Hospital Level Research Articles

The implementation of the guideline for the management of pediatric off-label use of drugs in China: a cross-sectional study.

Previously, we developed the Guidelines for the Management of Pediatric Off-Label Use of Drugs in China in addressing the need for standardization of pediatric off-label drug use. As the implementation of recommendations in Guidelines among healthcare professionals is weak, it is important to identify barriers to guideline implementation for developing appropriate strategies for specific settings and target groups. This study aimed to assess the difficulty and urgency in implementing the recommendations in the Guideline, identifying the factors affecting the implementation of these recommendations to realize the clinical translation of the Guideline. A cross-sectional study was conducted from March 1 to June 17, 2022. Pediatricians, pharmacists, and health managers from all 31 mainland Chinese provinces were involved. The electronic questionnaires were distributed nationwide by The Clinical Pharmacology Group of the Pediatric Society of the Chinese Medical Association and the National Clinical Research Center for Child Health. Data analysis, including frequency, percentages, averages, and standard deviations was performed using Microsoft Excel 16.54. Chi-squared tests, multi-factor logistic regression, and linear regression were analyzed in SPSS 23.0. A Sankey diagram was constructed using R software. A total of 869 valid questionnaires were collected from 491 participating organizations. More than half of the recommendations were implemented, and 12 recommendations were implemented more in tertiary hospitals than in secondary hospitals. The mean urgency scores of all 21 recommendations were over 5. The mean difficulty scores of all 21 recommendations were over 4. The percentage of the most urgent was 44.33%, and the least urgent was 1.45%. The most difficult portion was 12.03%, and the least difficult was 5.74%. Factors impacting the urgency and difficulty of guideline implementation were different, with common influences including the position, education level of clinicians and hospital level. The recommendations in the Guideline for the Management of Pediatric Off-Label Use of Drugs are considered highly urgent for implementation in China. Nevertheless, the study revealed challenges in applying all 21 recommendations within clinical practice. The key factors affecting implementation include the position, education, experience, and hospital level of healthcare professionals. It is recommended to facilitate implementing the recommendations by sharing experience across various hospital levels, starting from high-level hospitals and extending to primary healthcare settings. Moreover, adjustments to the professional structure within hospitals are needed to enhance the management of off-label drug use in pediatric patients.

ИНСУЛЬТ МЕНЕН ООРУГАН БЕЙТАПТАРДАГЫ ТЕРЕҢ ТАМЫР ТРОМБОЗУНУН ТОБОКЕЛДИК ФАКТОРЛОРУ ЖАНА БОЖОМОЛДООЛОРУ (ИЛИМИЙ АДАБИЯТТАРДЫ КАРАП ЧЫГУУ)

Currently there is no reliable evaluation system for predicting deep vein thrombosis (DVT) in the hospital after ischemic and even more – hemorrhagic stroke. Objective: to review current literature data on the verification of risk factors for the development of DVT in stroke patients and aggressive and early screening strategies in the early post-stroke period. Three fundamental factors underlie the development of DVT: damage to the venous wall, the tendency of blood to hypercoagulation and slow blood flow. Most of the factors that are more or less associated with the development of thromboembolic events revolve around these 3 elements. Typical factors were older age, female gender, changes in the levels of clinical and laboratory variables such as D-dimer or scores on the Berg equilibrium scale. An effective model of risk stratification for DVT at the hospital level after a stroke would be useful for identifying high-risk patients and for implementing individual preventive strategies, therefore further population studies are needed, including in Kyrgyzstan.

Profile of patients diagnosed with hydrogen-producing intestinal bacterial overgrowth and intestinal methanogenic overgrowth in a second level hospital

Profile of patients diagnosed with hydrogen-producing intestinal bacterial overgrowth and intestinal methanogenic overgrowth in a second level hospital

MEDICAL-SOCIAL SUBSTANTIATION OF THE DIRECTIONS FOR THE DEVELOPMENT OF THE CONCEPTUAL MODEL OF THE REGIONAL CENTRE OF CARDIOLOGY ON THE PRINCIPLES OF PUBLIC-PRIVATE PARTNERSHIP (on the example of Kyiv region)

Introduction. The transformation of our country's healthcare system is impossible without quality medical reform. One of the reform's starting directions is improving the provision of cardiac care to the population. Aim. Medical and social substantiation of directions for developing a conceptual model of a regional cardiology centre based on the principles of public-private partnership (on the example of the Kyiv region). Materials and methods. Data from state and industry statistical reports of healthcare institutions of the Ministry of Health of Ukraine and data from the State Statistics Service of Ukraine, as well as materials from a sociological survey of cardiologists and patients and a survey of 31 experts (highly qualified health care organizers) conducted according to specially developed programs) were the materials in this study. The research used complex methods: systematic approach and analysis, synthesis, generalization, interpretation, medical-statistical and sociological method, expert assessment and conceptual modelling method. Results. Stable high levels of circulatory system disease prevalence among the adult population of the Kyiv region and differences depending on different age groups, increase in the mortality rate due to cardiovascular diseases (CVD) in the studied time intervals and the mortality rate of cardiac patients were established. At the same time, there was a decrease in the level of hospitalization of patients along with a decrease in the average number of beds for the treatment of cardiology patients; there were no significant changes in the staffing indicators of health centres of the Kyiv region, which provide cardiac medical care to patients with CVD in 2018-2022. However, there was an increase in the number of cardiovascular surgeon positions for the adult population of the Kyiv region in 2020 by 12.9%, and then a decrease of 7.01% in 2021. The insufficient resource provision of healthcare facilities in which cardiac medical care is provided as evidenced by a significant decrease in the coverage of echocardiography in the study, despite the reform of the network of healthcare facilities in the region. The results of the survey of patients and cardiology specialists revealed significant levels of dissatisfaction with the possibilities of providing and receiving quality cardiology care. Conclusions. A range of problems in the field of providing high-quality cardiac care to the population was determined on the example of the Kyiv region, and a strategy with phased and complex steps to solve the most acute problematic issues was proposed with the proposed project of the Strategic Plan for the development of the regional system of cardiac care for the population of the region for the period 2024-2029.

Prescribing Patterns of Intravenous Artesunate for Severe Malaria and Compliance with National Malaria Treatment Protocol, Gezira State, Sudan

Background: Malaria is a major public health problem in Sudan. Severe malaria, due in majority of cases to P. falciparum, poses a real burden on hospitals. This study aims to describe the prescribing pattern of intravenous artesunate (IV-AS) for severe malaria and compliance with national malaria treatment protocol in Gezira State, Sudan. Methods: The study enrolled severe malaria patients who were admitted to the Wad Madani Teaching Hospital during June – August 2022. Patients were verbally consented and followed at hospital level till discharge. Data was recorded on data collection sheet and analyzed using SPSS version 20. Results: Over three months period, 500 patients were diagnosed as having severe malaria based on clinical criteria and the results of thick blood film. The majority were from rural areas and most of them were male. IV-AS was administered for all patients and 71% of patients discharged after administering three doses of artesunate with no serious adverse effects. In 96.4% of patients, the prescription followed the right dosage schedule. The source of the drug was health insurance fund and private sector in 78.4% and 21.6% respectively. The study investigates the prescribing patterns of intravenous artesunate (IV-AS) for severe malaria and compliance with the national malaria treatment protocol in Gezira State, Sudan. A Chi-Square Test of Independence was used to explore associations between gender and the number of IV-AS doses received, as well as between residence (rural vs. urban) and compliance with the dosage schedule. The results showed no significant association between gender and the number of IV-AS doses received (p = 0.915), and no significant association between residence and compliance with the dosage schedule (p = 0.925). These findings suggest that the prescribing patterns and compliance with the treatment protocol are consistent across different genders and between rural and urban patients. Conclusion: Severe malaria patients were treated with IV-AS according to national malaria treatment guidelines with few exceptions. Most patients discharged after administering three doses of artesunate with no serious adverse side effects. Efforts to establish quality assured microscopy and to maintain the current prescription pattern is highly needed.

Use of antihypertensive agents and its present perspective: an observational retrospective study

Objectives: To evaluate the utilization of antihypertensive agents for the patients of Hypertension and subsequently their health outcome at a Tertiary Care Level Hospital and to observe the relationship among demographic profile of the patients. Materials and Methods: An observational retrospective study was undertaken collecting total 680 patients’ data from patient admission ticket of a Tertiary Care Level Hospital. Mainly drugs used and outcome of the patients were recorded. Of all patients 306 were found to be treated with calcium channel blockers (CCBs), 77 with angiotensin receptor blockers (ARBs), 229 with CCBs plus ARBs, 46 with CCBs plus ARBs and beta blockers and only 22 patients got CCBs, ARBs and diuretics. Data were statistically analysed in respect of demographic profile, drugs used and clinical features of the patients. Results: Best outcome was observed in patients treated with solely CCBs where in 289 out of 306 patients, hypertension was controlled. 194 out of 229 patients with CCBs and ARBs showed desired outcomes. 41 out of 77 with only ARBs, 29 out of 46 with CCBs, ARBs and beta blockers and 16 out of 22 with CCBs, ARBs and diuretics ended with positive results. Conclusion: Calcium channel blockers alone and in few cases in combination with angiotensin receptor blocking agents are very effective in controlling hypertension. Keywords: Hypertension, calcium channel blockers and angiotensin receptor blockers

Prevalence, pattern and predictors of fast-food consumption among the undergraduate nursing students of a tertiary level hospital

The global fast-food industry has grown exponentially, significantly impacting public health by contributing to metabolic disorders like obesity and diabetes. This study aimed to investigate the prevalence, patterns, and predictors of fast-food consumption among 201 undergraduate nursing students at a tertiary-level hospital in India. Using a cross-sectional design, data were collected through a validated self-administered questionnaire and analyzed using R software. Descriptive statistics, chi-square tests, and logistic regression were employed to assess associations between demographic factors and fast-food consumption. Results showed a high prevalence of fast-food consumption (90.0%), with a significant association between fast-food and carbonated drink consumption (p < 0.01). However, no significant predictors of fast-food consumption were identified among demographic factors such as gender, academic year, and residence type. These findings underscore the need for targeted nutritional interventions within nursing curricula to promote healthier dietary habits among future healthcare providers.

Assessment of Quality of Life of Doctors during Corona Pandemic in a Tertiary Hospital in Dhaka City

Background: Corona pandemic is an event where there is a rupture of the normal life pattern. The healthcare professionals specially doctors had faced an unknown potential threat to life that made them work in an intense and fearful situation. So, their quality of life (QOL) was affected in that pandemic. Objectives: To assess the physical health, psychological, social relationship, and environmental domains of quality of life of doctors during COVID-19 pandemic in a tertiary level hospital. Methods: It was a cross sectional study that included 100 doctors who were working during corona pandemic in BSMMU. Then they were interviewed with a semi-structured socio-demographic questionnaire. Quality of life was assessed by validated Bengali version of World Health Organization quality of life scale brief (WHOQOL-BREF). Data analysis was performed by statistical package for social science (SPSS), version-20. Results: Among the four domains, the environmental domain had the lowest score followed by physical health and psychological health domain and the social relationship domain showed a relatively higher score. Besides, environmental health scores of female doctors were significantly higher than those of male doctors. Perceptions of quality of life were significantly poor among doctors who were in current economic struggle (p=0.034) or in fear of future economic struggle (p=0.009). Score of environmental health domain were significantly low among doctors who were in current economic struggle (p=0.0137) as well as in fear of future economic struggle (p=0.015). Conclusion: All domains of quality of life were impaired in doctors during COVID-19 pandemic situation. Among the four domains of WHOQOL-BREF scale, environmental domain was mostly affected. Environmental health of male doctors was worse than female doctors during COVID-19 pandemic. Current as well as fear of future economic struggle in COVID-19 pandemic detrimentally affected perception of quality of life among responded doctors. These also caused poor environmental health among doctors in COVID-19 pandemic. J Com Med Col Teachers Asso Jan 2024; 28(1): 09-13

Beyond American College of Surgeons Verification: Quality Metrics Associated with High Performance at Level I and II Trauma Centers.

The American College of Surgeons (ACS) Committee on Trauma has established a framework for trauma center quality improvement. Despite efforts, recent studies show persistent variation in patient outcomes across national trauma centers. We aimed to investigate whether risk-adjusted mortality varies at the hospital level and if high-performing centers demonstrate better adherence to ACS Verification, Review, and Consultation (VRC) program quality measures. We analyzed data from the 2018-2021 ACS TQIP Participant Use Files, focusing on adult admissions at ACS-verified Level I or II trauma centers for blunt, penetrating, or isolated traumatic brain injury. We used mixed-effects models to assess center-specific risk-adjusted mortality and identified high-performing centers (HPTC), defined as those with the lowest decile of overall risk-adjusted mortality. We compared patient and hospital characteristics, outcomes, and adherence to ACS-VRC quality measures between HPTC and non-HPTC. Over the study period, 1,498,602 patients across 442 Level I and II trauma centers met inclusion criteria: 65.3% presenting with blunt injury, 9.3% with penetrating injury, and 25.4% with isolated TBI. Management at HPTC was associated with lower odds of major complications, failure-to-rescue and takeback. Furthermore, HPTC status was associated with increased odds of adherence to several ACS-VRC quality measures, including balanced resuscitation (Odds Ratio [OR] 1.40, 95%Confidence Interval [CI] 1.29-1.51), appropriate pediatric admissions (OR 1.88, 95%CI 1.07-3.68), and substance abuse screening (AOR 1.14, 95%CI 1.12-1.16). Significant variation in risk-adjusted mortality persists across trauma centers. Given the association between adherence to quality measures and high-performance, multidisciplinary efforts to refine and implement guidelines are warranted.

Emergence of NDM-1-Producing Pseudomonas aeruginosa Nosocomial Isolates in Attica Region of Greece.

Here, we report on the emergence and spread of multidrug-resistant NDM-1-producing P. aeruginosa isolates from patients hospitalized in the Attica region, Greece, in 2022 to provide data on their resistome, their virulome, the genetic environment of blaNDM-1, and their molecular epidemiology. A total of 17 carbapenem-resistant P. aeruginosa isolates identified as NDM-producers by immunochromatography at the hospital level were sent to the Central Public Health Laboratory, in the frame of the laboratory surveillance of carbapenem-resistant pathogens, for further characterization. The initial screening for genetic AMR determinants was carried out by PCR and the MDR Direct Flow Chip assay. Typing was performed by MLST and DLST, the latter in a subset of isolates. Further analysis was performed by whole-genome sequencing (WGS) of six isolates from both hospitals to analyze their entire genomes and elucidate their genetic relatedness. All isolates were allocated to international high-risk clones, sixteen to ST773 and one to ST308. Five ST773 and the sole ST308 isolate were found to harbor the blaNDM-1 gene, along with various other ARGs integrated into their chromosomes, as well as with a wide variety of virulence genes. The blaNDM-1 gene was located in the integrative and conjugative elements ICE6600-like and ICETn43716385 in ST773 and ST308 isolates, respectively. Single-nucleotide polymorphism analysis of the five ST773 isolates indicated their clonal spread in both hospitals. These results suggested that two different molecular events contributed to the emergence of NDM-1-producing P. aeruginosa isolates in Athenian hospitals, highlighting the need for ongoing surveillance.

Frequency of antimicrobial-resistant bloodstream infections in 111 hospitals in Thailand, 2022

To evaluate the frequency of antimicrobial-resistant bloodstream infections (AMR BSI) in Thailand. We analyzed data from 2022, generated by 111 public hospitals in health regions 1 to 12, using the AutoMated tool for Antimicrobial resistance Surveillance System (AMASS), and submitted to the Ministry of Public Health, Thailand. Multilevel Poisson regression models were used. The most common cause of community-origin AMR BSI was third-generation cephalosporin-resistant Escherichia coli (3GCREC, 65.6%; 5101/7773 patients) and of hospital-origin AMR BSI was carbapenem-resistant Acinetobacter baumannii (CRAB, 51.2%, 4968/9747 patients). The percentage of patients tested for BSI was negatively associated with the frequency of community-origin 3GCREC BSI and hospital-origin CRAB BSI (per 100,000 tested patients). Hospitals in health regions 4 (lower central region) had the highest frequency of community-origin 3GCREC BSI (adjusted incidence rate ratio, 2.06; 95% confidence interval: 1.52-2.97). Health regions were not associated with the frequency of hospital-origin CRAB BSI, and between-hospital variation was high, even adjusting for hospital level and size. The high between-hospital variation of hospital-origin CRAB BSI suggests the importance of hospital-specific factors. Our approach and findings highlight health regions and hospitals where actions against AMR infection, including antimicrobial stewardship and infection control, should be prioritized.

Maternal Characteristics and Prevalence of Infants Born Small for Gestational Age

Being born small for gestational age (SGA) is a risk factor for neonatal mortality and adverse outcomes in the short and long term. The maternal profile in China has substantially changed over the past decade, which may affect the risk of infants born SGA. To analyze the prevalence of infants born SGA from 2012 through 2020 and explore the association of maternal sociodemographic characteristics and other factors with that prevalence. This cross-sectional study examined data from the National Maternal Near Miss Surveillance System on women who delivered singleton live births at gestational ages of 28 to 42 weeks from January 1, 2012, through December 31, 2020, in China. Statistical analysis was performed from December 2022 to September 2023. Characteristics of delivery (year, region of country, and hospital level), mother (age, educational level, marital status, prenatal visits, parity, preexisting diseases, or prenatal complications), and newborn (birth weight, sex, and gestational age). Prevalence of infants born SGA stratified by severity and by region of the country, changes in prevalence based on log-linear Poisson regression with robust variance, and association of maternal characteristics with changes in prevalence of infants born SGA between 2012 and 2020 based on the Fairlie nonlinear mean decomposition. Among 12 643 962 births (6 572 548 [52.0%] male; median gestational age, 39 weeks [IQR, 38-40 weeks]), the overall weighted prevalence of infants born SGA was 6.4%, which decreased from 7.3% in 2012 to 5.3% in 2020, translating to a mean annual decrease rate of 3.9% (95% CI, 3.3%-4.5%). The prevalence of infants born SGA decreased from 2.0% to 1.2% for infants with severe SGA birth weight and from 5.3% to 4.1% for those with mild to moderate SGA birth weight. The mean annual rate of decrease was faster for infants with severe SGA birth weight than for those with mild to moderate SGA birth weight (5.9% [95% CI, 4.6%-7.1%] vs 3.2% [95% CI, 2.6%-3.8%]) and was faster for the less developed western (5.3% [95% CI, 4.4%-6.1%]) and central (3.9% [95% CI, 2.9%-4.8%]) regions compared with the eastern region (2.3% [95% CI, 1.1%-3.4%]). Two-thirds of the observed decrease in the prevalence of infants born SGA could be accounted for by changes in maternal characteristics, such as educational level (relative association, 19.7%), age (relative association, 18.8%), prenatal visits (relative association, 20.4%), and parity (relative association, 19.4%). Conversely, maternal preexisting diseases or prenatal complications counteracted the decrease in the prevalence of infants born SGA (-6.7%). In this cross-sectional study of births in China from 2012 to 2020, maternal characteristics changed and the prevalence of infants born SGA decreased. Future interventions to reduce the risk of infants born SGA should focus on primary prevention.

Navigating complex care pathways-healthcare workers' perspectives on health system barriers for children with tuberculous meningitis in Cape Town, South Africa.

Tuberculous meningitis (TBM) occurs when tuberculosis (TB) bacilli disseminate and seed into the meninges, triggering a severe inflammatory response that often leads to brain infarction. It is the most severe and debilitating form of childhood TB with high mortality, and children who survive TBM often suffer lifelong physical and neuro-disability resulting in emotional, social, and economic burdens for families. In the early stages the symptoms may be non-specific and so the diagnosis is often made late when the patient already has significant brain injury. To facilitate earlier diagnosis, it is important to understand how patients are evaluated. This study aimed to chart health systems for paediatric TBM care at both primary healthcare (PHC) and hospital level in Cape Town, South Africa. We conducted fourteen in-depth interviews and eight days of semi-structured observations of patient flow across eight healthcare facilities. We found that children with TBM navigate multiple levels of care categorised into pre-admission and primary care, hospital admission and inpatient care, and post-discharge follow-up care. Healthcare workers identified the following health system barriers along the TBM care pathway for children: limited post-training and mentorship opportunities to manage TBM, overburdened facilities, time constraints, lack of recognition of TBM symptoms, delays in referral between PHC and hospital, lack of standardized diagnostic algorithms, limited diagnostic tests and a lack of child-friendly, easy-to-administer treatment. Regular and compulsory training on TB and TBM in children, including continuous mentoring and support to healthcare workers working in child health and TB services in high TB-burden settings, can facilitate early recognition of symptoms and rapid referral for diagnosis. Algorithms outlining referral criteria for patients with possible TBM at both PHC facilities and district level hospitals can guide healthcare providers and facilitate timely referral between different levels of healthcare services. An integrated data system and alert functions could flag multiple healthcare visits and improve communication between different healthcare facilities during diagnosis and treatment. Children and families affected by TBM are an especially vulnerable sub-population requiring high priority attention and support.

Trends of drug expenditure in Taiwan National Health Insurance before and during COVID-19 pandemic.

The Taiwanese government adopted the National Health Insurance (NHI) system in March 1995. This study aimed to understand the difference in medication costs before (year 2019) and during the COVID-19 pandemic (2020-2021) among different hospitals for treating their patients. The NHI claims database consisting of claims of prescription drugs for inpatients (IPD) and outpatients (OPD) in Taiwan was used to determine drug expenditure in different hospitals, particularly the top 10 prescription Anatomical Therapeutic Chemical (ATC) categories. In medical centers, L01X (other antineoplastic agents) showed the highest drug expenditure, followed by L04A (immunosuppressants) and J05A (direct-acting antivirals). The drug expenditure pattern in regional hospitals was similar to that in medical centers, with L01X (other antineoplastic agents) showing the highest drug expenditure. L01X (other antineoplastic agents) also showed the highest drug expenditure in district hospitals, followed by N05A (antipsychotics) and A10B (blood glucose-lowering drugs, excluding insulin). In clinics, A10B (blood glucose-lowering drugs, excluding insulin) showed the highest drug expenditure. The total medication costs in 2021 were lower or similar to those in 2019. The use of systemic use anti-infectives decreased over time in OPDs among all hospita1 levels but increased in IPDs in medical centers and district hospitals. Furthermore, our analysis revealed that the trend in drug expenditure closely mirrored the trend in drug prescription volume for the highest annual sum cost item among the top 10 drug subgroups across different hospital levels. Our analysis found that annual drug expenditures in 2021 were lower or similar to those in 2019, suggesting that the COVID-19 pandemic has contributed to this reduction in drug expenditure.

A comparative analysis of nurses' reported number of patients and perceived appropriate number of patients in integrated nursing care services.

This study aimed to compare the number of assigned and appropriate patients per nurse in integrated nursing care service wards and analyze factors associated with the gap. For this cross-sectional secondary analysis, data were collected from surveys of 2312 nurses and institutional data from their affiliated 106 hospitals in Korea. We used the Wilcoxon signed-rank test and t-test to compare the number of patients assigned to nurses with the number they considered appropriate. We used ratio analysis for measuring the gap between these numbers, and robust regression to evaluate the factors affecting this gap. The results found an average gap of 1.45, indicating that the reported number of assigned patients per nurse was 1.45 times higher than the appropriate number. Gender, employment type, wage satisfaction, workload, overtime work, and hospital level of care were identified as factors associated with the gap. Findings suggest that the current nurse staffing standard should be revised to consider nurses' professional judgments of appropriate staffing levels and adopt policies that reduce nurses' workload.

Which factors affect post-transfer gaps in follow-up care? A qualitative study of the insights of healthcare providers in Sweden and Belgium

BackgroundYoung people with congenital heart disease (CHD) are frequently affected by discontinued follow-up when transferring from paediatric to adult care. Identified predictors for discontinuation include mostly patient-related factors, and further...

Clinico-Mycological Study of Dermatophytosis among Diabetic and Non-Diabetic Patients in a Tertiary Level Hospital: A Comparative Study

Abstract Background: Dermatophytosis is a major public health concern in India, especially in recent years, with an alarmingly rising trend, particularly in relation to recurrent and chronic infection. The number of studies examining the relationship between an individual’s glycemic status and the development of dermatophytosis, and a comparison of the evolving species trend between diabetic and non-diabetic patients infected with dermatophytes, is limited. Aims and Objectives: To study and compare the clinical and mycological aspects of dermatophytosis among diabetic and non-diabetic patients and to compare the culture isolates in both groups. Materials and Methods: The study included 378 patients of clinically suspected dermatophytosis, divided into two groups of 189 known diabetics and non-diabetics each. We subsequently analysed and compared the demographics, clinical data, potassium hydroxide (KOH) mount, calcofluor white (CW) staining and fungal culture results of all patients in both groups. Results: Among the 378 patients, diabetic patients had a significantly greater extent of involvement and higher rates of recurrence when compared to non-diabetics. The overall positivity rate was higher in CW staining (77.8%) as compared to KOH (57.7%) in both non-diabetics and diabetics. Trichophyton mentagrophytes was the most common isolate (47.6%) in both diabetic (55.0%) and non-diabetic (61.4%) patients, followed by Trichophyton rubrum (31.8% and 29.6%, respectively). The positivity percentages of fungal culture, KOH and CW staining increased to 100%, 77.9% and 95.7%, respectively, when scrapings were taken from ≥2 sites. Conclusion: The pattern of dermatophytosis is comparatively more chronic and severe in diabetics compared to non-diabetics. T. mentagrophytes was the most common culture isolate in both groups. CW staining can potentially be used as the initial method of choice for the diagnosis of dermatophytosis as it has significantly outperformed the conventional KOH mount. Scrapings can regularly be taken from ≥2 sites to avoid false negative results.

Clinical characteristics and management of patient with portal hypertension at tertial level hospital in Tanzania

BackgroundPortal hypertension is a common diagnosis in Sub-Saharan African countries, with the majority of patients presenting late. This study aimed to understand Clinical characteristics, aetiology, the treatment offered in our setting, and factors associated with portal hypertension at a tertiary-level hospital, in Tanzania.MethodologyA prospective cross-sectional observational single hospital-based study was conducted at MNH, from May 2021 to April 2022. A minimum of 152 subjects were required with an error of less than 5% and a study power of 80% at a 95% confidence interval. A structured questionnaire was used to collect data. Ethical clearance was obtained from the MUHAS/MNH IRB.ResultsA total of 154 eligible participants consented and participated in this study. The mean age of participants was 42 ± 15.8 years (range 2–87). Most of the study participants were males 64.9% with a male-to-female (M: F) ratio of 1.8:1. Vomiting blood was the common symptom among the study participants 51.3%. Schistosomiasis 53.9% and viral infection 26.6% were the common etiologies followed by alcohol abuse 7.8%. Most were medically treated at 89.61% followed by radiological treatment at 8.44% while only 1.95% of patients received surgical treatment. There was a significant association between the grade of oesophagal varices and bleeding consequences (p-value < 0.01).ConclusionThe majority of patients were medically treated while patients who require surgical care are unable to assess it. We recommend the establishment of a transplant services program to counteract the unmet need and more retrospective research toward policy establishment.

Relevant factors affecting nurse staffing: a qualitative study from the perspective of nursing managers.

To understand the current situation of nursing manpower allocation, explore the factors affecting nurse staffing, improve nurse staffing level, and provide reference for better formulation of nursing human resources staffing standards. A descriptive research method was used to conduct semi-structured interviews with 14 nursing managers. The data were analyzed and refined by content analysis. The sample size was subject to content saturation. Nine themes and twenty sub-themes of influencing factors for nursing staffing were identified across four levels: hospital level, department level, patient level, and nurse level. Hospital and department managers need to comprehensively consider the factors of affecting nurse staffing. Adopting multidimensional optimization measures, improving relevant systems, optimizing nurse structure, and establishing flexible and mobile nurse database to cope with public emergencies, so as to effectively improve nurse staffing and nursing service quality.

Provider care segregation and hospital-region racial disparities for carotid interventions in the USA

BackgroundReasons for racial disparities in the utilization and outcomes of carotid interventions (carotid endarterectomy (CEA) and carotid artery stenting (CAS)) are not well understood, especially segregation of care associated with...