Management Of Hospitalized Patients Research Articles

Association between hospital ownership and patient selection, management, and outcomes after carotid endarterectomy or carotid artery stenting

BackgroundThis study analyses the association between hospital ownership and patient selection, treatment, and outcome of carotid endarterectomy (CEA) or carotid artery stenting (CAS).MethodsThe analysis is based on the Bavarian subset of the nationwide German statutory quality assurance database. All patients receiving CEA or CAS for carotid artery stenosis between 2014 and 2018 were included. Hospitals were subdivided into four groups: university hospitals, public hospitals, hospitals owned by charitable organizations, and private hospitals. The primary outcome was any stroke or death until discharge from hospital. Research was funded by Germany’s Federal Joint Committee Innovation Fund (01VSF19016 ISAR-IQ).ResultsIn total, 22,446 patients were included. The majority of patients were treated in public hospitals (62%), followed by private hospitals (17%), university hospitals (16%), and hospitals under charitable ownership (6%). Two thirds of patients were male (68%), and the median age was 72 years. CAS was most often applied in university hospitals (25%) and most rarely used in private hospitals (9%). Compared to university hospitals, patients in private hospitals were more likely asymptomatic (65% vs. 49%). In asymptomatic patients, the risk of stroke or death was 1.3% in university hospitals, 1.5% in public hospitals, 1.0% in hospitals of charitable owners, and 1.2% in private hospitals. In symptomatic patients, these figures were 3.0%, 2.5%, 3.4%, and 1.2% respectively. Univariate analysis revealed no statistically significant differences between hospital groups. In the multivariable analysis, compared to university hospitals, the odds ratio of stroke or death in asymptomatic patients treated by CEA was significantly lower in charitable hospitals (OR 0.19 [95%-CI 0.07–0.56, p = 0.002]) and private hospitals (OR 0.47 [95%-CI 0.23–0.98, p = 0.043]). In symptomatic patients (elective treatment, CEA), patients treated in private or public hospitals showed a significantly lower odds ratio compared to university hospitals (0.36 [95%-CI 0.17–0.72, p = 0.004] and 0.65 [95%-CI 0.42-1.00, p = 0.048], respectively).ConclusionsHospital ownership was related to patient selection and treatment, but not generally to outcomes. The lower risk of stroke or death in the subgroup of electively treated patients in private hospitals might be due to the right timing, the choice of treatment modality or actually to better structural and process quality.

Progressive muscle relaxation alleviates anxiety and improves sleep quality among healthcare practitioners in a mobile cabin hospital: a pre-post comparative study in China.

To investigate the anxiety levels, sleep quality and potential risk factors of healthcare practitioners involved in the management of COVID-19 patients in a mobile cabin hospital, and further to assess the impact of progressive muscle relaxation (PMR) on their anxiety levels and sleep quality. We conducted a pre-post self-controlled trial. Healthcare practitioners meeting the inclusion criteria underwent daily 30-min PMR sessions for seven consecutive days. The Pittsburgh Sleep Quality Index (PSQI) and Hamilton Anxiety Scale (HAMA) were used to assess the anxiety and sleep quality of subjects pre- and post-intervention. Statistical analysis was performed using the Wilcoxon test, Mann-Whitney U test, Kruskal-Wallis H test, and Spearman rank correlation. A total of 94 participants completed the study. No statistically significant differences in HAMA or PSQI total scores were observed between groups categorized based on demographic variables such as age, sex, and years of education (p > 0.05). The PSQI total score and its components (excluding sleep medication usage) exhibited a positive correlation with the HAMA total score and its psychological anxiety component (p < 0.05), and a correlation was observed between somatic anxiety manifestations and several components of the PSQI. The PSQI total scores before and after intervention were 10.0 (8.0, 13.0) and 8.0 (6.0, 9.0) respectively (p < 0.001); the HAMA total scores were 8.0 (5.0, 13.0) and 6.0 (4.0, 9.5) respectively (p < 0.001). The detection rates of poor sleep and anxiety states, along with their severity, significantly decreased post-intervention (p < 0.001). Healthcare practitioners experience prominent anxiety and sleep issues in the mobile cabin hospital. PMR can be an effective intervention for improving the anxiety and sleep quality of healthcare professionals during support periods in the mobile cabin hospital. However, trials with larger samples are necessitated to further affirm these preliminary findings.

MODERN DRUGS FOR NUTRITIONAL SUPPORT OF THE PATIENT

Introduction. Nowadays, nutritional support is an integral part of the management of patients in hospitals of any profile. Parenteral nutrition (PN) is a vital therapy and is indicated in those situations when enteral or oral nutrition is impossible or insufficient, for example, in such clinical conditions as advanced variants of Crohn's disease and ulcerative colitis, stenotic deformities of the esophagus, comatose change of consciousness, cancer cachexia, neuropathies of various etiologies, and others. The aim of the present study was to investigate preparations for parenteral nutrition as part of an integrated approach to the treatment of various pathologic conditions. Parenteral nutrition is in modern clinical medicine an integral part of adequate treatment in the presence of protein-energy deficiency in patients. Currently, there are many nutrient mixtures that can compensate for nutrient losses in various pathologies. There are standard systems that can compensate for substrate deficiencies individually, but the most effective are considered to be 3-in-1 systems, which are more harmonious and balanced in their composition, which, in turn, leads to the fullest satisfaction of the nutrient needs of patients. Conclusion. At the same time, it is necessary to take into account that in case of irrational use, the risks for the patient increase, therefore, in order to mitigate them, it is necessary to implement programs to control the production of mixtures and assess their qualitative and quantitative composition.

Emerging trends of antimicrobial sensitivity and resistance pattern and drug utilization study in burn patients at tertiary care teaching hospital

Background: One of the cases of accidental injuries is burns. Globally, every year estimated 180,000 mortalities occur due to burns, and most of the deaths are seen in the lower or poor socioeconomic class of developing countries. Due to predominantly poor and low socioeconomic status, overpopulation, poor education, and unreachability to advanced burn care in certain parts of the country - the incidence, complications, and deaths have continued to rise in developing countries. About 75% of the deaths associated with burn injuries are related to wound infection, especially in developing countries. The present study was undertaken to study the microflora of burn wounds as well as drug utilization in the management of burn patients in a tertiary care teaching hospital. Aims and objectives: Assessment of antimicrobial susceptibility and resistant pattern and drug utilization in burns patients. Materials and Methods: This observational cross-sectional descriptive study was performed on 130 hospitalized burn patients over 12 months (from November 2020 to November 2021). All burn patients who were admitted in the hospital and received at least 1 day of treatment were included in the study. All required information, including demographic data, prescribed medication, microbial culture sensitivity report, and treatment outcome were recorded in the case record form. Descriptive statistics using Microsoft Excel version 2019. Results: Of a total of 130 burn patients, 52% were females. The most common type of burn was flame in 69% of patients. The mean length of hospital stay was 9 days and it ranged from 1 to 40 days. Culture from burns wound revealed Pseudomonas aeruginosa (47.6%) as the most common organism isolated followed by Klebsiella pneumoniae (45.2%), Acinetobacter baumannii (14.2%), Proteus mirabilis (14.2%), Staphylococcus aureus (9.5%), and Escherichia coli (4.7%). Among the isolated microorganisms, most of them showed sensitivity to beta-lactam, aminoglycoside, and tetracyclines. Sulphonamide was dominant among the topically applied antibiotics, whereas cephalosporins were dominant among the systemically administered antibiotics. The average number of drugs pre-prescription ranges from 6.5 to 8.5. Conclusion: The present study results are helpful in understanding the pattern of burns wound sepsis, the dominant bacterial organism, the antimicrobial susceptibility/resistance, and the drug utilization pattern in burn patients.

Effect of Infectious Diseases Specialist Consultation on the Management and Outcome of Patients in a Public Sector Hospital

Aim: To assess the effect of infectious diseases specialist consultation on the management and outcome of patients in a public sector hospital. Materials and Methods: This was a prospective cohort study in which a total of 313 patients were enrolled. This study was conducted in Dr Ruth Km Pfau Civil Hospital Karachi. The study duration was 6 month from 1st January, 2023 to 30 June, 2023. Data were collected from the medicine, surgery and allied departments of Civil Hospital Karachi by the study investigators themselves. For statistical analysis we used SPSS Version 25. Results: We included a total of 313 patients in our study, with a mean age of 52.31±10.51 years and an average length of stay of 13.04±5.50. These patients were distributed across various departments, with 91 (29.1%) from medicine, 110 (35.1%) from surgery, and the remaining 112 (35.8%) from other allied departments. The majority of patients, 63 (20.1%), were diagnosed with bacteremia, while 52 (16.6%) had urine infections, and 56 (17.9%) experienced urinary tract infections (UTI). Other diagnoses included Ventilator-associated pneumonia/hospital-acquired pneumonia (17.9%), Mixed infections (3.2%), Necrotizing Fasciitis (11.2%), Peritonitis (9.6%), Pancreatitis (2.6%), Surgical Site Infections (SSI) (6.4%), Diabetic foot infections (4.5%), Osteomyelitis (4.8%), and Meningitis (3.2%) respectively. Patients were categorized based on the etiology of infection, revealing that 14 (4.5%) patients had unexplained fever. Additionally, malaria was found in 21 (6.7%) patients, Dengue in 32 (10.2%), Tuberculosis in 27 (8.6%), ATT-induced hepatitis in 9 (2.9%), Multidrug-Resistant Organisms (MDROs) in 148 (47.3%), Methicillin-resistant Staphylococcus aureus (MRSA) in 49 (15.7%), Fungal infections in 11 (3.5%), and Viral infections in 2 (0.6%). Regarding outcomes, 229 (73.2%) patients exhibited clearance of bacterial or fungal cultures, 13 (4.2%) showed no disability at the time of discharge, 229 (76.7%) demonstrated improvement in signs and symptoms, and mortality occurred in 1 (0.3%) patient. Conclusion: It was concluded that consulting with experts in infectious diseases has a major impact on patient management and results. Keywords: Infectious Disease specialist, management, consultation.

Cost of in-patient management of COVID-19 patients in a general hospital in Kuwait

BackgroundAmong the GCC countries affected by COVID-19 infections, Kuwait has been significantly impacted, with 658,520 cases and 2,563 deaths reported by the WHO on September 30, 2022. However, the impact of the COVID-19 epidemic on Kuwait’s economy, especially in the healthcare sector, remains unknown. Objective: This study aims to determine the total cost of managing COVID-19 in-patients in Kuwait.MethodA cross-sectional design was employed for this study. A total of 485 COVID-19 patients admitted to a general hospital responsible for COVID-19 cases management were randomly selected for this study from May 1st to September 31st, 2021. Data on sociodemographic information, length of stay (LOS), discharge status, and comorbidities were obtained from the patients’ medical records. The data on costs in this study cover administration, utility, pharmacy, radiology, laboratory, nursing, and ICU costs. The unit cost per admission was calculated using a step-down costing method with three levels of cost centers. The unit cost was then multiplied by the individual patient’s length of stay to determine the cost of care per patient per admission.FindingsThe mean cost of COVID-19 in-patient care per admission was KD 2,216 (SD = 2,018), which is equivalent to USD 7,344 (SD = 6,688), with an average length of stay of 9.4 (SD = 8.5) days per admission. The total treatment costs for COVID-19 in-patients (n = 485) were estimated to be KD 1,074,644 (USD 3,561,585), with physician and nursing care costs constituting the largest share at 42.1%, amounting to KD 452,154 (USD 1,498,529). The second and third-largest costs were intensive care (20.6%) at KD 221,439 (USD 733,893) and laboratory costs (10.2%) at KD 109,264 (USD 362,123). The average cost for severe COVID-19 patients was KD 4,626 (USD 15,332), which is almost three times higher than non-severe patients of KD 1,544 (USD 5,117).ConclusionManaging COVID-19 cases comes with substantial costs. This cost information can assist hospital managers and policymakers in designing more efficient interventions, especially for managing high-risk groups.

Experiences of healthcare personnel on the efficacy of artemisinin-based combination therapy and malaria diagnosis in hospitals in Uganda

BackgroundThe risk of widespread resistance to artemisinin-based combination therapy (ACT) remains high in Uganda following detection of Plasmodium falciparum parasites with delayed artemisinin clearance genotype and phenotype. Establishment of context specific interventions to mitigate emergence and spread of artemisinin resistance is thus key in the fight against malaria in the country. The aim of this study was to explore the experiences of healthcare personnel on malaria diagnosis and self-reported efficacy of ACT in the management of malaria symptomatic patients in hospitals in low and high malaria transmission settings in Uganda.MethodsThis was a qualitative study in which data was collected from healthcare personnel in hospitals using key informant interviews. The key informant interview guide was developed, pre-tested prior to use and covered the following areas, (i) sociodemographic characteristics, (ii) malaria diagnosis (clinical and parasite based), (iii) quality-assured artemisinin-based combination therapy, (iv) malaria patient follow-up, (v) artemisinin resistance, (vi) anti-malarial self-medication. Data was entered in Atlas.ti ver 9.0 and analysis done following a framework criterion.ResultsA total of 22 respondents were interviewed of which 16 (72.7%) were clinicians. Majority, 81.8% (18/22) of the respondents were male. The following themes were developed from the analysis, malaria diagnosis (procedures and challenges), use of malaria laboratory test results, malaria treatment in hospitals, use of quality assured ACT (QAACT) in malaria treatment, and efficacy of ACT in malaria treatment.ConclusionMost healthcare personnel-initiated malaria treatment after a positive laboratory test. Cases of malaria patients who report remaining symptomatic after prior use of ACT exist especially in high malaria transmission settings in Uganda. There is need for regular monitoring of artemisinin resistance emergence and spread in the country.

73 A pilot of introducing Comprehensive Geriatric Assessment (CGA) in older patients admitted to an acute hospital to prevent acute re-hospitalisation

Abstract Background Recurrent hospitalisation is increasingly observed in older adults aged 65 or above and, is associated with increased risk of adverse outcomes including delayed recovery, increased morbidity, and mortality. We introduced Performa-based, Multi-Disciplinary Team (MDT) driven Comprehensive Geriatric Assessment (CGA) as a model of care of older patients admitted to an acute Irish hospital, and to see its impact in preventing acute re-hospitalisation after an acute admission. Methods CGA was performed, on inpatients aged 65 or older, admitted to a designated ward which had multidisciplinary team access, via a designed and prescribed Performa, by Advanced Nurse Practitioner and interventions suggested by it, were offered to those patients. The pilot continued for three months. Patients who underwent CGA, were monitored for re-admission at 3 months from the date of their discharge via hospital patient management system. Data was compiled and studied via Microsoft excel spread sheet. Results 28 patients were admitted to the designated ward who underwent the CGA during the time frame of the pilot. 26 (92.8%) patients did neither present to ED nor were admitted to hospital in the immediate 3 months post discharge from the hospital. CGA resulted in various multidisciplinary interventions/referrals on all patients which were studied as secondary aims. The major interventions were MDT referrals (physiotherapy 100%, occupational therapy 85.7%, Swallow Therapists 46.4% and dietetic referrals 32.1%) and deprescribing (50% of patients). Conclusion The pilot showed reduced acute re-hospitalisation rates in older patients undergoing CGA, and an attempt to adopt CGA as model of care in acute hospitals to prevent acute re-hospitalisation in such patients. In the model, CGA also offered multiple interventions including MDT referrals/interventions and deprescribing. Further powered research replicating similar results, is needed to explore and adopt such CGA based models of care in older inpatients in acute hospitals.

Contamination dynamics of personal protective equipment (PPE) by SARS-CoV-2 RNA in a makeshift hospital with COVID-19 positive occupants

Personal protective equipment (PPE) helps protect healthcare workers (HCWs) from infection and prevents cross-contamination. Knowledge of the contamination dynamics of PPE during the management of COVID-19 patients in a makeshift hospital is limited. To describe the rate of SARS-CoV-2 contamination in PPE and to assess the change of contamination at different time points. HCWs were followed up for up to 4 hours with hourly collection of swab samples from PPE surfaces in a makeshift COVID-19 hospital setting. Swabs were tested using quantitative reverse transcription polymerase chain reaction (RT-qPCR) for SARS-CoV-2 RNA. SARS-CoV-2 was detected on 50.9% of the 1620 swabbed samples from 9 different sites of full-body PPE worn by HCWs. The proportion of sites contaminated with SARS-CoV-2 RNA varied from 10.6% to 95.6%. Viral RNA was most frequently detected from the sole of the outer foot cover (95.6%) and least frequently on the face shield (10.6%). The median Ct values among positive samples were 34.20 (IQR, 32.61-35.22) and 34.05 (IQR, 32.20-35.39) for ORF1ab and N genes, respectively. The highest rate of contamination with SARS-CoV-2 RNA for the PPE swab samples was found after 3 hours of use. The positive rate of outer surface of HEPA filters from air supply device was 82.1% during the full capacity period of the makeshift hospital. A higher rate of contamination was identified at 3 hours after the entrance to the COVID-19 patient care area. Virus-containing aerosols were trapped in the HEPA filter of air supply equipment, representing a potential protective factor against infection to HCWs.

Insights into the management of pulmonary arterial hypertension patients in Spain

Introduction and objectivesAccurate risk stratification is pivotal to tailor therapy according to the prognosis of pulmonary arterial hypertension (PAH) patients to positively impact the course of the disease. We conducted a nationwide study to assess how the current European Society of Cardiology/European Respiratory Society guidelines for risk assessment and management of PAH patients are followed in real-world practice in Spain. MethodsHospital-based physicians answered an online questionnaire describing their yearly caseload of PAH patients and their management of virtual cases scenarios for Word Health Organization functional class (FC) II–III PAH patients. ResultsThe main tests requested for a regular risk assessment were echocardiography, 6-minute walk test, measurement of brain natriuretic peptide/N-terminal pro-B-type natriuretic peptide plasma levels and right heart catheterization. The main treatment prescribed was an oral double-combination therapy with an endothelin receptor antagonist (ERA) and a phosphodiesterase type 5 inhibitor (PDE5i) or guanylate cyclase stimulator. Around 20% of the clinicians would also add the selective prostacyclin-receptor agonist (selexipag) to ERA and PDE5i as initial therapy for FC III patients, and nearly all clinicians (99%) would add a prostacyclin pathway agent to FC III PAH patients presenting multiple new intermediate-risk parameters despite a 6-month dual therapy with ERA and PDE5i. ConclusionsThe main decisive factor for the management of PAH patients in Spanish hospitals is their functional class and intermediate-risk parameters. Selexipag was more frequently prescribed than parenteral prostacyclin-analogs in triple-combination therapy for FC II–III PAH patients presenting low-risk and intermediate-risk parameters.

Telemedicine for the management of diabetic patients in a high-complexity Latin American hospital

BackgroundNoncommunicable diseases such as diabetes mellitus (DM) have gained attention worldwide. Latin America experienced a rise in rates of DM. During the COVID-19 pandemic, a telemedicine program was implemented in a quaternary care academic complex in Latin America to continue the follow-up of patients with diabetes.ObjectiveThe aim of this study is to describe the clinical experience of DM patient management through telemedicine and the HbA1c behavior of patients followed-up through this modality.Materials and methodsWe conducted a retrospective cohort study including all patients with type 1 or 2 diabetes who were treated via telemedicine from March to December 2020. A Wilcoxon statistical test was used to compare the changes in glycosylated hemoglobin between the first teleconsultation and after 6 months of telemedicine follow-up.ResultsA total of 663 patients were included, 17.65% (117) of whom had type 1 diabetes and 82.35% (546) of whom had type 2 diabetes. Patients with both types of diabetes, presented with stable HbA1c values regardless of the length of follow-up.ConclusionThe use of telemedicine can be a helpful tool for both patients and health care providers to support the continuity of care to maintain acceptable control levels within glycemic control goals.

Challenges of nurses in management of COVID-19 patients in tertiary hospital

Challenges of nurses in management of COVID-19 patients in tertiary hospital

Challenges of nurses in management of COVID-19 patients in tertiary hospital

Challenges of nurses in management of COVID-19 patients in tertiary hospital

Predicting medical specialty from text based on a domain-specific pre-trained BERT

BackgroundOwing to the prevalence of the coronavirus disease (COVID-19), coping with clinical issues at the individual level has become important to the healthcare system. Accordingly, precise initiation of treatment after a hospital visit is required for expedited processes and effective diagnoses of outpatients. To achieve this, artificial intelligence in medical natural language processing (NLP), such as a healthcare chatbot or a clinical decision support system, can be suitable tools for an advanced clinical system. Furthermore, support for decisions on the medical specialty from the initial visit can be helpful. Materials and methodsIn this study, we propose a medical specialty prediction model from patient-side medical question text based on pre-trained bidirectional encoder representations from transformers (BERT). The dataset comprised pairs of medical question texts and labeled specialties scraped from a website for the medical question-and-answer service. The model was fine-tuned for predicting the required medical specialty labels among 27 labels from medical question texts. To demonstrate the feasibility, we conducted experiments on a real-world dataset and elaborately evaluated the predictive performance compared with four deep learning NLP models through cross-validation and test set evaluation. ResultsThe proposed model showed improved performance compared with competitive models in terms of overall specialties. In addition, we demonstrate the usefulness of the proposed model by performing case studies for visualization applications. ConclusionThe proposed model can benefit hospital patient management and reasonable recommendations for specialties for patients.

Current trends of clinico-radiological findings, management and outcomes of chest trauma patients in a tertiary health care hospital in Western India

Background: There has been a rapidly rising trend of trauma cases, especially chest trauma; necessitating an in-depth study of its complications and management.Methods: We have studied 120 patients presenting to our emergency department for the demographics and etiology of their injury and recorded the results and outcomes of their radiological and clinical investigations and management protocol.Results: Middle aged men were the primary victims of chest trauma, mostly having blunt injuries and presenting with respiratory distress. A range of pleural and visceral injuries were seen like hemothorax, pneumothorax, flail chest; the mainstay of treatment for them being minimally invasive tube thoracostomy. We encountered a low mortality rate of 1.66%.Conclusions: Rapid intervention and resuscitation for all trauma cases prove to be lifesaving, amongst which focus on thoracic injuries must be primary. Ever increasing incidences of polytrauma cases indicate the requirement of strict vigilance and prevention of road traffic accidents.

Results of an Audit of Orthopaedic Operation Notes from a Tertiary Care Centre: Are We Doing It Right and Can We Do More?

The Royal College of Surgeons (RCS) published the Good Surgical Practice guidelines in 2008 and subsequently revised them in 2014. Essentially, they outline the basic standards that need to be met by all surgical operation notes. The objective of the present study was to retrospectively audit the orthopaedic operation notes from a tertiary care hospital in Mumbai (between October 2020 to March 2021) against the recommended RCS Good Surgical Practice guidelines published in 2014. In the present study a total of 153 orthopaedic operation notes of 200 patients were audited by a single reviewer. During the period between October 2020 and March 2021, the data collection took place. All notes were typed on the standard operative proforma available on the hospital patient management software (SAP). Overall, the mandated fields in the EMR had excellent documentation. Documentation was excellent for the date and time of surgery, name of the surgeon, the procedure performed (100%), operative diagnosis (99.35%), an extra procedure performed (100%), and details of antibiotic prophylaxis (99.35); Inadequate for details of incision (94.77%), details of operative findings (92.16%), details of prosthesis (97.37%), DVT prophylaxis (96.08%) and detailed post-operative instructions (93.46%) and poor for tourniquet time (41.83%;), estimated blood loss (59.48%), closure details (16.99%), documentation of complications or lack of (51.63%) and setting of surgery elective or emergency (0%). Compliance for completion and documentation of operative procedures was high in some areas; improvement is needed in documenting tourniquet time, prosthesis and incision details, and the location of operative diagnosis and postoperative instructions. With wider adoption of electronic medical record systems, there is a scope of improving documentation by mandating certain fields.

27. The ethics of contact precautions in hospital care: An interpretive description

Introduction: Health policymakers are committed to controlling multi-resistant organisms (MROs) in hospitals. Infection prevention and control (IPC) measures known as Contact Precautions (CP) were developed in the 1980’s however MROs persist. Research objectives were to understand the impact of CP on patients and health-professionals, to discuss study findings from a bioethical perspective, and make recommendations for ethically sound management of MRO-colonised hospital patients.

Venous Thromboembolism Prophylaxis and Screening: A Clinical Audit

Objective: We aimed to audit venous thromboembolism in surgical patients at risk of VTE presented to surgical department in 2021 using the caprini risk assessment model. Methodology: This clinical audit was conducted in surgical D unit department of Surgery, Khyber Teaching Hospital, Peshawar from July 2021 to December 2021. A total of 150 patients each for the audit group and the re-audit group were selected through non-probability consecutive sampling for both genders. A predesigned proforma according to caprini risk assessment model was used to assess the patient’s individual risk for DVT and provision of appropriate prophylaxis. Data was entered into Microsoft excel, analyzed through SPSS version 23 and results were presented in the form of descriptive writing and tables. Results: The mean age of the study population was 50.47 with relatively equal selection from both genders. None of the patients in the audit group were properly grouped for their risk of DVT and management needed as mentioned in the caprini RAM guidelines. In the re-audit group, 100% of the patients were accurately categorized into groups and the VTE risk assessment percentage significantly improved from 0% to 80.8%. Conclusion: The audit showed noticeable deficiencies in record keeping and clinical assessment of VTE risk in the management of hospital patients. However, through appropriate measures this insufficiency can be amended with appreciable results.

Slit-skin smear for the classification of leprosy; are we wasting time and resource?

Leprosy is a chronic neglected tropical disease, classified into two groups: multibacillary (MB) and paucibacillary (PB) leprosy based on the number of skin lesions and nerve involvement. A positive skin slit smear (SSS) result automatically puts a patient in the MB category. Although guidelines do not recommend routine use of SSS for classification and diagnosis of leprosy, it is performed for most patients in Ethiopia. However, the added value of performing SSS for the classification of leprosy on top of clinical classification is unclear. A cross sectional study was done using routine laboratory and clinical data from September 2018 to January 2020 at Boru Meda General Hospital, Ethiopia. All newly diagnosed leprosy cases were included. Descriptive statistics were performed to calculate frequencies and proportions. We included 183 new leprosy patients in our study, of which 166/183 (90.7%) were MB patients and 17/183 (9.3%) were PB patients. All clinical PB cases and 150/166 (90.4%) clinical MB patients had SSS done. All PB patients had negative SSS result and 68 (45.3%) clinical MB patients had a positive result. Based on the SSS, no patient with a clinical classification of PB was reclassified to MB. SSS microscopy was performed routinely for all leprosy cases without changing the classification and management of patients in Boru Meda Hospital. Therefore, we recommend restricted and rational use of the SSS for PB cases in which SSS could change management.

Enregistrement informatique normalisé des actes de pharmacie clinique en établissement de santé : retour d’expérience et évaluation de la valorisation économique potentielle

Clinical pharmacy procedures are clearly defined by the French society of clinical pharmacy. However, clinical pharmacists do not have efficient tools for their traceability. This need has increased following the publication of the instruction on the day hospital management of patients. Indeed, the action of the clinical pharmacist is included in it. In order to improve our traceability of clinical pharmacy acts and to take advantage of the implementation of the instruction, we worked with the medical information department to integrate our activity into their business software and to model the pathways valued by the intervention of the clinical pharmacist in outpatient care and in day hospital.