History Of Previous Admission Research Articles

Patient satisfaction and associated factors with inpatient health services at public hospitals in Ethiopia: a systematic review and meta-analysis

BackgroundThe way the healthcare delivery system is reflected by patient satisfaction. Establishing a health system with better results depends on it. It has been assumed that higher patient satisfaction levels correlate with quality healthcare outcomes. There is little national data to support patient satisfaction with inpatient health services in Ethiopia. In order to estimate the pooled proportion of patient satisfaction and determine the associated factors with inpatient health services at public hospitals, a systematic review and meta-analysis were conducted.MethodsThe Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed in the extraction of the data. To get the included studies, the following electronic databases were searched: Pub-Med, Google Scholar, Med-Line, Web of Science, Scopus and Repositories. Software called STATA version 17 was used to analyze statistical data using the random effects model. Forest plots were used to display the pooled results.ResultsOf the 1583 records resulted in electronic databases searching, 11 studies with 3,958 participants were included in this systematic review and meta-analysis. The estimated pooled proportion of patient satisfaction with inpatient health services was found to be 57.4% (95% CI: 50.88–64.59, I2 = 95.25%). Assuring privacy for patients (OR = 7.44, 95% CI: 3.63–15.25, I2 = 0.0%), availability of direction signs (2.96, 95% CI: 1.91–4.57, I2 = 0.0%), providing adequate information (OR = 3.27, 95% CI: 1.63–6,58, I2 = 65.60%), history of previous admission (OR = 0.29, 0.18–0.46, I2 = 86.36%) and providing on time treatment (OR = 1.63, 95% CI: 1.21–2.20, I2 = 86.36%) were statistically significant factors associated with patient satisfaction with inpatient health services.ConclusionThe estimated pooled level of patient satisfaction with inpatient health services is low in Ethiopia. A higher level of patient satisfaction with inpatient health treatments was predicted by factors such as privacy assurance, fast services, availability of direction signs, provision of services with adequate information transfer, and no history of previous admission. To improve patient satisfaction, the Ministry of Health and hospital administration must place a strong emphasis on ensuring the provision of high-quality, standard-based inpatient healthcare.

EP609 - Factors affecting the recurrence rate of acute uncomplicated diverticulitis: Single-center experience

Abstract Introduction Acute diverticulitis (AD) is a prevalent condition, and the use of antibiotics for uncomplicated cases remains a topic of debate. Understanding the risk factors for recurrence is crucial for guiding treatment strategies. This study aimed to investigate the risk factors for recurrence within one year following hospital admission for AD. Methods A retrospective analysis of patients admitted to a District General Hospital (DGH) with acute diverticulitis in 2022 was conducted. The study examined patient demographics, initial observations, admitting investigations, care methods, and recurrence within a year. Statistical analysis was performed using SPSS 22 and the Chi-square test. Results The results revealed that out of 105 patients, 39 (37.1%) experienced a recurrence within a year. Notably, age, gender, and diabetes did not significantly impact recurrence (P=0.2,0.06,0.6 respectively), while a history of previous diverticulitis and white cell count (WCC) between 10-15 were associated with higher recurrence rates (P=0.032,0.011 respectively). Furthermore, Hinchey grade, use of antibiotics, and the method of care, whether ambulatory or inpatient, did not show significant differences in recurrence rates (P=0.5,0.8,0.92 respectively). Surgical intervention or interventional radiology (IR) drainage also did not affect the occurrence of recurrence (P=0.91,0.92, respectively). Conclusion The findings suggest that the use of antibiotics for uncomplicated AD may not reduce the risk of recurrence. Additionally, a history of previous admission with AD and elevated WCC were identified as significant risk factors for recurrence within one-year post-hospitalization. However, age, gender, diabetes, Hinchey grade, and interventions did not demonstrate statistical significance in predicting recurrence.

Adult Patient Satisfaction with Nursing Care Services and Associated Factors Among Admitted Patients at Saint Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia, 2022: A Cross-Sectional Study.

Providing comprehensive nursing care and ensuring patient satisfaction are essential health performance indicators worldwide. Despite some efforts to improve patient satisfaction with nursing care, the approach in developing countries, including Ethiopia, remains insufficient. This study aimed to assess the level of adult patient satisfaction and identify the factors affecting satisfaction. This cross-sectional study included 407 participants selected using a simple randomization technique. The samples were distributed using proportional allocation to each selected adult inpatient department. The participants were interviewed using a modified structured Amharic version of the Newcastle Satisfaction with Nursing Scale. Bivariate and multivariable logistic regression analyses were also performed. The overall level of patient satisfaction with nursing care services was 54.3%. Respondents without formal education (P=0.010), male sex (P=0.041), free service consumers (P0.001), and health insurance users (P0.001) were significantly associated with satisfaction with nursing care. In addition, previously hospitalized patients (P=0.001), governmental workers (P0.001), and patients admitted to the medical ward (P=0.010) were associated with patient dissatisfaction with nursing care services. This study revealed that adult patient satisfaction with nursing care services is low. A previous admission history, higher education level, paying cash for services, and private and governmental workers were significant predisposing factors for dissatisfaction with nursing care. On the other hand, patients without formal education, free-service consumers, and male sex were significant predictors of satisfaction with nursing care services. Therefore, hospital administrators are encouraged to focus on patients' needs and expectations.

Characterization of Virulent Bacterial Isolates Associated with Multi-Drug Resistance among Patients with Surgical Site Infections in Selected Specialist Hospitals in Calabar, Nigeria

Aims: Increasing research findings have documented the continuous emergence and threats posed by drug resistant clinical isolates from post-operative wound infections to commonly used antibiotics globally. This hospital-based study investigated virulent bacterial pathogens implicated with post-operative wound infections among surgical site infection (SSI) patients in Calabar, Nigeria and determined their antibiotic resistance pattern.
 Methodology: A total of 127 bacterial isolates of different genus from 110 SSI patients, were isolated from pus and surgical wound exudates and fully characterized using standard bacteriological procedures. Antimicrobial susceptibility patterns of isolates were determined using Kirby- Bauer disk diffusion method, following the guidelines by Clinical Laboratory Standard Institute (CLSI).
 Results: Multi-drug resistant bacteria isolated and their percentage frequency were coagulase Negative Staphylococci (21.3%), Staphylococcus aureus (19.7%), Pseudomonas aeruginosa (14.2%), Escherichia coli (11.8%), Klebsiella pneumoniae (9.4%), Enterococcus faecium (6.3), Enterobacter cloacae (4.7%), Proteus mirabilis (4.7%), Acinetobacter baumannii (3.1%), Pseudomonas putida (3.1%) and Aerococcus viridans (1.6%). Among gram-positive bacteria isolated, S. aureus showed highest resistance to several antimicrobials (100% to oxacillin, 96% to ciprofloxacin, 92% to levofloxacin, and 76% resistance to vancomycin). All recovered S. aureus isolates were cefoxitin screen positive indicating possible MRSA isolates. Additionally, among Gram-negative isolates K. pneumoniae was found to possess higher resistance to several antibiotics (66.7% resistance to each of ciprofloxacin, levofloxacin, ceftazidime, trimethoprim /sulfamethoxazole, cefazolin, ampicillin, tobramycin and 58.3% resistance to each of ceftriaxone, gentamicin, and ampicillin/sulbactam). Statistical analysis of categorical variables of study subjects revealed that length of hospital stay, type of surgery, previous admission history, antibiotic use, and age were significant (p<0.05) in SSI outcome of patients, while patients’ gender was not significant (p>0.05) in SSI outcome.
 Conclusion: Adherence to measures of strict infection control, optimal preoperative, intraoperative, and postoperative patient care, including multifaceted approaches involving surveillance, and antimicrobial stewardship, are vital to SSI treatment outcomes.

Prediction of Mortality in Older Hospitalized Patients after Discharge as Determined by Comprehensive Geriatric Assessment.

Several dimensional impairments regarding Comprehensive Geriatric Assessment (CGA) have been shown to be associated with the prognosis of older patients. The purpose of this study is to investigate mortality prediction factors based upon clinical characteristics and test in CGA, and then subsequently develop a prediction model to classify both short- and long-term mortality risk in hospitalized older patients after discharge. A total of 1565 older patients with a median age of 81 years (74.0–86.0) were consecutively enrolled. The CGA, which included assessment of clinical, cognitive, functional, nutritional, and social parameters during hospitalization, as well as clinical information on each patient was recorded. Within the one-year follow up period, 110 patients (7.0%) had died. Using simple Cox regression analysis, it was shown that a patient’s Length of Stay (LOS), previous hospitalization history, admission Barthel Index (BI) score, Instrumental Activity of Daily Living (IADL) score, Mini Nutritional Assessment (MNA) score, and Charlson’s Comorbidity Index (CCI) score were all associated with one-year mortality after discharge. When these parameters were dichotomized, we discovered that those who were aged ≥90 years, had a LOS ≥ 12 days, an MNA score < 17, a CCI ≥ 2, and a previous admission history were all independently associated with one-year mortality using multiple cox regression analyses. By applying individual scores to these risk factors, the area under the receiver operating characteristics curve (AUC) was 0.691 with a cut-off value score ≧ 3 for one year mortality, 0.801 for within 30-day mortality, and 0.748 for within 90-day mortality. It is suggested that older hospitalized patients with varying risks of mortality may be stratified by a prediction model, with tailored planning being subsequently implemented.

Non-adherence to medications among patients with mental disorders attending tertiary care in Oman

Background: The primary aim of this study was to quantify the degree of non-adherence to medications among patients with mental health disorders attending a psychiatry clinic at a tertiary care hospital in Muscat, Oman.Methods: All patients attending the psychiatry clinic during the study period were invited to participate in this cross-sectional study. Demographic data and factors related to medication adherence were gathered from the participants. The level of adherence to medication was measured using the Medication Adherence Rating Scale (MARS).Results: A total of 251 patients were included in this study. The average MARS score was 5.7, indicating an overall poor level of compliance. Having an educational level of secondary school, a diagnosis of schizophrenia, having had a mental health condition for a longer time, previous history of admission to a psychiatry unit, lack of insight and poor therapeutic alliance were found to be significantly association with low level of adherence to psychiatric medications.Conclusions: Non-adherence to medications is common among patients with mental health disorders. In order to mitigate the impact of medication non-adherence in a psychiatric setting, appropriate interventions are recommended to address and manage the factors related to poor medication adherence.

One-Year Readmission Following Undifferentiated Acute Hypercapnic Respiratory Failure

Patients with acute hypercapnic respiratory failure (AHRF) often require hospitalization and respiratory support. Early identification of patients at risk of readmission would be helpful. We evaluated 1-y readmission and mortality rates of patients admitted for undifferentiated AHRF and identified the impact of initial severity on clinically important outcomes. We retrospectively analyzed patients who presented with AHRF to the emergency department of St Michael’s Hospital in 2017. We collected data about patients’ characteristics, hospital admission, readmission and mortality one year after the index admission. We analyzed predictors of readmission and mortality and conducted a survival analysis comparing patients who did and did not receive ventilatory support. A cohort of 212 patients with AHRF who survived their hospital admission were analyzed. At one year, 150 patients (70.8%) were readmitted and 19 (9%) had died. Main diagnoses included chronic obstructive pulmonary disease (60%), congestive heart failure (36%), asthma (22%) and obesity (19%), and these categories of patients had similar 1 y readmission rates. One third had more than one coexisting chronic illness. Although comorbidities were more frequent in readmitted patients, only a history of previous hospital admissions remained associated with 1 y readmission and mortality in multivariate analysis. Need for ventilatory support at admission was not associated with higher 1 y probability of readmission or death. Undifferentiated AHRF is the presentation of multiple chronic illnesses. Patients who survive one episode of AHRF and with previous history of admission have the highest risk of readmission and death regardless of whether they receive ventilatory support during index admission.

Patients Satisfaction with Pharmaceutical Care and Associated Factors in the Southwestern Ethiopia.

BackgroundAn evaluation of patient satisfaction with service provided in the health care system has been globally recognized as the measure of health care service quality. However, there is a lack of research findings that indicate patient satisfaction with newly implemented patient-oriented pharmaceutical care (PC) service provided by clinical pharmacists in Ethiopia. Therefore, the current study is aimed to determine the level of patient satisfaction and associated factors with PC service provided by clinical pharmacists in the Southwestern Ethiopia.MethodologyA facility-based cross-sectional study design was employed among patients admitted to Medical wards in Jimma University Medical Center (JUMC) (n=219) from May to June 2021. The pretested interviewer-administered questionnaire containing structured questions on a 5-point Likert scale was appropriately completed and returned for statistical analysis. For the analysis of data, Statistical Package for Social Sciences (SPSS) was used. The associations between status of patient satisfaction and predictors were determined at 5% (p<0.05) level of significance by employing multivariate logistic regression.ResultsThe current study revealed that more than half (56%) of the respondents were satisfied with clinical pharmacy service. From 30% of drug therapy problems (DTPs) reported, non-adherence was the most prevalent (11.4%), while the dose being too low and adverse effects (0.9%) were the least reported. Moreover, the assignment particular clinical pharmacist (AOR: 2.091, 95% CI: 1.028, 4.255), previous admission (AOR: 0.459, 95% CI: 0.244, 0.86), number of medications taken per day (AOR: 1.929, 95% CI: 1.996, 3.739) and length of hospital stay (AOR: 2.236, 95% CI: 1.124, 4.446) were significantly associated with patient satisfaction.ConclusionThe present study revealed that patient satisfaction towards PC was low. Lack of specific clinical pharmacist assignment, previous history of admission, number of medications taken per day and length of hospital stay are revealed as the major factors affecting the level of satisfaction. In addition, current findings implicate that clinical pharmacist collaboration with a multidisciplinary team is essential to increase patient satisfaction.

Risk Factors for Extended-Spectrum-β-Lactamase-Producing Escherichia coli in Community-Onset Bloodstream Infection: Impact on Long-Term Care Hospitals in Korea.

BackgroundThe prevalence of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) in the community has increased worldwide due to multifactorial reasons. ESBL-EC bloodstream infection (BSI) complicates the decision for proper antimicrobial administration. In this multicenter study, we investigated the prevalence, risk factors, and molecular background of community-onset (CO) ESBL-EC BSI.MethodsWe included data for all episodes of ESBL-EC BSI of community origin from May 2016 to April 2017 obtained from the Korean national antimicrobial resistance surveillance system, which comprises six sentinel hospitals. Data, including previous history of admission and use of antimicrobials and medical devices before BSI, were collected, along with microbiological analysis results.ResultsAmong 1,189 patients with CO BSI caused by E. coli, 316 (27%) were identified as ESBL producers. History of admission, especially to a long-term care hospital (LTCH), and previous use of β-lactams/β-lactamase inhibitors, carbapenem, lincosamide, aminoglycoside, and extended-spectrum cephalosporin were independent risk factors for CO ESBL-EC BSI; admission to an LTCH showed the highest odds ratio (3.8, 95% confidence interval 2.3-6.1). The most common genotype was CTX-M-15 (N=131, 41%), followed by CTX-M-14 (N=86, 27%). ST131 was the most common sequence type among ESBL-EC groups (57%).ConclusionsIn Korea, 27% of CO E. coli BSI were caused by ESBL producers. From perspectives of empirical treatment and infection control, history of admission to an LTCH and antimicrobial use should be noted.

Risk factors of multidrug-resistant bacterial infections among patients admitted in a tertiary care hospital of north India

Infections with drug-resistant organisms (DRO) have been associated with poor patient outcomes. To tackle this global problem, it is necessary to understand the risk factors that predispose to infections with DRO. This was a prospective observational study conducted over a three-year period at a tertiary-care hospital. Bacterial culture isolates from patients admitted in medicine wards with community or hospital-acquired infections were included. Logistic regression analysis was used to determine risk factors for drug-resistant infections. Of the 295 patients with 323 isolates included, 40 (12.3%) had non-MDR (N-MDR) infections, 86 (26.6 %) had MDR infections and 197 (61%) had possible extensively drug-resistant (P-XDR) infections. History of previous admission in the preceding three months (Odds Ratio, OR = 4.53, 95% Confidence interval, CI = 1.8 - 11.42, p = -0.01), high SOFA score at admission (OR = 1.14, 95% CI = 1.0 - 1.290, p = -0.039) and prolonged duration of ventilation (OR = 1.25, 95% CI = 1.05 - 1.41, p = -0.012) were independently associated P-XDR infections when compared to patients with N-MDR. High rate of multidrug-resistant infections in the studied area is alarming. In this single-centre study, we elicited various risk factors for drug-resistant bacterial infections ranging from patient characteristics to iatrogenic risk factors during the hospital stay. Infections with P-XDR and MDR isolates independently increased hospital and ICU stay duration and were associated with increased mortality.

Prevalence, Antimicrobial Susceptibility Patterns, and Risk Factors Associated with Enterococci among Pediatric Patients at Dessie Referral Hospital, Northeastern Ethiopia.

Background Enterococcus species, which is previously considered as medically not important, now becomes one of the leading causes of nosocomial infections. Even though it becomes the most public health concern and emerging multidrug-resistant pathogen, there is no enough data in the study area. Objective To determine the prevalence, antimicrobial resistance pattern, and associated risk factors of enterococci infection in pediatric patients. Methods A hospital-based cross-sectional study was conducted from February to May 2019 at Dessie Referral Hospital, Northeastern Ethiopia. A total of 403 pediatric patients were included in the study, and a pretested structured questionnaire was used to collect sociodemographic and risk factor-related data. Clinical samples such as urine, blood, wound swabs, discharges, and other body fluids were collected aseptically and inoculated on to Bile Esculin Azide Agar, and colony characteristics, Gram stain, catalase, salt, and temperature tolerance tests were employed for bacterial identification. Antimicrobial sensitivity tests were performed using the modified Kirby-Bauer disk diffusion method. Data was entered into SPSS software version 25 and descriptive statistics; bivariate and multivariate logistic regression analyses were performed. In all cases, a P value ≤ 0.05 with corresponding 95% confidence interval were considered as statistically significant. Result The overall prevalence of enterococci was 2.7% (11/403). Of which, the highest number of enterococci infection was recovered from urine sample (54.5%) followed by blood (27.3%), wound swab (9.1%), and other body fluids (9%). The overall multidrug resistance rate was 54.5%. Higher drug resistance pattern was observed against tetracycline, chloramphenicol, and amoxicillin/clavulanate. Having history of invasive procedure (P < 0.001), chronic illness (P < 0.001) and previous admission history of the children (P < 0.001) were statistically significant associated risk factors for pediatrics enterococci infection. Conclusion The prevalence of enterococci from pediatric patients in this study was relatively low compared to other studies. Significant rates of MDR and VRE were identified, and the risk of infection became high when children had a history of different chronic illnesses and history of admission and underwent invasive treatment procedures. Therefore, efforts should be made to prevent enterococci infections and spread of multidrug-resistant enterococci.

Incidence, predictors of bleeding and prognosis of bleeding in anticoagulated nonagenarian patients with atrial fibrillation

BackgroundThe prevalence of atrial fibrillation (AF) increases with age. The prescription of anticoagulation in very elderly patients is controversial and sometimes underused. Our objective is to report the incidence and predictors of major bleeding in anticoagulated nonagenarian patients with non valvular atrial fibrillation (NVAF). MethodsWe analyzed a large multicentre registry of anticoagulated nonagenarian patients diagnosed with NVAF from three health areas of Spain, between 2013 and 2017. Predictors of major bleeding were studied with a competing risk analysis and the impact of major bleeding with a time-dependent mortality analysis. ResultsThe incidence rate of major bleeding was 5 per100 person-year (95% Confidence Interval [CI]: 4.59–6.35), similar in the group of patients with vitamin K antagonists (VKAs) and direct oral anticoagulants (DOAC). In the VKAs group we found as predictors of major bleeding: previous admission for bleeding (sub-distribution hazard ratio [sHR] 3.25, 95% CI: 1.48–7.13), creatinine (sHR 1.38, 95% CI: 1.16–1.64,) and control out-of-range INR (sHR 1.90, 95% CI: 1.02–3.55). In DOAC group, male sex (sHR 1.92, 95% CI: 1.18–3.13) and the history of previous admission for bleeding (sHR 2.60, 95% CI 1.33–5.06) were found as a predictor. The HAS-BLED was not associated with major bleeding. Major bleeding was associated with increased mortality in both VKAs and DOAC groups without significant differences. ConclusionsWe found an incidence rate of major bleeding with relative low values, similar in those treated with VKAs and those treated with DOAC, with different predictors of major bleeding in each group. Major bleeding was associated with increased mortality, with no significant difference by oral anticoagulation therapy (OAT).

Nudging Discharge Readiness With a Poster: A Sequential, Exploratory Mixed Methods Pilot Study of Patient Caregivers.

Many hospitals face a common challenge: limited space for a high number of patients. This has led to quick patient throughput, which can impact patient perception of discharge readiness. This study examined whether a poster highlighting tasks to complete as part of the discharge process improved caregiver perception of readiness to transition home. Using a sequential, exploratory mixed methods design, focus groups were convened to explore clinical staff perspective on the discharge process on 3 pediatric inpatient units at a large, urban, pediatric academic medical center in the United States. Analysis of this content informed the design of a poster intervention to “nudge” caregivers (eg, parents, legal guardians) toward readiness and self-efficacy that was then tested in a randomized, controlled experiment. The poster focused on practical knowledge for specific areas of transition adjustment, such as medication and care recipient recovery behaviors, barriers, and enablers. Caregivers (n = 135) completed surveys at discharge indicating their perceived readiness to transition home with their child. Analysis of covariance was used to test the effect of the poster condition (poster vs no poster) on caregiver readiness, preparedness, and confidence for discharge while controlling for previous admission history. Significant effects for poster presence were found on caregivers’ perceived readiness for discharge, F 1,125 = 7.75, P = .006, Cohen’s d = 0.44; and caregivers’ perceived preparedness for the transition home, F 1,121 =7.24, P = .008, Cohen’s d = 0.44. Only a marginal effect was found for poster condition on caregivers’ confidence ratings, F 1,125 = 2.93, P = .090, Cohen’s d = 0.29. The results suggest that simple nudges in the patient care environment may yield measurable improvements in caregiver outcomes.

Characteristics, treatment, and outcome of patients with hypertensive crisis admitted to University of Gondar Specialized Hospital, northwest Ethiopia: A cross-sectional study.

Despite major public health initiatives are working in the control of hypertension, hypertensive crisis remains an important clinical problem. This study aimed at examining the characteristics, treatment and outcome of patients with hypertensive crisis admitted to the University of Gondar Specialized Hospital, Ethiopia. A cross-sectional study was conducted on patient medical records (n=304) between January 01, 2013 and December 31, 2017. Data were analyzed using Statistical Package for Social Sciences version21. A total of 252 patient medical records were included in the analysis. The mean age of the entire patients was 54±17years. Two hundred and nineteen (86.9%) patients have a documented history of hypertension and on antihypertensive drugs (n=166, 65.9%). The majority of cases (n=166, 65.9%) were hypertensive urgencies. In more than one-third of the patients (n=98, 38.9%), the cause of the illness was attributed to non-compliance to therapy. The most common presenting signs and symptoms at admission were headache (n=170, 67.5%), dyspnea (n=36, 14.3%), and vomiting (n=33, 13.1%). Of 852 tests ordered, the results of one-third (n=298,34.9%) were abnormal. Nearly two-thirds (n=336, 59.2%) of prescriptions documented were for hypertensive urgency. Captopril (n=136, 23.9%) and hydralazine (n=43, 7.6%) were the most commonly prescribed oral and intravenous drugs respectively. Ten patients died during 55hours of hospital stay. All hospital mortalities were documented for a hypertensive emergency. The median decrement of diastolic blood pressure among patients with no history of previous admission and hypertensive urgency was significantly higher than those patients with a previous history of admission (P=.005) and hypertensive emergency (P=.010). These findings justify better treatment and follow-up for these patients. Most importantly, to improve compliance with treatment health professionals should provide education to the patients.

What should the C ('congestive heart failure') represent in the CHA2 DS2 -VASc score?

What should the C ('congestive heart failure') represent in the CHA2 DS2 -VASc score?

Mental illness and social exclusion: assessment of the risk of violence after release.

ABSTRACTObjectivesTo examine the predictive validity of the HCR-20 (The Historical Clinical Risk Management-20) to predict future violent incidents in a representative sample of patients with severe mental disorders and with a history of previous admission to prison, who after release are in a situation of extreme social exclusion.Material and method The study sample was selected from the 235 patients treated by the Mental Health Street Team of Madrid (ECASAM) from June 2014 to June 2017, including those with a previous history of a previous internment in a penitentiary (about which, the HCR-20 was completed).ResultsOf the 44 patients included, 29.6% (n=13) ended up participating in a violent incident after the release. The ROC curves (Receiver Operating Characteristic) analysis indicated that the total score of HCR-20 (AUC 0.98, p=0.01) has a high predictive validity.ConclusionsThe social and medical changes that take place after the release of patients with severe mental illness justify the need to reassess the risk of violence. In this evaluation, the HCR-20 guide is a useful tool for predicting the risk of involvement in future violent incidents, and the inclusion of factors such as social exclusion and its consequences, as well as problems with substance use is especially important.

Expectation and Satisfaction with Nursing Care among Hypertensives Receiving Care at a Resource-Constrained Hospital in Ghana.

Background Hypertension accounts for a third of the global preventable premature deaths. In Sub-Saharan Africa, hypertension is the most rapidly increasing cardiovascular disease (CVD) and the second leading cause of death. Proper management of hypertension requires adherence to management by patients and this is partly possible if patients feel satisfied with the nursing care they receive. Satisfaction with nursing care is only possible if there is a congruence between the expectations of care and the actual care received from nurses. Aim We explored the expectations and satisfaction of Ghanaian hypertensives with nursing care received at the Korle-Bu Teaching Hospital (KBTH). Methods In this qualitative study, a phenomenological approach was used to gather data about the lived experiences of patients with hypertension about nursing care. In-depth interviews (IDIs) were conducted among sixteen (16) patients with hypertension from the hypertensive Out-Patient Department (OPD) Clinics of the Medical Department at the KBTH. Only patients with history of previous admission(s) at the KBTH during the immediate past six months were purposively recruited. The respondents were interviewed about the nursing care received during their immediate past admission(s) at the KBTH using an IDI-guide. The IDIs were recorded digitally, transcribed verbatim, and reviewed severally and thematic analysis was done. Nvivo 11 software was used to manage the data and aid with the thematic analysis. Results The results of this study showed that Ghanaian hypertensive patients perceived nurses as key players in the management of patients. On the respondents' expectations from nurses prior to their immediate past admissions at the KBTH, the data revealed the responsiveness of nurses to patient needs, prompt pain management, high confidentiality level of nurses, rendering of efficient health education, maintenance of therapeutic work environment, and ensuring effective communication as well as professional/ethical practice from the nurses. On the question of what made nursing care satisfying, it was observed from the respondents that they considered the competence of nurses, maintenance of therapeutic environment, and also effective handling of confidential information as determinants of their satisfaction with nursing care. Further, the respondents identified some key areas of dissatisfaction and these included the responsiveness of nurses to patient needs, prompt pain management, effectiveness of health education, and provision of culturally sensitive communication. Disproportionate distribution of nursing staff across the three nursing shifts, unethical practice among some nurses, inadequate resources for work, and low work morale of some nurses were identified as factors responsible for the gaps between patient expectations and actual care received. Conclusion Our study concludes that continuous professional development programs for nurses should focus on the areas of dissatisfaction so as to improve care for hypertensives. We also recommend that nursing staff distribution across the various shifts should be of keen interest to nurse managers if hypertension care in particular and overall patient care in general are to improve.

Study on Surgical Re-Admission in DMCH

Introduction: Re-admission of surgical patients following discharge from a surgical care unit to the same or different hospital is not uncommon. Underlying causes varied. Majority of re-admission are unplanned. Postoperative complications are mainly responsible for patients to seek re-admission. Post operative complications are the mainly liable for surgical re-admission.&#x0D; Methods: A prospective study was performed in General Surgical units of Dhaka Medical College Hospital, Dhaka for one year from August’2011 to July’2012. Amongst the patients admitted in surgical units, all re-admitted patients within the period had been studied. Purposive sampling was done. Rate, cause, avoidability etc. were studied according to criteria.&#x0D; Results: Among 4396 admitted patients 294 (7%) had history of previous admission in surgical department of different hospitals. 65% patients were male and 70.07% were middle aged (20-50yr). 67% re-admisssion occurred through emergency department of which 67.7% were unplanned. 58% re-admission were avoidable. Diagnosis at readmission contains quite a long list but notables were loop ileostomy (23.47%), enterocutaneous fistula (10.54%), incisional hernia (9.52%), mature colostomy (8.84%), wound infection (8.5%) and subacute intestinal obstruction (4.76%).&#x0D; Conclusion: Re-admission can be a contributing factor to assess quality and performance. It should be focused in audit and practice.&#x0D; J Bangladesh Coll Phys Surg 2019; 37(2): 54-59

Parkinson's Disease in Intensive Care Unit: An Observational Study of Frequencies, Causes, and Outcomes.

Objective:To analyze the frequency, causes, and outcomes of admission to the Intensive Care Unit (ICU) among Parkinson's disease (PD) population so that preventive measures can be developed.Methods:We prospectively observed patients with diagnosis of PD admitted to ICU from January 2014 to December 2016. Based on etiology for hospital admission, they were divided into two groups – related to PD (further divided into direct or indirect) or not associated with PD at all. Etiology for hospitalization was determined from history and investigational data. The primary outcome was death or discharge from the hospital. Factors contributing to ICU admission were analyzed by comparing these patients with a cohort of 50 PD patients admitted to the neurology ward during the same study period. All values were expressed as mean (standard deviation) and percentages using SPSS version 16.0.Results:Fifty-three (36%) out of a total of 146 patients required ICU admission. Most common causes leading to admission in decreasing order of frequency were fever (34%), delirium (16%), falls (12%), encephalopathy (8%), gastrointestinal emergencies (6%); while direct disease-related severe dyskinesias were seen only in two patients (4%). 13.7% needed mechanical ventilation and mean duration of ventilation was 5.94 days with mortality rate of 20%. Significant factors predicting ICU admission, and thus, poor outcomes were age >65 years, history of previous admission within the last 12 months, delirium, and hypoalbuminemia. There was no significant association between the incidence of ICU admission and duration of disease or severity of the disease.Conclusions:Poor outcome in PD patients is due to systemic causes, hence multidisciplinary teamwork may improve outcome in these patients.

Risk factors for severe acute malnutrition among children aged 6-59 months admitted at Lubango Pediatric Hospital, Angola

Background : The 4th Millennium Development Goal (MDG) is to reduce the mortality rates among underfives by two thirds between 1990 and 2015. Efforts to prevent child deaths need to be stepped up in order to meet that target but the challenge is how to reduce morbidity and mortality among children with SAM. In SSA, the nutritional and health situation is worsening. The hospital case fatality rates(CFR) for SAM remain high due to faulty case management in resource-poor settings. Despite the improved understanding of the clinical management of SAM, the CFR among admitted children in SSA has remained between 20- 30%. This study sought to determine the social demographic and clinical risk factors associated with severe acute malnutrition among children admitted at Lubango Pediatric Hospital. Methods : This was a case-control design where cases were compared with age and sex -matched controls with weight for height. Data was collected using an interviewer administered structured questionnaire, with caregivers as respondents: Clinical history and examination was conducted by a trained clinician eliciting duration of illness and categorizing symptoms such as fever and cough among others. The Nutritional status of the child was determined using anthropometric measurement. A pre- HIV test counselling was done to the care takers and the ones who gave consent, an HIVantibody test was conducted to the child using Determine and unigold HIV rapid test followed by a post-test counselling for both the HIV positive and negative children. For children who had been admitted the same year, the files were found for confirmation of the diagnosis of the previous admission(s). Results : The significant predictors of severe malnutrition were family order, HIV test results, previous history of admission with diarrhea and malnutrition, duration of breast feeding and number of previous admissions Conclusion: The burden of severe malnutrition is still high among children admitted in hospital. There is need to strengthen breast feeding campaigns and family planning strategies. Further clinicians need to be proactive in assessing the risk of malnutrition in HIV positive children and children with recurrent admissions especially with malnutrition and diarrhea.