Referral General Hospital Research Articles

Improving effective coverage of medical-oxygen services for neonates and children in health facilities in Uganda: a before–after intervention study

Medical oxygen services are essential for the care of acutely unwell patients. We aimed to assess the effects of a multilevel, multicomponent health-system intervention on hypoxaemia detection, oxygen therapy, and mortality among neonates and children attending level IV health centres and hospitals in Uganda. For this before-after intervention study, we included children who attended paediatric or neonatal wards of 24 level IV health centres and seven general or regional referral hospitals in the Busoga and North Buganda regions of Uganda between June 1, 2020, and June 30, 2022. All neonates younger than 1 month and children aged 1 month to 14 years were eligible for inclusion. We excluded neonates who were not sick but stayed in the maternity ward for routine postnatal care. The intervention involved clinical training, mentorship, and supportive supervision; provision of pulse oximeters and cylinder-based oxygen sources; biomedical-capacity support; and support to develop and disseminate oxygen supply strategies, oxygen therapy guidelines, and lists of essential oxygen supplies. Trained research assistants extracted individual patient data from case notes using a standardised electronic data collection form. Data were collected on health-facility details, age, sex, clinical signs and symptoms, admission diagnoses, pulse oximetry readings, oxygen therapy details, and final patient outcome. The primary outcome was the proportion of admitted neonates and children with a pulse oximetry oxygen saturation reading documented in their patient case notes on day 1 of health-facility admission (ie, pulse oximetry coverage). We used mixed-effects logistic regression to evaluate the effect of the intervention. We obtained data on 71 997 eligible neonates and children admitted to 31 participating health facilities; the primary analysis included 10 001 patients in the pre-intervention period (ie, June 1 to Oct 30, 2020) and 51 329 patients in the post-intervention period (ie, March 1, 2021, to June 30, 2022). Because 1356 patients had missing data for sex, 4365 (46·7%) of 9347 in the pre-intervention group and 22 831 (46·2%) of 49 410 in the post-intervention group were female; 4982 (53·3%) in the pre-intervention group and 26 579 (53·8%) in the post-intervention group were male. The proportion of neonates and children with pulse oximetry at admission increased from 2365 (23·7%) of 10 001 in the pre-intervention period to 45 029 (87·7%) of 51 328 in the post-intervention period. Adjusted analysis indicated greater likelihood of a patient receiving pulse oximetry during the post-intervention period compared with the pre-intervention period (adjusted odds ratio 40·10, 95% CI 37·38-42·93; p<0·0001). Large-scale improvements in hospital oxygen services are achievable and have the potential to improve clinical outcomes. Governments should be encouraged to develop national oxygen plans and focus investment on interventions that have been shown to be effective, including the introduction of pulse oximetry into routine hospital care and clinical and biomedical mentoring and support. Bill & Melinda Gates Foundation and ELMA Philanthropies. For the Luganda and Lusoga translations of the abstract see Supplementary Materials section.

Maternal mortality in Eastern Democratic Republic of Congo: a 10-year multi-zonal institutional death review

BackgroundMaternal mortality (MM) remains a real scourge that hits hardest in the poorest regions of the world, particularly those affected by conflict. However, despite this worrying reality, few studies have been conducted about MM ratio in the Democratic Republic of Congo (DRC). The study aimed to describe the trends as well as the epidemiological profile and causes of reported institutional maternal deaths between 2013 and 2022 in Eastern DRC.MethodsA retrospective descriptive study was conducted between March 2023 and August 2023 in eight Health Zones (HZ), five in South Kivu Province (Mwana, Minova, Miti-Murhesa, Kamituga and Idjwi) and three in North Kivu Province (Kirotshe, Karisimbi and Kayna) in the eastern region of the DRC. Our study covers 242 health facilities: 168 health centers (HC), 16 referral health centers (RHCs),50 referral hospitals (RH) and 8 general referral hospitals (GRHs). Data from registers and medical records of maternal deaths recorded in these zones from 2013–2022 were extracted along with information on the number of deliveries and live births. Sociodemographic, clinical parameters, blood and ultrasound tests and suspected causes of death between provinces were assessed.ResultsIn total, we obtained 177 files on deceased women. Of these, 143 (80.8%) were retained for the present study, including 75 in the 3 HZs of North Kivu and 68 in the 5 HZs of South Kivu. From 2013 to 2022, study sites experienced two significant drops in maternal mortality ratio (MMR) (in 2015 and 2018), and a spike in 2016–2017. Nonetheless, the combined MMR (across study sites) started and ended the 10-year study period at approximately the same level (53 and 57 deaths per 100,000 live births in 2013 and 2022 respectively). Overall, 62,6% of the deaths were reported from secondary hospital. Most deaths were of married women in their thirties (93.5%). Almost half (47.8%) had not completed four antenatal consultations. The main direct causes of death were, in decreasing order of frequency: post-partum haemorrhage (55.2%), uterine rupture (14.0), hypertensive disorders (8.4%), abortion (7.7%) puerperal infections (2.8%) and placental abruption (0.7%). When comparing among provinces, reported abortion-related maternal mortality (14.1% vs 0%) was more frequent in North Kivu than in South Kivu.ConclusionThis study imperatively highlights the need for targeted interventions to reduce maternal mortality. By emphasizing the crucial importance of antenatal consultations, intrapartum/immediate post-partum care and quality of care, significant progress can be made in guaranteeing maternal health and reducing many avoidable deaths.

Role of ortho-pantho-graphic X-ray in the diagnosis of osteoporosis

Background: Osteoporosis affects people, especially old age, as postmenopausal women and remains unnoticeable until the patient presents with a fracture. Osteoporosis in human begins started with the loss of bone mass that increases with age, this is related to the decrease in bone density and an increase in porosity that will cause fractures in this osteoporotic bone. Objective was to assess the usefulness of orthopanthographic (OPG) in the early detection of osteoporosis. Methods: This is an analytic across-sectional test validation study, was done in Hawari Hospital-Benghazi, Libya which considered a referral General Hospital affiliated with University of Benghazi. This study was done during a period from March 2022 to July 2023. Sixty women were selected, divided into osteoporotic and non osteoporotic groups depending on the clinical and laboratory investigations under the supervision of an orthopedic consultant in the outpatient clinic. Panoramic radiographic X-rays were taken for evaluation and estimation of the mandibular cortex on the basis of (Mental index, Klemetti index, and Panoramic mandibular index) as a diagnostic tool to differentiate normal from osteoporotic patient, all three indices correlated significantly with bone mineral density and used as useful indicators for detected the osteopenia and osteoporosis. Results: We calculated values of the three indices (Mental index, Klemetti index, and Panoramic mandibular index) values were low especially in the osteoporotic group, as well the values of mental index and panoramic mandibular index were low compared with low bone mineral density of the patient and klemetti index with: C2, C3 categories (moderate and severe erosion) most common observed in the osteoporotic patient. Conclusions: Orthopanthographic X-rays provide a valuable tool for early detection and assessment of osteoporosis (preclinical stage) especially when characterized by a decrease in bone mineral density.

The Impact of COVID-19 Pandemic on the Epidemiology of Hip and Knee Arthroplasty: A Two-Year Look into the Pandemic from A Single Tertiary Referral General Hospital in Indonesia

Highlights: Arthroplasty surgeries were reduced significantly during the COVID-19 pandemic. The number of operations gradually increased between the first and second year of the pandemic. Patients’ median age and hospital stays were reduced during the pandemic. Abstract Introduction: The COVID-19 pandemic has had significant effects on arthroplasty surgeries worldwide. Various studies have described decreased arthroplasty procedures among the most common orthopedic surgeries. This study aimed to analyze the effects of the pandemic on the epidemiology and demography of hip and knee arthroplasty in a tertiary referral general hospital in Indonesia. Methods: This was a retrospective study of medical records data conducted on hip and knee arthroplasty cases from the pre-pandemic (April 2019–March 2020), first-year pandemic (April 2020–March 2021), and second-year pandemic (April 2021–March 2022) periods. Each period was compared for epidemiology and demography data, which included the annual number of arthroplasties, female-to-male ratio, age, duration of hospitalization, and in-hospital post-operative rehabilitation participation. Results: This study observed a statistically significant decrease of 232.00% for hip and 371.43% for knee arthroplasty performed during the first-year pandemic and an increase of 41.86% for hip and 74.07% for knee arthroplasty in the second-year pandemic. A decrease in median age and fluctuation of the female-to-male ratio were observed. The median duration of hospitalization was 80.00% shorter between the pre-pandemic and first-year pandemics and 11.11% shorter between the first and second-year pandemics. Participation in rehabilitation fluctuated during each period. There were four positive cases of COVID-19 and two cases of mortality during the first- and second-year pandemics. Conclusion: The COVID-19 pandemic caused a significant reduction in arthroplasties performed during the first year and a slight increase during the second year. A decreased median age and shorter hospital stays were also observed.

Effect of fondaparinux anticoagulants on D-dimer levels in Covid-19 patients

Background: Anticoagulants can prevent thromboembolic activities, improve prognosis, and reduce the mortality rate in Covid-19 patients with coagulopathy. Objective: To analyse the effect of Fondaparinux in decreasing D-dimer levels, and to determine the correlation between patient characteristics, disease severity, and D-dimer levels. Methods: This is a single-centre retrospective cohort study using the medical records of Covid-19 in-patients who were ≥ 17 years old, on Fondaparinux 2.5 mg OD and had D-dimer measurement pre-and post-five days-Fondaparinux therapy during hospitalisation at referral general hospital in Bengkulu, Indonesia between April 2020 and December 2021. The data were assessed to evaluate the differences in the pre-post D-dimer levels, the relationship between patient characteristics and disease severity, and the relationship between disease severity and D-dimer levels. Results: A total of thirty-six patients were included in this study, of which 52.78% were males and 44.44% were aged 46-55 years old. Furthermore, 88.89% had comorbidity, and 55.55% had moderate severity. There was a significant decrease in D-dimer levels in all disease severity (p &lt; 0.05). Patient characteristics and disease severity were not associated with D-dimer depletion (p &gt; 0.05). Conclusion: Fondaparinux reduced the D-dimer levels in all severity of Covid-19 patients.

Compliance with the 2016 Surviving Sepsis Campaign Bundle and the 2018 Surviving Sepsis Campaign 1-Hour Bundle and patient outcomes in emergency presentation at a tertiary referral hospital

Background &amp; Objective: Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis has always been associated with high morbidity and mortality. Consensus committees of international organizations have recommended packages to reduce the high mortality. We evaluated the 2016 Surviving Sepsis Campaign (SSC) package with 3 and 6-hour sepsis packages and the 2018 SSC with 1-hour sepsis package on the mortality of septic patients who came to a tertiary referral hospital.&#x0D; Methodology: We enrolled 164 retrospective cohort patients in the tertiary emergency referral general hospital resuscitation ward. The patients were followed up for 48 h of observation. Sepsis and septic shock criteria are based on the Third International Consensus Definition of Sepsis and Septic Shock (Sepsis-3) 2016. Patients were divided into 3 groups, based upon compliance with SSC 16 at 3 h, 6 h, and SSC 18 at 1 h, and the mortality was recorded before 48 h and after 48 h.&#x0D; Results: Compliance rates at 1 h (27.4%), 3 h (39.6%), and 6 h (43.3%) were significantly associated with patient mortality (P ≤ 0.001). Population patients who met the criteria for SSC, 73.3% had been referred from peripheral hospitals. The mortality rate was 76 (46.34%) for &lt; 48 h and 37 (22.56%) for more than 48 h.&#x0D; Conclusion: Compliance with sepsis management contributes to improved patient condition and a better prognosis when the Surviving Sepsis Campaign package is adequately implemented.&#x0D; Abbreviations: SSC - Surviving Sepsis Campaign; SOFA - Sequential Organ Failure Assessment; qSOFA - quick Sequential Organ Failure Assessment; VIS - Vasopressor Inotropic Score&#x0D; Key words: Sepsis; SSC Sepsis Bundle Compliance-2016; 1 Hour SSC Sepsis Package 2018; Death; Vasopressors; Outcome; Mortality&#x0D; Citation: Utariani A, Semedi BP, Salinding A, Hamzah H. Compliance with the 2016 Surviving Sepsis Campaign Bundle and the 2018 Surviving Sepsis Campaign 1-Hour Bundle and patient outcomes in emergency presentation at a tertiary referral hospital. Anaesth. pain intensive care 2023;27(5):478−485; DOI: 10.35975/apic.v27i5.1852&#x0D; Received: March 26, 2022; Reviewed: December 21, 2022; Accepted: August 08, 2023

Deep Learning-based Approach to Predict Pulmonary Function at Chest CT.

Background Low-dose chest CT screening is recommended for smokers with the potential for lung function abnormality, but its role in predicting lung function remains unclear. Purpose To develop a deep learning algorithm to predict pulmonary function with low-dose CT images in participants using health screening services. Materials and Methods In this retrospective study, participants underwent health screening with same-day low-dose CT and pulmonary function testing with spirometry at a university affiliated tertiary referral general hospital between January 2015 and December 2018. The data set was split into a development set (model training, validation, and internal test sets) and temporally independent test set according to first visit year. A convolutional neural network was trained to predict the forced expiratory volume in the first second of expiration (FEV1) and forced vital capacity (FVC) from low-dose CT. The mean absolute error and concordance correlation coefficient (CCC) were used to evaluate agreement between spirometry as the reference standard and deep-learning prediction as the index test. FVC and FEV1 percent predicted (hereafter, FVC% and FEV1%) values less than 80% and percent of FVC exhaled in first second (hereafter, FEV1/FVC) less than 70% were used to classify participants at high risk. Results A total of 16 148 participants were included (mean age, 55 years ± 10 [SD]; 10 981 men) and divided into a development set (n = 13 428) and temporally independent test set (n = 2720). In the temporally independent test set, the mean absolute error and CCC were 0.22 L and 0.94, respectively, for FVC and 0.22 L and 0.91 for FEV1. For the prediction of the respiratory high-risk group, FVC%, FEV1%, and FEV1/FVC had respective accuracies of 89.6% (2436 of 2720 participants; 95% CI: 88.4, 90.7), 85.9% (2337 of 2720 participants; 95% CI: 84.6, 87.2), and 90.2% (2453 of 2720 participants; 95% CI: 89.1, 91.3) in the same testing data set. The sensitivities were 61.6% (242 of 393 participants; 95% CI: 59.7, 63.4), 46.9% (226 of 482 participants; 95% CI: 45.0, 48.8), and 36.1% (91 of 252 participants; 95% CI: 34.3, 37.9), respectively. Conclusion A deep learning model applied to volumetric chest CT predicted pulmonary function with relatively good performance. © RSNA, 2023 Supplemental material is available for this article.

Endocrinology specialty service for inpatients: an unmet growing need

BackgroundThere is recent concern regarding the documented mismatch between demand and supply, vis-à-vis the growing need for trained endocrinologists unmet by parallel rise in the world workforce of endocrinologist. Due to the increasing complexity of disease in inpatients, in recent years we have experienced a growing demand for inpatient endocrine consults. Surprisingly, the need for the endocrinology subspecialty in the overall care of inpatients in the current setting of general hospitals has received little attention.MethodsA retrospective analysis of endocrine consult service based on solicited consults carried out during 3 consecutive months.ResultsDuring 3 months, there were 767 consults, comprised of 156 diabetes referrals and 611 endocrine/metabolic consult requests. The 611 "non-glucocentric" consult requests were related to 295 inpatients (2.1 ± 2.7 consults/patient). Mean patient age was 58.9 ± .18 years (range 21–92), with some F/M preponderance (58/42%). Requests for endocrine consults were evenly distributed (49.8%, 50.2%) between internal medicine and surgery wards. Case distribution was as follows: thyroid 45.4%, calcium & bone 11.5%, pituitary 12%, adrenal 10% and all others 8.1–0.7%. The mean response time was 4.4 ± 2.7 h. The consults had a discernible effect on the patients' disease management in 60% of the patients. Of these, the consults modified the hospital treatment in 74%, the discharge treatment recommendations in 19% and the diagnosis in 7%.ConclusionAt a large medical center, endocrine consults were requested for ~ 3.3% of all admitted inpatients. The endocrine consults modified pre-consult diagnosis or treatment in ~ 60% of the cases. Contrary to its common image as an exclusively outpatient-based subspecialty, endocrinology practiced by specialists and endocrine trainees has a notable role in the daily care of inpatients admitted to a referral general hospital.

Psychopathological states among Congolese health workers during the first wave of COVID-19 pandemic: links with emotion regulation and social support

ABSTRACT Background: The COVID-19 pandemic is an unprecedented stressor for frontline healthcare workers, notably increasing acute stress disorder and depression rates. Emotion regulation and social support could be major protective factors against such psychopathological states, but their role has not been explored outside Western contexts. Objective: To assess the association between emotion regulation, social support, acute stress disorder, and depression among healthcare workers directly confronted with the first wave of COVID-19 pandemic in the eastern Democratic Republic of the Congo. Method: A cross-sectional study assessed acute stress disorder, depression, adaptive (i.e. acceptance, positive refocusing, …) and maladaptive (i.e. self-blame, rumination, catastrophizing, …) emotion regulation strategies, social support (instrumental, emotional, and informational levels), as well as self-reported situations and feelings related to COVID-19, in a population of 252 frontline healthcare workers (121 women; 131 men; mean age: 39 ± 11 years old) at the Referral General Hospital of Bukavu. We also explored the relations between these variables through bivariate and multivariate logistic regression. Results: Forty percent of participants presented symptoms of depression, and 16% presented acute stress disorder. In bivariate logistic regression, these psychiatric outcomes were associated with the availability of a COVID-19 protection kit [OR = 0.24 (0.12–0.98)], hostility toward health workers [OR = 3.21 (1.23–4.21)], putting into perspective [OR = 0.91 (0.43–0.98)], self-blame [OR = 1.44 (1.11–2.39)], catastrophizing [OR = 1.85 (1.01–4.28)], blaming others [OR = 1.77 (1.04–3.32)], emotional support [OR = 0.83 (0.49–0.98)], instrumental support [OR = 0.74 (0.28–0.94)], and informational support [OR = 0.73 (0.43–0.98)]. In multivariate logistic regression, hostility [OR = 2.21 (1.54–3.78)], self-blame [OR = 1.57 (1.02-2.11)], rumination [OR = 1.49 (1.11-3.13)] and emotional support [OR = 0.94 (0.65-0.98)] remained significantly associated with psychiatric outcomes. Conclusion: Depression and acute stress disorder were highly prevalent among Congolese healthcare workers during the first wave of the COVID-19 health pandemic. Hostility, self-blame, rumination, and social support were associated with depression and/or acute stress disorder and should be targeted by interventions aiming to support health workers’ wellbeing. HIGHLIGHTS Frontline health workers presented high prevalence of acute stress disorder (16%) and depression (40%) during the first wave of COVID-19 pandemic in the Eastern Democratic Republic of the Congo, as they were working in hostile environment without enough protection kits. Acute stress disorder and depression were negatively associated with adaptive emotion regulation and social support; and positively with maladaptive emotion regulation. Intervention aiming to support health workers in pandemics should target emotion regulation and social support.

Knowledge, Attitudes and Practices of Health Care Providers on HIV / AIDS in Kisangani (DR Congo)

Objective: Our objective was to determine the knowledge, attitudes and practices relating to HIV-AIDS among health care providers in general referral hospitals in the city of Kisangani.&#x0D; Methods: We carried out a cross-sectional descriptive study with providers of care from HGRs in the city of Kisangani. Our respondents completed a questionnaire designed to assess knowledge, attitudes and practices regarding HIV / AIDS.&#x0D; Results: Most of our respondents were female with a proportion of 52.2%, with an age between 26 to 35 years old. The results showed that approximately 75.06% of providers have an acceptable level of knowledge about the clinical manifestations of the disease, 86.7% had a positive attitude towards a Person living with HIV (PLHIV) and 78.1% demonstrated good practice.

Epidemiological Profile of Sexually Transmitted Infections in the Province of Lualaba, in the Democratic Republic of Congo. Case of Two General Referral Hospitals

Epidemiological Profile of Sexually Transmitted Infections in the Province of Lualaba, in the Democratic Republic of Congo. Case of Two General Referral Hospitals

Knowledge and Practices of Health Professionals on the Optimization of Radiation Protection in Diagnostic Radiology in Children and Adults in the General Referral Hospitals of Bukavu in South Kivu, DRC

Knowledge and Practices of Health Professionals on the Optimization of Radiation Protection in Diagnostic Radiology in Children and Adults in the General Referral Hospitals of Bukavu in South Kivu, DRC

Surgical procedures for children in the public healthcare sector: a nationwide, facility-based study in Uganda

ObjectiveThis study investigated the surgical services for children at the highest levels of the public healthcare sector in Uganda. The aim was to determine volumes and types of procedure performed...

Care needs and preferences from the perspective of COVID-19 patients: A qualitative study.

Background: The COVID-19 epidemic is one of the major health problems worldwide due to its inconceivable spreading power and potential damage. Given the increasing prevalence of the disease, the identification of care needs and preferences of patients could play an important role in providing effective training and caring programs. This study was conducted to explain the preferences and needs of care based on the experiences of patients with COVID-19. Methods: This qualitative study with a content analysis approach was performed in 2 months at a referral general hospital and quarantine centers of COVID-19 in Tehran, the capital of Iran, in 2020. The participants consisted of 15 COVID-19 patients selected through purposive sampling. The data analysis was performed using the conventional content analysis method according to the procedure proposed by Graneheim and Lundman. Results: The results were classified into 5 main categories: (1) access to desirable care and comfort services; (2) access to education and information from credible sources; (3) access to specialized care; (4) support social needs; and (5) need for deep emotional interactions. Conclusion: According to our results, identifying priorities and care needs from the perspective of patients with COVID-19 can help improve knowledge, reduce unrealistic patient concerns, and improve emotional interactions between patients and health care providers.

Surgical Site Infection (SSI) in the National Referral General Hospital of Ndjamena (Chad): Survey about Risk Factors

The risk to develop an infection after surgery depends on several factors. Those factors may be interdependent or not, depending on the nature of the surgery and the general condition of the patient. The aim of the present study was to identify the factors involved in the occurrence of the Surgical Site Infections (SSI) in the National referral general hospital of N’djamena (Chad). We first realized an interview in the emergency services and in the general surgery of the hospital. The information collected allowed us to draw up survey sheets. An investigation was then conducted on 152 patients who had surgery and were hospitalized during the study period. The frequency of the SSI was 33.6% (51/152). The main risk factors that we identified were the duration of hospitalization, the category of the hospitalization room, the urgent aspect of the surgical intervention, the patient’s nutritional status and the associated diseases with diabetes, which was present in 52.38% (11/21) of cases of associated pathologies. Analysis of the antibiotic prophylaxis administered to patients showed that ciprofloxacin was more effective in SSI prevention. Indeed, this antibiotic showed the fewest cases of infection with only 1.9% of patients having developed SSI. Our results show a very high frequency of SSI at the National referral general hospital of N’djamena. Poor hospital practices and factors associated to patients seem to be the most factors implicated in the SSI.

Work-Family Conflict and Mental Emotional Disorder in Female Nurses at National Referral Hospital in Jakarta

Introduction: Emotional mental disorder (EMD) is a state of psychological distress that, if not handled properly, can lead to severe mental disorders. One potential psychosocial hazard that is thought to be related to mental health disorders is work-family conflict (WFC). The issue of family-work balance has become an important issue among Indonesian female workers, especially with the rapidly growing female worker society and the strong family culture. This study aimed to identify the association between work-family conflict and emotional mental disorder in female nurses. Methods: This cross-sectional study included 264 female nurses who work at national referral general hospital in Jakarta. Their emotional mental disorder was measured using Self-Reported Questionnaire 20 (SRQ-20) and the work-family conflict was measured using the Work-Family Conflict Scale (WCFS). Results: The prevalence of emotional mental disorder in female nurses was 23.5%. The most dominant factor associated with emotional mental disorder is work-family conflict (OR 2,40, CI 95% 1,32-4,35, p=0,004). Conclusion: There is a significant association between work-family conflicts and emotional mental disorders in female nurses in Indonesia. Nurses with work-family conflicts are more likely to have emotional mental disorders. Regular mental health checks and counseling should be performed along with periodic health checks.

Delayed Symptoms in Patients Recovered from COVID-19.

Background:COVID-19 is a new disease, so we don’t know what comes next. Since information on delayed symptoms is limited, this study was conducted to assess the frequency of delayed symptoms in patients with COVID-19.Methods:This follow-up cross-sectional study was conducted in a referral general hospital in Tehran, Iran from Feb to Apr 2020. Two hundred patients hospitalized for COVID-19 and were discharged were assessed for delayed symptoms 6 wk after discharge.Results:The mean age of the participants was 55.58±13.52, and 160 (80%) Of them were male. On admission to hospital, patients reported a mean of 5.63±2.88 symptoms per patient, range from 1 to 14 symptoms. Dyspnea was seen in 119 (59.5%) 0f them as the most frequent symptom. Then weakness, myalgia, and shivering were reported with a frequency of 111 (55.5%), 107 (53.5%), and 103 (51.5%), respectively. Six weeks after discharge reassessment was done. None of the patients was readmitted to the hospital. Ninety-four (42%) of them were symptom-free. Fatigue was the most frequent delayed symptom with a frequency of 39 (19.5%), and then dyspnea, weakness, and activity intolerance with a frequency of 37 (18.5%), 36 (18%), and 29 (14.5%) were reported, respectively.Conclusion:Fatigue, dyspnea, weakness, anxiety, and activity intolerance were most frequent delayed symptoms, respectively. Majority of patient was symptoms free and those with symptom, had mild to moderate symptoms. The importance of symptoms is not fully recognized. Follow up clinics and in some cases rehabilitation programs may be helpful.

O CUIDADO TRANSPESSOAL COMO ESTRATÉGIA DE ACOLHIMENTO À FAMÍLIA EM HOSPITALIZAÇÃO PALIATIVA: UMA EXPERIÊNCIA POSSÍVEL

This article is an experience report describes the implementation of Transpersonal Care to a family system experiencing palliative oncological hospitalization. The experience described is part of an outreach action of the Multidisciplinary Family Welcoming Group carried out by Nursing and Psychology undergraduate students. The three-month action provided to a family facing palliative oncological hospitalization took place in a referral general hospital. The results involved researching the family followed by diagnoses and actions to meet the following transpersonal care: the use of images to stimulate the expression of feelings - emotional care; the use of images related to facts and myths about the pathology - educational action oriented to intellectual care; touch/comfort massage - physical care and reflective questions and music - spiritual care. Welcoming families in palliative oncological hospitalization is effective in systematized care actions and it is expanded in the light of the systemic-transpersonal approach.

Determinants of Motivation among Health Care Providers, Case of Four General Referral Hospitals in Lubumbashi

Introduction: The objectives of our study were to determine providers by structure, to determine the providers by age, to make recommendations improve the motivation of the human resources and finally to determine the factors that influence the motivation of the personnel in the HGR of the city of Lubumbashi. Methodology: This is a cross-sectional analytical descriptive study of 152 care providers from four reference hospitals in Lubumbashi, sur-veyed prospectively, and based on a pre-established questionnaire. Data were analysed using SPSS 23. The statistical associations were evaluated by deter-mining the p-value whose threshold was fixed at 0.05, using the chi-square test. Results: In the majority, 27.63% of respondents were between 39 and 45 years old. The average age was 37.58 ± 10.64 years, the extremes with 21 and 69 years. There is no statistical relationship between on-the-job training and pro-vider motivation (p-value greater than 0.05). Chi2 = 3.9; p = 0.06. We noticed that 71.05% of respondents were in medical services with the majority being 15.79% in the Internal Medicine department. Conclusion: Improving working conditions is of paramount importance to improve the performance of healthcare providers and, consequently, the quality of care in our environment; thus, we believe that this should be done through the mechanization of health care providers, their provision of the risk premium and the encouragement of those who work overtime.

External Validation of Carbapenem-Resistant Enterobacteriaceae Acquisition Risk Prediction Model in a Medium Sized Hospital

This study was aimed to evaluate the external validity of a carbapenem-resistant Enterobacteriaceae (CRE) acquisition risk prediction model (the CREP-model) in a medium-sized hospital. This retrospective cohort study included 613 patients (CRE group: 69, no-CRE group: 544) admitted to the intensive care units of a 453-beds secondary referral general hospital from March 1, 2017 to September 30, 2019 in South Korea. The performance of the CREP-model was analyzed with calibration, discrimination, and clinical usefulness. The results showed that those higher in age had lower presence of multidrug resistant organisms (MDROs), cephalosporin use ≥ 15 days, Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 21 points, and lower CRE acquisition rates than those of CREP-model development subjects. The calibration-in-the-large was 0.12 (95% CI: - 0.16~0.39), while the calibration slope was 0.87 (95% CI: 0.63~1.12), and the concordance statistic was .71 (95% CI: .63~.78). At the predicted risk of .10, the sensitivity, specificity, and correct classification rates were 43.5%, 84.2%, and 79.6%, respectively. The net true positive according to the CREP-model were 3 per 100 subjects. After adjusting the predictors' cutting points, the concordance statistic increased to .84 (95% CI: .79~.89), and the sensitivity and net true positive was improved to 75.4%. and 6 per 100 subjects, respectively. The CREP-model's discrimination and clinical usefulness are low in a medium sized general hospital but are improved after adjusting for the predictors. Therefore, we suggest that institutions should only use the CREP-model after assessing the distribution of the predictors and adjusting their cutting points.