Major Public Hospitals Research Articles

Auckland Cataract Study IV: Practical application of NZCRS cataract risk stratification to reduce phacoemulsification complications.

Reduction of intraoperative complications in phacoemulsification cataract surgery. To assess practicability of a risk stratification system, the New Zealand Cataract Risk Stratification (NZCRS) system, in a major teaching hospital service, without investigator oversight, to ascertain whether benefits identified in research studies are maintained in busy clinical practice. Prospective cohort study in a major public teaching hospital. Five hundred cases of phacoemulsification cataract surgery. NZCRS system inserted into 621 consecutive preoperative cataract patient files. Recommendation to allocate higher-risk cases to experienced surgeons. NZCRS system uptake and adherence, appropriate identification of high risk cases and intraoperative complication rates. NZCRS scores calculated in 500 of 621 (80.5%) cases and 98 (19.6%) scored as "high risk." Cataract surgery (N = 500) performed by: 12 Registrars (20%), 4 Fellows (7.2%), 26 Consultants (72.8%). Risk scores adhered to in 99%. Overall intraoperative complications (3.0%) included iris prolapse 1.6% and posterior capsule tear 0.8%. No statistical difference in complication rates identified between surgeon grades. Mean best-corrected visual acuity was 6/10 (20/32). Postoperatively, cystoid macular oedema occurred in 3.2%. Rescoring by an experienced investigator noted a greater number of "high risk scores" (31.6% vs 19.6%) related to differences in subjective scoring of anterior chamber depth and cataract density. Practical uptake of cataract risk stratification was promising in this study with NZCRS calculated in 80.5% with 99% adherence to scoring recommendations. Compared to baseline studies, in the day-to-day clinical setting, a continued, decreasing trend in frequency and severity of intraoperative complications was noted. Subjective variability of risk scoring may be further improved by better, objective, standardization.

The demographic predictors of job satisfaction among the nurses of a major public hospital in KSA.

ObjectiveNurses play fundamental roles in the delivery of health care services. Nurses' job satisfaction levels can have profound impacts on the quality of the care that they provide to patients. Accordingly, this study aimed to examine nurses’ levels of job satisfaction and the impact of key demographic variables on this variable.MethodsBetween April and May 2019, a quantitative cross-sectional descriptive study was conducted in a major public hospital in KSA. The Minnesota Satisfaction Questionnaire short form was completed by a sample of 382 nurses who had been recruited using systematic random sampling. The data were entered into Statistical Package for Social Sciences (SPSS) spreadsheets and analysed using SPSS version 22. Demographic differences in mean satisfaction scores were examined using independent-samples t-test and analysis of variance. Finally, multiple linear regression analysis was conducted.ResultsOut of a total of 382 nurses who were invited to participate in this study, 337 responded (response rate = 88%), and almost 85% of them were Saudi nationals. Overall, 48% of the participants were satisfied, and only 22% of them were dissatisfied with their jobs. The participants were more satisfied with intrinsic than with extrinsic factors of a job.ConclusionMost nurses reported moderate levels of overall job satisfaction. Greater job satisfaction was related to demographic factors such as sex (i.e. male), nationalilty (i.e. Saudi), and age (i.e. older). Job satisfaction was negatively correlated with higher salary. Age and salary predicted the outcome variable. Health care authorities should take more efforts to increase the job satisfaction of nurses in KSA.

A Cost and Efficiency Analysis of the WALANT Technique for the Management of Trigger Finger in a Procedure Room of a Major City Hospital.

Background:The “Wide Awake Local Anesthesia No Tourniquet” (WALANT) technique is gaining popularity in hand surgery owing to its benefits of reduced cost, shorter hospital stay, improved safety, and the ability to perform active intraoperative examinations. The aim of this study is to analyze the cost savings and efficiency of performing A1 pulley release for treatment of trigger finger using the WALANT technique in a major city hospital procedure room (PR) as compared with the standard tourniquet, operating room (OR) approach.Methods:Patients who underwent trigger finger release between 2012 and 2017 were identified. Demographic and procedural information were obtained. Patients were followed for an average of 82 and 242 days in the PR and OR groups, respectively.Results:Thirty-nine PR and 37 OR patients were identified. Case length and turnover time were shorter in the PR group [21.4 ± 7 versus 23.5 ± 14.3 min (P = 0.942) and 31.1 ± 11.1 and 65.3 ± 17.7 min (P < 0.001), respectively). The cost of the instrument tray utilized was calculated as $3,304.25 in the main OR and $993.79 in the PR. Cost per minute for all personal services in the OR was calculated to be $44/min, a cost that was virtually absent in the PR. Complication rates did not differ between both groups.Conclusion:Performing A1 pulley release for treatment of trigger finger using the WALANT technique is both cost effective and time efficient compared to performing the same procedure in the main OR of a major city public hospital.

Processes of Stroke Unit Care and Outcomes at Discharge in Vietnam: Findings from the Registry of Stroke Care Quality (RES-Q) in a Major Public Hospital

Background: An essential strategy to reduce mortality and disability after stroke is to ensure access to evidence-based care. In developed countries, it has been shown that if hospitals improve the quality of care, the impact of stroke is attenuated. However, in developing countries, data on the processes of care and associated patient outcomes are scarce. We examined the care processes and outcomes among patients with acute stroke from a stroke unit in a major public hospital in Vietnam whereby there are approximately 15,000 hospital admissions for stroke per year. Methods: We included first-ever strokes admitted to the 115 People’s Hospital (June 2017-March 2018). Data were collected in the Registry of Stroke Care Quality which is used in &gt;50 countries. Baseline characteristics, stroke-related factors (e.g., type and severity), processes of care (e.g., thrombolysis), and outcomes at discharge were examined including mortality and functional outcome, assessed as the walking ability without assistance. Results: Data were available for 6601 patients with first-ever stroke (44% women, 80% ischemic stroke [IS], median age: 62 years, interquartile range [IQR]: 53-72) who received stroke unit care. The median time from stroke onset to hospital arrival was 15.7 hours (IQR: 5.6-37.5). At admission, the median National Institute of Health Stroke Scale score indicating stroke severity was 7 (IQR: 4-12). Among those with IS, 9% received intravenous thrombolysis. Over 90% of the participants received recommended process of care including dysphasia screening (99%), antihypertensive agents (92%), cholesterol-lowering medication (IS = 99%), and antithrombotic medication (IS = 98%). At discharge (median length of stay: 4 days, IQR: 3-6), 3% of all cases died and 46% were able to walk independently. Advanced age, stroke severity, and not receiving antihypertensive agent(s) were contributing factors to mortality and poorer functional outcome. Conclusion: There was a considerable delay in the time from stroke onset to hospital arrival. Evidence-based care at the stroke unit was consistently provided. It remains unclear whether other hospitals in Vietnam and other developing countries perform as well. Greater public awareness of stroke to reduce onset to arrival times and more stroke units are warranted to achieve the excellent outcomes in the major public hospital.

Association of thrombocytopenia with splenomegaly in malaria patients in East Kalimantan: A cross-sectional, retrospective study.

Background:Malaria still presents as a major health problem in Indonesia and specifically in East Kalimantan. One common sign found in malaria patient is thrombocytopenia, the mechanism of which is still unclear. Several studies have suggested some mechanisms, one of which is splenomegaly. This study aimed to discover the association between thrombocytopenia and splenomegaly of malaria patients in East Kalimantan. Methods:This study was a descriptive retrospective study with clinical and laboratory data obtained from the medical records of malaria patients in four major public hospitals from January 2015 to July 2018. The association between thrombocytopenia with splenomegaly was analysed using Chi-Square test. Results:A total of 215 patients were included; 189 male (87.9%) and 26 female (12.1%). The etiologic agents found in these patients were Plasmodium vivax(43.2%), Plasmodium falciparum(42.8%), and mixed infection ( Plasmodium falciparumand Plasmodium vivax) (4.6%). The thrombocyte count was normal in 28 patients (13%) and decreased in 187 patients (87%). Among patients with thrombocytopenia, the percentage of mild, moderate and severe thrombocytopenia was 18.2%, 43.8% and 33%, respectively. Splenomegaly was found in only 11 patients (5.1%). We found no association between thrombocytopenia with splenomegaly (p=0.61). Conclusions:We conclude that splenomegaly, which was a rare clinical finding of these malaria patients, was not associated with thrombocytopenia.

Is ward round participation by clinical pharmacists a valuable use of time and money? A time and motion study.

While the benefits of multidisciplinary ward round (WR) participation by clinical pharmacists have been demonstrated, it can be time-consuming. No previous studies have compared the specific benefits of WR participation and other clinical activities. To assess the clinical impact of different clinical pharmacist activities and analyse patterns of practice based on WR involvement and timing and significance of clinical interventions. In a prospective, observational time and motion study, clinical pharmacists servicing 6 unmatched specialty areas in a major quaternary public hospital were observed and their activities documented. Pharmacists' self-recorded interventions underwent expert panel assessment for significance and potential cost savings. Workflows and interventions were analysed for the 4 pharmacists involved in WRs ('WR pharmacists') during their time 'on' and 'off' rounds and for 2 pharmacists not involved in WRs ('non-WR pharmacists') using chi-square analyses. During 170 h of observation, 267 clinical interventions (53.9% minor, 40.1% moderate, 6.0% major) were recorded. WR pharmacists spent 24.3% of their time on rounds, and 64.8% of interventions were made during this time (intervention rates: 4.5/hour on WR vs. 0.8/hour off WR vs. 1.3/hour for non-WR pharmacists). Differences in WR and non-WR pharmacists' workflows were observed, although there was no difference in time spent on clinical/patient-centred activities (p = 0.70). WR involvement was associated with significantly quicker interventions (p < 0.001). All major interventions were made by WR pharmacists; 80% were made on rounds. Major interventions were estimated to have decreased lengths of stay, intensive care requirements and procedure costs. Clinical pharmacists focussed on patient-centred activities, regardless of WR involvement. Notwithstanding differences in the WR and non-WR specialty areas, WR participation was associated with more significant and timely interventions and potential cost savings. Coupled with the subjective benefits of WR participation observed, these findings support the potential value of clinical pharmacist WR participation.

Antibiotic Utilization Trends in Two State Hospitals of Mongolia from 2013 to 2017

Background. The study aimed to evaluate inpatient antibiotic use in both the State Second Hospital and State Third Hospital in Mongolia, using the WHO developed and standardized ATC/DDD methodology. Methods. Data were collected from the State Second Hospital and State Third Hospital which are major public hospitals that provide health care for approximately one fifth of the Mongolian population. Antibiotic utilization was monitored retrospectively for five years (2013–2017) using the ATC/DDD methodology and data were presented in DDD/ admission and DDD/100 bed days. Statistical analysis was performed using a Student’s t-test for parametric data. A P value of ≤0.05 was considered to be statistically significant. Results. The annual consumption rates in the State Second Hospital were stable over time while in the State Third Hospital consumption rates varied considerately between years. Overall, the total antibiotic consumption rate was very high, but has decreased in both hospitals. The rate of consumption of all antibiotics was approximately twice that in the State Third Hospital (421.7 DDD/100 bed days) between 2013 and 2017 when compared with the State Second Hospital (199.7 DDD/ 100 bed days), P&lt;0.001). The seven most frequently used antibiotics comprised approximately 75% of all DDDs in both hospitals, in the period 2013–2017; being: amoxicillin, cefazolin, cefotaxime, ceftriaxone, clarithromycin, ciprofloxacin, and nitroxoline. However, this was not consistent when considering the individual years, since in 2015 and 2016, these seven active agents represented approximately 50%. Conclusion. This is the first hospital-based study of antibiotic consumption rates reported in Mongolia. In addition to very high consumption rates, large differences occurred between the hospitals investigated. Inappropriate and high levels of antibiotic use lead to increased costs and also increased nosocomial infection rates with potentially resistant species. The Government and health professionals need to take more active roles in improving and promoting quality antibiotic use among inpatients.

Rural-urban disparities in caesarean section rates in minority areas in China: evidence from electronic health records.

ObjectiveTo assess the rural–urban disparity in caesarean section rates using electronic health records from hospitals located in the Province of Inner Mongolia, which is a minority area in Northeastern China.MethodsThe study examined the electronic health records of women that gave birth in three major public hospitals between January 2012 and December 2016. Multinomial regression analyses were used to estimate rural–urban disparities in caesarean section rates.ResultsData from 61 903 women were examined. Caesarean section rates increased slightly over the study period and the rate was significantly higher in rural compared with urban hospitals (48% versus 38%). This disparity consistently increased over time. Multinomial regression analyses showed that maternal age, ethnicity, health insurance type, employment status, reproductive history and the newborn’s sex were significant risk factors associated with caesarean section rate. Furthermore, stratified analysis of first-time pregnancies, minorities and different age groups showed that the odds of undergoing an emergency caesarean section was lower in the rural hospital, but the odds of undergoing a planned caesarean section was higher in the rural hospital.ConclusionsCaesarean section rates have increased in rural areas and the disparity in rural–urban areas has increased substantially over the years.

Emotional intelligence, gender and transformational leadership among nurses in emerging economies

PurposeIn spite of the observation that nurse managers’ style of authority in sub-Saharan Africa is one of antagonistic vibe and lordship, there is not much information on the kind of leadership provided in the hospitals by nurse managers. Following the notion that transformational leadership is a solution to many leadership problems and often creates valuable positive change in followers, this study aims to examine the level of transformational leadership behavior of nurse leaders; determining the effects of the sub-constructs of emotional intelligence (EI) on the transformational leadership behavior of leaders; and determining whether there is a difference in the exhibition of transformational leadership behavior due to the gender of leaders.Design/methodology/approachThe study uses five of the major public hospitals in the Greater Accra Region (the capital) of Ghana. Evidence of such links would be considerable for Ghanaian healthcare providers in their quest to find potential nurse leaders to train, so as not to dwell highly on the seniority criterion in the selection of leaders. Using a quantitative approach, the Wong Law EI Scale (2002) and leadership items adapted from Rafferty and Griffin (2004) were used to collect the data. A descriptive statistics (mean) revealed that nurse leaders from the selected hospitals exhibited a high level (M= 3.90, SD = 0.14) of transformational leadership behavior.FindingsA multiple regression analysis revealed that three of the sub-constructs of EI significantly affected transformational leadership with the “self-emotion appraisal” construct having the strongest effect on transformational leadership behavior (β = 0.508, p = 0.000). However, the others’ emotion appraisal sub-construct did not significantly affect transformational leadership. Furthermore, the results from the independent sample t-test revealed no significant difference in the exhibition of transformational leadership due to gender.Practical implicationsBased on the findings, when leaders are trained to be emotionally intelligent and their skills are fostered, they are more likely to exhibit transformational leadership behaviors, which will further result in organizational effectiveness and follower satisfaction. Hospitals must focus on the control of one’s emotions at work, and subsequently, understanding others’ emotions. In developing transformational leaders, there is the need to identify some tools that will increase EI level, more specifically, traits related to the understanding of others’ emotion. The findings from this study indicate that one of the factors to check when selecting nurse leaders should be their EI and not necessarily a matter of seniority in many cases in emerging economies.Originality/valueThe originality of this study is in the fact that it focuses on an emerging economy, which is under researched. In Ghana, the criteria for promotion of nurse leaders’ is based strictly on seniority and age and not on factors such as the leaders EI. The profession of nursing is such that leaders need to understand that certain soft skills such as EI are considered necessary to transform the hospitals and staff they lead. This study, therefore, sheds light on these key areas from the perspective of an emerging economy, which are usually not in the domain of literature in the area of healthcare leadership.

Clinical and Radiologic Evaluation of an Individual with Hypochondroplasia and a Novel FGFR3 Mutation

Hypochondroplasia (HCH), a skeletal dysplasia caused by mutations in the fibroblast growth factor receptor 3 ( FGFR3 ) gene, is characterized by disproportionate short stature. The p.Asn540Lys (p.N540K) mutation accounts for ∼50 to 70% of cases of HCH, but novel FGFR3 mutations are described. We present a family with disproportionately short stature and mild radiologic findings seen in a major public pediatric hospital in Argentina. A previously undescribed heterozygous missense variant in FGFR3, NM_000142.4:667C > T; p.(Arg223Cys) was identified. The predicted phenotype correlates well with the mild auxologic and radiologic characteristics observed. In this case, disproportionately short stature raised the suspicion of skeletal dysplasia.

Time from diagnosis to treatment of colorectal cancer in a South Australian clinical registry cohort: how it varies and relates to survival

ObjectivesSome early studies indicated lower survival with longer time from diagnosis to cancer treatment, but others showed the reverse. We investigated time to treatment of colorectal cancer and associations with...

Exploring Incontinence-Associated Dermatitis in a Single Center Intensive Care Unit: A Longitudinal Point Prevalence Survey.

The purpose of this study was to provide longitudinal prevalence rates of incontinence-associated dermatitis (IAD) in patients in an intensive care unit (ICU) and to identify patient characteristics associated with IAD development. Prospective observational. The sample comprised 351 patients aged 18 years and older in a major metropolitan public hospital ICU in Queensland, Australia. All consenting, eligible participants at risk of developing IAD underwent weekly skin inspections to determine the presence of IAD. Data were collected weekly for 52 consecutive weeks. Descriptive statistics described the study sample and logistic regression analysis was used to identify patient characteristics associated with development of IAD. The weekly IAD prevalence ranged between 0% and 70%, with IAD developing in 17% (n = 59/351) of ICU patients. The odds of IAD developing increased statistically significantly with increasing age (odds ratio [OR]: 1.029, 95% confidence interval [CI]: 1.005-1.054, P = .016), time in the ICU (OR = 1.104; 95% CI: 1.063-1.147, P < .001), and Bristol Stool chart score (OR = 4.363, 95% CI: 2.091-9.106, P < .001). Patients with respiratory (OR = 3.657, 95% CI: 1.399-9.563, P = .008) and sepsis (OR = 3.230, 95% CI: 1.281-8.146, P = .013) diagnoses had increased odds of developing IAD. These data show the high variability of IAD prevalence over a 1-year period. Characteristics associated with the development of IAD in patients in the ICU included older age, longer lengths of ICU stay, incontinent of liquid feces, and having respiratory or sepsis diagnoses.

Electronic Health Literacy Among Magnetic Resonance Imaging and Computed Tomography Medical Imaging Outpatients: Cluster Analysis.

BackgroundVariations in an individual’s electronic health (eHealth) literacy may influence the degree to which health consumers can benefit from eHealth. The eHealth Literacy Scale (eHEALS) is a common measure of eHealth literacy. However, the lack of guidelines for the standardized interpretation of eHEALS scores limits its research and clinical utility. Cut points are often arbitrarily applied at the eHEALS item or global level, which assumes a dichotomy of high and low eHealth literacy. This approach disregards scale constructs and results in inaccurate and inconsistent conclusions. Cluster analysis is an exploratory technique, which can be used to overcome these issues, by identifying classes of patients reporting similar eHealth literacy without imposing data cut points.ObjectiveThe aim of this cross-sectional study was to identify classes of patients reporting similar eHealth literacy and assess characteristics associated with class membership.MethodsMedical imaging outpatients were recruited consecutively in the waiting room of one major public hospital in New South Wales, Australia. Participants completed a self-report questionnaire assessing their sociodemographic characteristics and eHealth literacy, using the eHEALS. Latent class analysis was used to explore eHealth literacy clusters identified by a distance-based cluster analysis, and to identify characteristics associated with class membership.ResultsOf the 268 eligible and consenting participants, 256 (95.5%) completed the eHEALS. Consistent with distance-based findings, 4 latent classes were identified, which were labeled as low (21.1%, 54/256), moderate (26.2%, 67/256), high (32.8%, 84/256), and very high (19.9%, 51/256) eHealth literacy. Compared with the low class, participants who preferred to receive a lot of health information reported significantly higher odds of moderate eHealth literacy (odds ratio 16.67, 95% CI 1.67-100.00; P=.02), and those who used the internet at least daily reported significantly higher odds of high eHealth literacy (odds ratio 4.76, 95% CI 1.59-14.29; P=.007).ConclusionsThe identification of multiple classes of eHealth literacy, using both distance-based and latent class analyses, highlights the limitations of using the eHEALS global score as a dichotomous measurement tool. The findings suggest that eHealth literacy support needs vary in this population. The identification of low and moderate eHealth literacy classes indicate that the design of eHealth resources should be tailored to patients’ varying levels of eHealth literacy. eHealth literacy improvement interventions are needed, and these should be targeted based on individuals’ internet use frequency and health information amount preferences.

Palliative Care Awareness Among Advanced Cancer Patients and Their Family Caregivers in Singapore

We investigated the awareness of palliative care (PC) services in advanced cancer patients and their family caregivers and whether negative perceptions was a possible barrier to PC utilisation in Singapore. Patients with stage 4 solid cancer and their caregivers were interviewed between July 2016 and March 2018 at outpatient clinics located in the medical oncology departments of 2 major public hospitals in Singapore. Patients and caregivers were asked whether they were aware of PC services, how they first learned about them, who first recommended PC to the patient, whether the patient had received PC, and reasons for not receiving PC. Awareness of PC was lower in patients compared to caregivers (43% vs 53%; P <0.01). The odds of being aware in patients was higher if they had higher education (odds ratio [OR] = 2.927; P <0.001) and higher income (OR = 1.798; P = 0.005). Compared to patients, more caregivers reported that a healthcare provider recommended PC to the patient (10% vs 20%; P <0.012). Furthermore, 7% of patients and 15% of caregivers reported that the patient received PC (P = 0.031). The most common reasons for not receiving PC reported by patients and caregivers (respectively) were that the patient was still receiving treatment (68% and 78%), it is not time for PC (76% and 59%) and PC would not be of help (18% and 19%). Less than half of patients indicated an awareness of PC. Our findings suggest that efforts should be made to increase awareness of PC and promote its acceptance in cancer patients and their family caregivers in Singapore.

Association of thrombocytopenia with splenomegaly in malaria patients in East Kalimantan: A cross-sectional, retrospective study

Background:Malaria still presents as a major health problem in Indonesia and specifically in East Kalimantan. One common sign found in malaria patient is thrombocytopenia, the mechanism of which is still unclear. Several studies have suggested some mechanisms, one of which is splenomegaly. This study aimed to discover the association between thrombocytopenia and splenomegaly of malaria patients in East Kalimantan. Methods:This study was a descriptive retrospective study with clinical and laboratory data obtained from the medical records of malaria patients in four major public hospitals from January 2015 to July 2018. The association between thrombocytopenia with splenomegaly was analysed using Chi-Square test. Results:A total of 215 patients were included; 189 male (87.9%) and 26 female (12.1%). The etiologic agents found in these patients were Plasmodium vivax(43.2%), Plasmodium falciparum(42.8%), and mixed infection ( Plasmodium falciparumand Plasmodium vivax) (4.6%). The thrombocyte count was normal in 28 patients (13%) and decreased in 187 patients (87%). Among patients with thrombocytopenia, the percentage of mild, moderate and severe thrombocytopenia was 18.2%, 43.8% and 33%, respectively. Splenomegaly was found in only 11 patients (5.1%). We found no association between thrombocytopenia with splenomegaly (p=0.61). Conclusions:We conclude that thrombocytopenia is not associated with splenomegaly in these malaria patients.

The Perception of Patients on the Service Quality Offered by Healthcare Professionals at Two Major Public Hospitals in South East Regional Health Authority (Serha), Jamaica

The study of human memory has progressed greatly beyond those early philosophical notions and currently involves clinical psychiatry, experimental psychology, neuropsychology, neurology, and a variety of other cognitive sciences. These have provided new insights into the human memory and managed to differentiate and isolate diverse structures and aspect of memory, such as immediate vs. long-term memory, procedural vs. declarative memory, retrieval vs. distortion of memory, and so forth.

Discourse on hygiene between hospitalized patients and health care workers as an accepted norm: Making it legitimate to remind health care workers about hand hygiene

BackgroundDespite World Health Organization recommendations that patients should play a role in encouraging hand hygiene (HH) as a means of preventing infection, patient engagement remains an underused method. From the perspectives of hospitalized patients (HPs) and health care workers (HCWs) at 2 major public hospitals in Haifa, Israel, this research investigated (1) HP barriers to reminding HCWs to maintain HH, (2) HCW barriers to giving HPs instruction on proper hygiene, (3) what could help HPs and HCWs overcome these barriers, and (4) how video clips can be used to devise tailored strategies governing discourse on HH between HCWs and HPs. MethodsIntervention type 2 design and examination of 2 population groups—HPs and HCWs—before and after intervention by means of mixed methods research. ResultsBoth HPs and HCWs reported partial knowledge, embarrassment, and fears regarding commenting to staff, as well as a lack of cultural adaptation. The interviewees indicated that the video clips granted legitimacy to reminding HCWs about hygiene through strategies designed to identify and solve barriers, authenticity, and cultural adaptation. ConclusionsTo overcome HP and HCW barriers to maintaining HH, tailored video clips on HH should specify barriers and solutions with which they can both identify, thus turning discourse on HH into an accepted norm.

Tobacco consumption and premenstrual syndrome: A case-control study.

ObjectiveTo assess whether tobacco smoking is associated with Premenstrual Syndrome (PMS) and its most severe form, Premenstrual Dysphoric Disorder (PMDD).DesignCase-control study with incident cases using the Spanish public healthcare system.Setting3 major public hospitals and one family counseling and planning center.PopulationWomen consulting for troubles related to menstruation and for other motives such as screening for uterine cancer, contraception counseling or desire for pregnancy.MethodsLogistic regression.Main outcome measuresOdds Ratios of PMS and PMDD.Results285 incident PMS cases and 285 age-matched controls on the one hand, and 88 incident PMDD cases and 176 controls on the other hand participated in the study. The odds of premenstrual disorders was higher in current smokers compared with never smokers: Odds Ratio (OR) = 1.78, 95% Confidence Interval (CI): 1.20–2.63 for PMS and OR = 2.92, 95%CI: 1.55–5.50 for PMDD. For PMS, women who smoke 1 to 5 cigarettes/day presented an OR = 2.82, 95%CI: 1.57–5.06 and those who smoke more than 15 cigarettes/day an OR = 2.52, 95%CI: 0.99–6.40.Compared to non-smokers, current and ex-smokers who smoked < 3 pack-years presented an OR = 1.79, 95%CI: 1.04–3.08 for PMS, and an OR = 3.06, 95%CI: 1.27–7.35 for PMDD. Smokers of 3 to 8 pack-years presented an OR = 2.34, 95%CI: 1.33–4.13 for PMS and OR = 3.56, 95%CI: 1.55–8.17 for PMDD.These results were confirmed by the exposure-effect curve obtained from a cubic spline model.ConclusionsThis study shows that smokers are more likely to develop PMS and PMDD.

Association of thrombocytopenia with splenomegaly in malaria patients in East Kalimantan: A cross-sectional, retrospective study

Background: Malaria still presents as a major health problem in Indonesia and specifically in East Kalimantan. One common sign found in malaria patient is thrombocytopenia, the mechanism of which is still unclear. Several studies have suggested some mechanisms, one of which is splenomegaly. This study aimed to discover the association between thrombocytopenia and splenomegaly of malaria patients in East Kalimantan. Methods: This study was a descriptive retrospective study with clinical and laboratory data obtained from the medical records of malaria patients in four major public hospitals from January 2015 to July 2018. The association between thrombocytopenia with splenomegaly was analysed using Chi-Square test. Results: A total of 215 patients were included; 189 male (87.9%) and 26 female (12.1%). The etiologic agents found in these patients were Plasmodium vivax (43.2%), Plasmodium falciparum (42.8%), and mixed infection ( Plasmodium falciparum and Plasmodium vivax) (4.6%). The thrombocyte count was normal in 28 patients (13%) and decreased in 187 patients (87%). Among patients with thrombocytopenia, the percentage of mild, moderate and severe thrombocytopenia was 18.2%, 43.8% and 33%, respectively. Splenomegaly was found in only 11 patients (5.1%). We found no association between thrombocytopenia with splenomegaly (p=0.61). Conclusions: We conclude that splenomegaly, which was a rare clinical finding of these malaria patients, was not associated with thrombocytopenia.

Stakeholder involvement in drug inventory policies

This paper experimentally investigates the relationships among three major stakeholders that are involved in drug inventory management at Intensive Care Units (ICUs), namely: i) nurses, who in person manage drug orders and carry out storage operations, ii) clinicians, who choose the therapy and shape demand, and iii) the hospital management, who is in charge of the economic sustainability of the hospital. As a case study, we consider the ICU ward of a major Italian public hospital and we focus on antibiotics. We exploit a previously developed Mixed Integer Linear Programming model which decides, for each drug, when and how much to order, and we improve it by adding different sets of constraints to represent each stakeholders’ point of view. By solving three generalized models, each of which ties the satisfaction of a single stakeholder to different thresholds, we explore the mutual effects of taking explicitly into account different perspectives within the inventory policy. We implemented an instance generator, built on the basis of empirical probability distributions extracted from a large set of observed historical data and representing the decision flow ruling drugs prescription. Extensive experiments have been carried out on a set of realistic instances provided by the generator. Results based on our test case not only provide computational evidence to intuitive relations among stakeholders, but also suggest possible levels of compromise. Improved stakeholder satisfaction would also benefit the patient, the passive stakeholder who is the ultimate subject of the caring process.