Non-university Hospitals Research Articles

Current management of acute left colon diverticulitis: What have Italian surgeons learned after the IPOD study?

The acute left diverticulitis is a common problem encountered by surgeons in the acute setting. Some years ago, the Italian Prospective Observational Diverticulitis (IPOD) study showed several disputes in managing acute left colon diverticulitis in Italian surgical department. The aim of this study is to check the compliance of Italian surgeons with clinical evidence-based guidelines in non-university hospitals. A 21 multiple-choice questions survey was sent to the Italian Society of Hospital Surgeons (ACOI) mailing list members, from the 1st April 2019 to 6th June 2019. One hundred and seventy-four Italian general surgeons (the ACOI collaborative diverticulitis group) joined the project and answered to the survey. The response rate was 7% (174/2500 ACOI members). Despite current international guidelines about the management of acute diverticulitis, several controversies have emerged from the analysis of this survey in the clinical practice of Italian surgeons, resulting from their low compliance with evidence-based recommendations.

Automatic speech recognition in the operating room – An essential contemporary tool or a redundant gadget? A survey evaluation among physicians in form of a qualitative study

IntroductionFor decades, automatic speech recognition (ASR) has been the subject of research and its range of applications broadened. Presently, ASR among physicians is mainly used to convert speech into text but not to implement instructions in the operating room (OR). This study aimed to evaluate physicians of different surgical professions on their personal experience and posture towards ASR. MethodsA 16-item survey was distributed electronically to hospitals and outpatient clinics in southern Germany addressing physicians on the potential applications of ASR in the OR. ResultsThe survey was responded by 185 of 2693 physicians (response rate: 6.9%) with a mean age of 41.8 ± 9.8 years. ASR is desirable in the OR regardless of the field of speciality (93.7%). While only 2.7% have used ASR, 87.9% evaluate its future potential as high. 91.0% of those working in a university hospital would consider testing ASR, while 67.5% of those in non-university hospitals and practices (p = 0.001). 90.1% of responders of strictly surgical specialities see potential in ASR while 73.7% in non-surgical specialities evaluate its future potential as high (p = 0.01). 58.3% of those over the age of 60 consider the use of ASR without a headset to be imaginable, while 96.3% among those under the age of 60. There were no statistically significant differences regarding sex and professional position. ConclusionForeseeably, ASR is anticipated to be integrated into ORs and valued at a high market potential. Our study provides information about physicians’ individual preferences from various surgical disciplines regarding ASR.

Prophylactic risk-reducing salpingo-oophorectomy in BRCA mutation carriers: what is going on in a region of northern Italy?

BackgroundBRCA1 mutation carriers are recommended to undergo prophylactic risk-reducing salpingo-oophorectomy (RRSO) between the ages of 35 and 40 or when child bearing is complete, with a possible delay until age 40–45 for BRCA2 mutation carriers. Study QuestionPrimary outcome was the rate of unsuspected cancer findings during RRSO in a region of northern Italy (Emilia Romagna) and secondary outcomes were details of RRSO: age at surgical intervention, the venue of the procedures in relation to the surgical/pathological quality and the rate/role of concomitant opportunistic hysterectomies. Study DesignMulticentre data collection by invitation to report current RRSO practices. ResultsA total of 222 RRSOs (54.5 % BRCA1, 34.7 % BRCA2, 1.8 % BRCA1 and BRCA2 combined, 5.8 % BRCA-VUS and 3.2 % BRCA not better specified) were reported from 9 different centres, half in non-university hospitals and the remainder in university hospitals.Breast cancer survivors (56.3 %) underwent the RRSO at a younger age (47.8 vs 50.6 years, p = 0.02). The mean and median ages at surgical intervention (49.0 and 48.0, respectively) were similar for BRCA1 and BRCA2 mutation carriers, as was the temporal trend in age distribution, and proportions treated in university and non-university hospitals.A diagnosis of ovarian invasive cancer was reported in 3.5 % of subjects, all BRCA1 or BRCA-combined subjects, at a median and mean age of 57 years (range 42–68). Abnormal tubal findings, such as serous tubal intraepithelial lesions (STIL) (100 %), secretory cell outgrowth (SCOUT) (100 %) and STIC (71.4 %), were mainly reported by pathologists in university hospitals. Of the 222 procedures, 15 (6.7 %) included hysterectomies: in none of these cases was a primitive uterine endometrioid or serous cancer found. ConclusionsThe results from this multicentre regional study should guide future preventive health policies for RRSO in BRCA mutation carriers.

Hospital characteristics preferred by medical students for their residency programs: A nationwide matching data analysis.

BackgroundIn 2004, Japan introduced a mandatory 2‐year postgraduate training program for graduating medical students with a super‐rotation curriculum. A national matching system was established to determine the hospital residency programs best suited for the students. We examined the hospital characteristics preferred by applicants for residencies.MethodsA nationwide cross‐sectional study was conducted. Data on salaries, bonuses, and number of accepted ambulances were compiled from the Residency Electronic Information System. Information on the prefectural population, urban area, and number of senior residents (postgraduate years 3–5) for specialty training was extracted from data published on the web page. The ratio of the number of first‐choice applicants to recruitment capacity (matching ratio) for each program was compared between the characteristics of the hospitals and prefectures.ResultsA strong linear relationship was observed between the number of first‐choice applications and the allocated number of resident positions (correlation coefficient, .72). The matching ratio was greater in community hospitals (2.10 times compared with university hospitals; 95% confidence interval [CI], 1.75–2.53), in hospitals with higher numbers of accepted ambulance cases (1.05 times per 1000 annually; 95% CI, 1.03–1.08), and in hospitals that served a larger prefectural population (1.05 times per million; 95% CI, 1.02–1.08).ConclusionsFinancial incentives do not seem to attract residency applicants. Applicants prefer non‐university hospitals located in populous areas and those that accept larger number of ambulance cases. To recruit junior residents, an emergency department may need to have higher activity with larger numbers and variety of cases.

Medical Emergencies During the COVID-19 Pandemic.

In this study, we investigate the number of emergency room consultations during the COVID-19 pandemic of 2020 in Germany compared to figures from the previous year. Case numbers from calendar weeks 1 through 22 of the two consecutive years 2019 and 2020 were obtained from 29 university hospitals and 7 non-university hospitals in Germany. Information was also obtained on the patients' age, sex, and urgency, along with the type of case (outpatient/inpatient), admitting ward, and a small number of tracer diagnoses (I21, myocardial infarction; J44, COPD; and I61, I63, I64, G45, stroke /TIA), as well as on the number of COVID-19 cases and of tests performed for SARS-CoV-2, as a measure of the number of cases in which COVID-19 was suspected or at least included in the differential diagnoses. A total of 1 022 007 emergency room consultations were analyzed, of which 546 940 took place in 2019 and 475 067 in 2020. The number of consultations with a positive test for the COVID-19 pathogen was 3122. The total number of emergency room consultations in the observation period was 13% lower in 2020 than in 2019, with a maximum drop by 38% coinciding with the highest number of COVID-19 cases (calendar week 14; 572 cases). After the initiation of interpersonal contact restrictions in 2020, there was a marked drop in COVID-19 case numbers, by a mean of -240 cases per week per emergency room (95% confidence interval [-284; -128]). There was a rise in case numbers thereafter, by a mean of 17 patients per week [14; 19], and the number of cases of myocardial infarction returned fully to the level seen in 2019. In Germany, the COVID-19 pandemic led to a significant drop in medical emergencies of all kinds presenting to the nation's emergency departments. A recovery effect began to be seen as early as calendar week 15, but the levels seen in 2019 were not yet reached overall by calendar week 22; only the prevalence of myocardial infarction had renormalized by then. The reasons for this require further investigation.

Patient-Level and Hospital-Level Risk Factors for In-Hospital Mortality in Patients Ventilated for More Than 24 Hours: Results of a Nationwide Cohort Study.

Prolonged ventilation is associated with a high risk of death. This study investigated both patient-level and hospital-level risk factors for in-hospital mortality in patients ventilated for more than 24 hours. The analyses were conducted in the framework of a German national multicenter retrospective cohort study. Patient and hospital characteristics were examined using descriptive statistics. Risk factors of in-hospital mortality were analyzed using multilevel robust Poisson regressions for binary outcomes. Potential effect modifications were examined by stratified analyses. The sample includes 95 672 cases of patients ventilated >24 hours in 163 hospitals covering the period 2016 to 2017. According to the results of multilevel Poisson regressions, main patient-level risk factors for in-hospital mortality were age (per year relative risk [RR] = 1.021, 95% CI = 1.020-1.023), stroke (RR = 1.459; 95% CI = 1.361-1.563), emergency case admission (RR = 1.273, 95% CI = 1.156-1.403), and transfer from another hospital (RR = 1.169, 95% CI = 1.084-1.261). The individual risk of in-hospital death was positively associated with hospital size (RR of hospitals with 600-799 beds vs <100 beds = 1.412, 95% CI = 1.095-1.820) and negatively related to cumulated ventilation patient time (per 1000 days RR = 0.995, 95% CI = 0.993-0.996). University hospital status was identified as an effect modifier, particularly with regard to the patients' admission reasons. The RR of in-hospital death in patients admitted after transfer from another hospital was higher in university hospitals (RR = 1.456, 95% CI = 1.298-1.634) compared to nonuniversity hospitals (RR = 1.077, 95% CI = 1.019-1.139). Likewise, patients admitted as emergency case had a higher relative risk in university hospitals (RR = 1.619, 95% CI = 1.359-1.929) than in nonuniversity hospitals (RR = 1.141, 95% CI = 1.080-1.205). By providing evidence on multiple patient-level and hospital-level risk factors for in-hospital mortality in patients ventilated for more than 24 hours, this large multicenter study has main implications for quality assessment of clinical care and the adequate specification of risk adjustment models. The revealed effect modifications indicate the relevance of stratified analyses.

Limits of the G-DRG system to reflect Complexity in German University Hospitals

Since the introduction of the G-DRG-system in Germany for the reimbursement of in-hospital patients in 2003 the Institute for the Hospital Remuneration System (InEK) annually determines case reimbursements for currently 1300 individual diagnosis-related groups (DRGs). These are based on the cost documentation of 200 representative hospitals, coopted by InEK (§ 21-KHEntG-dataset). Since DRGs represent cost averages, one half of German hospitals would be expected to report an annual income surplus, the other half a deficit. In spite of sustained cost reductions two thirds of public University Hospitals, but only 29 % of non-University hospitals, report annual deficits. The German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) has obtained the § 21-cost-dataset from 74 InEK-hospitals and 7 Mio anonymized cases since 2012 in order to appeal for individual DRG-corrections to InEK. In the current project this database was used to investigate whether the cost of care at University Hospitals is appropriately reflected in three representative DRGs and OPS codes (operation and procedure codes): Liver cirrhosis with hepatic encephalopathy, endoscopic procedure-tiers, and an endoscopic intervention after patient transfer from one hospital to another. The analysis reveals that the higher patient complexity, severity and cost at University Hospitals cannot be corrected by modification or further differentiation of individual DRGs within the existing G-DRG-system. Even in DRGs for which a differentiation would be possible and economically appropriate it is often not permitted. A further rise of the systematic deficit of German University Hospitals (currently 300 Mio. Euro annually) can only be prevented by introducing either a case-based DRG-System-Surcharge for University Hospitals or by separation of a University Hospital U-DRG-System from the general G-DRG-System.

Issues and Challenges Associated with Data-Sharing in LMICs: Perspectives of Researchers in Thailand.

.Data-sharing helps advance scientific research and assures the benefits of research data are maximized. Previous work has highlighted ethical challenges, especially in low- and middle-income countrie (LMIC) countries. This study examined the views of researchers in a middle-income country, Thailand, regarding the most important data-sharing challenges. The target researchers worked in biomedical and related research. The survey was distributed to 38 academic and health-science institutes, 18 university hospitals, 84 nonuniversity hospitals, and 22 research institutes across Thailand; 229 researchers in clinical/basic and social/behavioral sciences, and pubxxlic health/policy participated. Thai researchers were less concerned with informed consent and the feasibility of conducting research and sharing data, focusing on the importance of safeguards when handling data, including transfer to others, and possible lack of control over subsequent data use. The respondents felt that researchers should decide what types of project data are shareable and which data are likely useful to the scientific community. They were more concerned with appropriate acknowledgment and protecting the legal rights of the primary data collectors and providers. Although they had concerns about data access conditions, they rated sharing sufficient data and metadata to reproduce the analysis of the primary outcomes as highly important. These results are important for future efforts of the LMIC countries to develop efficient data-sharing frameworks and establish institutional data access committees. They highlight the importance, for the sustainability and fairness of these efforts, to ensure that parties in LMIC countries receive appropriate credit and are involved in determining where/when/how their data may be used.

Hysteropexy in the treatment of uterine prolapse stage 2 or higher: laparoscopic sacrohysteropexy versus sacrospinous hysteropexy-a multicentre randomised controlled trial (LAVA trial).

To investigate whether laparoscopic sacrohysteropexy (LSH) is non-inferior to vaginal sacrospinous hysteropexy (SSHP) in the surgical treatment of uterine prolapse. Multicentre randomised controlled, non-blinded non-inferiority trial. Five non-university teaching hospitals in the Netherlands, one university hospital in Belgium. 126 women with uterine prolapse stage 2 or higher undergoing surgery without previous pelvic floor surgery. Randomisation in a 1:1 ratio to LSH or SSHP, stratified per centre and severity of the uterine prolapse. The predefined inferiority margin was an increase in surgical failure rate of 10%. Primary outcome was surgical failure, defined as recurrence of uterine prolapse (POP-Q≥2) with bothersome bulging/protrusion symptoms and/or repeat surgery or pessary at 12months postoperatively. Secondary outcomes were anatomical recurrence (any compartment), functional outcome and quality of life. Laparoscopic sacrohysteropexy was non-inferior for surgical failure (n=1, 1.6%) compared with SSHP (n=2, 3.3%, difference -1.7%, 95% CI: -7.1 to 3.7) 12months postoperatively. Overall, anatomical recurrences and quality of life did not differ. More bothersome symptoms of overactive bladder (OAB) and faecal incontinence were reported after LSH. Dyspareunia was more frequently reported after SSHP. Laparoscopic sacrohysteropexy was non-inferior to SSHP for surgical failure of the apical compartment at 12months' follow up. Following LSH, bothersome OAB and faecal incontinence were more frequent, but dyspareunia was less frequent. Laparoscopic sacrohysteropexy and vaginal sacrospinous hysteropexy have equally good short-term outcomes.

Compliance with national guidelines for antibiotic prophylaxis in hip fracture patients: a quality assessment study of 13 329 patients in the Norwegian Hip Fracture Register

ObjectiveWe assessed compliance with new guidelines for prophylactic antibiotics in hip fracture surgery in Norway introduced in 2013.DesignThe data from the Norwegian Hip Fracture Register was used to assess the...

Interdisciplinary tumor boards in the radiological routine : Current situation based on an online survey in Germany

Interdisciplinary tumor boards are periodical conferences, where optimal individual therapy plans are developed among medical experts with different specializations. The presence of aboard-certified radiologist is medically indispensable in almost all relevant boards. In order to systematically evaluate the current workload for radiologists caused by these boards, we evaluated the current situation within German radiology to obtain numbers for future personnel planning. We performed an online survey. We invited all 33German university chairmen and 50 randomly selected head physicians of radiology at level3 hospitals to participate. We had aparticipation rate of 79% (26/33) at university hospitals and 56% (28/50) at of level3 non-university hospitals. The average total number of tumor boards was 3.3/day or 16.7/week at university hospitals and 2.6/day or 13/week at level3 non-university hospitals. We calculated an average time considering preparation and execution as well as the average number of boards of 33.1 h/week for university hospitals and 18.2 h/week for level3 hospitals. This results in a78.8% workload for aboard-certified radiologist at auniversity hospital (regular weekly work time 42 h) and 45.5% work load for level3 hospitals (regular weekly work time 40 h). "Speaking radiology" as in interdisciplinary tumor boards represents afundamental matter of course in radiology. The active participation in boards accomplished by radiologists improves evidence-based patient care. However, given the prevailing scarcity of resources in medicine, the data collected here regarding personnel costs for clinical radiology for participation in tumor boards must be taken into account in future discussions on personnel compensation.

Impact of iatrogenic biliary injury during laparoscopic cholecystectomy on surgeon's mental distress: a nationwide survey from China

BackgroundIatrogenic biliary injury (IBI) following laparoscopic cholecystectomy (LC) is the most serious iatrogenic complications. Little is known whether LC-IBI would lead to surgeon's severe mental distress (SMD). MethodsA cross-sectional survey in the form of electronic questionnaire was conducted among Chinese general surgeons who have caused LC-IBI. The six collected clinical features relating to mental distress included: 1) feeling burnout, anxiety, or depression, 2) avoiding performing LC, 3) having physical reactions when recalling the incidence, 4) having the urge to quit surgery, 5) taking psychiatric medications, and 6) seeking professional psychological counseling. Univariable and multivariable analyses were performed to identify risk factors of SMD, which was defined as meeting ≥3 of the above-mentioned clinical features. ResultsAmong 1466 surveyed surgeons, 1236 (84.3%) experienced mental distress following LC-IBI, and nearly half (49.7%, 614/1236) had SMD. Multivariable analyses demonstrated that surgeons from non-university affiliated hospitals (OR:1.873), patients who required multiple repair operations (OR:4.075), patients who required hepaticojejunostomy/partial hepatectomy (OR:1.859), existing lawsuit litigation (OR:10.491), existing violent doctor–patient conflicts (OR:4.995), needing surgeons' personal compensation (OR:2.531), and additional administrative punishment by hospitals (OR:2.324) were independent risk factors of surgeon's SMD. ConclusionFour out of five surgeons experienced mental distress following LC-IBI, and nearly half had SMD. Several independent risk factors of SMD were identified, which could help to make strategies to improve surgeons' mental well-being.

The CAHP (cardiac arrest hospital prognosis) score: A tool for risk stratification after out-of-hospital cardiac arrest in elderly patients

BackgroundOlder age is associated with worse outcome after out-of-hospital cardiac arrest (OHCA). Therefore, we tested the performance of CAHP score, to predict neurological outcome in elderly OHCA patients and to select patients most likely to benefit from coronary angiogram (CAG). Materials and methodsThe present study was a retrospective multicentre observational study at 3 non-university hospitals and 1 university hospital. CAHP score was calculated, and its performance to predict outcomes was evaluated. Factors associated with the use of CAG were analysed and the rate of CAG across each CAHP score risk group reported. ResultsOne hundred seventy-six patients fulfilled inclusion criteria (median age of 81, [79–84]), among which a cardiac cause was presumed for 99 patients. The hospital unfavourable outcome was 91%. The ROC-AUC values for hospital neurological outcome prediction of CAHP score was 0.81 [0.68–0.94], showing good discrimination performance. ST-segment elevation in ECG and initial shockable rhythm were independent factors for performing early CAG, whereas age and distance from the percutaneous coronary intervention centre were independently associated with the absence of early CAG. The percentages of patients receiving early CAG in the low, medium and high CAHP score risk groups were 64%, 33% and 34%, respectively, and differed significantly between low CAHP score risk group and other groups (p = 0.02). ConclusionsThe CAHP score exhibited a good discrimination performance to predict neurological outcome in elderly OHCA patients. This score could represent a helpful tool for treatment allocation. A simple prognostication score could permit avoiding unnecessary procedures in patients with minimal chances of survival.

INVESTIGATING THE FREQUENCY OF NORMAL VAGINAL DELIVERY AND CESAREAN SECTION AND CAUSES OF CESAREAN SECTION IN PUBLIC AND PRIVATE CENTERS AND COMPARING IT WITH EDUCATIONAL CENTERS IN ZAHEDAN

Introduction. Cesarean section plays an important role in decreasing the mortality and complications of childbirth in the mother and fetus. But the worrying issue in modern midwifery is the high rate of cesarean section. The current study was done to evaluate the frequency of normal vaginal delivery and cesarean section and the causes of cesarean section in public-private centers and compare it with educational centers in Zahedan in 2016-2017. Materials and methods. This is a descriptive cross-sectional study and a total of 792 deliveries were studied, 300 cases were from university hospitals and 492 from non-university hospitals in Zahedan. SPSS22 software was used for data analysis. Findings. The results disclosed that in university hospitals, 65.3 of the deliveries were normal vaginal delivery and 34.7 were cesarean, and in the non-university hospitals, 44.5 and 55.5 of the deliveries were normal and cesarean deliveries, respectively. There was a significant relationship between the type of delivery and the hospital where the delivery was done (P < 0.001). The most common causes of cesarean section in this study were: previous cesarean section (33.7), fetal distress (14.9), cesarean delivery on maternal request (CDMR) (11.7), delivery failure (11.4), mother's disease (7.4), abnormal fetal placement (6.6), multiparous pregnancy (4.5), problems with the placenta and umbilical cord (4), cephalopelvic disproportion (3.2) and embryonic diseases (2.7). There was no cesarean delivery on maternal request (CDMR) in university hospitals while in non-university hospitals it was 16.1. Conclusion. Generally, the percentage of normal vaginal delivery was higher than that of the cesarean section, but the number of cesarean sections was higher in non-university hospitals than in university hospitals. Also, ethnicity, number of pregnancy, job, education, history of infertility, and awareness of complications were significantly related to the type of delivery.

Assessing Delay in Receiving Adequate and Appropriate Treatment: A Client Perspective among Women Admitted to Emergency Obstetric Hospitals of Ethiopia

Background: In Ethiopia, the maternal death is still unacceptably high, but instead of women dying in their 'hovels', they die in hospitals. For improving quality of medical care in obstetric emergencies, appropriate timing is extremely important and key to reduce maternal mortality. The aim of the study was to assess delay in receiving adequate and appropriate treatment for women faced emergency obstetric complications admitted to emergency room on five referral hospitals of Ethiopia. Methods: Facility based Cross-sectional study was conducted on five referral hospitals of Ethiopia. Mixed of health facilities (university and non-university hospitals) that provide specialized obstetric care and perform a minimum number of 1,000 deliveries per year was considered. Women faced obstetric complications and fulfill world Health Organizations Criteria for potential life-threatening conditions was included in the study. A total of 360 study subjects were sampled. Samples was proportionally allocated to each facilities based on their clients flow and systematic random sampling technique was used to select study subjects. Data was collected using exist interview and from maternal cards. Data was analyzed using SPSS software. Multivariable analysis was conducted using logistic regression; variables with the largest p-value of 0.2 in bivariable analysis were included. Result: The mean age of the respondent was 30 year with standard deviation of (SD , ± 6). Out of the total sampled, 60% of them faced obstetric complications at home. Even though, the time of getting appropriate treatment for a women faced obstetric complications vary from complication to complication they faced, but the median time were 1.10 hours. About 49 percent of women faced obstetric complications were delayed to get appropriate treatment which was above the median time. Of which, one in six women were delayed to received appropriate treatment because of training issues. women who got information about emergency obstetric complications were two times more likely to reduce delay in receiving appropriate treatment than women who did not get the information (AOR: 2.09, 95% CI, 1.0-4.36). Conclusion : About 49 percent of women were delayed in receiving appropriate treatment, and women who were got information about emergency obstetric complications were got appropriate treatment on time. Therefore referral hospitals of Ethiopia, are recommended to check there liaison system and emergency medical management protocols. Keywords : Emergency obstetric care, Multivariable analysis, SPSS software, Third delay

Do obstetricians apply the national guidelines? A vignette-based study assessing practices for the prevention of preterm birth.

To describe spontaneous preterm birth prevention practices self-reported before and after the dissemination of relevant guidelines, and to identify personal and organisational factors associated with adherence. A repeated cross-sectional vignette-based survey study. French obstetricians. French obstetricians practicing in public or private maternity units. Before and after the dissemination of the 2017 French guidelines on the prevention of spontaneous preterm birth, participants were asked to complete a web-based self-administered questionnaire based on two clinical vignettes. Vignette 1 focused on respondents' attitudes towards strict bed rest, cerclage, and progesterone treatment for women with a short cervix in mid-trimester; vignette 2 focused on attitudes towards strict bed rest and maintenance tocolysis after successful tocolysis for preterm labour. A mixed quantitative and qualitative analysis was conducted. Non-adherence to guidelines for the prevention of spontaneous preterm birth in responses to each vignette. We obtained complete responses from 286 obstetricians before and 282 obstetricians after guideline dissemination, including 145 obstetricians participating in both. After dissemination, 51.4% of obstetricians self-reported non-adherent practices for vignette 1 and 22.3% of obstetricians self-reported non-adherent practices for vignette 2. No improvement was observed after dissemination. The quantitative analysis identified factors associated with non-adherence, including older age and practice in non-university or small hospitals, whereas the qualitative analysis highlighted barriers to implementation, including fear of change, habits, work overload, and lack of time. Adherence to guidelines was generally low, with practices unmodified by their dissemination. Improvement is required, especially regarding applicability. Adherence to guidelines to prevent spontaneous preterm birth was generally low and remained unmodified after guideline dissemination.

Motivation to teach surgery at non-university affiliated hospitals in Saudi Arabia: A qualitative study

This article was migrated. The article was not marked as recommended. Background: Most Saudi Arabian medical colleges rely on non-university affiliated hospitals for clinical training of their students. We explored what motivates or demotivates the surgeons who work in these hospitals to teach. Methods: Eighteen surgeons from five non-university affiliated hospitals in the Al-Qassim region of Saudi Arabia who were directly involved in teaching surgery participated in this qualitative study. The surgeons' in-depth interviews with a semi-structured questionnaire were audio-taped, transcribed, and analyzed to identify responses related to motivating and demotivating factors for teaching surgery. Results: Surgeons identified three unique factors related to teaching: (1) to accumulate spiritual credit for good deeds (motivating), (2) refusal by patients to be examined by trainees (demotivating), and (3) refusal by female patients to be examined by male trainees (demotivating). Additional motivating factors were self-satisfaction, earning a good reputation, updating knowledge, and witnessing the success of trainees. The demotivating factors were unenthused trainees, inadequate teaching settings at the hospitals, an absence of medico-legal protection for the trainees, a heavy workload, and no incentives for teaching activities. Conclusion: Providing student-trainees legal protection, offering incentives for teaching, and marketing the hospitals as training facilities will likely improve the teaching environment in non-university affiliated hospitals in Saudi Arabia.

Time Tracking of Standard Ultrasound Examinations in Pediatric Hospitals and Pediatric Medical Practices - A Multicenter Study by the Pediatric Section of the German Society of Ultrasound in Medicine (DEGUM).

Ultrasonography is the primary imaging modality in pediatrics but still lacks sufficient reimbursement in Germany. In this multicenter study, national data for the duration of standard ultrasound in pediatrics were systematically documented in order to specify the actual time required. N = 10 hospitals (N = 5 university hospitals, N = 5 non-university hospitals) and N = 3 medical practices in Germany recorded the entire process of an ultrasound examination in a special protocol developed by the Pediatric Section of the DEGUM. The duration of each of seven single steps during ultrasonography (from data input to final discussion of the results) of different organ systems was logged. In total, N = 2118 examinations from different organ systems were recorded. N = 10 organ systems were examined frequently (> 30 times). The total duration of an ultrasound examination was statistically significantly longer in hospitals compared to medical practices (median (IQR) 27 min. (18-38) vs. 12 min. (9-17), p < 0.001). The "hands-on" patient time was approximately one half of the total required time in both settings (49.9 % vs. 48.9 %). Ultrasonography of the abdomen and brain lasted longer in university hospitals than in non-university hospitals (p < 0.001, and p = 0.04, respectively). Cooperation and age did not uniformly correlate with the total duration. This study provides novel comprehensive national data for the duration of standardized ultrasound examinations of children and adolescents in Germany. These data are essential for a further evaluation of the economic costs and should support better remuneration in the future.

2417. Feasibility and Safety of Using a Probiotic Comprised of Lactobacillus acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2 for C. difficile Infection Prevention Among Antibiotic Users: 15-Years of Prospective Results from a Single-Center

BackgroundHospitals use multiple concurrent prevention strategies to curb nosocomial C. difficile infection, but there are limited data on the long-term feasibility or safety of using a probiotic. Pierre-Le Gardeur Hospital, Québec, has been administering a probiotic comprised of Lactobacillus acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2 since 2004 with documented results through March 31, 2014. Here we present an update for the past 5 years.MethodsSeveral nosocomial infection prevention practices were running concurrently at the hospital. Adult inpatients treated with antibiotics from April 1, 2014 to March 31, 2019 were eligible to receive the probiotic. The hospital pharmacy ensured that each patient took the probiotic capsules (Bio-K+® 50 Billion) daily from the initiation of antibiotic use. Confirmed nosocomial cases of C. difficile infection were recorded and reported to the provincial public health agency. The rate of nosocomial CDI for this hospital was compared with other non-University affiliated hospitals in the health region with more than 110 beds and fewer than 45% of patients age 65 and older, and, to all other hospitals in the health system.ResultsCumulatively over the past 15 years, more than sixty thousand antibiotic-treated adult inpatients took the probiotic daily during antibiotic use. Among 13 comparable hospitals, Pierre-Le Gardeur Hospital had the lowest rate of nosocomial CDI in 2014–2015, 2015–2016, 2016–2017, 2017–2018 and on average had the lowest rate for 2013–2018 (1.1 CDI cases per 10,000 patient-days). Compared with all hospitals in the Province of Quebec health system, N = 95, the hospital had the lowest nosocomial CDI rate on average for 2013–2018. No cases of Lactobacillus bacteremia were detected.ConclusionThe overall infection prevention strategy has been highly effective, resulting in a consistently low rate of nosocomial CDI. We found that it is feasible to administer this probiotic to antibiotic-treated inpatients with few restrictions. No Lactobacillus infections were observed from any of the three strains of bacteria for this probiotic when given to more than sixty thousand adult inpatients. Disclosures All authors: No reported disclosures.

2813 Clinical Prediction of Unsuccessful Endometrial Ablation: Random Forest vs Logistic Regression

Study Objective To compare the performance of the prediction models of surgical re-intervention within 2 years after endometrial ablation (EA) by a multivariate random forest model vs the previously presented multivariate logistic regression model. Design Retrospective cohort study, minimal follow-up time of 2 years. Setting Data from Catharina Hospital, Eindhoven and Elkerliek Hospital, Helmond, both non-university teaching hospitals in the Netherlands, were used. Patients or Participants Pre-menopausal women (18+) who have had an EA for heavy menstrual bleeding between January 2004 & April 2013. A total number of 446 patients were eligible for analysis. Interventions Used ablation methods were Cavatherm (Veldana Medical SA, Morges, Switzerland), Gynecare Thermachoice (Ethicon, Sommerville, US.) and Thermablate EAS (Idoman, Ireland). Used interventions and other ablation techniques had the same outcomes according to previously published literature. Measurements and Main Results Data-analysis was done by using IBM SPSS statistics software version 21.0 (IBM Corp., Armonk, NY, USA). The random forest model was trained in MATLAB (2018b) using the TreeBagger function in the Statistics and Machine Learning Toolbox. The prediction model based on a multivariate logistic regression analysis had an AUC of 0.71. The machine learning model had an AUC of 0.63 and an AUC of 0.65 after hyperparameter optimization. Conclusion Based on the preliminary results, we can conclude that the random forest model in this case is not better than the logistic regression model to predict the outcome of surgical re-intervention within two years after EA. In summary, the performance of a random forest clinical prediction model is not necessarily superior to a logistic regression model. The performance of each model is influenced by the sample size, the number of predictors, hyperparameter tuning and the linearity of associations.