Major General Hospital Research Articles

Elevated creatinine kinase levels amongst Dutch adolescents with acute alcohol intoxication

This study aims to explore the prevalence of creatinine kinase elevation amongst a sample of Dutch adolescents admitted for acute alcohol intoxication. The data on all admitted adolescents < 18 years old with acute alcohol intoxication between 2008 and 2021 were collected from a Dutch major district general hospital, Reinier de Graaf Gasthuis, in Delft. Overall, 495 adolescents who were treated for symptoms of acute alcohol intoxication during this period were included in the study. When evaluating the blood samples of the included patients, elevated creatinine kinase levels were found in 60% of the cases, with a mean of 254 U/I (normal value ≤ 145 U/I). A confirmed diagnosis of rhabdomyolysis (increase in CK > fivefold the upper limit of normal) was present in 4.4% of cases. Moreover, using a linear regression this study found that a higher blood alcohol concentration was associated with higher creatinine kinase levels, when adjusted for positive drug screenings amongst the adolescents with acute alcohol intoxication (p = 0.027; β = 66.88; 95% CI 7.68 − 126.08). Conclusions: This is the first study focusing on how acute alcohol intoxication affects adolescents’ muscle tissue. The results could potentially help to prevent alcohol use within the sports world. It could also aid understanding of how acute alcohol intoxication influences the breakdown of adolescents’ muscle tissue.What is Known:• Alcohol, alongside pharmaceutical agents and illicit drugs, is a significant cause of rhabdomyolysis (increase in creatinine kinase > fivefold the upper limit of normal).• Creatinine kinase elevation in alcohol intoxicated patients may be as a result of direct “muscular” toxicity” (myotoxicity) or from prolonged immobilization and ischemic compression induced by coma.What is New:• Our retrospective cohort study is a pioneer in addressing the effect of acute alcohol intoxication amongst adolescents (< 18 years) upon muscle tissue (creatinine kinase level) within a large population. When evaluating the blood samples of the included population, elevated creatinine kinase levels were found in 60% of the cases, with a mean of 254 U/I (normal value ≤ 145 U/I).• There is an association between alcohol intoxication and elevated creatinine kinase levels amongst adolescents. Future research is needed to further understand the pathophysiology and causality of this interaction.

How Do Presenteeism and Family Functioning Affect the Association Between Chinese Nurses' Job Stress and Intention to Stay?

Despite a great deal of existing research on nurses' job stress and intention to stay, it is still unclear how the association between Chinese nurses' job stress and intention to stay is affected by presenteeism and family functioning. This study aimed to investigate the correlations of Chinese nurses' job stress, presenteeism, and family functioning with their intention to stay and clarify the mediating effect of presenteeism and the moderating effect of family functioning on the association between their job stress and intention to stay. A cross-sectional study of 1,008 nurses was performed in a major general hospital in Qiqihar City, Heilongjiang Province, China. The participants were invited to engage in a questionnaire survey regarding job stress, presenteeism, family functioning, and intention to stay. A moderated mediation analysis was conducted through multiple linear regression analysis and the PROCESS macro. Job stress and presenteeism were negatively correlated with intention to stay, whereas family functioning was positively correlated with intention to stay. The effect of job stress on intention to stay was partially mediated by presenteeism (Effect = -0.147, 95% CI = [-0.305, -0.003]). In addition, family functioning moderated the direct effect of job stress on intention to stay (Index = -0.134, 95% CI = [-0.274, -0.001]). Presenteeism and family functioning were found to play mediating and moderating roles, respectively, in the relationship between job stress and intention to stay. Relevant interventions or family-friendly programs should be developed to enhance nurses' intention to stay.

Discrepancy of financial burden among elderly visiting a private general hospital in Phnom Penh, Cambodia: A three-year cross-sectional study

ObjectivesThis study aims to clarify the financial burden of health on the elderly. Out-of-pocket payment (OOPP) in a major private general hospital in Phnom Penh was considered an indicator of financial burden. Study designThis study is a three-year cross-sectional study. MethodsTo investigate the characteristics of patients who visited the Sunrise Japan Hospital (SJH), their data were obtained from the electronic reception database. ResultsA total of 119,938 patients who visited SJH from January 2017 to September 2019 were included. The median age (25th, 75th centiles) was 52 years (36, 66) and 38.31% of patients were aged over 60 years. The OOPP median (25th, 75th centiles was 73.78 USD (32, 161.89). The median OOPP was the lowest in the 20s and highest in the 90s. The OOPP of an emergency patient was the highest in the consultation classifications. ConclusionsThe need to raise public awareness regarding the financial burden on the elderly is becoming increasingly urgent. It is vital to establish a social system to prevent the medical catastrophes.

Adaptation and Validation of Diabetes Knowledge Questionnaire (DKQ- 24 item) within Greek Population

Background: The Michigan Diabetes Research and Training Centre develop, during the 80s, the Diabetes Knowledge Questionnaire in order to determine the level of diabetes knowledge. Providing insights both to researchers and health professionals as an aid to intervening and improving diabetes self-management. Aim: The aim of this study was to translate, adapt and validate the Diabetes Knowledge Questionnaire (DKQ) to Greek Language. Method and Material: The 24-item DKQ was administrated to a preselected sample of 40 patients with type 2 diabetes. The validation study was conducted from February to March 2020, in the diabetes clinic of a major Greek general hospital. The questionnaire was transcribed in Greek using “forward–backward” translation by two independent translators. Individuals’ demographic data were recorded. The data is expressed as mean ± SD, in significant level 0.05. Results: DKQ Cronbach’s alpha had an adequate value. The intraclass correlation coefficient for average measures was significant, based on the 95% confident interval. Gender, profession and educational level did not correlate with the total score of the DKQ, individual’s age though was correlated. Conclusions: The Greek version of the DKQ is a reliable and credible instrument for assessing the level of diabetes knowledge in Greece.

Prevalence of antimicrobial resistance in Gram-negative clinical isolates from a major secondary hospital in Kuwait: a retrospective descriptive study.

Building an antimicrobial resistance (AMR) surveillance system in a country requires analysis of available data on AMR in clinical isolates. This study's objective was to determine the AMR prevalence of Gram-negative bacterial (GNB) isolates cultured from clinical specimens at a major general hospital in Kuwait. A retrospective descriptive study was conducted on AMR profiles of GNB clinical isolates (n=5290) between January and December 2018. Data were extracted from the laboratory information system in the hospital. The GNB organisms (i.e., Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii) were isolated from five main locations at the hospital (i.e., intensive care units [ICUs], surgical wards, medical wards, pediatric wards, and outpatient polyclinics). Overall, high AMR prevalence (>50%) against ampicillin, cefuroxime, cefotaxime, ceftazidime, ciprofloxacin, and trimethoprim/sulfamethoxazole, were observed across the GNB organisms. However, low resistance prevalence (<10%) were observed against amikacin, ertapenem, meropenem, and piperacillin/tazobactam. In general, AMR prevalence in E. coli isolates from ICU, medical and surgical wards was significantly (p<0.05) higher compared to other locations, whereas, AMR prevalence in P. aeruginosa isolates from pediatric ward was higher (p<0.05) compared to other locations. The overall multidrug resistance (MDR) prevalence was 38.7% (95% CI: 37.4-40.0). The highest MDR prevalence was among E. coli isolates from respiratory specimens (48%); wounds, bones, or other tissues (47.7%); and body fluids (47.1%). Similarly, MDR prevalence in K. pneumoniae, P. aeruginosa, and A. baumannii isolated from respiratory specimens was significantly (p<0.05) higher compared to other specimen types. The most frequent MDR phenotypes in the four GNB organisms and across the different specimen types included three antimicrobial drug classes: penicillins, cephalosporins, and fluroquinolones. Our findings demonstrate high AMR prevalence among common Gram-negative bacteria at this major hospital. Monitoring data on antimicrobial susceptibility of common bacterial organisms is critical for assessing trends in AMR at hospitals and for informing policy decisions.

Relationships of organisational justice, psychological capital and professional identity with job burnout among Chinese nurses: A cross-sectional study.

The present study was aimed at describing the status of job burnout and exploring the mediating roles of psychological capital and professional identity on the association between organisational justice and job burnout. With the shortage of nurses all over the world, nurses' job burnout has become the focus of studies in recent years. However, limited published research has examined the mediating roles of psychological capital and professional identity on the association between organisational justice and job burnout within hospital contexts in China. A cross-sectional design. A total of 1,009 nurses were enrolled from a major general hospital located in Qiqihar City in the northeast of China from March-July 2018, and asked to complete questionnaires regarding organisational justice, psychological capital, professional identity and job burnout. The STROBE checklist was adhered to in this study. It was observed that the overall proportion of nurses with job burnout was 58.8%. All the correlations among organisational justice, psychological capital, professional identity and job burnout were statistically significant, with coefficients ranging between -0.487-0.863. Psychological capital and professional identity had indirect effects equal to -0.072 and -0.142, respectively, on the association between organisational justice and job burnout, taking up 13.7% and 26.9% of the total effect, respectively. The serial indirect effect of psychological capital and professional identity was -0.129, accounting for 24.5% of the total effect. This study showed the necessity of addressing the status of job burnout among Chinese nurses. Psychological capital and professional identity may mediate the linkage between organisational justice and job burnout independently and accumulatively. Nursing managers should strengthen organisational justice and improve the psychological capital and professional identity of nurses through effective strategies to prevent the job burnout of nurses.

Data from a large Western centre exploring the impact of COVID-19 pandemic on endoscopy services and cancer diagnosis

ObjectiveThe global COVID-19 pandemic has changed healthcare across the world. Efforts have concentrated on managing this crisis, with impact on cancer care unclear. We investigated the impact on endoscopy services...

Self-harm on roads: Register-based study of methods and characteristics of individuals involved

BackgroundSuicide on roads is receiving increased attention. However, there has been little research on non-fatal road-related self-harm. This study was conducted in order to investigate the characteristics of such acts. MethodInformation on non-fatal road self-harm was extracted from a self-harm monitoring system database of self-harm presentations to a major general hospital in England during 2005-2017. Patients were identified through being referred for psychosocial assessment by a clinical service and through scrutiny of medical records. ResultsDuring the 13-year study period 110 individuals (67 males, 43 females) presented to the hospital with road-related self-harm: 38 (34.5%) jumped from bridges, 34 (30.9%) jumped or lay in front of vehicles, 27 (24.5%) crashed vehicles and 11 (10.0%) jumped from moving vehicles. Crashing vehicles was more common in males and jumping from vehicles more common in females. In patients who received a psychosocial assessment, their most frequent problems were with a partner, employment and family members. Over half had been in psychiatric care and nearly two-thirds had a history of previous self-harm. Suicide intent was often high, especially in those who crashed a vehicle or jumped from a bridge. LimitationThe study was based on presentations to a single hospital. Some data were not available for non-assessed patients. ConclusionsRoad-related self-harm, while not common, more frequently involves males and the acts are often of high suicidal intent. The range of problems preceding this method of self-harm indicates that there needs to be a variety of aftercare interventions, adapted to each individual's situation.

Unplanned Reoperation Following Gynaecological Surgeries: A report from Jordan.

ObjectivesUnplanned return to the operating theatre refers to an unplanned reoperation following a primary surgical procedure and can result in serious complications. The rate of unplanned reoperations is often used as a measure of in-hospital quality monitoring and improvement. This study aimed to review the prevalence rate and features of unplanned gynaecological reoperations at a major general hospital in Jordan.MethodsThis retrospective study took place between January 2011 and January 2018 at The Specialty Hospital in Amman, Jordan. The medical records of all women who underwent unplanned reoperations following a primary gynaecological procedure during this period were reviewed.ResultsA total of 4,895 primary gynaecological procedures were performed during the study period, of which 4,175 (85.3%) were elective and 720 (14.7%) were emergency operations. There were 15 unplanned reoperations (0.3%); of these, 14 (93.3%) followed elective procedures and one (6.7%) followed an emergency surgery. Most reoperations were performed following hysterectomies (53.3%). Bleeding was the predominant reason for reoperation (93.3%), with the source of the bleeding successfully identified in 71.3% of cases. In terms of outcome, none of the cases required a subsequent reoperation and there were no mortalities.ConclusionThe rate of unplanned reoperation at a hospital in Jordan was 0.3%. Unplanned reoperations occurred primarily as a result of bleeding following hysterectomies. Development of care pathways may reduce surgical complications and rates of unplanned reoperation.

Influence of COVID-19 Pandemic on Cardiology Practice at a Major General Hospital in Kuwait.

Influence of COVID-19 Pandemic on Cardiology Practice at a Major General Hospital in Kuwait.

Learning from experience in a National Healthcare System: organizational dynamics that enable or inhibit change processes.

To study the organizational dynamics that either enable or inhibit the changes needed by the system for the ongoing organizational development of the major acute general public hospital in Malta. The main public acute general hospital in Malta. Malta is the main island of a small archipelago in the Mediterranean with a total population reaching around 460 000. This qualitative study utilized two major research methods: action research and in-depth interviews. Data collection and analysis were guided by the grounded theory paradigm and operated within a constructivist and informed grounded theory approach. The action research was conducted through the documentation and interpretation of a practitioner-researcher experience working within a multi-disciplinary hospital team consisting of up to 15 members from different healthcare professional groups. The in-depth interviews involved 25 interviewees using theoretical sampling techniques. The findings affirmed the high potential and capabilities of the hospital workforce. This potential is nonetheless susceptible to be affected and gradually transformed by identified organizational and external forces into a workforce that is highly territorial, cynical and showing lack of 'ownership' of the organizational vision and objectives. The organizational culture, structures, systems and leadership as well as external factors that were frequently rooted at the national level were identified as strong impacting and underlying factors. A theoretical framework was generated depicting a vicious circle that needs to be broken to enable the desired organizational development and learning. This additional knowledge can be used by and inspire other organizations operating within comparable conditions.

Analysis of the Smoking Behavior of Personnel at Major General HM Ryacudu North Lampung Regional Hospital, Indonesia in 2016

.

AN ANALYSIS OF OPERATING PHYSICIAN AND PATIENT RADIATION EXPOSURE DURING RADIAL CORONARY ANGIOPLASTIES.

The objective of this study was to evaluate radiation exposure levels in conjunction with operator dose implemented, patient vascular characteristics, and other technical angiographic parameters. In total, 756 radial coronary angioplasties were evaluated in a major metropolitan general hospital in Tabriz, Iran. The classification of coronary lesions was based on the ACC/AHA system. One interventional cardiologist performed all of the procedures using a single angiography unit. The mean kerma-area product and mean cumulative dose for all cases was 5081 μGy m2 and 814.44 mGy, respectively. Average times of 26.16 and 9.1 min were recorded for the overall procedure and fluoroscopy, respectively. A strong correlation was demonstrated between types of lesions, number of stents and vessels treated in relation to physician radiation exposure. It was determined that operator radiation exposure levels for percutaneous coronary interventions lesions (complex) were higher than that of simple and moderate lesions. In addition, operator radiation exposure levels increased with the treatment of more coronary vessels and implementation of additional stents.

Electric bicycle-related injuries presenting to a provincial hospital in China: A retrospective study.

The use of electric bicycles (EBs) in China is growing. In the present study, we aimed to characterize the pattern and outcomes of EB-related injuries presenting to a major general hospital in China.This was a retrospective review of EB-related injuries presenting to Zhejiang Provincial People's Hospital from 2008 to 2011. Cases were identified from medical records according to diagnosis codes. Data captured included demographics, injury characteristics, and outcomes.A total of 3156 cases were reviewed in the present study. There were 1460 cases of traffic accidents, of which 482 cases were EB-related (32.7%). In addition, most of EB-related cases (44.6%) belonged to the 41- to 60-year-old age group. Median injury severity score was 10. Moreover, 34.9% underwent surgery and 24.7% were admitted to intensive care unit. The median hospitalization cost was 14,269 USD. Fracture (56.5%) was the most frequently diagnosed injury type, and head was the most commonly injured body region (31.1%).EB-related injuries have become a major health concern, making up a sizeable proportion of injuries presenting to the emergency department. Therefore, it is necessary to establish injury prevention and strategies for EB road safety. Implementation of policy such as compulsory helmet use, as well as popularization of EB road safety education should be considered to improve the current situation of EB-related injuries in China.

Role of Single Dose Antibiotic Prophylaxis in Clean General Surgery

1 Professor, D.Y. Patil Medical College, Pimpri, Pune-411018 Email: mahendrabendredr@gmail.com, Mobile no – 9561744365 2 Assistant Professor, D.Y. Patil Medical College, Pimpri, Pune-411018 Email: drvinusagar@yahoo.co.in, Mobile no. 9850930621 3 Assistant Professor, D.Y.Patil Medical College, Pimpri, Pune-411018 Email: drprashant.male@gmail.com, Mobile no. 7057145363 4 Senior Resident, D.Y.Patil Medical College, Pimpri, Pune-411018 Email: cr7.zizou.kaka@gmail.com, Mobile no. – 7769927522 5 Assistant Professor, D.Y.Patil Medical College, Pimpri, Pune-411018 Email: drshiva.khandalkar@gmail.com, Mobile no. 9422636996 ABSTRACT Background – Postoperative wound infection is an important cause of morbidity in surgical patients and antibiotic prophylaxis forms one of the important preventive measures. Aims and Objectives – This study was performed in a major general hospital to establish the efficacy of antibiotic prophylaxis in clean general surgeries. Materials and Methods – The study was done in 100 cases divided in 2 groups, one of which was given a single dose of ceftriaxone within 2 hours of operative incision without any postoperative antibiotics and the other was given routine postoperative antibiotics. Postoperative evaluation was done for development of fever or wound infection. Observation and Results – Mean age was 35 and 33 in both groups while mean operative time was 45 – 53 minutes. Majority of cases performed were of hernioplasty. Various other factors such as length of incision, use of electrocautery and postoperative hospital stay were considered. Incidence of infection in both groups was similar but cost reduction of 88.11% was achieved in the first group. Conclusion – The restriction of antibiotic usage in preoperative period and omission of it in postoperative period didn’t result in increase in incidence of surgical site infection. However significant cost reduction is achieved in the cases where preoperative prophylactic antibiotics were used and hence can be advocated in clean general surgeries.

Hospital Acute Malnutrition Before and After a Three‐Year Multidisciplinary Hospital Nutrition Intervention in a Major Urban General Hospital, Vietnam

ObjectivesChange in % ideal body weigh (IBW) and risk of acute malnutrition after a 3y hospital nutrition intervention.MethodsCross‐sectional data from patients aged 31d‐90y hospitalized in seven key wards were obtained using a one‐day survey method in 2010 and 2013, Bach Mai Hospital. Data included age, sex, admission type, ward, length of stay (LOS), actual/recall weight and height. Exclusions criteria were discharge &lt;24h, unavailability, or lack of nutrition status data (n=85/1474). Acute malnutrition was defined as pediatric wasting or thinness and adult underweight (WHO). Regression analyses were used.Results624 (57% male) patients in 2010 and 765 (58% male) in 2013. At baseline, IBW was 90.8+0.6% with 17%(18/104) pediatric wasting or thinness and 34% (175/520) adults underweight. After adjusting for potential confounding variables including sex, admission type, ward, LOS, and missing actual weight or height, patients admitted in 2013 showed a 3% increase in IBW (3.3+0.8%, p&lt;0.0001) and were 29% less likely to have acute malnutrition (OR: 0.71 [0.55‐0.92]).ConclusionA reduction in hospital acute malnutrition was observed after a nutrition intervention. (Support: the Abbott Fund)

LB003-MON: The Effect of Dietary Glutamine Supplementation on Chemotherapy-Induced Oral Mucositis in Patients with Esophagogastric Cancer

multidisciplinary nutrition intervention project at a major urban general hospital in Hanoi. Methods: Cross-sectional data from patients aged 31 d 90 y hospitalized in seven key wards were obtained using a one-day survey method in 2010 and repeated in 2013. Data included age, sex, admission type, route of feeding, days of hospitalization, actual or recall weight and height, and nutrition Subjective Global Assessment (SGA) scores. Unavailable patientsand those expected to be discharged within 24 hours were excluded. Malnutrition was defined based on WHO references. Kappa and logistic regression analyses were performed. Results: The 2010 and 2013 samples consisted of 674 (57% male) and 791 (58% male) patients. At baseline, 18% (19/106) children were wasted, 13% (14/106) stunted, 4% (4/106) overweight and 0% obese, while 33% (179/536) adults were underweight, 5% (29/536) overweight and 1% (4/536) obese. Using SGA at baseline, 48% (52/108) children and 50% (268/542) adults were at nutrition risk (Fair agreement, Kappa 0.21 [0.06 0.35], p < 0.01). Inpatients in 2013 vs. 2010 differed by admission type, weight documentation, and feeding route (P< 0.05). After adjusting for potential confounding variables including sex, age, missing actual weight (or height), and days of hospitalization, patients admitted in 2013 vs. 2010 were 23% less likely to be malnourished (OR: 0.77 [0.61 0.98]). Using this adjusted model, the hazard ratio of malnutrition in children <5 y was 75% lower (OR: 0.25 [0.13 0.49]) and 2.6 times higher in adults 19 24.9 y (OR: 2.57[1.62 4.10]) compared to adults age 25 65 y. Conclusion: The risk of malnutrition in a major Vietnamese general hospital improved over a three-year period of nutrition intervention and was highest in young adults. Prospective studies are needed.

IPad-assisted measurements of duration estimation in psychiatric patients and healthy control subjects.

Handheld devices with touchscreen controls have become widespread in the general population. In this study, we examined the duration estimates (explicit timing) made by patients in a major general hospital and healthy control subjects using a custom iPad application. We methodically assessed duration estimates using this novel device. We found that both psychiatric and non-psychiatric patients significantly overestimated time periods compared with healthy control subjects, who estimated elapsed time very precisely. The use of touchscreen-based methodologies can provide valuable information about patients.

Quantifying high dependency care: a prospective cohort study in Yorkshire (UK)

High dependency care (HDC) is a level of care situated between intensive care and usual ward care with its delivery being independent of location. Inadequate definition makes it problematic to determine the number of children receiving HDC, to identify their care setting and therefore to undertake service planning. We aimed to estimate the volume of hospital inpatient HDC in a geographically defined population using a customised measurement tool in four types of paediatric hospital services (1) tertiary specialist wards, (2) tertiary paediatric intensive care units, (3) district general hospitals (DGHs) general wards and (4) wards at a major acute general hospital. A region-wide prospective cohort study during 2005 collected data to develop a 36-item HDC measurement tool, which then identified children receiving HDC by day and night. The cohort identified 1,763 children as receiving HDC during an admission to 1 of 36 hospital wards in 14 hospitals. HDC was delivered during 9,077 shift periods of 12 h or 4,538 bed days. The volume of care and patient profiles varied by hospital type, within hospital by ward type and by age and season. Tertiary specialist wards and ICUs provided 72% of HDC, with the remainder delivered at the DGHs and the major acute general hospital. The volume of admissions to tertiary specialist wards showed little seasonality and children tended to be older (26% were aged 10-15 years). By comparison, admissions to DGHs were younger with an excess during the winter months. This is the first UK study to quantify HDC from empirical data encompassing all hospital and ward types within a large clinical network. A lack of HDC-designated beds across the region resulted in HDC delivery on all types of hospital wards. The study size and representativeness makes the estimated number of HDC bed days per head of population likely to reflect the wider UK population.

Extraparenchymal Neurocysticercosis in Albuquerque, New Mexico

neurocysticercosis (NCC) prevalence is increasing throughout the United States mainly because of immigration from Latin America. Clinicians may fail to recognize the extraparenchymal disease because they do not consider the diagnosis. to analyze neuroimaging and clinical characteristics of extraparenchymal NCC, we retrospectively reviewed all such cases presenting to a major general medical school hospital in the State of New Mexico. eleven (30%) of our 37 cases of NCC diagnosed using standard criteria from 1998 through 2004 had extraparenchymal disease. On neuroimaging, 36% of the patients lacked parenchymal cysts, 64% had intraventricular cysticerci, 64% had subarachnoid cysticerci, and 64% had hydrocephalus due to either basal arachnoiditis or direct obstruction of intraventricular pathways. Lumbar puncture was performed in 6 patients. All had a cerebrospinal fluid (CSF) pleocytosis, none had CSF or blood eosinophilia, and CSF antibody to NCC could be absent while present in serum. Response to treatment was frequently suboptimal. extraparenchymal NCC is more frequent than previously thought. Because clinicians outside the Southwest United States are often unfamiliar with NCC as a cause of chronic meningitis, chronic ventriculitis, or hydrocephalus without obvious cysts, the diagnosis of extraparenchymal NCC often depends on the correct interpretation of neuroimaging.