Non-hospital Setting Research Articles

A race against time – an evaluation of lifesaving treatment pathways for patients following cardiac arrest in a non-hospital setting.

BackgroundCardiac arrest occurs when the heart ceases pumping blood around the body. Most take place outside hospital. A sequence of effective interventions (a “chain of survival”) is essential for patient survival and recovery of organ function. Out of Hospital Cardiac Arrest (OHCA) requires prompt recognition and call for help, proficient CPR, early defibrillation and conveyance by the emergency services to an appropriate hospital. If initial resuscitation is successful, effective post-resuscitation care is required, delivered usually in the intensive care unit (ICU). New patient pathways were introduced following an update to national guidelines, which recommend conveyance of patients to centres with percutaneous coronary intervention (PCI) services where possible. ObjectiveWe have evaluated outcomes for patients, comparing those conveyed to PCI settings and those conveyed elsewhere to quantify the effect of the new patient pathway on mortality, survival and length of hospital stay. ApproachWe have linked electronic health records from emergency departments, acute hospital settings, ICUs and the national deaths register for OHCA patients living in Wales, UK. We have undertaken temporal analysis and time to event analysis to compare patient subgroups. ResultsVariation in patient pathways will be described using characteristics of conveyance method, the type of treating hospital and transfers between PCI and non-PCI settings adjusted for individual patient level confounders such as age, sex and comorbidities. ConclusionThis work is important to evaluate efficacy of operational procedures and inform national policies which aim to improve survival following OHCA and save lives.

A case of a lidocaine intoxication of a 12 week old boy due to a circumcision in a domestic setting - clinical, toxicological and forensic aspects.

Lidocaine is a local anaesthetic commonly used during circumcision for dorsal penile nerve block (DPNB). We describe a case of a 12-week-old infant who presented generalized seizures due to local anesthetic systemic toxicity after Lidocaine administration for circumcision in a non-hospital setting. Serum concentrations of Lidocaine (16.4mg/L) and its main active metabolite monoethylglycinexylidide (MEGX, 1.36mg/L) were determined by HPLC-DAD, in a sample collected shortly after administration, which were higher than in comparable cases reported in literature. The reason for the overdose was assumed to be accidental systemic application. Due to suspicion of an improperly performed circumcision and bodily harm, police was involved and a clinical forensic examination was carried out. Here, we present analytical, clinical and forensic aspects of this case.

Impact of the COVID-19 pandemic on the epidemiology of bronchiolitis at Hôpital du Jura in Delémont, Switzerland: a retrospective observational study.

Non-pharmaceutical interventions during the COVID-19 pandemic caused an unusual epidemiology in bronchiolitis hospitalisations, with a peak in the summer seasons of 2020 and 2021. The aim of this study was to analyse data from a 5-year period (2018-2022) at Hôpital du Jura in Delémont, Switzerland, regarding bronchiolitis hospitalisations before, during and towards the end of the COVID-19 pandemic in order to prepare for future changes in bronchiolitis epidemiology. Anonymous retrospective data on bronchiolitis hospitalisations for children under 2 years of age with hospital admission date from 1 January 2018 to 31 December 2022 was obtained from the Health Records Coding Unit of our hospital. A clear shift in the peak of bronchiolitis is seen in 2021 compared to the three previous years. Starting in spring 2022, the trend begins to mimic pre-pandemic years. For respiratory syncytial virus (RSV) bronchiolitis hospitalisations specifically, an important peak in hospitalisations is seen in the summer months of 2021, with over 20 admissions, compared to zero admissions in the previous years. This peak shifts to the winter months in 2022. The non-pharmacological interventions implemented during 2020 and early 2021 did not cause a long-lasting seasonal shift in bronchiolitis. In 2022, when the non-pharmacological interventions were no longer in place in the non-hospital setting, the peak of bronchiolitis hospitalisations is seen once again in the winter months. We predict that hospitalisation patterns will gradually revert to those of pre-pandemic years.

Surgical correction of senile entropion of the lower eyelid in non-hospital setting

Aim. To present a method for surgical correction of senile entropion by excision of a triangular musculocutaneous flap in non-hospital setting.Material and methods. We analyzed the outcome of surgical treatment of 11 patients aged 60–83 years diagnosed with senile entropion (3 men and 8 women). Out of the studied group, 3, 5 and 3 patients suffered from a mild, average and pronounced entropion degree, respectively (Bystrov’s classification, 1979). The results were assessed based on the presence of complications and the occurrence of relapses.Results. The recovery was observed in 9 patients; the disease recurrence – in 2 cases.Conclusion. The proposed method of surgical correction of senile entropion implies excision of a triangular musculocutaneous flap with the base to the outer or inner commissure of the eyelid with the movement of the sliding skin flap. The method showed high efficiency (81.8%) in eliminating the horizontal and vertical weakness of the musculocutaneous plate of the lower eyelid.

Peripheral Arterial Disease Treatment in the Non-Hospital Setting.

Treatment of peripheral artery disease (PAD) has undergone a progressive shift toward less invasive, endovascular options within the last three decades. For PAD patients, the benefits of this shift are numerous and include less periprocedural pain, decreased blood loss, shorter recovery times, and fewer missed workdays. Commonly, patient-reported outcomes are very positive with this "endovascular first" strategy and the number of open surgical procedures for various stages of PAD has declined steadily over the last 20 years. Coincident with this trend is the move toward "ambulatory" lower extremity arterial intervention (LEAI) in the hospital outpatient "same-day" department. The next logical extension was then performing LEAI in a true physician office-based lab (OBL), ambulatory surgical center (ASC), or "non-hospital setting." This article examines these trends and the concept that the OBL/ASC provides a safe, alternative site of service for PAD patients requiring LEAI.

Disparities in asthma place of death among races and ethnicities in the United States and Puerto Rico

Non-Hispanic Black individuals (NHB) and Puerto Rico residents (PR) have higher risk of dying from asthma as underlying cause, compared to Non-Hispanic White individuals (NHW). The place of death, whether at hospital or non-hospital setting, such as residence, has not been compared by ethnicity or race.

A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications in Non-Hospital Care Settings in 2021.

The scope of antimicrobial stewardship programs has expanded beyond the acute hospital setting. The need to optimize antimicrobial use in emergency departments, urgent, primary, and specialty care clinics, nursing homes, and long-term care facilities prompted the development of core elements of stewardship programs in these settings. Identifying the most innovative and well-designed stewardship literature in these novel stewardship areas can be challenging. The Southeastern Research Group Endeavor (SERGE-45) network evaluated antimicrobial stewardship-related, peer-reviewed literature published in 2021 that detailed actionable interventions specific to the nonhospital setting. The top 13 publications were summarized following identification using a modified Delphi technique. This article highlights the selected interventions and may serve as a key resource for expansion of antimicrobial stewardship programs beyond the acute hospital setting.

Clinical characteristics and laboratory parameters of deep venous thrombosis after SARS-CoV-2 infection in a non-hospital setting – a single-center retrospective study

To assess the differences in clinical and laboratory parameters of non-hospitalized patients with deep venous thrombosis (DVT) according to the SARS-CoV-2 status. We retrospectively reviewed demographic, clinical, laboratory, and ultrasound data of adult patients admitted to the Emergency Department of University Hospital Split between March 2020 and January 2021. Patients were classified into three groups: recent COVID-19 (<1 month), non-recent COVID-19 (1 to 12 months), and non-COVID-19. Fifty (47.2%) of 106 patients had a history of SARS-CoV-2 infection (23 patients in the recent COVID-19 and 27 in non-recent COVID-19 group). The three groups did not significantly differ in demographic and clinical parameters, including the location of deep venous thrombosis. The recent COVID-19 group had significantly higher neutrophils and CRP levels, and significantly lower prothrombin than the other two groups. Our results confirm the role of elevated inflammatory and coagulation response in DVT development in the first month after the infection, but not in non-recent COVID-19 or non-COVID-19 patients.

Association between antidepressant use and ED or hospital visits in outpatients with SARS-CoV-2

Antidepressants have previously been associated with better outcomes in patients hospitalized with COVID-19, but their effect on clinical deterioration among ambulatory patients has not been fully explored. The objective of this study was to assess whether antidepressant exposure was associated with reduced emergency department (ED) or hospital visits among ambulatory patients with SARS-CoV-2 infection. This retrospective cohort study included adult patients (N = 25 034) with a positive SARS-CoV-2 test performed in a non-hospital setting. Logistic regression analyses tested associations between home use of antidepressant medications and a composite outcome of ED visitation or hospital admission within 30 days. Secondary exposures included individual antidepressants and antidepressants with functional inhibition of acid sphingomyelinase (FIASMA) activity. Patients with antidepressant exposure were less likely to experience the primary composite outcome compared to patients without antidepressant exposure (adjusted odds ratio [aOR] 0.89, 95% CI 0.79–0.99, p = 0.04). This association was only observed with daily doses of at least 20 mg fluoxetine-equivalent (aOR 0.87, 95% CI 0.77–0.99, p = 0.04), but not with daily doses lower than 20 mg fluoxetine-equivalent (aOR 0.94, 95% CI 0.80–1.11, p = 0.48). In exploratory secondary analyses, the outcome incidence was also reduced with exposure to selective serotonin reuptake inhibitors (aOR 0.87, 95% CI 0.75–0.99, p = 0.04), bupropion (aOR 0.70, 95% CI 0.55–0.90, p = 0.005), and FIASMA antidepressant drugs (aOR 0.87, 95% CI 0.77–0.99, p = 0.03). Antidepressant exposure was associated with a reduced incidence of emergency department visitation or hospital admission among SARS-CoV-2 positive patients, in a dose-dependent manner. These data support the FIASMA model of antidepressants’ effects against COVID-19.

Use of Electrocardiogram Monitoring in Adult Patients Taking High-Risk QT Interval Prolonging Medicines in Clinical Practice: Systematic Review and Meta-analysis.

IntroductionElectrocardiogram (ECG) monitoring is an important tool to detect and mitigate the risk of potentially fatal drug-induced QT prolongation and remains fundamental in supporting the quality use of high-risk QT interval prolonging medicines.ObjectiveThe aim of this systematic review was to determine the prevalence of baseline and/or follow-up ECG use in adult patients taking high-risk QT interval prolonging medicines in clinical practice.MethodsCINAHL, Cochrane Library, Embase, PubMed, EThOS, OpenGrey and Proquest were searched for studies in adults that reported ECG use at baseline and/or at follow-up in relation to the initiation of a high-risk QT interval prolonging medicine in any clinical setting; either hospital or non-hospital. Two reviewers independently assessed the methodological quality of included studies. Proportional meta-analysis was conducted with all studies reporting baseline ECG use, before medicine initiation, and follow-up ECG use, within 30 days of medicine initiation.ResultsThere was variability in baseline ECG use according to the practice setting. The prevalence of baseline ECG use for high-risk QT interval prolonging medicines was moderate to high in the hospital setting at 75.1% (95% CI 64.3–84.5); however, the prevalence of baseline ECG use was low in the non-hospital setting at 33.7% (95% CI 25.8–42.2). The prevalence of follow-up ECG use was low to moderate in the hospital setting at 39.2% (95% CI 28.2–50.8) and could not be determined for the non-hospital setting.ConclusionsThe use of ECG monitoring for high-risk QT interval prolonging medicines is strongly influenced by the clinical practice setting. Baseline ECG use occurs more in the hospital setting in comparison to the non-hospital setting. There is lower use of follow-up ECG in comparison to baseline ECG.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40264-022-01215-x.

Bacterial and fungal communities in indoor aerosols from two Kuwaiti hospitals.

The airborne transmission of COVID-19 has drawn immense attention to bioaerosols. The topic is highly relevant in the indoor hospital environment where vulnerable patients are treated and healthcare workers are exposed to various pathogenic and non-pathogenic microbes. Knowledge of the microbial communities in such settings will enable precautionary measures to prevent any hospital-mediated outbreak and better assess occupational exposure of the healthcare workers. This study presents a baseline of the bacterial and fungal population of two major hospitals in Kuwait dealing with COVID patients, and in a non-hospital setting through targeted amplicon sequencing. The predominant bacteria of bioaerosols were Variovorax (9.44%), Parvibaculum (8.27%), Pseudonocardia (8.04%), Taonella (5.74%), Arthrospira (4.58%), Comamonas (3.84%), Methylibium (3.13%), Sphingobium (4.46%), Zoogloea (2.20%), and Sphingopyxis (2.56%). ESKAPEE pathogens, such as Pseudomonas, Acinetobacter, Staphylococcus, Enterococcus, and Escherichia, were also found in lower abundances. The fungi were represented by Wilcoxinia rehmii (64.38%), Aspergillus ruber (9.11%), Penicillium desertorum (3.89%), Leptobacillium leptobactrum (3.20%), Humicola grisea (2.99%), Ganoderma sichuanense (1.42%), Malassezia restricta (0.74%), Heterophoma sylvatica (0.49%), Fusarium proliferatum (0.46%), and Saccharomyces cerevisiae (0.23%). Some common and unique operational taxonomic units (OTUs) of bacteria and fungi were also recorded at each site; this inter-site variability shows that exhaled air can be a source of this variation. The alpha-diversity indices suggested variance in species richness and abundance in hospitals than in non-hospital sites. The community structure of bacteria varied spatially (ANOSIM r2 = 0.181–0.243; p < 0.05) between the hospital and non-hospital sites, whereas fungi were more or less homogenous. Key taxa specific to the hospitals were Defluvicoccales, fungi, Ganodermataceae, Heterophoma, and H. sylvatica compared to Actinobacteria, Leptobacillium, L. leptobacillium, and Cordycipitaceae at the non-hospital site (LefSe, FDR q ≤ 0.05). The hospital/non-hospital MD index > 1 indicated shifts in the microbial communities of indoor air in hospitals. These findings highlight the need for regular surveillance of indoor hospital environments to prevent future outbreaks.

PO-697-03 CATHETER ABLATION OF ATRIAL FIBRILLATION IN THE AMBULATORY SURGICAL CENTER DURING THE SARS-COV-2 PANDEMIC

The scheduling of elective ablation procedures in hospitals has been significantly disrupted by the SARS-CoV-2 pandemic. Between March 2020 and December 2021, we performed approximately 500 AF ablations in our specialized heart rhythm ambulatory surgical center. Describe the clinical effectiveness and safety of symptomatic patients with Atrial Fibrillation (AF) or Atypical Atrial Flutter (AAFL) undergoing ablation in the non-hospital setting with same day discharge. All patients received general anesthesia and intubation. Intravenous Heparin was administered to maintain an ACT of > 350 sec. throughout the procedure. A TEE or intracardiac echo was performed to guide trans-septal access. Carto 3 Version 7 (Biosense Webster, CA) was used in all patients; LA mapping consisted of a PENTARAY catheter, and ablation was performed with an Irrigated STSF 8F catheter. The end-point of the procedure was pulmonary vein isolation (PVI) and absence of inducible AF or AAFL and conduction block across ablation lines. Reversal of Heparin was achieved with intravenous Protamine. The study group consists of 652 consecutive patients (83 men, mean age 72 +/- 8 years), including the first patient enrolled in 04/2020. There were 90 patients with paroxysmal AF, 535 patients with persistent AF and/or AAFL. 345 patients (53%) were undergoing their first ablation procedure. PVI was achieved in all patients. LA lines with conduction block (Roof, Mitral Isthmus and/or Septal) were performed in 550 patients (86%). Procedure duration varied between 61-247 minutes (mean 114.9). The total time in the ASC varied between 5.2-14.5 hours (mean 6.4). All except 3 patient were discharged home the same day as the procedure. Complications: 1 acute pericardial eff req. paracentesis, 2 large hematoma req. hospitalization without intervention, 1 protamine anaphylactic rxn treated prior to discharge. The overall major complication rate was <1%. Throughout the pandemic, the ASC has provided an effective outpatient setting to safely perform ablation of AF and AAFL. These findings have important implications for interventional electrophysiology, and support a shift of health care delivery of performing complex ablations in a lower cost and non-hospital setting.

PO-697-06 INTERVENTIONAL ELECTROPHYSIOLOGY IN THE AMBULATORY SURGICAL CENTER DURING SARS-COV-2 PANDEMIC

The SARS-CoV-2 pandemic has resulted in major disruptions of patient care due to suspension or cancellation of elective hospital procedures. In response, the Center for Medicare and Medicaid Services (CMS) created the Hospitals Without Walls program and authorized Ambulatory Surgical Centers (ASC) to provide services as a hospital. Demonstrate how our first-in-nation dedicated ASC in cardiac electrophysiology was able to perform therapeutic procedures in patients with arrhythmias throughout the pandemic. The ASC consists of 4,961 square feet, with 2 procedure rooms equipped with imaging and 3D mapping systems and 6 recovery room beds. Patients with cardiac arrhythmias were evaluated in the outpatient office, had pre-admission labs including COVID-19 testing and were discharged on the same day of their intervention. This prospective study group consists of 1686 procedures in 1070 patients. A TEE/ Cardioversion was performed in 208. Device implantation was performed in 552 (Pacemakers:156, Defibrillators:70, Bi-Ventricular devices: 49). Radiofrequency Ablation (RFA) was done in 1134 patients (Supraventricular Tachycardia:374, Atrial Fibrillation:662, Ventricular tachycardia:180). Complications resulting in patients requiring hospital admission occurred in 4 patients (Protamine reaction in 1 patient, Pericardial Effusion in 1 patient and groin hematoma in 2 patients) During the continued pandemic, the ASC has provided an alternative non-hospital setting for patients with cardiac arrhythmias who require invasive procedures. As a novel concept in the health care delivery of patient with cardiac arrhythmias, a specialized ASC in cardiac electrophysiology can successfully and safely treat patients in a non-hospital and lower cost environment.

Research Subject Perceptions Regarding Infection Control Procedures to Reduce COVID-19

IntroductionThe COVID pandemic has altered health care delivery, including clinical research, by introduction of measures to reduce COVID. How these measures affect clinical research participation is unclear.ObjectivesThe purpose of this survey was to document research volunteer's attitudes toward COVID infection control procedures.MethodsOur research program implemented the following: 1. Staff wore masks, disposable gowns, face shields and gloves when with subjects. 2. Subjects were asked if they tested positive or were experiencing COVID symptoms; upon entry their temperature was measured, and hand sanitizer used. 3. Disinfecting was expanded to all scanner room surfaces in contact with humans between each visit. 4. Only 1 subject was allowed in the research office at a time. Staff, when possible, remained > 6 feet away from other persons. As part of a study evaluating total body DXA, community dwelling volunteers completed a self-administered health care delivery preference survey from Dec 2020 to May 2021. A 5-point scale was used to capture responses to 10 questions (Table 1). Responses were tested using Chi Square with age and sex comparisons assessed by ANOVA.ResultsEighty-two adults (41F/41M) mean (SD) age 50.9 (18.3) yrs (range 18-79) without sex difference participated. Participants strongly agreed (84%; p < 0.001) they were more comfortable seeing effort to prevent COVID-19; 72% agreed 1 subject, without a companion, should be seen, and 81% strongly agreed masks be required. Seeing staff clean visit space was important to 66%, more so among women (33%) than men (21% (p = 0.007)). Most subjects (83%) reported comfort having elective procedures and did not feel “unclean” or “diseased” (87%) by procedures. Some, 26%, preferred a non-hospital setting, 66% were neutral; those age 50+ (17%) preferred this more (p = 0.004) than younger subjects (5%). Finally, 91% preferred to have a brief test description before visit arrival.ConclusionsIn this university-based study, most subjects favored masking, cleaning and limiting personal contact for research visits. Notably, no information regarding vaccination status was exchanged and the study began just as vaccines became available and ended just after all US citizens over age 16 were eligible for vaccination. Thus, it is unknown if vaccination status might alter research participation perception. However, people do prefer that steps are taken to reduce infection in research settings. It seems likely that this would be the case in clinical care settings.

Clinical decision support systems to guide healthcare providers on HIV testing.

To understand the impact of clinical decision support systems (CDSSs) on improving HIV testing and diagnosis. An original global systematic review (PROSPERO Number: CRD42020175576) of peer-reviewed articles reporting on electronic CDSSs that generate triggers encouraging healthcare providers to perform an HIV test. Medline, Embase, Cochrane CENTRAL and CINAHL EBSCOhost were searched up to 17 November 2020 and reference lists of included articles were checked. Qualitative and quantitative syntheses (using meta-analyses) of identified studies were performed. The search identified 1424 records. Twenty-two articles met inclusion criteria (19 of 22 non-HIV endemic settings); 18 clinical and four laboratory-driven reminders. Reminders promoted 'universal' HIV testing for all patients without a known HIV infection and no recent documented HIV test, or 'targeted' HIV testing in patients with clinical risk-factors or specific diagnostic tests. CDSSs increased HIV testing in hospital and nonhospital setting, with the pooled risk-ratio amongst studies reporting comparable outcome measures in hospital settings (n = 3) of 2.57 [95% confidence interval (CI) 1.53-4.33, random-effect model] and in nonhospital settings (n = 4) of 2.13 (95% CI 1.78-4.14, random effect model). Results of the clinical impact of CDSSs on HIV diagnosis were mixed. CDSSs improve HIV testing and may, potentially, improve diagnosis. The data support the broader study of CDSSs in low- and high prevalent HIV settings to determine their precise impact on UNAIDS goals to reach universal HIV testing and treatment coverage.

Asymptomatic SARS-COV-2 carriage and sero-positivity in high risk contacts of COVID-19 cases’

PurposeIdentifying asymptomatic SARS-COV-2 carriage is one of the crucial factors in controlling the COVID 19 pandemic. The relationship between the asymptomatic viral carriage and the rate of seroconversion needs better understanding. The present study was conducted to identify the asymptomatic COVID-19 infection and seropositivity in high-risk contacts in the southern district of Delhi, India. MethodsFollowing the screening of 6961 subjects, a total of 407 asymptomatic high-risk subjects were selected. Demographic data, socioeconomic status, and history of COVID-19 related symptoms in the last 4 months were recorded. Blood samples and Nasopharyngeal/oropharyngeal swabs were collected for the detection of SARS-COV-2 RNA and anti-SARS-COV-2 antibodies. Results55 asymptomatic high-risk subjects (13.5%) tested positive for SARS-COV-2 infection and among them, 70.9% remained asymptomatic throughout their course of infection. The seropositivity among the subjects was 28.9% (n ​= ​118) and was found significantly higher among lower-middle socioeconomic strata (p ​= ​0.01). The antibody levels were significantly higher (p ​= ​0.033) in individuals with a previous history of COVID-19 like symptoms as compared to the subjects, who had no such history. Asymptomatic healthcare workers showed a significantly increased rate of SARS-COV-2 infection (p ​= ​0.004) and seropositivity (p ​= ​0.005) as compared to the non-healthcare workers. Subjects, who were exposed to infection at their workplace (non-hospital setting) had the least RT-PCR positivity rate (p ​= ​0.03). ConclusionsA large proportion of SARS-COV-2 infection remains completely asymptomatic. The rate of asymptomatic carriage and seropositivity is significantly higher in healthcare workers as compared to the general population. The level of SARS-COV-2 antibodies is directly related to the appearance of symptoms. These observations may contribute to redefining COVID 19 screening, infection control, and professional health practice strategies.

Factors Associated with Neonatal Mortality among Newborns Admitted in the Special Care Baby Unit of a Nigerian Hospital.

With Nigeria being one of the countries with the highest neonatal mortality rate globally, identifying the risk factors associated with neonatal mortality is essential as we strive to proffer sustainable solutions. This retrospective hospital-based survey aimed to bridge this gap by evaluating the trends and risk factors associated with neonatal mortality in a teaching hospital in Southwestern Nigeria. Records of newborns admitted at the special care baby unit from January 2018 to December 2019 (n = 1098) were accessed, and available data were extracted. Descriptive analysis and inferential statistics were performed at 0.05 level of significance. The mortality rate was determined to be 16.9% (inborn babies- 12.9% and out-born babies- 22.3%), with 83.3% of the newborns dying within the first week. Some of the factors associated with neonatal mortality were proximity of newborns' mothers home to the hospital [p = 0.041; Odds Ratio (OR) = 0.670; 95% Confidence Interval (CI) = 0.455-0.985], maturity of the baby at delivery (p < 0.001; OR = 0.514; CI = 0.358-0.738), place of delivery-inborn or out-born (p < 0.001; OR = 0.515; CI = 0.375-0.709), place of delivery-in a hospital or a non-hospital setting (p = 0.048; OR = 0.633; CI = 0.401-0.999), and baby's weight (p < 0.001; CI = -0.684 to -0.411). Findings from the study indicate that newborns delivered at home, traditional birth attendant centres or hospitals without essential healthcare facilities have a higher mortality risk. This suggests that measures to improve the accessibility of pregnant women to essential healthcare services are a prerequisite to reducing the neonatal mortality rate in Nigeria.

Resistance profile of bacteria to antibiotics in an out hospital environment

For an increasing number of infections and causative agents, treatment becomes more difficult or impossible because of the loss of antibiotic efficacy. As a result, resistance is a real public health problem. The purpose of this study is to evaluate the frequency of community bacterial infection as well as to establish a susceptibility profile of bacteria isolated from antibiotics. It is a prospective study, descriptive type. It was conducted in a non-hospital setting over a six-month period. The inclusion criteria were all positive specimens: urinary examination, vaginal sampling, urethral sampling, pus, sputum, sperm. Exclusion criteria included patients with negative examinations and other microorganisms (viruses, fungal infections and parasites). The data collection was done using an information sheet. An antibiogram is performed for the study of resistance. Data mining was performed and analyzed statistically. Of 1565 samples that met the inclusion criteria, 1228 strains were Gram-negative bacilli (78.46%), 323 Gram-positive cocci (20.64%), 14 Gram-negative cocci (0.9%). The sex ratio was 2.2. The distribution of isolates showed a predominance of urinary examinations 1076 (68.8%), vaginal samples 195 (12.5%), urethral specimens 111 (7.1%), sputum 105 (6.7%), spermocultures 36 (2.3%), plus 28 (1.8%) and various 14 (0.8%). It was represented by Escherichia coli 986 (63.1%), Klebsiella pneumoniae 235 (15.1%), Staphylococcus sp 106 (6.8%), Enterococcus sp 64 (4.1%), Streptococcus sp 59 (3%). , 8%), Enterobacter sp 39 (2.5%), Pseudomonas sp 28 (1.7%), Proteus sp 25 (1.5%), Neisseria gonorrhoae 13 (0.8%), Citrobacter koseri 8 (0%) , 5%) and Acinetobacter sp 2 (0.1%). The susceptibility frequency of enterobacteria is represented by amoxicillin + clavulanic acid 49.3%, ceftriaxone 97.1%, cefuroxime 89%, cefotaxime 100%, gentamicin 69.6%, ciprofloxacin 75.1% , sulfamethoxazole-trimethoprim 41.1% and doxycycline 29.9%.

Higher Medicare Spending On Imaging And Lab Services After Primary Care Physician Group Vertical Integration.

In recent years direct ownership of physician practices by hospitals and health systems (that is, vertical integration) has become a prominent feature of the US health care system. One unexplored impact of vertical integration is the impact on referral patterns for common diagnostic tests and procedures and the associated spending. Using a 100percent sample of 2013-16 Medicare fee-for-service claims data, we examined whether hospital and health system ownership of physician practices was associated with changes in site of care and Medicare reimbursement rates for ten common diagnostic imaging and laboratory services. After vertical integration, the monthly number of diagnostic imaging tests per 1,000 attributed beneficiaries performed in a hospital setting increased by 26.3 per 1,000, and the number performed in a nonhospital setting decreased by 24.8 per 1,000. Hospital-based laboratory tests increased by 44.5 per 1,000 attributed beneficiaries, and non-hospital-based laboratory tests decreased by 36.0 per 1,000. Average Medicare reimbursement rose by $6.38 for imaging tests and $0.57 for laboratory tests, which translates to $40.2million and $32.9million increases in Medicare spending, respectively, for the entire study period. This study highlights how the growing trend of vertical integration, combined with differences in Medicare payment between hospitals and nonhospital providers, leads to higher Medicare spending.

Interventions to reduce social isolation and loneliness during COVID-19 physical distancing measures: A rapid systematic review.

A significant proportion of the worldwide population is at risk of social isolation and loneliness as a result of the COVID-19 pandemic. We aimed to identify effective interventions to reduce social isolation and loneliness that are compatible with COVID-19 shielding and social distancing measures. In this rapid systematic review, we searched six electronic databases (Medline, Embase, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews and SCOPUS) from inception to April 2020 for systematic reviews appraising interventions for loneliness and/or social isolation. Primary studies from those reviews were eligible if they included: 1) participants in a non-hospital setting; 2) interventions to reduce social isolation and/or loneliness that would be feasible during COVID-19 shielding measures; 3) a relevant control group; and 4) quantitative measures of social isolation, social support or loneliness. At least two authors independently screened studies, extracted data, and assessed risk of bias using the Downs and Black checklist. Study registration: PROSPERO CRD42020178654. We identified 45 RCTs and 13 non-randomised controlled trials; none were conducted during the COVID-19 pandemic. The nature, type, and potential effectiveness of interventions varied greatly. Effective interventions for loneliness include psychological therapies such as mindfulness, lessons on friendship, robotic pets, and social facilitation software. Few interventions improved social isolation. Overall, 37 of 58 studies were of "Fair" quality, as measured by the Downs & Black checklist. The main study limitations identified were the inclusion of studies of variable quality; the applicability of our findings to the entire population; and the current poor understanding of the types of loneliness and isolation experienced by different groups affected by the COVID-19 pandemic. Many effective interventions involved cognitive or educational components, or facilitated communication between peers. These interventions may require minor modifications to align with COVID-19 shielding/social distancing measures. Future high-quality randomised controlled trials conducted under shielding/social distancing constraints are urgently needed.