Mater Dei Research Articles

Addressing Mater Dei Hospital’s Bed Occupancy Challenge: The Role of Improved Influenza Vaccine Uptake

Statistics from the triennial 2010-2013, Mater Dei Hospital Activity Analyses suggest that pressure on bed occupancy is at its greatest during the months from December to March. For the “top five” medical causes for hospitalization, admission numbers increase from an average 305 admissions per month to 399 admissions per month during the peak winter period. This time of the year coincides with the annual influenza season. Influenza vaccination of high risk population groups has been reported to reduce hospitalization by 32% to 45%. The World Health Organization (WHO) and European Union (E.U.) have recommended that, by 2010 and 2014 respectively, 75% of high risk groups should be immunized against influenza every year. Vaccination of the elderly population in Malta is currently 40%. Only 70,000 individuals are vaccinated in the Maltese Islands giving a overall population vaccination rate of approximately 16%. In addition, this shortfall in vaccination uptake has in the past resulted in a perennial wastage of more than 8,000 vaccinations per year. In order to address these lacunae, an influenza vaccination initiative was spearheaded by Mater Dei Hospital’s Patient Safety and Quality Improvement Team (PaSQIT), focusing on high risk patients attending the hospital environs for outpatient or other appointments. The vaccination station was sited in a strategic position close to the Outpatients’ Department so as to increase vaccination uptake. The total number of vaccinations given through this initiative exceeded 7,500.

Dental age estimation of children and adolescents: Validation of the Maltese Reference Data Set

The purpose of this study was to validate a Reference Data Set, developed from the radiographic archives of the Dental Department, Mater Dei Hospital, Malta, for Dental Age Estimation of the Maltese population and to assess the accuracy of the method. Dental Panoramic Tomograms of 100 male and 100 females were selected. Tooth Development Stages were recorded for all 16 permanent teeth on the left and both third molars on the right. Summary and percentile data were calculated for each Tooth Development Stage and the Dental Age of each subject estimated using the unweighted average method. The distribution of the differences between the Dental and Chronological age was analysed. There was no statistically significant difference between the means of the Dental and Chronological ages and the mean differences were within acceptable limits. The conclusion was that the Dataset is valid for the Maltese population and the method used gives adequate accuracy.

Caesarean sections at Mater Dei Hospital, Malta

Caesarean sections at Mater Dei Hospital, Malta

Induction of labour at Mater Dei Hospital, Malta

Induction of labour at Mater Dei Hospital, Malta

Anomaly Scans – a 1 year plus review at Mater Dei Hospital Obstetric Unit

Anomaly Scans – a 1 year plus review at Mater Dei Hospital Obstetric Unit

Maternal weight gain in pregnancy

Introduction: Maternal BMI (body mass index) should be calculated during the first antenatal visit and the mother should be counselled regards the appropriate weight gain, exercise and diet. The higher the BMI at onset of pregnancy, the less the weight gain during pregnancy should be, as a high BMI in turn increases the need for medical inductions or emergency C-sections. There is also an associated increase in risk of complications such as shoulder dystocia and post-partum haemorrhage. Aim: To assess maternal weight gain during pregnancy in mothers delivering at Mater Dei hospital and the fetal weight at birth. Method: Data was collected after delivery from the antenatal and delivery records over a number of weeks. Maternal BMI and age at onset of pregnancy were noted. The weight gain, any medical conditions which complicated the pregnancy and fetal weight were also recorded. Results: From a total of 153 mothers, 1% were underweight at onset of pregnancy, 47% were in the normal range, 29% were overweight and 22% were obese. An average weight gain of 12.55 kg was noted, with the higher weight gain seen in those with a normal BMI. Fetal weight was also noted with 21% of babies born to obese mothers having either low or high birth weight compared to the 6.9% born to those with a normal BMI. In total 188 mothers were included but 19% did not have data at onset of pregnancy whilst 26% were not having regular weight checks. Conclusions: The importance of educating expectant mothers regards diet and exercise and of doctors being meticulous and monitoring weight gain to be able to advise accordingly.

PTH-089 Childhood Environmental Factors and Trends in Inflammatory Bowel Disease

Introduction Genetic predisposition, does not account solely for disease aetiology. Other environmental and childhood factors might explain the rise of inflammatory bowel disease (IBD) in recent years. Methods All patients diagnosed with IBD between 2012 and 2014 at Mater Dei Hospital in Malta were included in this study. Each patient was then asked to fill in a questionnaire related to childhood factors. Results 152 patients (mean age 42.4 years sd±17.7; mean age at diagnosis 39.8 years sd±17.7) were included in this study. 55.9% were male. 65.8% patients suffered from UC. Association between Montreal classification and childhood factors: If patients were brought up with siblings, they were more likely to have an older Montreal age at diagnosis (p Association of type of IBD with childhood factors: When factors were assessed individually, more patients with UC than CD shared a bedroom with their siblings (p Association of childhood factors with age at diagnosis: Factors leading to an older age at diagnosis of IBD: whether patients were brought up with siblings (p Conclusion Certain factors such as vaccination and swimming at a young age might predispose to a younger age at diagnosis of IBD. Other factors such as being brought up with siblings were protective and lead to an older age at diagnosis. Studying such factors on a bigger scale might further confirm these trends and may influence lifestyle changes. Disclosure of Interest None Declared

The physical and psychological effects of breast reconstruction in breast cancer patients. A retrospective quantitative analysis between 2009 and 2011 at Mater Dei Hospital, Malta

Breast cancer is a devastating disease afflicting many women. The aim of this retrospective review was to assess the physical and psychological effects of patients who underwent breast reconstruction after breast cancer surgery. Clearance from the patients’ consultants, data protection officer and medical ethics committee was sought and granted. A participation letter was sent to 67 eligible patients who had reconstructive breast surgery between 2009 and 2011. Forty-two (63%) patients agreed to participate. These patients had a short personal interview during which two questionnaires (SF-36v2 health survey and one on the physical aspects) were completed. The patients’ mean age was 53.9 years (range 31-75). Reconstructive breast surgery using implant-only was performed in twenty-eight (66.7%) cases. Twenty-three (54.8%) of the forty-two patients had complications, with 1.35 complications/per person affected. The complication rate did not differ significantly amongst the different reconstruction groups (p=0.196). Patients who underwent autologous and oncoplastic reconstructive procedures scored significantly higher satisfaction scores than the prosthesis and prosthesis/autologous group (p= 0.01). Whether or not the reconstruction was immediate or delayed or the patients had complications, did not have statistically significant effects on the patients’ health domain scores (p>0.05). The difference of two proportions between the sample studied and the norm showed that the sample studied had a statistically significant higher depression risk than the norm population (p=0.0154). Complication rates were comparable amongst the different reconstruction techniques. A higher than normal depression risk was found in the sample studied and therefore improvement of the support services given to patients is recommended.

Dental age assessment of Maltese children and adolescents. Development of a reference dataset and comparison with a United Kingdom Caucasian reference dataset

The purpose of this study was to develop and validate a Reference Data Set for Dental Age Assessment of the Maltese population and compare the mean Age of Attainment to a UK Caucasian Reference Data Set.The Maltese Reference Data Set was developed from 1593 Dental Panoramic Tomograms of patients aged between 4 and 26 years, taken from the radiographic archives of the Dental Department, Mater Dei Hospital, Malta. Tooth Development Stages were recorded for all 16 maxillary and mandibular permanent teeth on the left side and both permanent third molars on the right, according to Demirjian's staging method. Summary and percentile data were calculated for each Tooth Development Stage, including the mean Age of Attainment. These means were used to estimate the Dental Age of each subject in the study sample using the simple unweighted average method. The estimated Dental Age was compared to the gold standard of the Chronological Age. Comparison of the Maltese and UK Caucasian Reference Data Set was by a series of t-tests, carried out for each paired Tooth Development Stage by gender.The mean Age of Attainment was slightly higher for the Maltese than the UK Caucasians in both males and females. However there was no statistically significant difference between the Chronological Age and Dental Age for either sex.

Reply: Analysis of the sex ratio at birth in South Africa increased 9 months after the 2010 FIFA World Cup

a Irish Centre for Fetal and Neonatal Translational Research (INFANT), Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland b Gravida: National Centre for Growth & Development, University of Auckland, Auckland, New Zealand c Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa d Academic Department of Paediatrics, Medical School, Mater Dei Hospital, Malta e Helmholtz Zentrum Munchen—German Research Center for Environmental Health, Institute of Computational Biology, Ingolstadter Landstr. 1, D-85764 Neuherberg, Germany

Comment on "Biomarkers as Potential Treatment Targets in Inflammatory Bowel Disease: A Systematic Review".

We read with interest the article entitled “Biomarkers as Potential Treatment Targets in Inflammatory Bowel Disease: A Systemic Review,” which brings forward evidence that serum and faecal biomarkers do not possess adequate operational characteristics to make them stand-alone treatment targets in inflammatory bowel disease (IBD) but should be considered as important adjunctive measures to clinical, endoscopic, and radiographic assessment [1]. We recently carried out a study at Mater Dei Hospital, Malta, where we compared the positive predictive value of faecal calprotectin (FC) in patients with newly diagnosed inflammatory bowel disease (IBD), compared to the more widely used erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Our patient population consisted of 97 patients with a histological diagnosis of IBD and in whom all three biomarkers (FC, ESR, and CRP) were taken. All faecal calprotectin values were positive (with a mean average of 807 mg/L; normal < 50 mg/L). ESR was only elevated in 45% of cases while CRP was elevated in only 21% of cases. From the 97 patients; 60 were diagnosed with Crohn's disease (CD), 34 with ulcerative colitis (UC), and 3 with indeterminate IBD. The mean FC level, ESR, and CRP were 857 mg/L, 37 mm/hr, and 30 mg/L in CD; 771 mg/L, 39 mm/hr, and 62 mg/L in UC; 180 mg/L, 40 mm/hr, and 23 mg/L in indeterminate IBD. There was no statistical significance between the adult and paediatric populations. These results demonstrate and confirm that ESR and CRP are poor markers of intestinal inflammation, when compared to faecal calprotectin. This data suggests that all IBD patients should have a faecal calprotectin measured at outpatients rather than ESR and CRP in order to assess clinical activity even in the absence of gastrointestinal symptoms. The role of FC in the investigation and management of gastrointestinal pathologies has been on the increase. Nowadays faecal calprotectin is playing a major role in the investigation and diagnosis of patients presenting to the physician with lower gastrointestinal symptoms. When taken appropriately a negative faecal calprotectin would rule out IBD thus sparing most people with irritable bowel syndrome from having costly and invasive investigations [2]. Faecal calprotectin has been demonstrated to correlate better with endoscopic disease activity than clinical activity, CRP, platelets, haemoglobin, and blood leukocytes. Furthermore, the strong correlation of faecal calprotectin with endoscopic disease activity suggested that calprotectin is indeed a useful biomarker for the noninvasive monitoring of disease activity in patients [3]. FC is also useful in predicting the probability of relapses in both quiescent ulcerative colitis and quiescent Crohn's disease [4, 5]. Thus in the context of the ever-increasing financial burden on the health services and the better performance of FC as a biomarker, ESR and CRP should only be requested in exceptional circumstances.

A Study of the Management of Hyponatremia at Mater Dei Hospital, Malta

Hyponatremia is a frequent electrolyte abnormality in hospital practice. The aim of this study is to assess the prevalence, investigations and outcome of hyponatremia at Mater Dei Hospital (MDH), Malta. All admissions throughout the month of January 2015 were analysed. Patients with low sodium on admission were audited and data collected from iSoft clinical manager and discharge letters to assess if the relevant investigations and treatment changes were performed to correct the hyponatremia. There were 1905 casualty admissions. 16.5% had hyponatremia on admission. 8.55% had mild (131-134 mmol/L), 5% moderate (125-130mmol/L) and 2.56% severe (<125mmol/L) hyponatremia. In the severe cohort 69.7% patients had glucose taken, 57.1% had thyroid function tests (TFTs), 46.5% had serum osmolality, 14% had urine osmolality and electrolytes taken and 18% had serum cortisol. Rise in sodium in 24 hrs ranged from 1 to 24 mmol with a mean of 8.72 mmol/L. In the moderate cohort 67% had glucose taken, 45.9% had TFTs and 43.5% serum osmolality. Rise in sodium in 24 hrs ranged from 1 to 14 mmol with a mean of 4.7 mmol/L. In the mild cohort 66.7% had glucose taken, 27.4% had TFTs and 35.5% had serum osmolality. Rise in sodium in 24 hrs ranged from 1 to 16 mmol with a mean of 4.1 mmol/L. This study shows the current poor management of severely hyponatremic patients in our medical and surgical wards. There is a definite need to set up local guidelines for the management of such a common electrolyte abnormality.

Lessons learnt and challenges in adopting the ECDC and who Ebola guidelines at Mater Dei Hospital

Ebola is one of the Viral Haemorrhagic Fever (VHF) infections. The EVD outbreak in West Africa represents a major public health issue. EVD is a serious occupational health and safety risk for healthcare workers (HCWs). Mater Dei Hospital, the main tertiary care hospital in Malta organised and prepared for a potential confirmed or suspected case.

WHO multimodal strategy for improving hand hygiene supported within the organization’s management system, Mater Dei Hospital, Belo Horizonte, Brazil

Hand hygiene (HH) has been singled out as a core element of patient safety for the prevention of healthcare-associated infections (HAIs) and the spread of antimicrobial resistance. Cleansing hands with alcohol-based hand rub is a simple and undemanding procedure that requires only a few seconds. Although we already had the five components of the WHO Multimodal Hand Hygiene Improvement Strategy implemented in our facility and a steady mandatory training program, compliance remains stable, with no further increase for many months.

The Multidisciplinary Approach to Mood Disorders

Introduction An analysis of the multidisciplinary treatment of mood disorders used at the short stay psychiatric unit (SSPU) in Mater Dei Hospital, Malta was carried out. Objectives The modalities considered were: • Pharmacological therapy • Electroconvulsive therapy • Psychological therapy • Occupational therapy • Social worker involvement Aims To record whether a multidisciplinary approach (MDA) was being used and whether this affected the clinical outcome. Methods The data used was obtained from a logbook in the SSPU and set up as an excel spreadsheet. The patient selection criteria was: 1. Diagnosed as having mood disorders (unipolar or bipolar depression) 2. Admitted for the first time to SSPU (with no previous admissions to an acute psychiatric ward) in 2008 3. The multidisciplinary approach was defined as the use of 3 or more modalities of treatment. Results 1. 87 patients were selected. In group 1: 6 patients received MDA and group 2: 81 patients did not receive MDA 2. 50% of patients in group 1 and 48% of patient in group 2 belonged to the age group of 46-55 years. 3. 100% for group 1 and 73.3% in group 2 were females. 4. 50% of patient were re-admitted in group one while 58% of patients were re-admitted in group 2. 5. MDA prolonged the average duration till next re-admission by 81 days. 6. The cost per bed is approximately 300euros daily, thus saving 24,300 euros per patient when MDA is used. Conclusions MDA improves patient outcome by preventing or prolonging re-admissions. This should be emphasized in the female population and in the age group of 46-55 years.

A study of hypothermic patients presenting to a Mediterranean emergency department

A retrospective chart review was carried out in the adult Emergency Department of Mater Dei Hospital in the 'sunny warm Mediterranean island' Malta, on patients admitted with a rectal temperature of less than 35°C during the two consecutive winters of 2010-2011 and 2011-2012. The aim of this study was to find any correlation among patients presenting with hypothermia and the weather conditions, age and residential background. We also studied their mortality outcomes. All patient data were collected from the Emergency Department's medical records and patients' case notes. All 199 patients admitted with hypothermia during these two winters were included in the study: 78 patients in winter 1 and 121 patients in winter 2. This showed that warm Malta also has its fair share of patients suffering from hypothermia during its winters. The minimum recorded temperatures ranged from +3.8 to +14.2°C in winter 1 and +3.6 to +13.1°C in winter 2. The majority of patients were suffering from either mild or moderate hypothermia, in roughly equal numbers. However, 4% of hypothermic admissions in the first winter and 7% in the colder second winter had severe hypothermia. Hypothermic admissions were most common among patients in their late seventies. Survival rates in primary hypothermia were better than in secondary hypothermia. The type of residence of the patient did not significantly affect the admission rate.

The Significance of Religious Experience. By Howard Wettstein. Pp. xii, 228, Oxford, Oxford University Press, 2012, $65.00.

The Heythrop JournalVolume 56, Issue 1 p. 167-168 BOOK REVIEW The Significance of Religious Experience. By Wettstein, Howard. Pp. xii, 228, Oxford, Oxford University Press, 2012, $65.00. Peter Admirand, Peter Admirand Mater Dei Institute, DCUSearch for more papers by this author Peter Admirand, Peter Admirand Mater Dei Institute, DCUSearch for more papers by this author First published: 05 December 2014 https://doi.org/10.1111/heyj.12200Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume56, Issue1January 2015Pages 167-168 RelatedInformation

Wound swab use and misuse at a regional general hospital.

Guidelines for swab use at our centre cover lower-limb wounds, ulcers and postoperative wound infections but not all types of wound. The objective of this study was to assess current practices in wound management at Mater Dei Hospital and to identify areas for improvement. Wound swabs received at the microbiology department between February and April 2013 from adult inpatients departments were included. Wound swabs from the ophthalmology and paediatric departments were excluded. Patient comorbidities, detailed wound descriptions, acknowledgement of and documentation of culture and sensitivity results, and antibiotic changes during treatment were collected. Indictors of infection including white cell counts (WCCs) and C-reactive protein (CRP) were recorded. The study included 134 patients. Diabetes mellitus (61.9%, n=83) was the most common underlying comorbidity. Postoperative wounds were the most common type of wounds swabbed (34.3%). The wound swab characteristics were not fully documented in 27 patients (20.1%). The CRP results were not recorded in 39.6% and WCCs were not taken in 10.4% of patients. Wound swab results were not acknowledged in the medical notes of 76% of cases. Wound swabs that were not indicated, lack of documentation and untimely acknowledgement of results were evident. This suggests that a significant proportion of wound swabs may not have been justified and had no impact on wound management. Our study clearly underlines the need for a more comprehensive guideline. There was no sponsorship of this study. The authors have no conflict of interest to declare.

The real-life clinical effects of 52 weeks of omalizumab therapy for severe persistent allergic asthma.

Omalizumab was introduced in Malta in 2011. To date, no local data have been published. To obtain baseline characteristics of our local cohort, determine effectiveness of omalizumab at 52 weeks, compare clinical outcomes 52 weeks pre- and postomalizumab therapy and to assess its safety and tolerability. The Mater Dei Hospital in Malta. All consented adult patients who were eligible to start treatment with omalizumab for asthma were enrolled in this open, prospective observational real-life study. A questionnaire was completed and an Asthma Control Test and spirometry performed. Patients were reviewed on a regular basis. Any undesirable symptoms were recorded. Treatment effectiveness was evaluated at 16 and 52 weeks, during which a decision was taken whether patients were responders. Outcomes were compared 52 weeks pre- and post- treatment initiation. Main outcome measure To determine effectiveness of treatment following 1 year of omalizumab by assessing its impact on the rate of asthma-related exacerbations and health care utilization including hospitalizations. Our cohort included 22 patients, all non-smokers (mean age 52.7 ± 11, 64 % males). The mean baseline IgE level was 448.6 ± 444 IU/ml. At week 12, treatment was stopped in one patient due to arthralgias. The drug was stopped in two patients at week 16 due to treatment ineffectiveness. At week 20, treatment was stopped in another patient in view of arthralgias. A significant reduction in the number of asthma exacerbations (p = .03) and number of systemic steroid courses required (p = .03) was identified at 52 weeks. There was a significant improvement in the ACT score (p < .001) after 52 weeks but no significant improvement in FEV1. There was a non-significant decline in the number of hospitalizations (p = .6), asthma-related healthcare visits (p = .2) and days off work (p = .09). Adverse events occurred in 10 % of patients. Costs related to asthma hospital-stay and medicines administered during hospitalisations were decreased by half following 1 year on omalizumab. Omalizumab treatment resulted in an improved asthma control, with a significant reduction in asthma exacerbations and systemic steroid courses required and improvement on ACT score. Adverse events were infrequent and the drug was well tolerated.

PTU-025 Endoscopy In Patients Having Long-term Oral Anticoagulant Therapy. Challenge Or Routine Daily Practice?

IntroductionWhile oral anticoagulant therapy increases the possibility of bleeding, withholding it could cause thromboembolic complications. The BSG provides guidance regarding endoscopy and anticoagulation. Patients may be considered as having a...