Patients In General Hospital Research Articles

Association of Nucleophosmin-1 (NPM1) Expression with Leucocyte Count, Blast Count, and Gingiva Hypertrophy in Acute Myeloid Leukemia De Novo Patients in General Hospital of Dr M Djamil Padang Indonesia

Acute myeloid leukemia (AML) is a malignant disease derived from hematopoietic system characterized by neoplastic transformation of myeloid progenitor cell, present as excessive proliferation and differentiation alteration leading to inhibition of myeloid maturation. From various studies, incident and prevalence of AML these days is increasing in morbidity and mortality. This make AML known with poor prognosis. Nucleophosmin-1 (NPM-1) was established by WHO revision 2016 as prognostic gene marker in AML. Nucleophosmin-1 gene is mutated in 35-60% of AML cases. Recently, molecular biologic development suggests that prognostic gene examination is needed to reduce morbidity and mortality of AML patients. If myeloid progenitor cell encounters carcinogenic/leukemogenic stresses, mutation of several genes could happen. NPM1 gene is a likely mutated gene and predominantly located in nucleolus. Overexpression of NPM1 will promote activities of tumor suppressors like P53, ARF and MDM2. Interactions of those tumor suppressors promote proliferation, differentiation, cell survival, apoptosis and DNA repair, which give a better prognosis in AML patients. To study about association of NPM1 expression with leucocyte count, blast count, and gingiva hypertrophy in AML de novo patients in general hospital of Dr M Djamil Padang, Indonesia. Analytic observational study with cross-sectional approach to 25 adult AML patients from Policlinic and Inpatient Installation of Dr M Djamil Hospital from March to August 2018 who met inclusion and exclusion criteria. Expression of NPM1 was measured with qRT-PCR. We found significant increase of NPM1 expression in AML in the amount of 22.62x107 copies/ml. There was a significant very strong correlation between NPM1 expression and leucocyte count (p<0.05 & r=0.870) and blast count (p<0.05 & r=0.828). There was also significant differences of NPM1 expression in AML patients with gingival hypertrophy and without gingival hypertrophy (31.3 x 107 copies/ml dan 9.6 x 107 copies/ml). There was a significant very strong correlation between NPM1 expression with leucocyte count and blast count. There was significant increases of NPM1 expression in AML patients with gingival hypertrophy. Keywords: acute myeloid leukemia, Nucleophosmin-1, leucocyte, blast, gingival hypertrophy Disclosures No relevant conflicts of interest to declare.

Hypercalcaemia management in in-patients in a district general hospital

Hypercalcaemia management in in-patients in a district general hospital

Focusing on Good Responders to Pneumococcal Polysaccharide Vaccination in General Hospital Patients Suspected for Immunodeficiency. A Decision Tree Based on the 23-Valent Pneumococcal IgG Assay.

Background and Aim: Recently, the 23-valent IgG-assay was suggested as screening assay to identify poor responders to pneumococcal polysaccharide (PnPS)-vaccination with the serotype-specific assay as a second-line test. However, in a low pre-test probability general hospital setting predicting good responders could be more valuable to reduce the number of samples needing serotyping.Methods: Serotype-specific PnPS antibody-assays were performed for suspected immunodeficiency in two Dutch general hospitals (Jeroen Bosch Hospital, 's-Hertogenbosch; Elisabeth Tweesteden Hospital, Tilburg). 23-Valent PnPS antibody-assays were subsequently performed in archived material. Data were analyzed using receiver operating characteristic curves (AUC) and agreement indices (ICC).Results: Sera of 284 patients (348 samples) were included; 23-valent IgG-titres and the corresponding sum of PnPS-serotype specific antibodies showed moderate correlation (ICC = 0.63). In 232 conjugated-pneumococcal-vaccine-naïve patients (270 samples), a random 23-valent IgG-titer could discriminate between samples with and without ≥7/11, ≥7/13, or ≥6/9 pneumococcal serotypes when both cut-off values 0.35 and 1.0 μg/ml were used (AUC 0.86 and 0.92, respectively). All patients with a pre-immunization-titer ≥38.2 μg/ml and/or post-immunization-titer ≥96.1 μg/ml and none with a post-immunization-titer ≤38.5 μg/ml exhibited a good response to PnPS vaccination. Using these breakpoints as screening test to predict good responders, only 24% of patients would require further serotyping, as opposed to 68% if breakpoints to predict poor responders would have been used.Conclusion: In a low pre-test probability setting, the 23-valent IgG-assay proved to be a reliable screening test for good responders in conjugated-pneumococcal-vaccine-naïve patients, reducing the overall number of patient samples needing further serotyping, thus reducing overall costs of pneumococcal vaccination response assessment.

84. Evaluation of the NHSN Standardized Infection Ratio (SIR) Risk Adjustment for HO-CDI in Oncology and ICU Patients in General Acute Care Hospitals

BackgroundThe NHSN healthcare-facility onset Clostridioides difficile infection (CDI) standardized infection ratio (SIR) is used to compare hospital quality and set hospital reimbursement but inadequate risk adjustment could penalize hospitals unnecessarily. We hypothesized that general hospitals with large oncology and/or ICU populations were not fully adjusted in the 2015 NHSN acute care hospital CDI Laboratory-Identified (LabID) event prediction model and SIRs would be affected.MethodsWe validated a negative binomial regression HO-CDI event prediction model identical to the 2015 published model and used FY2016 data from eight general hospitals in California to test our hypothesis. We compared HO-CDI events and SIR values, with and without oncology/hematopoietic stem cell transplant or ICU unit events, patient-days, admissions, bed counts, and adjustment parameters included.ResultsSeven major teaching and one nonteaching general acute care hospitals were included (see Table). Eight had oncology/hematopoietic stem cell transplant units; seven had ≥43 ICU beds (median: 134; interquartile range [IQR]: 84–161). The median facility unmodified FacWideIn SIR was 1.23 [IQR: 1.15, 1.29]. Removal of oncology unit data resulted in a 15% median facility decrease in HO-CDI events (IQR: 14%, 21%) and −8% median facility decrease in SIR (IQR: −2%, −14%). Removal of ICU unit data resulted in a 22% median facility decrease in HO-CDI events (IQR: 16%, 26%) and 97% median facility increase in SIR at each facility (IQR: 78%, 105%).ConclusionThe ICU bed adjustment in the 2015 NHSN SIR is a powerful correction that fully adjusted for ICU HO-CDI events at all hospitals in the study. However, the lack of risk adjustment for oncology/hematopoietic stem cell transplant unit HO-CDI events suggests that the current model unfairly penalizes general acute facilities, many of which also provide specialized oncologic care. Thus, the model needs to be re-adjusted to account for this important specialty care population in general acute care facilities. Disclosures All Authors: No reported Disclosures.

Care challenges in older general hospital patients : Impact of cognitive impairment and other patient-related factors.

BackgroundOlder general hospital patients, particularly those with cognitive impairment, frequently experience adverse events and other care complications during their stay. As these findings have so far been based on small and selected patient samples, the aim of the present study was to provide reliable data on a) the prevalence of adverse care issues (summarized under the term care challenges) in older general hospital patients and on b) associated patient-related risk factors (e.g. cognitive impairment).MethodsA cross-sectional representative study comprising 1469 patients aged ≥65 years from 33 randomly selected general hospitals in southern Germany (GHoSt). Data collection included the use of different data sources, e.g. structured interviews with responsible nursing staff concerning care challenges and procedures for determining the patients’ cognitive status.ResultsCare challenges were statistically significantly (p < 0.001) more often reported for patients with dementia and/or delirium (87.5%) and mild cognitive impairment (47.9%) compared to cognitively unimpaired patients (24.6%). Adjusted odds ratios suggested cognitive impairment, impaired activities of daily living, receiving long-term care and unplanned admission as significant patient-related risk factors for care challenges. Furthermore, the occurrence of such issues was associated with the application of physical restraints, support from relatives, prescription of psycholeptics and specialist consultations.ConclusionThe findings suggest a strong impact of different degrees of cognitive impairment on challenges in care. The results might help to design appropriate training programs for hospital staff and other interventions to prevent or reduce critical situations.

Effects of anxiety and depression and early detection and management of emotional distress on length of stay in hospital in non-psychiatric inpatients in China: a hospital-based cohort study

BackgroundEmotional distress, including anxiety and depression, is associated with negative outcomes (such as poorer prognosis of physical diseases, longer hospital stays, and more readmissions) of patients in non-psychiatric settings. We investigated the effects of anxiety and depression, as well as the effects of early detection and management of emotional distress, in non-psychiatric inpatients on length of stay in hospital, with the aim of better informing the provision of medical care to meet the needs of non-psychiatric patients receiving general hospital care. MethodsThis real-world hospital-based cohort study included inpatients (aged ≥15 years) from 20 non-psychiatric departments in West China Hospital. The Huaxi emotional-distress index (HEI), a validated questionnaire for screening depression and anxiety in Chinese non-psychiatric clinical settings, was recommended for use in brief screening of non-psychiatric inpatients on their admission to hospital. Patients with depression or anxiety were provided with a graded psychological service, ranging from brief supportive care (for mild distress [HEI score 9–12]) to treatment by a psychiatrist or psychotherapist (for severe distress [HEI score ≥17]). Patients were grouped on the basis of whether brief screening and graded psychological service was provided (BS-GPS group) or not (non-BS-GPS group). Length of stay was compared between the groups and between patients with and without clinically significant anxiety or depression. FindingsFrom Jan 1, 2015, to Dec 31, 2018, 487 871 patients admitted to 20 non-psychiatric departments were included in the study, of whom 178 883 (36·7%) patients underwent brief screening on admission (BS-GPS group) and 308 988 (63·3%) patients were not screened (non-BS-GPS group). Across all departments, 9590 (5·4%) patients in the BS-GPS group (range 2·6–20·5% across departments) showed clinically significant anxiety or depression (ie, total HEI score ≥11). Mean length of stay differed significantly between patients with (12·7 days [SD 0·12]) and without (9·5 days [0·02], p<0·0001) clinically significant anxiety or depression, and between the BS-GPS group (9·6 days [0·02]) and the non-BS-GPS group (10·8 days [0·02], p<0·0001). These differences remained significant after controlling for sociodemographic factors and categories of physical diseases. InterpretationAnxiety and depression significantly prolonged the length of stay of non-psychiatric inpatients in general hospital. Early detection and management of emotional distress should be promoted and applied to better care for patients with non-psychiatric disorders and to conserve medical resources. Funding1.3.5 Project for Disciplines of Excellence of West China Hospital (Sichuan University), Science and Technology Benefit the People Project of Chengdu Municipal Government (grant numbers 2015-HM01-00011-SF and 2016-HM02-00095-SF), Science and Technology Support Program of Sichuan Provincial Government (grant number 2015SZ0058).

Mini-Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a secondary care setting.

The diagnosis of Alzheimer's disease dementia and other dementias relies on clinical assessment. There is a high prevalence of cognitive disorders, including undiagnosed dementia in secondary care settings. Short cognitive tests can be helpful in identifying those who require further specialist diagnostic assessment; however, there is a lack of consensus around the optimal tools to use in clinical practice. The Mini-Cog is a short cognitive test comprising three-item recall and a clock-drawing test that is used in secondary care settings. The primary objective was to determine the diagnostic accuracy of the Mini-Cog for detecting Alzheimer's disease dementia and other dementias in a secondary care setting. The secondary objectives were to investigate the heterogeneity of test accuracy in the included studies and potential sources of heterogeneity. These potential sources of heterogeneity will include the baseline prevalence of dementia in study samples, thresholds used to determine positive test results, the type of dementia (Alzheimer's disease dementia or all causes of dementia), and aspects of study design related to study quality. We searched the following sources in September 2012, with an update to 12 March 2019: Cochrane Dementia Group Register of Diagnostic Test Accuracy Studies, MEDLINE (OvidSP), Embase (OvidSP), BIOSIS Previews (Web of Knowledge), Science Citation Index (ISI Web of Knowledge), PsycINFO (OvidSP), and LILACS (BIREME). We made no exclusions with regard to language of Mini-Cog administration or language of publication, using translation services where necessary. We included cross-sectional studies and excluded case-control designs, due to the risk of bias. We selected those studies that included the Mini-Cog as an index test to diagnose dementia where dementia diagnosis was confirmed with reference standard clinical assessment using standardised dementia diagnostic criteria. We only included studies in secondary care settings (including inpatient and outpatient hospital participants). We screened all titles and abstracts generated by the electronic database searches. Two review authors independently checked full papers for eligibility and extracted data. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool. We extracted data into two-by-two tables to allow calculation of accuracy metrics for individual studies, reporting the sensitivity, specificity, and 95% confidence intervals of these measures, summarising them graphically using forest plots. Three studies with a total of 2560 participants fulfilled the inclusion criteria, set in neuropsychology outpatient referrals, outpatients attending a general medicine clinic, and referrals to a memory clinic. Only n = 1415 (55.3%) of participants were included in the analysis to inform evaluation of Mini-Cog test accuracy, due to the selective use of available data by study authors. There were concerns related to high risk of bias with respect to patient selection, and unclear risk of bias and high concerns related to index test conduct and applicability. In all studies, the Mini-Cog was retrospectively derived from historic data sets. No studies included acute general hospital inpatients. The prevalence of dementia ranged from 32.2% to 87.3%. The sensitivities of the Mini-Cog in the individual studies were reported as 0.67 (95% confidence interval (CI) 0.63 to 0.71), 0.60 (95% CI 0.48 to 0.72), and 0.87 (95% CI 0.83 to 0.90). The specificity of the Mini-Cog for each individual study was 0.87 (95% CI 0.81 to 0.92), 0.65 (95% CI 0.57 to 0.73), and 1.00 (95% CI 0.94 to 1.00). We did not perform meta-analysis due to concerns related to risk of bias and heterogeneity. This review identified only a limited number of diagnostic test accuracy studies using Mini-Cog in secondary care settings. Those identified were at high risk of bias related to patient selection and high concerns related to index test conduct and applicability. The evidence was indirect, as all studies evaluated Mini-Cog differently from the review question, where it was anticipated that studies would conduct Mini-Cog and independently but contemporaneously perform a reference standard assessment to diagnose dementia. The pattern of test accuracy varied across the three studies. Future research should evaluate Mini-Cog as a test in itself, rather than derived from other neuropsychological assessments. There is also a need for evaluation of the feasibility of the Mini-Cog for the diagnosis of dementia to help adequately determine its role in the clinical pathway.

Frequency of Homocysteinemia in Young Ischemic Stroke Patients and Its Relationship with the Early Outcome of a Stroke.

ObjectiveTo find out the frequency of hyperhomocysteinemia in young ischaemic stroke patients and its relationship with early morbidity and mortality.MethodsThis prospective study was conducted on young ischemic stroke patients in Pakistan Atomic Energy Commission General Hospital, Islamabad. Ischaemic stroke patients of age < 45 years were selected from both the outpatient and inpatient departments. A fasting venous blood sample was sent for analysis. Data was collected through a structured proforma and were analyzed using SPSS 24.0 (IBM Corp, Armonk, NY, US). The outcome was measured at discharge using the modified Rankin scale.ResultsThe mean age of the 71 patients in the study was 35.8 years. Overall, 36 (50.7%) cases had hyper-homocysteinemia. The frequency was significantly higher in males and in the age group 36-45 years (63.4%). Levels of homocysteine did not significantly affect the outcome at discharge.ConclusionHyperhomocysteinaemia, a modifiable risk factor for ischaemic stroke, was seen in about half of young stroke patients. The levels of homocysteine did not correlate with early stroke outcome.

Symptomatology differences of major depression in psychiatric versus general hospitals: A machine learning approach

BackgroundSymptomatology differences of major depressive disorder (MDD) in psychiatric and general hospitals in China leads to possible misdiagnosis. Looking at the symptomatology of first-visit patients with MDD in different mental health services, and identifying predictors of health-seeking behavior using machine learning may help to improve diagnostic accuracy. Methods1500 patients first diagnosed with MDD were recruited from 16 psychiatric hospitals and 16 general hospitals across China. Socio-demographic characteristics, causal attribution, symptoms of depression within and outside Diagnostic and Statistical Manual of Mental Disorders (DSM) framework were collected using a self-made questionnaire. A predictive model of 62 variables was established using Random forest, symptom frequencies of patients in general hospitals and psychiatric hospitals were compared. ResultsThe machine learning approach revealed that symptoms were strong predictors of health-seeking behavior among patients with MDD. General hospitals patients had higher frequencies of suicidal ideation (χ2=15.230, p<0.001), psychosis (χ2=14.264, p<0.001), weight change (all p<0.001), hypersomnia (χ2=25.940, p<0.001), and a tendency of denying emotional/cognitive symptoms compared with psychiatric hospitals patients. LimitationsStigma and preference bias were not measured. Severity of current depressive episodes was not assessed. Data of previous episode(s) was not presented. ConclusionsSymptom evaluation targeting specific patient population in different hospitals is crucial for diagnostic accuracy. Suicide prevention reliant on collaboration between general hospitals and psychiatric hospitals is required in the future construction of Chinese mental health system.

Suicide Prevention Strategies for General Hospital and Psychiatric Inpatients: A Narrative Review.

Background:In-patient (IP) suicides contribute a small but significant proportion of overall suicides. Despite this, suicide prevention strategies focusing on the general hospital IP population remain relatively underresearched. This paper is intended to provide an overview of various proposed suicide prevention approaches in the general hospital, including psychiatric IP, settings, and their evidence base.Methodology:Electronic searches of MEDLINE through PubMed, ScienceDirect, and Google Scholar databases were performed to identify potentially relevant articles from inception till January 2019. The generated abstracts were systematically screened for their eligibility to be included in the review. Included articles were grouped under five broad themes: environmental modification, staff education, pharmacotherapy, psychotherapy, and brain stimulation. Data extraction was done using a structured proforma.Results:Environmental modifications and educating the health care professionals appear to be the most promising strategies to reduce suicide-related mortality among IPs. Among pharmacological methods, ketamine has shown initial promise in reducing suicidal ideations. Follow-up data are lacking for most of the described methods. Limited but positive evidence exists for cognitive therapies focusing on the immediate postadmission period and brain stimulation techniques, and it warrants further replication.Conclusion:There is a striking paucity of original research on IP suicide prevention. Given the ethical and methodological issues in carrying out studies with IP suicide as the primary outcome, there is a need to focus on intermediate suicide outcome measures, such as knowledge, attitude, and skills among staff handlers of suicidal patients.

The prevalence of HIV infection in patients of general hospitals as a parameter for monitoring the system of epidemiological surveillance

Aim. The aim of this study is to compare the prevalence of HIV infection in patients of large multidisciplinary hospitals in providing emergency and planned medical care and to evaluate the value of the long-term dynamics of this indicator as a quantitative characteristic of the epidemic process of HIV infection. Materials and methods. We retrospectively analyzed the results of examination for HIV infection of patients in the Sklifosovsky Research Institute for Emergency Medicine (RIEM) and Moscow Regional Research Clinical Institute (MONIKI) from 2008 to 2017. Long-term dynamics of the prevalence HIV infection were analyzed by using linear regression analysis. The intensity of trends (growth/decline) was assessed by the criteria proposed by V. D. Belyakov et al. (1981). Results. We examined for HIV infection 251 213 and 165 194 people in the research RIEM and MONIKI, respectively. For decade, the number of hospitalizations of HIV-infected patients to RIEM increased by 1.7 times, to MONIKI by 3.1 times. Prevalence of HIV infection in the patients of RIEM exceeded MONIKI ones from 3,2 to 6,0 times. At the same time, MONIKI showed a statistically significant trend towards an increase in hospitalizations of HIV-infected citizens (R2=0,8049, p=0,0004) with a pronounced average annual growth rate of 9,6% per year. Conclusion. We obtained results indicates a tendency to increase the number of recourses HIV-infected persons to general hospitals inMoscow andMoscow region. The most significant average annual increase in the prevalence over a decade period were recorded in the intensive care (+14.2%) and surgical (+9.8%) departments of MONIKI. Indicator groups of high risk of HIV infection in theMoscow region should be considered patients with urgent surgical pathology, acute exogenous poisoning of chemical etiology, as well as persons suffering from mental disorders.

Prevalence and determinants of postoperative deficiencies secondary to bariatric surgery among patients in king fahad general hospital in Jeddah 2019

Introduction: Presently, bariatric surgery is considered the most compelling treatment modality for morbid obesity patient and one of the most effective procedures. The study aimed to identify the prevalence and determinants of patients’ compliance to the recommended vitamin and mineral supplements and to identify the prevalence and determinants of post-bariatric surgery nutritional deficiencies in King Fahad General Hospital in Jeddah city so as to improve the patients’ health. Materials and Methods: This is a cross-sectional study wherein a validated questionnaire was used to collect data and were encoded and analyzed using IBM SPSS version 23, (IBD Corp., Armonk, NY). Results: The findings of the study showed that nutritional deficiency is more likely to happen to female gender who is working. The study also revealed that deficiencies are common in HB, Vit D, Vit B12, calcium, iron and folate. The longer the period of intensive fluid taken following surgery increases the risk of vitamin deficiency. Furthermore, there’s low compliance to vitamins and supplements and patients who underwent bariatric surgery only become adherent to vitamins/minerals when they discover complications. Conclusion: This study concluded that there are various factors causing and affecting nutritional deficiencies preoperatively and postoperatively such as gender, work status, complications, and vitamins and supplements compliance. Overall, the present study concluded that it is imperative for the patients to adhere to vitamins and supplements intake according to the recommendation of the clinicians and dieticians. Keywords: Obesity, Bariatric surgery, Nutritional deficiency.

Hubungan waktu tunggu dan length of stay (LOS) Dengan kepuasan pasien di instalasi Gawat darurat rsud jombang

Introduction: Waiting time and length of stay ( LOS ) is one of indicators the quality of service in emergency room (ER ) that affects satisfaction patients, where speed and the accuracy is the essence service in ER. Research aims to understand the relations of waiting time and LOS with satisfaction patients in of emergency room Jombang general hospital. Method: This research using correlational design with cross sectional approached. The technique sampling is accidental sampling. The population were 1.204 people. And the sample size 60 people. Data collection used a questionnaire for measuring satisfaction patients and observation stopwatch a use for measuring waiting time and LOS. Data analyzed by statistical tests the spearman rank. Result: The results of the study obtained 31 people ( 51.7 % ) of respondents with waiting time slow, 24 people ( 40,0 % ) of respondents with los slow, while for the satisfaction of patients 31 people ( 51.7 % ) of a patient is satisfied with service. Statistical tests the spearman rank showsed that waiting time with satisfaction obtained r value = 0,666, p value = 0,000. To LOS with satisfaction the r value = 0,350, p value = 0,006. There is a significant relation exists between waiting time and LOS with satisfaction patients. Discussion: Waiting time and LOS significant correlated with satisfaction patients in ER Jombang general hospital. The ER in Jombang general hospital is expected to have strong commitment, to give priority to the quality of service and interests of patients. Health workers is expected to give rapid service, right and respond to the problem of patients. And advanced research required about satisfaction patients in ER and the supporting factors.

Studi Epidemiologi Kualitas Hidup Penderita Paska Stroke di RSUD Propinsi Nusa Tenggara Barat

troke is a leading cause of mortality and morbidity in Indonesia. Post stroke patients has a higher disability hence results in poor quality of life compared with normal population. In Indonesia, studies related to the quality of life of post-stroke patients are scarce, so studies are required to explore the quality of life of post-stroke patients, particularly in West Nusa Tenggara. Aim of this study is to determine the epidemiology of quality of life for post-stroke patients in West Nusa Tenggara. Methods of this study is An Observational with cross-sectional design was performed in population of post-stroke patients admitted to West Nusa Tenggara General Hospital. The quality of life of post stroke patient was evaluated with SSQOL (Stroke Specific Quality of Life) questionnaire. The collected data was analyzed by the appropriate test. Result of this study is the average age of subject is 60.33±10.68 years. Hypertension is a major risk factor of stroke. The average SSQOL score is 177.02±45.75. SSQOL assesses 4 dimension are physical, functional, psychological and social health. Based on the physical dimension, the average score is 17.00, the functional dimension, the average score is 14.91, the psychological dimension, the average score is 13.17 and the social health dimension the average score is 13.44. The quality of life for post-stroke patients in West Nusa Tenggara General Hospital is good.

University hospitals, general hospitals, private clinics: Place-based differences in patient characteristics and outcomes of AF—A SAKURA AF Registry Substudy

BackgroundRelations between characteristics and outcomes of patients in Japan with atrial fibrillation (AF) and the type of medical facility providing their outpatient care are unclear. Methods and resultsWe compared patient characteristics and outcomes between 2 university hospitals (n=1178), 20 general hospitals (n=1308), and 41 private clinics (n=751) (follow-up: 39.3 months) in the prospective SAKURA AF Registry. Private clinic patients were significantly older than university hospital and general hospital patients (73.4±9.2 vs. 70.3±9.8 and 72.6±8.9 years; p<0.001), and these patients’ CHADS2 scores were significantly lower than general hospital, but higher than university hospital patients (1.8±1.1 vs. 2.0±1.2 and 1.6±1.1; p<0.001). The Kaplan–Meier incidences of stroke/systemic embolism (SE) (1.72 vs. 1.58 vs. 0.84 events per 100 patient-years; p=0.120), a cardiovascular event (4.09 vs. 2.44 vs. 1.40; p<0.001), and death were higher (2.39 vs. 2.21 vs. 1.24; p=0.015) for university and general hospital patients than for private clinic patients; the incidences of major bleeding were equivalent (1.78 vs. 1.33 vs. 1.16; p=0.273). After multivariate adjustments, this trend persisted. ConclusionsAdverse clinical events at small to large hospitals appear to be higher than those at private clinics, suggesting that careful attention for preventing stroke/SE and cardiovascular events should be paid to patients at a university or general hospital.

A study of the epidemiology and risk factors for attempted suicide and suicide among non-psychiatric inpatients in 48 general hospitals in Hubei province, China, 2015–2017

ObjectiveThis was a large-scale epidemiological survey of non-psychiatric inpatient attempted suicides/suicides in general hospitals in China, allowing a detailed quantitative analysis of the characteristics of inpatient attempted suicides/suicides. MethodsThe incidence, inpatient demographic and behavioral characteristics, and risk factors for attempted suicide/suicide were explored through a survey of non-psychiatric inpatients admitted to 48 general hospitals, between 2015 and 2017. A Vector Error Correction model was established to explore hospital variables as predictors of inpatient attempted suicide/suicide using the annual numbers of inpatient attempted suicides/suicides, undergraduate or above nurses per total number of nurses, and number of beds per nurse in a tertiary general hospital, between 1998 and 2017. ResultsThe incidence of attempted suicide/suicide among inpatients in general hospitals was 3.26/100,000 admissions. 180 inpatient attempted suicides/suicides were reported, which were associated with particular inpatient demographic and behavioral characteristics and a specific temporal and spatial distribution. Incidence of attempted suicide/suicide was higher in inpatients aged ≥60 years, with junior high school or lower level of education, in secondary general hospitals, suffering from malignant tumors or chronic diseases. Number of beds/nurse had a significant impact on the incidence of inpatient attempted suicide/suicide. ConclusionWe recommend that general hospital administrators establish a targeted approach to inpatient suicide prevention efforts in their hospitals.

Knowledge and practice of hand hygiene among hospitalised patients in a tertiary general hospital in China and their attitudes: a cross-sectional survey

ObjectivesWe aimed to gain a better understanding of patients’ practice of hand hygiene (HH) and their knowledge and attitudes.DesignA cross-sectional survey.SettingA 3500-bed university-affiliated medical hospital in China.ParticipantsInpatients and their family...

The prevalence of common psychiatric disorders in general hospital inpatients: A meta-review of systematic reviews

The prevalence of common psychiatric disorders in general hospital inpatients: A meta-review of systematic reviews

Prevalence of Bacterial and Fungal Isolates Associated with Road Traffic Accident In-patients in General Hospitals in Niger State

Aim: This study was carried out to determine the prevalence and antimicrobial susceptibility of bacteria and fungi isolated from wounds of in-patients with road traffic accidents at four General hospitals in Niger State.&#x0D; Place and Duration of Study: Department of Microbiology, Federal University of Technology, Minna, Nigeria, between October 2017 and May 2018.&#x0D; Methodology: Wound swabs were taken twice per patient, first swab at contact and second swab taken seven days post wound dressing. The outcome of 1000 wound swabs taken from 409 (267 male and 142 female) in-patients with road traffic accident wound treated in the General hospitals Bida, Minna, Kontagora and Suleja areas of Niger State, Nigeria.&#x0D; Results: The results showed that 405 (40.5%) samples were positive for bacteria and fungi pathogens while 595 (59.5%) were negative. 262 (80.6%) swabs yielded single isolates while 46 (14.2%) yielded double organisms and 17 (5.2%) yielded three or more organisms. Of the 405 positive cultures, 347 (85.7%) were bacterial isolates while 58 (14.3%) were fungal isolates. Staphylococcus aureus predominates (37.7%), followed by Pseudomonas aeruginosa (15.6%), E. coli (11.4%), Streptococcus pyogenes (9.4%), Bacillus subtillis (7.2%), Klebsiella pneumonia (4.4%), Aspergillus niger (4.2%), Candida albicans (3.7%), Aspergillus flavus (2.7%), Candida pseudotropicallis (2.2%) and Mucor pusillus (1.5%).&#x0D; Conclusion: Most bacterial isolates were sensitive to Levofloxacin, Ciprofloxacin, Streptomycin and Gentamycin, while others showed some degree of resistance to the remaining antibiotics. Klebsiella pneumoniae showed the highest resistance to all the antibiotics used. All the fungi isolated were highly sensitive to the antifungal drugs used except Griseofulvin.

Association Between Hidradenitis Suppurativa and Metabolic Syndrome: A Systematic Review and Meta-analysis

BackgroundRecent studies have shown a relationship between hidradenitis suppurativa (HS) and metabolic syndrome (MS), but the literature offers no meta-analysis restricted to studies that have been adjusted for confounders. ObjectiveTo determine the association between HS and MS. MethodsA systematic review and meta-analysis of observational studies on HS and MS in adults. We searched MEDLINE, SCOPUS, SCIELO, Google Scholar, Science Direct and LILACS from the inception of the databases to January 2016. We performed a random effects model meta-analysis for studies reporting adjusted and crude odds ratios (ORs) with 95% CIs. A subgroup analysis was related to the type of HS patient (general patients vs hospital patients) and age group (adults vs children and adults). ResultsFive studies including 3950 HS patients were analyzed. We found that MS was present in 9.64% of HS patients (OR, 1.82; 95% CI, 1.39–2.25). Studies from tertiary care hospital dermatology clinics (OR, 2.82; 95% CI, 0.58–5.06) reported a greater risk for MS than studies carried out in patients treated outside hospitals (OR, 1.78; 95% CI, 1.34–2.22). Studies that included pediatric populations reported a significant association (OR, 2.10; 95% CI, 1.58–2.62). LimitationFew of the included studies reported adjusted ORs. ConclusionsHS patients have an increased risk for MS. Clinicians should consider screening HS patients for metabolic risk factors.