Major Public Hospitals Research Articles

Risk factors of post-anaesthesia care unit delirium in patients undergoing non-cardiac surgery in Singapore.

Post-anaesthesia care unit (PACU) delirium affects 5%-45% of patients after surgery and is associated with postoperative delirium and increased mortality. Up to 40% of PACU delirium is preventable, but it remains under-recognised due to a lack of awareness of its diagnosis. The nursing delirium screening scale (Nu-DESC) has been validated for diagnosing PACU delirium, but is not routinely used locally. This study aimed to use Nu-DESC to establish the incidence and risk factors of PACU delirium in patients undergoing non-cardiac surgery in the surgical population. We conducted an audit of eligible patients undergoing major surgery in three public hospitals in Singapore over 1 week. Patients were assessed for delirium 30-60 min following their arrival in PACU using Nu-DESC, with a total score of ≥2 indicative of delirium. A total of 478 patients were assessed. The overall incidence rate of PACU delirium was 18/478 (3.8%), and the incidence was 9/146 (6.2%) in patients aged > 65 years. Post-anaesthesia care unit delirium was more common in females, patients with malignancy and those who underwent longer operations. Logistic regression analysis showed that the use of bispectral index (P < 0.001) and the presence of malignancy (P < 0.001) were significantly associated with a higher incidence of PACU delirium. In this first local study, the incidence of PACU delirium was 3.8%, increasing to 6.2% in those aged > 65 years. Understanding these risk factors will form the basis for which protocols can be established to optimise resource management and prevent long-term morbidities and mortality in PACU delirium.

Doctor-patient relationship: Evidence from Bangladesh.

Background and AimsThis study analyses the nature and magnitude of the doctor‐patient relationship in Bangladesh, intending to trigger policy discussions for improving healthcare quality. The dearth of research on the nature and degree of this relationship in Bangladesh as well as the global context motivates us to conduct this study.MethodWe use primary data from three different surveys conducted during July to October 2018. The study conducts a public perception survey on 701 individuals at various public places in Dhaka City. In addition, we interview 100 exit‐patients from two major public hospitals, four for‐profit‐private hospitals, and one not‐for‐profit private hospital in Dhaka City. We also interview a total of 62 doctors of different ladders. Each survey uses a structured questionnaire with a set of questions customized in the Bangladesh context.ResultsThe score of the doctor‐patient relationship is found quite low from the viewpoint of the public, the patients, and the doctors. However, the score is comparatively high from the doctor's point of view. The results show that lack of optimum time allocation for the patients, not explaining the prescription clearly, and discriminating the patients by their social status are the main factors for a poor relationship with doctors.ConclusionsThe doctor‐patient relationship is substantially poor from the public, patients, and the doctors' viewpoints. Orienting the doctors to non‐therapeutic care (ie, respectful behavior, privacy, dignity, prompt attention, clear communication) in all levels of medical education and training, and improving working conditions of the hospitals are the crucial policy implications.

Spatiotemporal Trends in the Incidence of Gastrointestinal Neoplasms in Wuwei City of Northwestern China From 1995 to 2016: A Hospital-Based Retrospective Observational Study

ObjectiveTo determine the characteristics and spatiotemporal distribution of major gastrointestinal (GI) neoplasms in inpatients from 1995 to 2016 in Wuwei city, northwestern China.MethodData from all paper and electronic medical records entered between 1995 and 2016 at 12 major public hospitals in Wuwei city were retrospectively collected. Patients with GI neoplasms were identified and classified according to the International Classification of Diseases (ICD)-10. Trends in the incidence of major GI neoplasms were expressed as an annual percentage change (APC), and the Z test was used to assess the time fluctuation trends. Age-standardized incidence rates (ASIRs) were also calculated and the corresponding APC was estimated by the Joinpoint software for long-term trend analysis. Thematic maps of annual incidence at the township level were produced.ResultsAmong the 19,137 new inpatients identified with GI neoplasms in Wuwei, gastric cancer was the leading cause of morbidity, followed by cancers of the esophagus, colorectum, gastric cardia, liver, and pancreas with ASIRs of 21.8, 11.0, 5.8, 5.7, 4.4, and 1.7 per 100,000 person-years, respectively. Overall, there was a steady increase in the ASIR for all GI neoplasms, and male cases were 2.1 times more frequent than female cases. The ASIR significantly increased by 12.2% per year from 1995 to 2009 for all GI neoplasms, and the increase rates ranged 9.4%-16.7% per year for the individual GI neoplasm. Despite an increase by 1.4% per year from 2009 to 2016, the ASIR decreased for esophageal and gastric cardia cancers by 4.6% and 17.3% per year, respectively. The annual incidence of all GI neoplasms showed significantly differential geographic distributions among different townships of the city during the study period.

Managing shifts to value-based healthcare and value digitalization as a multi-level dynamic capability development process

Hospital care worldwide changes with the needs and expectations of patients, caregivers, clinicians, and communities. Given that the value-based healthcare (VBHC) approach and the digital technology's role to add value receive increasing attention, the literature provides compelling evidence of their advantages for patients and healthcare transformation generally. Shifts to VBHC and digital health require hospitals to undertake organizational changes, balance countervailing processes within their organizations, and build new dynamic capabilities. Yet, the literature remains silent about managing shifts to VBHC and digital health. By focusing on perspectives of public healthcare service providers, this research conducted a qualitative study of a major European public hospital's cardiology department. Building on the multi-level theory of dynamic capability, this research shows that the development of new capabilities in healthcare occurs by linking micro-levels (individual levels) and macro-levels (hospital levels) through a constructive dialogue at the meso‑level (department and interdepartmental level) and by acknowledging the improvement processes' iterative nature. The paper contributes with new insights on managing and digitalizing VBHC as a multi-level dynamic capability development process.

Audit of ultrasound usage in emergency departments in greater metropolitan Brisbane.

The Australasian College for Emergency Medicine identifies five ultrasound applications which the College deem core to the practice of emergency medicine but there is scant information as to the uptake of ultrasound or the qualification of users. This study aims to determine the percentage of ED physicians in one metropolitan area who utilise ultrasound for core diagnostic and procedural applications in participating hospitals and the percentage of users who have been formally assessed in any ultrasound application. The EDs of eight major public hospitals in greater metropolitan Brisbane area participated in this audit. Data-collectors at each participating ED approached every senior house officer, registrar and senior medical officer in the department and, after obtaining informed consent, asked the participant six questions pertaining to their use of ultrasound for five core applications and about ultrasound training and recorded the answers without information as to the identity of the participant. 94.4% of the physicians participated. Of those participating, 90% used ultrasound for venous access, with progressively fewer using E-FAST (69%), AAA (51%), Lung (40%) and BELS (29%) for diagnostic purposes. Ninety-eight percent of participants were in favour of enhanced departmental training. Only 33% of participants had their ultrasound skills assessed by a qualified person for even one application. While use of ultrasound in some applications is widespread, few users have had their skills assessed. Assessment being a routine part of structured training, it cannot be assumed that these users can competently use ultrasound for procedural or diagnostic applications.

From the sidelines: The indirect repercussions of COVID-19 on the delivery of hospital surgical services.

BackgroundDespite relatively few COVID‐19 cases within New South Wales, the uncertainty surrounding the pandemic has prevented a return to business as usual for the delivery of surgical services. This study aims to describe the evolving impact of COVID‐19 on surgical activity and patient outcomes at a major public tertiary referral hospital.MethodsA retrospective cohort study involving adult surgical patients treated at a large public tertiary referral hospital in Sydney, Australia. Surgical activity, surgical outcomes and patient demographics were compared across two time periods, including the ‘first wave’ (February–May 2020 vs. February–May 2019) and the ‘perseverance phase’ (June–September 2020 vs. June–September 2019). Variables across both groups were compared using an independent t test or chi‐squared test.ResultsA −32% reduction in surgical separations was observed in the ‘first wave’, including −20% emergency and −37% elective. In the ‘perseverance phase’, there was a −19% reduction in surgical activity, including 0% emergency and −27% elective. The average length of stay, intensive care admissions, postoperative complications and in‐hospital costs significantly increased in the ‘first wave’. The proportion of public patients increased marginally (3%) in the ‘first wave’.ConclusionThe impact of COVID‐19 was most severely experienced in the initial months of the pandemic and observed in the number of patients treated. Although there was an initial effect on surgical outcomes, overall, the standard of care remained safe. The delivery of elective surgery remains a challenge and reflects the ongoing system‐wide changes that are required to manage the COVID‐19 pandemic.

THE PREVALENCE OF HPV POSITIVE OROPHARYNGEAL SQUAMOUS CELL CARCINOMA AT A MAJOR REFERRAL CENTER IN SOUTHERN AFRICA

<h3>Objective</h3> Limited data on the prevalence of human papilloma virus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC) in Southern Africa exist. The aim of the current study was to determine the prevalence of HPV-positive OPSCC at a major referral public hospital (Tygerberg Hospital) in the Western Cape region, South Africa. <h3>Methods</h3> Sequential surgical samples of 266 cases of OPSCC diagnosed over a 10-year period (2007-2017) were selected for evaluation and relevant patient characteristics were documented. p16 immunohistochemistry was performed as a screening test. All p16-positive cases were further evaluated for HR-HPV using a novel DNA polymerase chain reaction technology (BD Onclarity HPV assay). <h3>Results</h3> Of 266 cases, 14% were positive for p16 (n = 36). Of 36 p16-positive cases, 23 were negative and 13 were positive for HR-HPV (5%) when evaluated by PCR. p16 was found to have a positive predictive value of 36.1%. HPV subtypes were HPV-16 (n = 10), HPV-18 (n = 1), HPV-52 (n = 1), and HPV-31 (n = 1). One case was positive for HPV-16 and HPV-31. HPV-positive OPSCC occurred in 10 men and 3 women with a mean age of 51 years (range, 33-72 years). Most HPV-positive OPSCC were nonkeratinizing (n = 10) or partially keratinizing (n = 1). In contrast, HPV-negative OPSCC were predominantly keratinizing (n = 218). <h3>Conclusions</h3> The presence of HR-HPV in 5% of cases suggests that HR-HPV as a minor etiologic agent in OPSCC at this institution. Because of its suboptimal positive predictive value (36.1%), p16 immunohistochemistry alone is insufficient to confirm an HPV-positive OPSCC at this center and, when positive, HPV-specific testing must be performed by one of the available platforms.

The Prevalence and Associated Factors of Short Sleep Duration Among Nurses in Tertiary Public Hospitals in China: Findings from a National Survey.

BackgroundSleep is an essential component of health and well-being. Short sleep duration may negatively affect nurses’ health and patients’ safety.ObjectiveTo investigate the sleep duration and subjective satisfaction with sleep duration among nurses in tertiary public hospitals in China and to explore the associated factors.MethodsThis cross-sectional study was conducted between December 18 and 31, 2017 in 136 major public hospitals from 31 provinces in mainland China. An online anonymous questionnaire was delivered through WeChat. Totally 27,575 nurses completed the survey.ResultsThe response rate was 95.46%. The mean reported total sleep duration was 6.67±0.97 hours per day. About 46.87% (n=12,924) reported having short sleep duration (SSD, less than 7 hours per day), and 27.63% (n=7618) were not satisfied with their sleep duration. In the SSD group, 45.67% (n=5902) were dissatisfied with their sleep duration. SSD was significantly associated with sociodemographic factors, including an older age, having more than one child, being divorced or separated, and job-related factors, including longer working hours, more night shifts and heavy workload.ConclusionNearly half of the nurses in the public hospitals in China reported sleeping less than 7 hours, and more than one quarter were dissatisfied with their sleep duration. Interventions are needed to improve Chinese nurses’ sleep, including reducing working hours, night shifts or workload.

High anxiety and depression scores and mental health service use among South Asian advanced cancer patients: A multi-country study

ContextAddressing symptoms of anxiety and depression is important in cancer palliative care. However, little information exists on the prevalence of anxiety and depression and mental health service use among advanced cancer patients in South Asia. ObjectivesTo examine among South Asian advanced cancer patients, the 1) prevalence of high anxiety and depression scores, 2) factors associated with high anxiety and depression scores, and 3) mental health service use. MethodsThis cross-sectional, multi-site study recruited patients receiving oncology care across six major public hospitals in India, Bangladesh and Sri Lanka. Participants were adults, diagnosed with stage IV metastatic solid cancer and aware they had cancer. Participants’ high anxiety and depression scores (using clinically-relevant Hospital Anxiety and Depression Scale threshold of >10), sociodemographic characteristics, patient-perceived cancer stigma and mental health service use were assessed. ResultsIn the overall sample (N = 1140), 54% met threshold for high anxiety and/or depression scores: 32% reported high anxiety scores and 47% reported high depression scores. Symptom burden (OR's [95% CI's] = 1.09-1.13 [1.05-1.09, 1.12-1.17]) and perceived stigma (1.11-1.16 [1.06-1.11, 1.16-1.22]) were statistically significantly associated with high anxiety and depression scores. Of the patients with high anxiety and/or depression scores (n = 617), 97% had not received mental health services, and 38% of them indicated they were open to a referral. ConclusionHigh, clinically-relevant anxiety and depression scores are common among South Asian advanced cancer patients. Efforts should be made to alleviate psychological morbidity, including providing greater access to supportive/palliative medicine teams or mental health services.

Patient violence, physicians treatment decisions, and patient welfare: Evidence from China.

Although violence in healthcare settings has become a common occurrence worldwide, there is limited evidence on the spillover effects of patient violence on physicians' medical decisions. Utilizing microdata on inpatients from a major public hospital, we investigated how extreme patient violence-the murder of a physician in China-affected physicians' treatment decisions and patient welfare in a hospital geographically distant from the murder site. By matching this patient dataset to physician profiles, we performed a difference-in-differences analysis in which the treatment group comprised patients admitted shortly before and after the murder shock, and the control group consisted of patients admitted during the same months in the previous year. Immediately after the shock, the provision of medical treatment was notably higher, with a 16.9% increase in the number of surgeries and a 9.5% increase in the treatment expenditures. However, patient health outcomes were worse, with an increased mortality rate of 0.9% points. Findings suggest that patient violence dramatically changed physician behavior, causing negative consequences on patients even when the healthcare workers were not direct victims of patient violence.

Impaired health-related quality of life, psychological distress, and productivity loss in younger people with persistent shoulder pain: a cross-sectional analysis

Purpose To investigate wellbeing and work impacts in younger people with persistent shoulder pain. Materials and methods People aged 20–55 years with shoulder pain of >6 weeks’ duration (excluding those with recent fracture or dislocation) were recruited from orthopaedic clinics at three major public hospitals. Health-related quality of life (HRQoL) and psychological distress were evaluated using the Assessment of Quality of Life (AQoL) and K10 instruments and compared to population norms. Shoulder-related absenteeism and presenteeism were quantified using the Work Productivity and Activity Impairment (WPAI) Questionnaire. Results Of the 81 participants (54% male), 69% had shoulder pain for over 12 months. Substantial HRQoL impairment was evident (mean reduction from population norms 0.33 AQoL units, 95% CI −0.38 to −0.27; minimal important difference 0.06 AQoL units). High or very high psychological distress was three times more prevalent among participants than the general population (relative risk 3.67, 95% CI 2.94 to 4.59). One-quarter of participants had ceased paid employment due to shoulder pain and 77% reported shoulder-related impairment at work. Conclusions The broader impacts of painful shoulder conditions on younger people extend well beyond pain and upper limb functional limitations. In particular, the work-related impacts should form a routine part of patient assessment and rehabilitation. Implications for rehabilitation Persistent shoulder pain in younger people (aged 20–55 years) is associated with substantially reduced health-related quality of life and greater psychological distress, compared to population norms, as well as work participation and productivity impacts. As rotator cuff conditions, shoulder capsule pathology, and glenohumeral instability are relatively common, our data suggest that persistent shoulder pain is likely to have a high community impact among people of working age. Information resources that people with painful shoulder conditions can share with their families, employers, and colleagues may assist others to better understand the broader impacts of these conditions. Work-related challenges associated with shoulder pain should be considered within routine clinical care, and may require referral to an occupational health clinician or vocational rehabilitation service.

Clinical and health-related quality of life outcomes of transfusion-dependent thalassaemia patients in Singapore

IntroductionTransfusion-dependent thalassaemia is associated with complications related to iron overload from frequent red cell transfusions which affect quality of life. We collected data on the clinical outcomes, complications, socioeconomic status and health-related quality of life (HRQoL) of transfusion-dependent thalassaemia patients in Singapore, and analysed the associations between clinical and socioeconomic factors with development of transfusion-related complications and HRQoL scores. Materials and methodsThis was a cross-sectional study of transfusion-dependent thalassaemia patients treated at four major public hospitals in Singapore. Clinical information was obtained from retrospective reviews of medical records. Socioeconomic data and patient-reported compliance to iron chelators were obtained from prospective interviews of patients or caregivers using a questionnaire. A validated, disease-specific HRQoL instrument, the TranQOL, was administered to patients and caregivers during a routine clinic or transfusion visit. ResultsLiver iron loading was the most common transfusion-related complication and occurred in 79% of patients. Cardiac iron loading was noted in 28.3% and endocrine complications were present in 34.2%. Liver iron loading was significantly associated with higher mean ferritin level. Cardiac iron loading was significantly associated with increasing age, higher mean ferritin level and type of iron chelator. Endocrine complications were associated with increasing age, higher mean ferritin level, type of iron chelator and poorer patient-reported compliance to iron chelators. The lowest TranQOL scores were reported by caregiver parents of patients aged less than 18 years. Lower TranQOL scores were significantly associated with increasing age, especially in the 31–50 age cohort, and with reception of social assistance. ConclusionThe main morbidities noted in transfusion-dependent thalassaemia patients in Singapore are from complications associated with iron loading. The cohort of older thalassaemia patients aged 31–50 experienced significantly higher rates of cardiac iron loading, endocrine complications and lower TranQOL scores compared to younger age cohorts.

Applicability of COVID-19 Pandemic Recommendations for Urology Practice: Data from Three Major Italian Hot Spots (BreBeMi)

BackgroundLombardy has been the first and one of the most affected European regions during the first and second waves of the novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]). ObjectiveTo evaluate the impact of coronavirus disease 2019 (COVID-19) on all urologic activities over a 17-wk period in the three largest public hospitals in Lombardy located in the worst hit area in Italy, and to assess the applicability of the authorities’ recommendations provided for reorganising urology practice. Design, setting, and participantsA retrospective analysis of all urologic activities performed at three major public hospitals in Lombardy (Brescia, Bergamo, and Milan), from January 1 to April 28, 2020, was performed. Outcome measurements and statistical analysisJoin-point regression was used to identify significant changes in trends for all urologic activities. Average weekly percentage changes (AWPCs) were estimated to summarise linear trends. Uro-oncologic surgeries performed during the pandemic were tabulated and stratified according to the first preliminary recommendations by Stensland et al (Stensland KD, Morgan TM, Moinzadeh A, et al. Considerations in the triage of urologic surgeries during the COVID-19 pandemic. Eur Urol 2020;77:663–6) and according to the level of priority recommended by European Association of Urology guidelines. Results and limitationsThe trend for 2020 urologic activities decreased constantly from weeks 8–9 up to weeks 11–13 (AWPC range –41%, –29.9%; p < 0.001). One-third of uro-oncologic surgeries performed were treatments that could have been postponed, according to the preliminary urologic recommendations. High applicability to recommendations was observed for non–muscle-invasive bladder cancer (NMIBC) patients with intermediate/emergency level of priority, penile and testicular cancer patients, and upper tract urothelial cell carcinoma (UTUC) and renal cell carcinoma (RCC) patients with intermediate level of priority. Low applicability was observed for NMIBC patients with low/high level of priority, UTUC patients with high level of priority, prostate cancer patients with intermediate/high level of priority, and RCC patients with low level of priority. ConclusionsDuring COVID-19, we found a reduction in all urologic activities. High-priority surgeries and timing of treatment recommended by the authorities require adaptation according to hospital resources and local incidence. Patient summaryWe assessed the urologic surgeries that were privileged during the first wave of coronavirus disease 2019 (COVID-19) in the three largest public hospitals in Lombardy, worst hit by the pandemic, to evaluate whether high-priority surgeries and timing of treatment recommended by the authorities are applicable. Pandemic recommendations provided by experts should be tailored according to hospital capacity and different levels of the pandemic.

Newly diagnosed seizures assessed at two established first seizure clinics: Clinic characteristics, investigations, and findings over 11 years.

Objective‘First seizure’ clinics (FSCs) aim to achieve early expert assessment for individuals with possible new‐onset epilepsy. These clinics also have substantial potential for research into epilepsy evolution, outcomes, and costs. However, a paucity of FSCs details has implications for interpretation and utilization of this research.MethodsWe reviewed investigation findings over 11 years (2000‐2010) from two established independent FSCs at Austin Health (AH) and Royal Melbourne Hospital (RMH), Australia. These adult clinics are in major public hospitals and operate with similar levels of expertise. Organizational differences include screening and dedicated administration at AH. Included were N = 1555 patients diagnosed with new‐onset unprovoked seizures/epilepsy (AH n = 901, RMH n = 654). Protocol‐driven interviews and investigations had been recorded prospectively and were extracted from medical records for study.ResultsMedian patient age was 37 (IQR 26‐52, range 18‐94) years (AH 34 vs RMH 42 years; P < .001). Eighty‐six percent of patients attended FSC within three weeks postindex seizure (median AH 12 vs RMH 25 days; P < .01). By their first appointment, 42% had experienced ≥2 seizures. An EEG was obtained within three weeks postindex seizure in 73% of patients, demonstrating epileptiform discharges in 25% (AH 33% vs RMH 15%). Seventy‐six percent of patients had an MRI within 6 weeks. Of those with imaging (n = 1500), 19% had potentially epileptogenic abnormalities (RMH 28% vs AH 12%; P < .01). At both sites, changes due to previous stroke/hemorrhage were the commonest lesions, followed by traumatic brain injury. ≥WHO level 1 brain tumors diagnosed at presentation comprised a very small proportion (<1%) at each clinic. At both sites, epilepsy type could be determined in 60% of patients; RMH had more focal and AH more generalized epilepsy diagnoses.SignificanceDifferences between the clinics’ administrative and screening practices may contribute to differences in investigation findings. Insight into these differences will facilitate interpretation and utilization, and planning of future research.

Spatial Distribution of Cancer Cases Seen in Three Major Public Hospitals in KwaZulu-Natal, South Africa.

Background:Noncommunicable diseases (NCDs) like cancer are posing a challenge in the health system especially in low- and middle-income countries (LMICs). In South Africa, cancer is under-reported due to the lack of a comprehensive cancer surveillance system. The limited knowledge on the extent of cancer burden has led to inaccurate allocation of public health resources. The aim of this study was to describe cancer incidence and spatial distribution of cancer cases seen at 3 main public oncology facilities in KwaZulu-Natal.Methods:In this retrospective study, cases of cancer observed from year 2015 to 2017 were extracted from medical records. The crude incidence rate was estimated for the total cancer cases and for different type of cancer reported over that period. Age-standardised incidence rates (ASR) per 100 000 was calculated per year using age groups and sex according to the district population data of KwaZulu-Natal. The comparisons of cancer diagnosed incidences were made between 11 districts using the ASR. Choropleth spatial maps and Moran’s Index were used to assess the ASR cancer spatial distribution along with geographical patterns among the districts. One sample chi-square test was used to assess the significant increase/decrease over time.Results:The study lost numerous cases due to incompleteness. A total of 4909 new cases were diagnosed with cancer during 2015 to 2017, 62% of which were female. Both uMgungundlovu and eThekwini districts had the highest ASR among district municipalities of KwaZulu-Natal for both male and female (83.6 per 100 000 per men year for men, 158.2 per 100 000 women per year, and 60.1 per 100 000 men per year and 96.9 per 100 000 women per year, respectively). Random distribution of reported cancer cases in KwaZulu-Natal was observed with a high concentration being in and around 2 metropolitan districts. Spatial variation showed a significant difference from year to year between the districts with the random spatial distribution. Overall, there was a significant decline of cancer incidences observed from 2015 to 2017 (P < .05) in the province.Conclusion:The overall cancer incidence in the study shows that female cancers (breast and cervical) are still on the rise and still need to be given priority as they were most prevalent in KwaZulu-Natal. Spatial analysis (choropleth maps) was used to show a pattern of higher concentration of cancer incidence in the north-western parts of the province.

Epidemiological characteristics of children with coronavirus at a joint commission-accredited hospital in the United Arab Emirates.

Objectives:Our aim was to identify the epidemiological characteristics and transmission patterns of coronavirus (COVID-19) among pediatric patients in the multicultural and multiethnic city of Al Ain in the United Arab Emirates (UAE).Method:A retrospective study was conducted by abstracting data from the electronic medical records of pediatric patients with COVID-19 from two major public hospitals in Al Ain. The data of patients from birth through 16 years of the cases with COVID-19 confirmed by reverse transcription-polymerase chain reaction were obtained. In addition to the epidemiological characteristics, transmission patterns, comorbidities, index cases, travel history, and coinfection with other viruses were analyzed. Cohen's kappa was used to assess interrater reliability and descriptive data. Chi-square test was used to assess significant differences between the variables and was conducted using Statistical Product and Service Solutions software.Results:We identified 298 (150 males, 148 females) laboratory-confirmed cases. The patients’ median age was 7 years. Of these, 50% had parents who also tested positive. Most patients (86.9%) were healthy without any known medical problems. The coinfection rate was ~2%.Conclusion:The epidemiological characteristics of children with COVID-19 in Al Ain are similar to those observed internationally. Children of all ages appeared to be susceptible to COVID-19 and no significant sex or ethnicity differences were detected. Furthermore, this study provides strong evidence of human-to-human transmission.

Computed Tomographic Findings of Malignant Bowel Neoplasms: A Retrospective Study

Introduction: Malignant neoplasms of bowel particularly colorectal carcinomas are third commonest cause of death all over world. Computed Tomography (CT) plays a very important role in evaluation of malignant bowel neoplasms. CT examination for gastrointestinal tract evaluates the intestinal lumen along with demonstration of intestinal wall, adjacent tissues and solid viscera. Aim: To evaluate malignant neoplasms of small and large intestine and also to define the various CT findings in malignant bowel neoplasms, extra-intestinal involvement to stage intestinal neoplasms and to accurately characterise the tumour histologically as far as possible. Materials and Methods: A retrospective descriptive study included 38 patients who were proven to have malignancy of bowel on biopsy, underwent CT abdomen in major public hospital in a period of from November 2014 to May 2017 and evaluated for various CT findings in malignant bowel neoplasms in terms of involved intestine, length of diseased intestinal segment, degree of intestinal wall thickening, extra-intestinal involvement to stage bowel neoplasms and to accurately characterise the tumour histologically as far as possible. Data were tabulated and presented as frequency (n) and precentage (%). Results: In small intestine, ileum is the commonest site of involvement seen in 5 cases (13%), whereas rectum 10 cases (26.3%) was the commonest site of involvement in large intestine. Short segment involvement of bowel is more common 27 cases (71.1%) than long segment involvement 11 cases (28.9%). Circumferential wall thickening is more common in 33 cases (86.8%) than eccentric wall thickening 5 cases (13.2%). Lymph nodal involvement was seen in 17 cases (44%) and metastasis to liver was also seen in 11 cases (28.9%). Local invasion with involvement of surrounding structures was seen in 4 cases (10.5%). Adenocarcinoma was the commonest histological subtype seen in the highest number of 23 cases (60.5%), followed by lymphoma in 9 cases (23.6%), mucinous adenocarcinoma in 4 cases (10.5%) and few cases of about 2 cases (5.2%) were Gastrointestinal Stromal Tumour (GIST). Conclusion: Computed Tomography (CT) imaging findings like involved intestine, length of diseased intestinal segment, degree of intestinal wall thickening, extra intestinal involvement with respect to involvement of surrounding structures, lymph nodal involvement, distant metastasis along with histological type in most cases could be found, thus permitting tumour characterisation which can provide very useful guide in diagnosis of malignant neoplasms of small and large intestine.

Improving outpatient medication counselling in hospital pharmacy settings: a behavioral analysis using the theoretical domains framework and behavior change wheel.

Background:Despite the importance of medication counselling for patients, it is common knowledge that it is often sub-optimally carried out by pharmacy staff. While some interventions have been designed to help improve counselling, no study till date has used the Capability Opportunity and Motivation behavior model (COM-B) or Theoretical Domains Framework (TDF) as a basis for identifying evidence-based intervention strategies to improve medication counselling.Objective:To understand barriers/facilitators to optimal medication counselling by conducting a behavioral analysis using the COM-B model and TDF, and use the Behavior Change Wheel (BCW) as a basis for identifying evidence-based intervention strategies and policy categories that could be used to improve outpatient medication counselling by pharmacy staff in hospital settings located within Northwest Nigeria.Methods:Semi-structured interviews were used to collect data from 25 purposively sampled pharmacy staff working at eight major public hospitals, from January till March 2020. Data from the interviews were then transcribed and deductively coded using the COM-B model and TDF. These findings were then used to identify areas requiring change, as well as the intervention type and policy functions required to support these changes.Results:Findings from the behavioral analysis revealed shortfalls in pharmacy staff capability, opportunity and motivation with respect to outpatient medication counselling. To improve their counselling behaviors, change was identified as necessary in eight TDF domains namely ‘knowledge’, ‘interpersonal skills’, ‘memory’ ‘environmental context’, ‘social influences’, ‘intentions’, ‘reinforcement’ and ‘beliefs about capabilities’. Seven intervention functions including ‘education’, ‘training’, ‘modelling’, ‘enablement’ and ‘environmental restructuring’, in addition to three policy categories (‘guidelines’, ‘regulations’ and ‘environmental/social planning’) were also identified as relevant to future intervention design.Conclusions:Various factors were identified as affecting medication counselling by the pharmacy staff, with several of them requiring changes if counselling was to be improved upon. Multi-component interventions combining several of these intervention functions are recommended for hospital authorities and other relevant stakeholders to improve outpatient medication counselling.

Adherence to antimicrobial prophylaxis guidelines in cardiac implantable electronic device procedures in two Australian teaching hospitals.

Objective This study investigated antibiotic prophylaxis (AP) guideline adherence and the cardiac implantable electronic device (CIED) infection rate in two major Australian public teaching hospitals. Methods In a retrospective observational study, the medical records of patients who underwent CIED procedures between January and December 2017 were reviewed (Hospital A, n = 400 procedures; Hospital B, n = 198 procedures). Adherence to AP guidelines was assessed regarding drug, dose, timing, route and frequency. Infection was identified using follow-up documentation. Results AP was administered in 582 of 598 procedures (97.3%). Full guideline adherence was observed in 33.9% of procedures (203/598) and differed significantly between Hospitals A and B (47.3% vs 7.1%, respectively; P < 0.001). Common reasons for non-adherence were the timing of administration (42.3% vs 60.6% non-adherent in Hospitals A and B, respectively; P < 0.001) and repeat dosing (19.3% vs 78.8% non-adherent in Hospitals A and B, respectively; P < 0.001). Twenty infections were identified over 626.6 patient-years of follow-up (mean (±s.d.) follow-up 1.0 ± 0.3 years). The infection rate was 3.19 per 100 patient-years (P = 0.99 between hospitals). Two devices were removed due to infection; no patients died from CIED infection. Conclusions Although the rate of serious CIED infection was low, there was evidence of highly variable and suboptimal antibiotic use, and potential overuse of AP. What is known about the topic? Previous Australian studies have revealed high rates of inappropriate surgical AP. CIED infections are potentially life threatening, but can be avoided through effective use of AP. However, prolonged durations of AP in this setting may also result in complications, including Clostridioides difficile infection. What does this paper add? This study, the first to our knowledge to focus specifically on adherence to Australian guidelines for AP in CIED procedures, highlighted several common issues between AP in this setting and surgical and procedural AP more broadly. 'Early' and 'late' dose administration and extended post-procedural AP were common. Only 34% of prescriptions fully adhered to the guidelines; practices varied significantly between the two hospitals. What are the implications for practitioners? There is a clear need for institution-specific antimicrobial stewardship strategies to optimise AP in CIED procedures, aligned with the Antimicrobial Stewardship Clinical Care Standard. Patients are being placed at potentially avoidable risk of both complications of extended durations of AP and CIED infection, although the rate of serious CIED infection was low. A standardised approach to surveillance of CIED infections and prospective multisite audits of AP in CIED procedures using a validated tool, such as the Surgical National Antimicrobial Prescribing Survey, are recommended to better inform evidence-based practice. Potential strategies to optimise guideline adherence include prescribing support in patients with immediate penicillin hypersensitivity or methicillin-resistant Staphylococcus aureus colonisation, optimising the in-patient location of drug administration to promote timely dosing, limiting inappropriate post-procedural prophylaxis and routine S. aureus screening and decolonisation.

Risk of “On Job Non Compliance” towards Various COVID-19 Standard &amp;amp; Transmission Based Infection Prevention &amp;amp; Control Measures/Precautions among the Healthcare Workers Working in OPD Settings of Public Sector Tertiary Care Hospitals of Quetta Balochistan (Prospective Cohort Study)

Background: COVID-19 Pandemic is still circulating within the human population and proving to be a deadlier disease with a mortality rate ranging from 0.5% to 7%. Since COVID-19 is a highly transmissible disease; there is always a probability for its outward spread towards the general public and community from the hospitals and healthcare facilities where they come to seek treatment. Methodology: A prospective cohort study design was used, considering the limited available resources and time—a total of 200 healthcare workers (including doctors, nurses, para-medical staff, janitorial staff, reception staff & pharmacists) working in the OPDs of the two major public sector hospitals of Quetta were made part of this study. The study participants were selected using a simple random sampling technique and selection was made from the daily attendance register. The study participants from “Hospital-A” were first of all educated and trained on various COVID-19 IPC measures later on various COVID-19-IEC materials; written in simple Urdu language, were displayed clearly everywhere in the OPD. Similarly, handwashing stations along with hand sanitizers/soaps and surgical face masks were also made available free of cost for all the study participants of Hospital-A. Moreover the importance and effectiveness of COVID-19 IPC measures were continuously announced in the OPD gallery of Hospital-A, these announcements used simple wording in local languages (i.e., Urdu, Pashto, Balochi and Brahvi). On the other hand, in the OPD of “Hospital-B”, no such interventions were made. The study participants of both the hospitals were followed for one month and observations like which group showed more on-job noncompliance towards various COVID-19 IPC measures were recorded. The data was recorded on daily basis (from 1st May-to-31st May 2021) after observing the study participants for compliance towards using face masks, face shields, personal protective gowns, gloves, hand sanitizers, maintaining 6 feet social distancing and implanting triage at his or her OPD counter. Any study participant with daily proper practice of at least face masks, gloves, hand sanitizer and maintaining a 6 feet social distancing SOPs during duty hours at the outdoor patients department was considered to be a compliant individual if even one of these minimum required SOPs has not practiced the study participant, he/she was classified as non-compliant individual. A checklist was used to record these findings for every study participant on daily basis by trained data collectors. Lastly, all the data was analyzed using Microsoft Excel 2007 version. Results: The major findings of this study are almost in line with the set objectives, the study results are clearly showing the Risk Ratio (RR) as 0.27, indicating that the intervention group participants were only 27% as likely to develop on-job non-compliance for various COVID-19 IPC measures compare to the non-intervention group. Discussion & Conclusion: It is highly recommended that various COVID-19 specific infection prevention and control interventions like COVID-19 IPC trainings, COVID-19 IEC and BCC materials be displayed clearly everywhere in the healthcare facilities especially in the OPD department. Moreover, audio announcements made in simple wording using local languages like Urdu, Pashto, Balochi and Brahvi could really serve as constant reminder tools especially in an OPD department where every next patient in the queue could present with a different infectious bug.