Local Regional Hospital Research Articles

Referral, Diagnosis, and Pharmacological Management of Peripheral Artery Disease: Perspectives from Taiwan.

Peripheral artery disease (PAD) imposes a heavy burden of major adverse cardiovascular events that are associated with considerable mortality and morbidity, and major adverse limb events (e.g., thrombectomy, revascularization, amputation) that can substantially impact patients' daily functioning and quality of life. Global registry data have indicated that PAD is an underdiagnosed disease in Taiwan, and its associated risk factors remain inadequately controlled. This review discusses the burden of PAD in Taiwan, major guidelines on PAD management, and the latest clinical trial outcomes. Practical experience, opinions, and the latest trial data were integrated to derive a series of clinical algorithms - patient referral, PAD diagnosis, and the antithrombotic management of PAD. These algorithms can be adapted not only by physicians in Taiwan involved in the clinical management of patients with PAD but also by general practitioners in local clinics and regional hospital settings, with the ultimate aim of improving the totality of PAD patient care in Taiwan.

Did the coronavirus vaccination program in a rural and regional area work? Health outcomes of the vaccination program in Wide Bay.

The objective of this case study is to evaluate the effectiveness of the Wide Bay region coronavirus vaccination program in preventing hospitalisation for coronavirus disease 2019 (COVID-19). Population vaccination data and the vaccination status of patients hospitalised with confirmed COVID-19 have been used to evaluate preventable hospitalisations and risk reduction during and after a 2 month period following the outbreak of COVID-19 in Wide Bay after removal of public health measures in Queensland in December 2021. Wide Bay is a rural region of Queensland including K'Gari (formerly Fraser Island) to the east, the North Burnett farming region in the west and extending from the Fraser Coast to the Discovery Coast. Two local regional hospitals received and managed hospitalised COVID-19 patients. The region had, at this time, 171 365 people 20 years and older eligible for coronavirus vaccination. The risk reduction for hospitalisation of those receiving fewer than two vaccinations, two vaccinations and three vaccinations was calculated to determine the vaccination program effectiveness. The program achieved 90% effectiveness for people with two or more vaccinations (those with two vaccinations and those receiving boosters of third or more vaccination), and 97% effectiveness for those having received three vaccinations, in preventing hospitalisation for COVID-19 during the period. This translated into a significant risk reduction for hospitalisation for those receiving two or more vaccinations, preserving capacity to enable the health service to manage all cases locally.

Management and referral of acute laryngotracheitis - Croup: The New South Wales Neonatal and Paediatric Emergency Transport Service experience.

To evaluate the experience of NETS (The Newborn and paediatric Emergency Transport Service) New South Wales (NSW) with children referred with a provisional diagnosis of croup. To examine the adherence of referral hospitals to NSW Health policy guidelines and to establish criteria for the need to transfer and the level of escort required for a child with croup to a higher level of care. A retrospective audit of all children with a provisional diagnosis of croup referred to NETS over the epoch: 2005-2015. The NETS database was searched for keywords: croup and laryngotracheitis. Demographics, retrieval characteristics and management strategies were collected. A total of 432 patients were identified. The number of children triaged to a medically led NETS team for transfer decreased (P< 0.001) whilst those transferred into more local regional or metropolitan hospitals (P< 0.001) increased. The number of adrenaline doses was not associated with intensive care admissions or the need for invasive ventilation. Medically led retrieval teams are not necessary for safe transfer of children with a provisional diagnosis of croup unless the airway is secured with an endotracheal tube. Transfer to more local hospitals for paediatric care should be considered and time allowed for medications to take effect prior to movement.

An exploration of Neonatal Intensive Care Unit (NICU) staff experiences of attending pre-brief and debrief groups surrounding a patient's death or redirection of care

This paper presents the findings of a service evaluation project exploring staff experiences of Neonatal Intensive Care Unit staff support groups. The Neonatal Intensive Care Unit at a local regional hospital, developed and provided staff support groups before (pre-brief) and after (debrief) a death of an infant on the ward. These groups were run between December 2018 and July 2019. Content analysis was used to understand and summarise patterns and themes within the data. Frequency data was used to identify how these themes linked with staff ratings of the groups. The majority of staff had a positive experience of the group and recommended expanding the support groups to wider intensive care units. A subgroup of staff felt vulnerable in the groups and recommendations were put forward to promote the group's psychological safety. Directions for future service evaluations are discussed.

Designing an efficient blood supply chain network in crisis: neural learning, optimization and case study

In recent years, attention to blood supply chain in disaster circumstances has significantly increased. Disasters, especially earthquakes, have adverse consequences such as destruction, loss of human lives, and undermining the effectiveness of health services. This research considers a six-echelon blood supply chain which consists of donors, blood collection centers (permanent and temporary), regional blood centers, local blood centers, regional hospitals, and local hospitals. For the first time, we considered that helicopters could carry blood from regional hospitals to local hospitals and return injured people that cannot be treated in local hospitals to regional hospitals due to the limited capacity. In addition to the above, different transportations with limited capacities regarded, where the optimal number of required transportations equipment determined after the solution process. This research aims to avoid the worst consequences of a disaster using a neural-learning process to gain from past experiences to meet new challenges. For this aim, this article considers three objective functions that are minimizing total transportation time and cost while minimizing unfulfilled demand. The model implemented based on a real-world case study from the most recent earthquake in the Iran–Iraq border which named the deadliest earthquake of 2017. Based on our results, we learned how to design an efficient blood supply chain that can fulfill hospitals blood demand quickly with the lowest cost using simulation and optimization processes. Moreover, we performed in-depth analyses and provided essential managerial insights at last.

Epidemiology of respiratory syncytial virus infection and its effect on children with heart disease in Hong Kong: a multicentre review.

There is no guideline in Hong Kong regarding respiratory syncytial virus (RSV) immunoprophylaxis for children with heart disease because of a lack of local data on RSV infection. Therefore, this study evaluated the epidemiology and impact of RSV infection on children with heart disease in Hong Kong, with the goal of providing recommendations regarding RSV immunoprophylaxis. This multicentre retrospective case-control study on paediatric RSV infection was conducted in four local regional hospitals from 2013 to 2015. The patients' demographic and clinical data were retrieved and analysed. There were 3538 RSV hospitalisations during the study period, and the mortality rate was 0.14%. Some RSV seasonality was present in Hong Kong, primarily in spring and summer. Respiratory syncytial virus infection was positively correlated with relative humidity and negatively correlated with wind speed and atmospheric pressure. Patients with heart disease had a more severe outcome than those without, including longer median hospital stay (4 vs 2 days, P<0.001), higher complication rate (28.6% vs 9.8%, P<0.001), and higher rates of intensive care (11.6% vs 1.4%, P<0.001) and mechanical ventilation (3.6% vs 0.4%, P=0.003). Complications in non-cardiac patients included myocarditis and Kawasaki disease. Predictors of severe RSV infection in patients with heart disease were heart failure, pulmonary hypertension, and severe airway abnormalities associated with congenital heart disease. Respiratory syncytial virus infection occurs mainly in spring and summer in Hong Kong, and is related to meteorological conditions. Respiratory syncytial virus infection poses a heavy disease burden on children with heart disease. A local guideline on RSV immunoprophylaxis for these children is therefore needed.

Effectiveness of regional medical schools in attracting and retaining students for early-career practice in the local area: The James Cook University experience.

The regionally based James Cook University medical school in northern Australia has focused its selection processes and curriculum on recruiting, training and graduating doctors to address local workforce needs. This study investigates if James Cook University's regionally based medical school model promotes graduates undertaking internship in local regional hospitals. Cross-sectional survey of final year James Cook University Bachelor of Medicine, Bachelor of Surgery graduates towards the end of the 2016 and 2017 academic years (n=207; response rate=58%). Multivariate (binary outcomes) logistic regression analysis identified the personal and curriculum factors predicting students' choice to do their internship in northern Australia supported by content analysis of free text responses to expand on quantitative associations. Students applied to medicine at James Cook University because there was: "an undergraduate program" (62%); "reputation for a good course/quality graduates" (59%); and "interest in rural medicine or Indigenous health" (39%). Internship in northern Australian hospitals was predicted by: "familiarity with the hospital in Years 5 and 6"; "having a northern Australia hometown at time of application to medical school"; "an interest in rural medicine or Indigenous health"; and "interns have better learning experiences in regional teaching hospitals". The findings suggest regionally based medical schools can promote early-career rural practice by incorporating purposive selection, a rurally focused curriculum supported by quality clinical training experiences in local hospitals and a sufficient number of locally available intern places. However, it is likely regionally based medical schools also require locally available specialty training pathways to support rural practice in the longer term.

Advances in Early Detection of Pancreatic Cancer.

Pancreatic ductal adenocarcinoma (PDAC) is a lethal disease. PDAC is the fourth leading cause of death in the United States and Japan based on epidemiological data. Early detection of PDAC is very important to improve the prognosis of PDAC. Early detection of pancreatic ductal adenocarcinoma (PDAC) requires further examination after selecting cases with risk factors for the condition, such as family history, hereditary pancreatic carcinoma syndrome, intraductal papillary mucinous neoplasms, or chronic pancreatitis. The Japan Study Group on the Early Detection of Pancreatic Cancer has investigated and clarified the clinicopathological features for the early diagnosis of PDAC. In Japan, an algorithm for the early diagnosis of PDAC, which utilized the cooperation of local clinics and regional general hospitals, has been a breakthrough in the detection of early-stage PDAC. Further approaches for the early diagnosis of PDAC are warranted.

Decompression illness and other injuries in a recreational dive charter operation.

Health and safety within the recreational diving industry are poorly described. We aimed to obtain the true prevalence of decompression illness (DCI) and other diving and non-diving injuries, including occupational injuries, in a large recreational diving charter operation. A New Zealand recreational diving operator keeps detailed records of diving activity and event/incident reports. We extracted passenger and crew numbers, dive numbers and incident statistics from all boat trips and associated work-related injuries between 01 January 2008 and 31 December 2014. The records of divers referred to the regional hyperbaric unit for suspected DCI were reviewed retrospectively. Using these data the prevalence of DCI and non-diving injuries were calculated. There were 65,536 person-trips to sea and 57,072 divers undertook 97,144 dives. Fifty-five injury events were documented over seven years, 31 in customers and 24 in staff. Four divers (including one staff member) diagnosed with DCI underwent recompression therapy, giving a prevalence of 0.41 cases requiring recompression per 10,000 dives, or one case per 24,386 dives, whilst five other divers were assessed as not having DCI. There was one cardiac-related fatality. Thirty-five non-diving injuries (mainly lacerations and minor musculoskeletal injuries) were documented in 30 people resulting in 10 consulting a general practitioner and seven presenting to the local regional hospital emergency department. DCI requiring recompression was relatively rare in this supervised recreational diving operation. Minor non-diving injuries were the most common adverse event. Compared to other adventure sports, the prevalence of injury in recreational scuba diving is low.

Effectiveness of manual therapy versus surgery in pain processing due to carpal tunnel syndrome: A randomized clinical trial.

People with carpal tunnel syndrome (CTS) exhibit widespread pressure pain and thermal pain hypersensitivity as a manifestation of central sensitization. The aim of our study was to compare the effectiveness of manual therapy versus surgery for improving pain and nociceptive gain processing in people with CTS. The trial was conducted at a local regional Hospital in Madrid, Spain from August 2014 to February 2015. In this randomized parallel-group, blinded, clinical trial, 100 women with CTS were randomly allocated to either manual therapy (n=50), who received three sessions (once/week) of manual therapies including desensitization manoeuvres of the central nervous system, or surgical intervention (n=50) group. Outcomes including pressure pain thresholds (PPT), thermal pain thresholds (HPT or CPT), and pain intensity which were assessed at baseline, and 3, 6, 9 and 12months after the intervention by an assessor unaware of group assignment. Analysis was by intention to treat with mixed ANCOVAs adjusted for baseline scores. At 12months, 95 women completed the follow-up. Patients receiving manual therapy exhibited higher increases in PPT over the carpal tunnel at 3, 6 and 9months (all, p<0.01) and higher decrease of pain intensity at 3month follow-up (p<0.001) than those receiving surgery. No significant differences were observed between groups for the remaining outcomes. Manual therapy and surgery have similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with CTS. Neither manual therapy nor surgery resulted in changes in thermal pain sensitivity. The current study found that manual therapy and surgery exhibited similar effects on decreasing widespread pressure pain sensitivity and pain intensity in women with carpal tunnel syndrome at medium- and long-term follow-ups investigating changes in nociceptive gain processing after treatment in carpal tunnel syndrome.

Diabetic foot syndrome: farfetched or real threat?

Actuality of the problem. Mortality from diabetes is higher than the mortality rate from AIDS, tuberculosis and malaria combined, however, in the International Classification of Diseases such a difficult and life-threatening complication of diabetes as diabetic foot syndrome (DFS) is absent. Status of the problem in Ukraine. Absence of diabetic foot service, in and of itself, in Ukraine. No verified statistics about the prevalence of diabetes mellitus and its complications (cardiovascular, neuropathic, related amputations – high or low). The absence of the level-divided aid management. We have not also the national standards for prevention and treatment schemes. Instead, a different subordination of existing DF clinics, departments takes place, thus there is no clear plan for examinations and treatment schemes and sometimes questionable methods and tactics of treatment being used. The training centers for podologists and podiatrists (nurses) are lacking. Also we have to notice an anarchy and disorder of scientific and research programs and studies, which often repeat each other and the foreign investigations. Ways of solving the problems. 1. Implementation of common standards and criteria for classification, diagnosis, prevention and treatment of DFS based on international consensus documents, foremost by IWGDF. As a result, official protocols due to be published and approved by the Ministry of Health. 2. Establishing of regional "anchor" hospitals for treatment of DFS on the basis of regional hospitals headed by the responsible person (responsible for the statistics of DFS too). We need the implementation of a unified system of medical and preventive care at three levels (the local clinics, regional hospitals and expert hospitals) with well-defined functionality, as recommended by IWGDF and IDF. 3. Ministry of Health and NGOs must to define strategy and tactics of the state supply of treatment of patients according to the newly-established national protocol based on international consensus documents (on the principles of evidence-based medicine) with expertise approach to regular changes and updates. Together with postgraduate universities we have to develop and implement a system of podiatrists-training and approve range of paramedical personnel - podiatric nurse. It is necessary to streamline the scientific work in different specialties (endocrinology, surgery, orthopedics, vascular surgery, neurology, etc.) for the optimization and systematization.

Medication induced osteonecrosis of the jaws — a local regional hospital experience

Medication induced osteonecrosis of the jaws — a local regional hospital experience

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Correlation of Helical Computed Tomography (CT) Features With Pathologic Findings

Intraductal papillary mucinous neoplasms (IPMNs) are precancerous lesions of the pancreas. Computed tomography (CT) has been recommended to screen the malignant potential of IPMNs. However, data evaluating the use of CT to differentiate categories of IPMN based on disease progression are limited. This study aimed to explore the correlation between CT characteristics and pathology in IPMN associated with invasive carcinoma. A total of 31 patients with intraductal papillary mucinous carcinoma (IPMC) treated at one local regional hospital in Shanghai, China, were enrolled in this study. Patients were divided into two groups based on invasion component and characterized as follows: group A, an invasive component of less than 50% (IPMC-I); and group B, with invasion of 50% or greater and defined as pancreatic ductal adenocarcinoma associated with IPMN (PDAC-IPMN). First, we analyzed the imaging information of the 31 patients retrospectively. Then, we compared the imaging differences between the two groups. Fifteen patients with IPMC-1 and 16 patients with PDAC-IPMN were identified. There was no statistically significant difference in sex, age, lesion location, radiologic type, tumor size, mural nodule size, and lymphatic metastasis between the two groups. However, the arterial increased CT values were significantly different between the two groups (P < .01), with values of 29.2 ± 12.4 HU for group A and 14.2 ± 8.8 HU for group B. The venous increased CT values were 44.6 ± 12.0 HU for group A and 28.4 ± 12.3 HU for group B, and these were significantly different between the two groups (P < .01). In group A, 13 cases (86.7%) were classified as T1 or T2 stage, and in group B, eight cases (50.0%) were classified as T1 and T2 stage. There was a statistically significant difference in tumor classification between group A and group B patients (P < .05). IPMC-I and PDAC-IPMN have different characteristics in CT imaging, and we demonstrated that CT scans based on blood supply and lymphatic metastasis could be used to evaluate and potentially screen for variation in IPMC disease outcomes.

Twelve‐Year Experience with Necrotising Fasciitis in an Intensive Care Unit of a Local Regional Hospital

BackgroundNecrotising fasciitis (NF) is a life threatening condition and is a medical and surgical emergency. The mainstay of management includes early recognition, prompt surgical intervention, appropriate antibiotics and intensive care for organ support. However, the mortality is still very high despite the advance in the intensive care.ObjectiveTo examine the 12‐year outcomes, causative organisms, time to diagnosis, surgery and institution of adequate antibiotic coverage of patients with NF admitted to the intensive care unit (ICU) in a local regional hospital; and to identify the independent predictors of ICU mortality.MethodWe performed a retrospective analysis of the clinical records of all patients with NF admitted to the ICU between 1st July 2002 and 30th June 2014. Logistic regression analysis was conducted to identify the independent predictors of ICU mortality.ResultsOne hundred and thirty seven patients were recruited. Causative organisms included: Group A Streptococcus (16.2%), other streptococcus (31.1%), Methicilin‐resistant Staphylococcus aureus (8.8%), Vibrio species (14%) and other Gram negatives (44%). The mean length of ICU stay was 9.9 days (range: 1‐74 days) and the ICU mortality rate was 42.3%. The APACHE II score (odds ratio [OR] 1.132; 95% confidence interval [CI] 1.060‐1.209), Diabetes Mellitus (OR 5.017; 95% CI 1.919‐13.119), Glasgow coma scale ≤8 (OR 4.525; 95% CI 1.319‐15.530), low white cell count (OR 0.931; 95% CI 0.876‐0.990) and urea level (OR 1.049; 95% CI 1.001‐1.100) were statistically significant independent predictors of ICU mortality.ConclusionsThe mortality of patients with NF in ICU remains very high. The causative microorganisms in our locality are similar to those observed elsewhere. NF patients treated in ICU with underlying diabetes mellitus or presenting with Glasgow Coma Scale less than 8 are significantly more likely to die.

Does previous abdominal surgery a true contraindication to laparoscopic hepatectomy? Experience from local regional hospital

Introduction: The indication for laparoscopic hepatectomy (LH) is widely expanded because of its advantage, but previous abdominal surgery that might interfere the surgical field is still considered a contraindication to most of surgeons. Method: From July 2012 to May 2015, we had performed 50 laparoscopic hepatectomy procedures. We compare patients who did not have previous abdominal surgery to those who had abdominal surgery before, the operating time, percentage of major hepatectomy, blood loss, hospital stay and complication rate were analyzed. Result: There were 23 (46%) patients who had previous operation, including 9 of them had hepatectomy before. Compare patients who had no operation before to those who had previous abdominal surgeries, the operation time was 364.55 minutes to 372.13 minutes (p = 0.876), percentage of major hepatectomy was 55.5% to 56.4%, blood loss was 893.1 ml to 561.11 ml (p = 0.207), post-operation discharged day was 9 days to 9.14 days (p = 0.943), finally the complication rate was 21.4% to 21.7% (p = 0.97). Conclusion: Patients had previous abdominal surgery seems to be had more blood loss, but there was no significant different in both groups, as well as the operation time, hospital-stay period and complication. Our result support that laparoscopic hepatectomy to who had previous abdominal surgeries can still consider a suitable procedure.

Totally laparoscopic hepatectomies: A local regional hospital's experience

Totally laparoscopic hepatectomies: A local regional hospital's experience

FRAMEWORK AND VERIFICATION OF A BLENDED E-LEARNING SYSTEM BEHAVIORAL INTENTION MODEL AMONG CLINICAL NURSES

As the various applications of Internet and information communication technology (ICT) grow rapidly, the education and hospital institutions provide more distance learning programs, which also makes the research on e-learning more important. However, disadvantages in e-learning have been identified. Blended e-learning systems (BELSs) are considered effective alternative learning approaches. This research proposes a conceptual model to explain the factors affecting nurses’ behavioral intention to use a blended e-learning system (BELS). This research integrated perceived risk and the technology acceptance model to hypothesize a theoretical model for explaining and predicting learners’ behavioral intention to use a BELS. Self-report questionnaires were distributed to local community hospitals, regional hospitals, and medical centers in Central Taiwan. To confirm this research hypothesis, data were collected 682 nurses, with a response rate of 97.4%. Using structural equation modeling (SEM), the results show that perceived risk, perceived ease of use, and attitude influenced BELS behavioral intention. Perceived ease of use, and perceived usefulness substantially influenced use attitude. In addition, the path coefficient of perceived risk on attitude was non-significant. On the basis of the results, hospital institutions can devise better strategies for developing their blended e-learning system. Key words: nurses education, blended learning, technology acceptance model, nurse perceptions, structural equation model.

Pilot study of a dedicated education unit: Lessons learned

Background and objective : Nursing programs in Australia, New Zealand, and the United States are implementing Dedicated Education Units (DEU) as an innovative approach to provide clinical experiences for undergraduate nursing students. In August 2014 a university in Texas received a state grant to institute a pilot implementation of a DEU as a means of increasing the number of pre-licensure nursing students in the BSN program. The following objectives were designed to provide structure to implement and evaluate the DEU project: (1) Develop and implement a DEU model for pre-licensure nursing clinical education in four medical-surgical courses, using two nursing units at a local regional hospital; (2) Test the effectiveness of the DEU model of clinical education for pre-licensure nursing students; and (3) Increase the number of BSN-prepared nurses serving as DEU Clinical Instructors who enroll in a MSN-Nurse Educator program by six in the first semester of the grant. Methods : A variety of methods were used to evaluate effectiveness of this project, including focus groups of participants; qualitative assessment of the project orientation process for students, faculty and staff; quantitative analysis of examination scores, course scores, competency evaluations, and enrollment data. Results : Project evaluation revealed some positive results; however, problems related to orientation and ongoing support were seen as a barrier to successful implementation. Work overload for the Clinical Instructors also negatively impacted the effectiveness of the project. The number of students involved in this project was dictated by the space available in the designated DEUs. Even though the small sample size was insufficient for a research study, the results of this project may be of interest to others implementing a DEU. Conclusions : This paper focuses on lessons learned from the implementation a DEU pilot project and provides a number of suggestions for addressing challenges. The analysis of the results of this pilot project and related recommendations to avoid or ameliorate the challenges may be instructive for other schools planning to initiate a DEU.

New York Psychiatrists Work to Hold Insurance Carrier Accountable

New York Psychiatrists Work to Hold Insurance Carrier Accountable

Limitation of radiological T3 subclassification of rectal cancer due to paucity of mesorectal fat in Chinese patients.

To describe the thickness of mesorectal fat in local Chinese population and its impact on rectal cancer staging. Case series. Two local regional hospitals in Hong Kong. Consecutive patients referred for multidisciplinary board meetings from January to October 2012 were selected. Reports of cases that had undergone staging magnetic resonance imaging for histologically proven rectal cancer were retrospectively retrieved and reviewed by two radiologists. All magnetic resonance imaging examinations were acquired with 1.5T magnetic resonance imaging. Measurements were made by agreement between the two radiologists. The distance in mm was obtained in the axial plane at levels of 5 cm, 7.5 cm, and 10 cm from the anal verge. Four readings were obtained at each level, namely, anterior, left lateral, posterior, and right lateral positions. A total of 25 patients (16 males, 9 females) with a median age of 69 (range, 38-84) years were included in the study. Mean thickness of the mesorectal fat at 5 cm, 7.5 cm, and 10 cm from the anal verge was 3.1 mm (standard deviation, 3.0 mm), 9.8 mm (5.3 mm), and 11.8 mm (4.2 mm), respectively. The proportions of patients with mean mesorectal fat thickness of <15 mm were 100%, 84%, and 75% at 5 cm, 7.5 cm, and 10 cm from the anal verge, respectively. The thickness of mesorectal fat was the least anteriorly, and <15 mm at all three arbitrary levels (P<0.001). The thickness of mesorectal fat was <15 mm in the majority of patients and in most positions. Tumours invading 10 mm beyond the serosa on magnetic resonance imaging may paradoxically threaten the circumferential resection margin in Chinese patients. Use of T3 subclassification of rectal cancer in Chinese patients may be limited.