Non-surgical Wards Research Articles

Care Complexity Individual Factors Associated With Hospital Readmission: A Retrospective Cohort Study

To determine the frequency of care complexity individual factors documented in the nursing assessment and to identify the risk factors associated with hospital readmission within 30 days of hospital discharge. Observational analysis of a retrospective cohort at a 700-bed university hospital in Barcelona, Spain. A total of 16,925 adult patient admissions to a ward or intermediate care units were evaluated from January to December 2016. Most patients were admitted due to cardiocirculatory and respiratory disorders (29.3%), musculoskeletal and nervous system disorders (21.8%), digestive and hepatobiliary conditions (17.9%), and kidney or urinary disorders (11.2%). Readmission was defined as rehospitalization for any reason within 30 days of discharge. Patients who required hospital readmission were compared with those who did not. The individual factors of care complexity included five domains (developmental, mental-cognitive, psycho-emotional, sociocultural, and comorbidity or complications) and were reviewed using the electronic nursing assessment records. Multivariate logistic analysis was performed to determine factors associated with readmission. A total of 1,052 patients (6.4%) were readmitted within 30 days of hospital discharge. Care complexity individual factors from the comorbidity or complications domain were found to be the most frequently e-charted (88.3%). Care complexity individual factors from developmental (33.2%), psycho-emotional (13.2%), mental-cognitive (7.2%), and sociocultural (0.7%) domains were less frequently documented. Independent factors associated with hospital readmission were old age (≥75 years), duration of first hospitalization, admission to a nonsurgical ward, major chronic disease, hemodynamic instability, immunosuppression, and relative weight of diagnosis-related group. A substantial number of patients required readmission within 30 days after discharge. The most frequent care complexity individual factors recorded in the nursing assessment at index admission were related to comorbidity or complications, developmental, and psycho-emotional domains. Strategies related to transition of care that include clinical characteristics and comorbidity or complications factors should be a priority at hospital discharge and after leaving hospital, but other factors related to developmental and psycho-emotional domains could have an important effect on the use of healthcare resources. Nurses should identify patients with comorbidity or complications, developmental, and psycho-emotional complexity factors during the index admission in order to be able to implement an effective discharge process of care.

Blood Bank Services at Tertiary Care Center

Background: Audit is one mechanism for evaluating the effectiveness of the total quality system. Transfusion medicine or blood bank audit embraces all procedures from blood procurement to the long term consequences of transfusion. Aims and Objectives To understand the problems arising in day to day working of blood bank and to ensure the appropriate indication for issuing blood and blood components to different departments. Materials and methods Present audit of blood bank is retrospective study done for a year in tertiary care center in central region of India. Data collection of donors and whole blood issue is done for one year from 1st January 2016 to 31st December 2016. Component separation had started from August 2016, so audit of component separation and its usage has been done for one year from 1stAugust 2016 to 31stJuly 2017. Results In year 2016, total blood units collected were 6131 and issued were 5897. Majority of blood issue was to surgical wards 3790 compared to non-surgical wards 2107. Out of 6109, 203 were positive for transfusion transmitted infections (TTI). 20 transfusion reactions were reported in 2016. From 1st August 2016 to 31st July 2017, total 1060 Packed Red Cells (PRC) were prepared and 1009 were utilized , 1120 units of FFP were prepared, out of which 778 were utilized and 817 platelet concentrates were prepared but only 205 is utilized. Conclusion Results obtained from these types of retrospective studies will provide opportunity for finding strategies in improving the blood bank services.

Badanie fizykalne stosowane przez pielęgniarki na wybranych oddziałach szpitalnych

Introduction. The history of the use of physical examination by nurses in the United States of America dates back to the 1960s. Transformation of nurses’ education and midwives in Poland also enabled the introduction of classes preparing students and nurses for physical examination. Aim. The aim of the study was to assess the scope of physical examination used by nurses in selected surgical and non-surgical departments. Material and methods. The study involved 89 nurses employed in one of the hospitals in the Pomeranian Voivodeship. The study was conducted in 2017. The work involved the method of a diagnostic survey and the research tool was a questionnaire of own authorship. The results of the study were subjected to statistical analysis using the Microsoft Excel 2013 spreadsheet and the IBM SPSS Statistics 23 statistical package. Results. There are statistically significant differences in the physical examination of the general subjects (assessment of the structure and body proportions, nutritional status), as well as the measurement of breathing, heart rate, blood pressure, body temperature during hospitalization and within the head and neck and chest. Conclusions. Nurses working in surgical wards are more likely to perform general physical examination and measurement of breathing, pulse, blood pressure and body temperature during hospitalization compared to nurses from non-surgical wards. However, when admitted to the hospital, they more often assess the arterial system. Level of education and work experience in the profession are factors affecting the frequency of physical examination.

Prevalence of antibiotic resistance in adult septic patients of H. Adam Malik central general hospital, Medan under Indonesia’s mandatory health scheme

Sepsis is a severe bacterial infection whose treatment still varies in preference. However, for more than 60 years, antibiotics have been regarded as the panacea, as long as they are used wisely and timely. Antibiotic resistance has escalated in recent years, resulting in an accelerating global health security emergency, that is rapidly outpacing available treatment options. In January 2014, the new mandatory health insurance scheme (JKN) was introduced, whose treatments must comply with National Formulary (FORNAS) policy. We aimed to systematically review the prevalence of antibiotic resistance to FORNAS policy’s preferential treatments in adult septic patients who had been in the non-surgical wards. Based on an overall view, 76 out of 90 kinds of antibiotics which had undergone antibiotic susceptibility test (AST) had alarming resistance rate and preferential antibiotics in the current JKN scheme may have become ineffective.

Childhood trauma and factors associated with depression among inpatients with cardiovascular disease.

AIMTo identify factors associated with depressive symptoms among inpatients with cardiovascular disease (CVD).METHODSThis is a cross-sectional study performed in a subsample of a large cross-sectional research that investigated affective disorders and suicide behaviour among inpatients hospitalized in non-surgical wards of the University Hospital of the Federal University of Minas Gerais from November 2013 to October 2015. Sociodemographic and clinical data were obtained through a structured interview and medical record review. Depression was assessed by the depression subscale of the Hospital Anxiety and Depression Scale, with scores ≥ 8 considered as positive screening for depression. We used the Fageström Test for Nicotine Dependence to characterize nicotine dependence. For assessing resilience and early-life trauma, we used the raw scores of the Wagnild and Young Resilience Scale and Childhood Trauma Questionnaire, respectively.RESULTSAt endpoint, we included 137 subjects. Thirty-eight (27.7%) subjects presented depressive symptoms and nine (23.7%) of those were receiving antidepressant treatment during hospitalization. The female sex; a lower mean educational level; a greater prevalence of previous suicide attempts; a higher level of pain; a higher prevalence of family antecedents of mental disorders; a lower resilience score; and higher childhood trauma score were the factors significantly associated with screening positive for major depression (P < 0.05). Multivariate analysis demonstrated that the factors independently associated with the depressive symptoms were a higher childhood trauma severity (OR = 1.06; P = 0.004); moderate to severe nicotine dependence (OR = 8.58; P = 0.008); and the number of previous hospital admissions (OR = 1.11; P = 0.034). The obtained logistic model was considered valid, indicating that the three factors together distinguished between having or not depressive symptoms, and correctly classified 74.6% of individuals in the sample.CONCLUSIONOur results demonstrate that inpatients presenting both CVD and a positive screening for depression are more prone to have antecedents of childhood trauma, nicotine dependence and a higher number of previous hospitalizations.

Outcomes Associated With the Nationwide Introduction of Rapid Response Systems in The Netherlands.

To describe the effect of implementation of a rapid response system on the composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death. Pragmatic prospective Dutch multicenter before-after trial, Cost and Outcomes analysis of Medical Emergency Teams trial. Twelve hospitals participated, each including two surgical and two nonsurgical wards between April 2009 and November 2011. The Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments were implemented over 7 months. The rapid response team was then implemented during the following 17 months. The effects of implementing the rapid response team were measured in the last 5 months of this period. All patients 18 years old and older admitted to the study wards were included. In total, 166,569 patients were included in the study representing 1,031,172 hospital admission days. No differences were observed in patient demographics between periods. The composite endpoint of cardiopulmonary arrest, unplanned ICU admission, or death per 1,000 admissions was significantly reduced in the rapid response team versus the before phase (adjusted odds ratio, 0.847; 95% CI, 0.725-0.989; p = 0.036). Cardiopulmonary arrests and in-hospital mortality were also significantly reduced (odds ratio, 0.607; 95% CI, 0.393-0.937; p = 0.018 and odds ratio, 0.802; 95% CI, 0.644-1.0; p = 0.05, respectively). Unplanned ICU admissions showed a declining trend (odds ratio, 0.878; 95% CI, 0.755-1.021; p = 0.092), whereas severity of illness at the moment of ICU admission was not different between periods. In this study, introduction of nationwide implementation of rapid response systems was associated with a decrease in the composite endpoint of cardiopulmonary arrests, unplanned ICU admissions, and mortality in patients in general hospital wards. These findings support the implementation of rapid response systems in hospitals to reduce severe adverse events.

A cross-sectional survey of patient needs in hospital evacuation.

To aid development of contingency plans, a cross-sectional survey of inpatient needs in the event of a total hospital evacuation within a few hours was undertaken. The hospital is a part of a tertiary care facility with a mixed surgical and medical population and a relatively large load of emergency medicine. A doctor or nurse on each ward registered patients' physical mobility, special needs complicating transportation (intensive care, labor, isolation, etc), and the lowest acceptable level of care after evacuation. Of the 760 included patients, 57.8 percent could walk, 20.0 percent needed wheelchair, and 22.2 percent needed transport on stretcher. Special needs were registered for 18.2 percent of patients. Only 49.7 percent of patients needed to be evacuated to another hospital to continue care on an acceptable level, while 37.6 percent could be discharged to their own home, and 12.6 percent could be evacuated to a nursing home. Patients in psychiatric wards and high dependency units had distinctly different needs than patients in ordinary somatic wards. The differences between patients in surgical and nonsurgical wards were minor. Patient discharge seems to be a considerable capacity buffer in a hospital crisis situation.

A cross-sectional survey of patient needs in hospital evacuation.

To aid development of contingency plans, a cross-sectional survey of inpatient needs in the event of a total hospital evacuation within a few hours was undertaken. The hospital is a part of a tertiary care facility with a mixed surgical and medical population and a relatively large load of emergency medicine. A doctor or nurse on each ward registered patients' physical mobility, special needs complicating transportation (intensive care, labor, isolation, etc), and the lowest acceptable level of care after evacuation. Of the 760 included patients, 57.8 percent could walk, 20.0 percent needed wheelchair, and 22.2 percent needed transport on stretcher. Special needs were registered for 18.2 percent of patients. Only 49.7 percent of patients needed to be evacuated to another hospital to continue care on an acceptable level, while 37.6 percent could be discharged to their own home, and 12.6 percent could be evacuated to a nursing home. Patients in psychiatric wards and high dependency units had distinctly different needs than patients in ordinary somatic wards. The differences between patients in surgical and nonsurgical wards were minor. Patient discharge seems to be a considerable capacity buffer in a hospital crisis situation.

Obstructive sleep apnea and adverse outcomes in surgical and nonsurgical patients on the wards.

Obstructive sleep apnea (OSA) has been associated with clinical deterioration in postoperative patients and patients hospitalized with pneumonia. Paradoxically, OSA has also been associated with decreased risk of inpatient mortality in these same populations. To investigate the association between OSA and in-hospital mortality in a large cohort of surgical and nonsurgical ward patients. Observational cohort study. A 500-bed academic tertiary care hospital in the United States. A total of 93,676 ward admissions from 53,150 unique adult patients between November 1, 2008 and October 1, 2013. None. OSA diagnoses and comorbidities were identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Logistic regression was used to control for patient characteristics, location prior to ward admission, and admission severity of illness. The primary outcome was in-hospital death. Secondary outcomes included rapid response team (RRT) activation, intensive care unit (ICU) transfer, intubation, and cardiac arrest on the wards. OSA was identified in 5,625 (10.6%) patients. Patients with OSA were more likely to be older, male, and obese, and had higher rates of comorbidities. OSA patients had more frequent RRT activations (1.5% vs 1.1%) and ICU transfers (8% vs 7%) than controls (P < 0.001 for both comparisons), but a lower inpatient mortality rate (1.1% vs 1.4%, P < 0.05). OSA was associated with decreased adjusted odds for ICU transfer (odds ratio [OR]: 0.91 [0.84-0.99]), cardiac arrest (OR: 0.72 [0.55-0.95]), and in-hospital mortality (OR: 0.70 [0.58-0.85]). After adjustment for important confounders, OSA was not associated with clinical deterioration on the wards and was associated with significantly decreased in-hospital mortality.

Prévention des évènements thromboemboliques veineux par fondaparinux 2,5 mg chez des patients hospitalisés pour une affection médicale aiguë. Étude ArchiMed. ArchiMed hôpital – étude observationnelle d’usage du fondaparinux 2,5 mg en vie réelle ; 718 patients inclus par 107 pharmaciens hospitaliers

To evaluate the average duration of in-hospital treatment with fondaparinux 2.5mg prescribed for venous thromboprophylaxis in acutely ill medical patients and to describe the treatment population. Prospective, observational, national, multicentre, epidemiological study, performed in France at the request of the Transparency Commission of the French National Health Authority (Haute Autorité de Santé). This is part of a larger study program that also included a study with similar design in the general practice setting. The hospital practice part of the study was conducted by hospital pharmacists who were asked to include the first 15 adult subjects hospitalized in a non-surgical ward for whom fondaparinux 2.5mg was initiated for prophylaxis. Fifty-three pharmacists (49.5%) included a total of 718 patients. The average age was 71 ±16 years (47%<75 years old); 54% were women. For 41% of patients, duration of fondaparinux 2.5mg administration ranged from 6 to 14 days. Eighty-five percent of patients had at least one acute illness related to the prescription of fondaparinux 2.5mg for thromboprophylaxis. Ten percent of the population had at least one risk factor listed on the Case Report Form. Characteristics of patients from the hospital practice study differ from those included in the general practice part of the ArchiMed Study program. The hospital practice part of the ArchiMed Study, which is similar to "audits of practices", shows that the real-life conditions of prescription of fondaparinux 2.5mg in patients hospitalized are generally in line with guidelines with respect to indication for thromboprophylaxis in acute medical illness.

Pyloric stenosis—postoperative care on a nonsurgical ward

BackgroundRecent progress has been made in the care of infants with hypertrophic pyloric stenosis (HPS), including earlier operative intervention and shorter hospital length of stay (LOS), which is attributable to expedited postoperative feeding protocols developed and implemented by surgeons. We hypothesized that patients with HPS admitted to a unit that is co-managed by nonsurgeon providers postoperatively have a longer LOS than those on the surgical ward. Materials and methodsWe reviewed the medical records of infants who underwent pyloromyotomy for HPS at a single institution from April, 2009–July, 2013. ResultsA total of 259 patients underwent pyloromyotomy (35 female; 13.5%), 205 (79%) were admitted to the surgical ward; 46 had a planned neonatal intensive care unit (NICU) admission (18%) and were co-managed with the neonatology team. Eight (3%) had an unplanned NICU admission and were excluded from the analysis. The groups did not differ in terms of sex, age, serum electrolytes at presentation, or time between surgeon evaluation and operative intervention. Surgical ward patients had longer preoperative symptom duration. Operative time was longer in the NICU patients. Comparing the two groups, there was no difference in postoperative apnea, hypoxic, or bradycardic episodes. NICU patients achieved ad libitum feeds later than floor patients (2.0 versus 1.4 d; P = 0001) and had a longer postoperative LOS (2.2 versus 1.6 d; P = 0.0012). ConclusionsPatients with HPS admitted to the NICU postoperatively had a longer time to full feeds and hospital LOS. The reduction in LOS between hospital wards may be improved with implementation of a hospital-wide postoperative protocol for patients with HPS.

Akutschmerztherapie in der stationären Versorgung an deutschen Krankenhäusern

In 2007, the German national guidelines on "Treatment of acute perioperative and post-traumatic pain" were published. The aim of this study was to describe current structure and process data for acute pain management in German hospitals and to compare how the guidelines and other initiatives such as benchmarking or certification changed the healthcare landscape in the last decade.All directors of German departments of anesthesiology according to the DGAI ("Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin", German Society for Anesthesiology and Intensive Care) were mailed a standardized questionnaire on structures and processes of acute pain management in their hospitals.A total of 403 completed questionnaires (46 %) could be evaluated. Of hospitals, 81 % had an acute pain service (ASD), whereby only 45 % met defined quality criteria. Written standards for acute pain management were available in 97 % of the hospitals on surgical wards and 51 % on nonsurgical wards. In 96 %, perioperative pain was regularly recorded (generally pain at rest and/or movement, pain-related functional impairment in 16 % only). Beside these routine measurements, only 38 % of hospitals monitored pain for effectiveness after acute medications. Often interdisciplinary working groups and/or pain managers are established for hospital-wide control. As specific therapy, the patient-controlled analgesia and epidural analgesia are largely prevalent (> 90 % of all hospitals). In the last decade, intravenous and oral opioid administration of opioids (including slow release preparations) has become established in acute pain management.The survey was representative by evaluating 20 % of all German hospitals. The organizational requirements for appropriate pain management recommended by the German guidelines for acute pain recommended have been established in the hospital sector in recent years. However, the organizational enforcement for acute pain management in nonsurgical areas is not adequate yet, compared to the perioperative care. In all hospitals modern medication and invasive techniques are widely available.

Acute pain treatment on postoperative and medical non-surgical wards.

The effectiveness of acute pain treatment in hospitals is examined. An efficient therapy of acute pain is efficient and cost-effective. Although every patient is entitled for the relief of pain, many hospitals do not treat acute pain in an optimal manner.

Measuring patient satisfaction with the Polish version of the Newcastle Satisfaction with Nursing Scale

The measurement of patients' satisfaction is increasingly becoming legal and ethical duty of healthcare providers worldwide. Till now, there were no validated, widely available Polish scales to assess patients' satisfaction with nursing care. The aim of this study was to assess the experiences and satisfaction with nursing care of patients hospitalized in surgical and nonsurgical wards in Poland using Polish version of the Newcastle Satisfaction with Nursing Scale. This is a multicentre, cross-sectional, descriptive study. Eight hospitals were qualified to participate in a convenience manner. The correlations between variables were analysed using the Mann-Whitney or the Kruskal-Wallis tests. In the case of a significant correlation, the Dunn's test was used to conduct multiple comparisons for the group of variables. A significance of α = 0.05 was assumed for the tests. A total 918 patients participated in the study, and 787 (85.72%) questionnaires were correctly filled out. The average result on the 'experience' scale was 73.22 (Me 73.07) and on the 'satisfaction' scale, 74.98 (Me 76.31). Education levels did not affect the experiences of nursing care levels p = 0.2204 and satisfaction with nursing care p = 0.1075. Patient age had a statistically significant impact on the results of the 'experiences of nursing care' scale p = 0.0005 and the 'satisfaction with nursing' scale p = 0.0194. The experiences of nursing care (p = 0.0002) and patients satisfaction (p = 0.0000) were significantly higher in surgical wards than in nonsurgical wards. The experiences of nursing care were significantly lower in the university hospital than in provincial hospitals (p = 0.0374) and district hospitals (p = 0.0183). A comparison of patient satisfaction with nursing in various hospitals shows that patients were most satisfied in district hospitals (average 78.10, Me 82.89), followed by provincial hospitals (average 72.11, Me 76.31) and the university hospital (average 70.64, Me 71.05).

Development of a classification system for drug-related problems in the hospital setting (APS-Doc) and assessment of the inter-rater reliability

Identifying, preventing and resolving drug-related problems (DRP) is an important issue in the pharmaceutical care process. Because DRPs have been detected in a more systematic way, the need for a classification system to document, classify and evaluate the collected data has become necessary. The objective was to develop a classification system for DRPs within the hospital setting, to evaluate the practicality and to assess the inter-rater reliability. All DRPs defined in PI-Doc and PCNE, which are relevant in the hospital setting, were included. Further relevant DRPs identified in other projects in a hospital setting as well as DRPs from the daily work on the ward were collected, and a short description of each DRP was written. A prospective study was conducted at Klinikum Fulda, Germany, in both a non-surgical and a surgical setting to explore whether the new classification system is suitable to classify DRPs in clinics with different specifications. For assessing the inter-rater reliability, 24 standardized case reports were provided. All participants classified them independently. The inter-rater reliability was analysed using Kappa coefficient. A classification system for DRPs in the hospital setting (APS-Doc) was established with 10 main categories and 48 subcategories. Practicality was assessed in 250 patients in a non-surgical ward as well as in 100 patients in a surgical ward. The inter-rater agreement was 0·68 (95% CI, 0·66-0·69) for main categories, which comprises substantial agreement. Moderate agreement (κ = 0·58; 95% CI, 0·58-0·59) was demonstrated for the subcategories. A new hierarchical classification system for DRPs in the hospital setting has been developed. APS-Doc seems suitable for various parts of the medication process such as medication reconciliation and drug therapy within both non-surgical and surgical wards. Inter-rater reliability was found to be substantial in the main categories and moderate in the subcategories.

The Quality of Pain Management in German Hospitals

The Pain-Free Hospital Project was initiated in 2003 with the aim of improving pain management throughout Germany. We assessed the current state of pain management in German hospitals. From 2004 to 2006, data were obtained anonymously from 2252 patients who had undergone surgery, and 999 who had been treated non-surgically, in a total of 25 hospitals. They were interviewed about the intensity of pain they had experienced and about the effectiveness of its treatment. No pain at all was reported by 12.4% of patients who had undergone surgery and by 16.7% of the non-surgically treated patients. Moderate to severe pain at rest was reported by 29.5% of the surgical group and 36.8% of the non-surgical group. More than 50% of the overall group reported pain on movement. 55% of the surgical group, and 57% of the non-surgical group, were dissatisfied with their pain management. Peak pain tended to occur outside normal working hours. No analgesic treatment at all was given to 39% of patients in the non-surgical group, even though they were in pain; the corresponding figure for the surgical group was 15% (a significant difference, p<0.001). Inadequately effective pain management was reported by 45.6% of patients in the non-surgical group and 29.6% in the operative group (again, a significant difference. Cancer patients were treated more often with potent opioids. Severe postoperative pain is still too common among hospitalized patients, particularly pain that is induced by movement. Patients being treated on non-surgical wards also often suffer severe pain needlessly. Pain management seems to be worse for non-surgical patients (cancer patients excepted) than for surgical patients: waiting times for medication are longer, and ineffective medications are given more often. On the other hand, a number of hospitals provide positive examples of the potential effectiveness of pain management for both surgical and non-surgical patients.

Clinical characteristics, outcome and the role of viral load in nontransplant patients with Epstein--Barr viraemia

Epstein--Barr virus (EBV) is important in the development of post-transplant lymphoproliferative disease in allogeneic stem cell and solid organ transplant recipients. We have studied the clinical significance of EBV DNAaemia among nontransplant patients in a tertiary referral hospital. We retrospectively reviewed the medical records for main diagnosis, outcome, immunosuppressive/cytotoxic chemotherapy and other opportunistic infections of the patients who were found -positive in quantitative real-time PCR assay for EBV (EBV-qPCR) between the years 2000 and 2007. Allogeneic stem cell and solid organ transplant recipients were excluded, and all patients in nonsurgical adult wards were included. Altogether, 62 patients had at least one plasma sample -positive with an EBV-qPCR. Fifteen were immunocompetent, most had primary EBV infection, and the outcome was good. On the other hand, 36 had malignant disease, seven had HIV infection and seven had immunosuppressive conditions of an other aetiology. All but one of the malignancies were of lymphoid origin, and most of these patients had a history of multiple cytotoxic treatments. Immunosuppressed patients had higher viral loads. EBV viraemia is associated with severe immunosuppression and lymphoid malignancies.

Pattern and Outcome of Pediatric Surgical Admissions to a Nigerian Tertiary Hospital

Background/Purpose: The patterns and the factors influencing outcome of paediatric surgical admissions may be crucial to policy formulation. This study reports the pattern and the outcome of paediatric surgical admissions in a developing country. Materials & Methods: The pattern and the outcome of paediatric surgical admissions at the University of Benin Teaching Hospital between January and December 2009 were audited in a retrospective study. Results: In total, 871 children aged between one day and 16 years who accounted for 43% of paediatric surgical workload were admitted, 322 (37%) on emergency basis. Of these, only 530 (60.8%) were admitted to a paediatric surgical ward while the rest were admitted in different wards, including nonsurgical wards, due to shortage of manpower and lack of paediatric surgical facilities. Three consultant paediatric surgeons and 17 nurses (only one paediatric nurse) managed an average of 46 new admissions per month with doctor to patient and nurse to patient ratio of 1: 15 and 1:33 respectively. Shortage of bed spaces also resulted in the admission of many clean surgical cases in the same ward with septic medical cases. This increased postoperative infective complications, duration of hospitalization and mortality rate especially among 106 neonates admitted to Special Care Baby Unit compared to those in paediatric surgical ward (P<0.0001). Conclusion: The need for the provision of more paediatric surgical facilities and training of more paediatric surgical personnel to match the high paediatric surgical workload is emphasized by this audit.

Evaluation of the frequency of venous thromboembolism prophylaxis in a selected population of patients hospitalized in nonsurgical wards. Results of the all‑Poland EPID Registry

The results of the Prophylaxis in Medical Patients with Enoxoparin (MEDENOX) trial demonstrated the benefit of thromboprophylaxis in patients hospitalized because of acute heart failure, respiratory failure and rheumatic disease. Analysis of clinical practice shows that thromboprophylaxis is rarely used in these patients. To assess thromboprophylaxis use in a selected population of patients hospitalized in internal departments in Poland. Between the years 2002 and 2006, 14,707 hospitalized patients were included into the EPID Registry. The study population, selected for the purpose of this analysis, involved 5246 patients (mean age 71, 95% CI: 70.6 -71.4 years), reported by 60 internal wards, who met the entry criteria of the MEDENOX study. Patients receiving long-term antithrombotic treatment and patients with indications for initiating antithrombotic treatment were not enrolled. Thromboprophylaxis was administered in 63% of patients. The average duration of thromboprophylaxis was 8.1 days (95% CI: 7.8-8.4). In the group of patients admitted to the intensive care unit thromoprophylaxis was administered in 81% of cases compared with 58% in nonsurgical departments (p < 0.0001). Low-molecular-weight heparins were used in 93% of patients receiving prophylaxis. The risk of hemorrhage (9.5%) and lack of indications for thromboprophylaxis (27%) according to the physicians were the main reasons for not using prophylaxis. The frequency of thromboprophylaxis use varied from 35% to 89% between different regions of Poland. Hemorrhagic complications were reported in 0.8% of patients receiving prophylaxis. Administration of thromboprophylaxis in the MEDENOX-like population is of great importance from an epidemiological point of view because this patient group accounts for 31% of in-patients. Thromboprophylaxis is underused with large differences between regions, which should be improved by an adequate educational program for physicians from internal wards.

Epidemiology, Risk and Prognostic Factors in Mesenteric Venous Thrombosis

Conclusion: Mesenteric venous thrombosis (MVT) can be accurately diagnosed with portal venous-phase computed tomography (CT) scanning, and activated protein C resistance is associated with MVT. Summary: The authors used an inpatient and autopsy registry to identify patients at their hospital with MVT from 2000 to 2006. MVT was diagnosed in 51 patients. The diagnosis was made at autopsy in six patients. Patients aged 70 to 79 years had the highest incidence of MVT (11.3 per 100,000 person-years). Testing for activated protein C resistance was done in 29 patients, and 13 were positive. D-dimer levels were assessed in five patients, and all had elevated D-dimer. Multidetector row CT scans were done in the portal venous phase in 20 patients. The examination was positive in all 20 patients. There were 12 patients with surgery, with a median length of bowel resection of 0.6 m (range, 0.1-2.2 m). The 30-day mortality for the entire group was 20%. Increased mortality was associated with intestinal infarction (P = .046), treatment on a nonsurgical ward (P = .001), and lack of performance of CT scan (P = .022). Long-term mortality was associated with presence of cancer, with a hazard ratio of 4.03 (95% CI, 1.03-15.85; P = .046). Comment: MVT, at least symptomatic MVT, occurs infrequently. The diagnosis is difficult because symptoms are generally nonspecific. Mortality rates can be high. The authors' data are consistent with what one would suspect. CT scanning with a venous phase works well for diagnosis, and many of these patients will have a hypercoagulable state with, at least in this study, factor V Leiden mutation identified as the most prevalent abnormality. The study highlights the current standard of care for patients with possible MVT: a CT scan for diagnosis, anticoagulation for most patients, bowel resection for those with peritonitis, and an aggressive evaluation for hypercoagulable state with likely long-term anticoagulation. Long-term prognosis is largely related to the presence of malignancy.