINALYSIS IN OFFSPRING OF WOMEN TREATED FOR GESTATIONAL DIABETES

The worldwide prevalence of gestational diabetes mellitus (GDM), defined as any degree of glucose intolerance with onset or first recognition during pregnancy, is increasing, and affects up to 20% of pregnancies. Evidence from animal studies indicate that maternal hyperglycemia can be detrimental to renal development and kidney function in exposed offspring. In humans, renal dysfunction and disease has been reported in adults whose mothers had Type 1 or Type 2 diabetes, suggesting that pre-gestational maternal diabetes influences kidney development and the risk of renal dysfunction in adulthood. Despite its high prevalence, few studies have examined kidney development or renal function in offspring of women with GDM. The aim of this study was to evaluate the impact of treated GDM on fetal kidney size and infant renal physiology. A prospective cohort study was conducted between June 2013 and August 2016 in Melbourne, Australia. Participants were recruited at a large public university teaching hospital and clinical data were collected from women without GDM (n=82) and women diagnosed and treated for GDM (n=76). GDM was diagnosed by routine screening at 26-28 weeks gestation. Women with GDM received specialist support for glucose monitoring, diet and exercise in addition to routine antenatal care. One-third of women with GDM also required insulin therapy. Participants underwent an obstetric ultrasound at 32-34 weeks gestation for fetal biometry and fetal kidney volume measurement. Quantitative urinalyses were performed in infant urine samples at 3 months of age for analysis of protein and electrolytes. Maternal age, weight and body mass index were similar in no-GDM and GDM women. Estimated fetal weight and birth weight were also similar in no-GDM and GDM pregnancies. There were no differences in fetal kidney dimensions, total kidney volume, infant urinary albumin or electrolyte levels. Fetal kidney size did not differ by mode of GDM treatment (i.e. diet and exercise alone, or diet and exercise with insulin therapy). There were no associations between maternal glucose levels at screening and fetal total kidney volume or infant urine albumin in multivariable regression analyses. Findings suggest that a limited period of hyperglycemia prior to diagnosis and treatment of GDM in women attending a large metropolitan public hospital in Australia does not alter fetal kidney volume at 32-34 weeks gestation or urinalysis in 3-month-old infants, a favourable finding considering the increasing number of women diagnosed with GDM.

Improved detection and reduced biopsies: the effect of a multiparametric magnetic resonance imaging-based triage prostate cancer pathway in a public teaching hospital.

Multiparametric magnetic resonance imaging (mpMRI) improves clinically significant prostate cancer (csPCa) detection by facilitating targeted biopsy (cognitive, fusion technology, or in-gantry MRI guidance) and reducing negative biopsies. This study sought to describe the feasibility of introducing an mpMRI-based triage pathway, including diagnostic performance, applicability to training, and cost analysis. An observational retrospective cohort study of consecutive patients attending a large public tertiary referral training hospital who underwent mpMRI for suspicion of prostate cancer was considered. Standard clinical, MRI-related, histopathological, and financial parameters were collected for analysis of biopsy avoidance, diagnostic accuracy of biopsy approach, and operator (consultant and resident/registrar) and logistical (including financial) feasibility. 653 men underwent mpMRI, of which 344 underwent prostate biopsy resulting in a 47% biopsy avoidance rate. Overall, 240 (69.8%) patients were diagnosed with PCa, of which 208 (60.5%) were clinically significant, with higher rates of csPCa observed for higher PIRADS scores. In patients who underwent both systematic and targeted biopsy (stTPB), targeted cores detected csPCa in 12.7% and 16.6% in more men than systematic cores in PIRADS 5 and 4, respectively, whereas systematic cores detected csPCa in 5% and 3.2% of patients, where targeted cores did not. A high standard of performance was maintained across the study period and the approach was shown to be cost effective. Introdution of an mpMRI-based triage system into a large public tertiary teaching hospital is feasible, cost effective and leads to high rates of prostate cancer diagnosis while reducing unnecessary biopsies and detection of insignificant PCa.

An Inclusive Model for Assessing the Quality of Service in Public Sector Tertiary Hospitals

Quality has taken central stage in contemporary organizations and is one of the key areas of competition. Healthcare organizations, in particular, strive to provide better quality services to their patients in order to gain competitive advantage. Researchers and academicians have yet to agree on how to define and measure quality of service. Attempts have been made to develop standards and measurements to determine the degree of quality of services. However, the literature does not contain a model or standards to measure the quality of health care services. The paper in question presents an inclusive model to measure the quality of service of healthcare organizations. In addition to healthcare services (cure and care) the model encompasses teaching aspect of hospitals as well. This model was developed on the basis of an in-depth and careful study of a large (2400 bedded) public sector teaching hospital spread over a period of two years. Data was collected from 400 patients, 250 employees, 200 general public, and 250 students through questionnaire followed by in-depth interviews. In addition to all this, various processes and interactions among individuals in the hospital were closely observed. Hospital records were studied. Anything that possibly could contribute to the quality of service in hospital was placed under one of the three dimensions of the model. Since the model has been inductively developed through data triangulation, it can safely be used to measure the quality of health care services with a good deal of accuracy.

Good training, systems and funding, not good luck: what hematologists and oncologists believe would make it easier for them to refer their cancer patients to psychosocial care.

Rates of referral of patients to psychosocial services are low in most cancer treatment centers, while rates of distress are high. The purpose of this study is to identify clinicians' barriers to referring cancer patients to psychosocial services and strategies that could increase rates of referral. A purposive sampling method ensured data were gathered in two large public teaching hospitals from seven oncologists and five hematologists with varying levels of experience, of whom five were female. Data were collected using semistructured interviews guided by the Capability, Opportunity, Motivation and Behavior model (Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to Designing Interventions. United Kingdom: Silverback Publishing; 2014.). This helped us to identify modifiable variables associated with referral likelihood and associated evidence-based strategies using the Behavior Change Wheel. Data were analyzed using Thematic Analysis. Barriers relating to capability, opportunity, and motivation to refer to psychosocial services were identified, including lack of knowledge of available services, how to refer to them, and the types of patients who would benefit. Other barriers included the following: lack of time to discuss and refer, convoluted referral pathways, long waiting times, and fear of patient reluctance due to stigma. Respondents identified numerous strategies for overcoming barriers, including training on referral best practice, role-plays, the provision of lists of services with referral and contact details, and increasing service capacity via additional funding. Findings inform the development of acceptable, evidence-based strategies, to improve rates of referral to psychosocial services by oncologists and hematologists. Without implementation, a substantial number of people affected by cancer will continue to suffer from potentially treatable distress.