Regional Acute Hospital Research Articles

Acceptability of self-collected vaginal samples for human papillomavirus testing for primary cervical cancer screening: comparison of face-to-face and online recruitment modes

BackgroundThis study aimed to assess the acceptability and attitudes of women towards human papillomavirus (HPV) self-sampling and compare the effectiveness of two delivery modes utilising face-to-face and online website for cervical cancer screening in Hong Kong.MethodsWomen aged 30–65 years were invited to participate by distributing the study information pamphlets at the specialist clinics of a regional acute hospital. Those who were interested in participating were given the option to join directly face-to-face or through an online website. All participants provided informed consent and received self-sampling kits and acceptability questionnaires either immediately (face-to-face) or through the post after registering at the website (online). All participants were requested to collect their own vaginal samples using a swab which was then brushed on a DNA sample storage card and returned to the hospital either in person or by post. The self-collected samples were tested for high-risk HPV using the Sentis™ HPV assay, a validated isothermal nucleic acid amplification real-time fluorescent detection assay. The primary outcome was the uptake rate of HPV self-sampling.ResultsOf the 1998 women recruited (1200 face-to-face, 798 online), 1377 returned their samples, giving an overall uptake rate of 68.9%. The uptake rate was significantly greater in the face-to-face mode than in the online mode (74.6% vs. 60.4%, p < 0.001). The median age of the participants was 49 years, 43.7% were never or under-screened, and 7.1% had high-risk HPV detected. Overall, 82.1% of the participants reported self-sampling convenient, and 79.3% were not embarrassed when collecting self-samples. However, only 49.8% were confident that they had collected the self-samples correctly. Most (91.1%) of the participants expressed willingness to perform self-sampling again, mostly because it was simple (79.2%) and quick (56.3%).ConclusionsHPV self-sampling can serve as an alternative primary screening method for cervical cancer in Hong Kong, especially for individuals who have not been adequately screened in the past. Both face-to-face and online website recruitment were associated with high acceptability, emphasising the potential benefits of utilising different platforms and strategies for reaching diverse populations.

Nurses’ and patients’ perceptions on interruptions on admission processes at an acute public hospital using cross-sectional survey

ProblemAdmissions are a critical component of patient care. However, nurses get interrupted during care provision. There is limited understanding of the dynamics regarding interruptions during admission and their effect. AimTo ascertain how often and why interruptions occurred; and whether these impacted patients. MethodsThe cross-sectional survey study took place in the hospital of a 327-bed regional acute public hospital in Queensland, Australia, during July 2020. Nurses completed a survey asking about the admissions and interruptions they had encountered. Patients completed a survey asking about their perceptions of admissions and interruptions during the admission process. FindingsNurses across five units completed 171 surveys, and patients completed 55 surveys. There was no statistical difference in interruptions per hour between admissions of 15-44 min, 45 min to 1 h 15 min, and over 1 h 15 min. When the admissions with and without interruptions were compared, the ‘interrupted’ group had a median admission time of 50 min (interquartile range 35−75), and the ‘non-interrupted' group was 30 min (20-39) (p < 0.01). Nurses identified three themes of what could be improved to streamline admission processes: Simpler admission paperwork, admission timing and process, and emergency department input on admission documentation. Overall, patients were satisfied with the admission process. Patients' satisfaction was not impacted by the interruptions. ConclusionWhile nurses reported that admission processes were repetitive and could be simplified, patients were not concerned with the interruptions during admission in our study. However, future research with robust measures is required.

Modified Glasgow Prognostic Score (mGPS) for Prognostication of Adult Oncology Patients With Palliative Intent in a Regional Victorian Hospital, Australia.

Accurate prognostication is essential in caring for palliative patients. Various prognostication tools have been validated in many settings in the past few years. Biomarkers of inflammation (albumin and C-reactive protein) are combined to calculate the modified Glasgow prognostic score (mGPS), which has been found to be a simple prognostic tool in this population. This retrospective cohort study was to evaluate mGPS as a prognostication tool for cancer patients admitted to an acute hospital in regional Australia. Adult cancer patients admitted to an acute Australian regional hospital during 2017 who had albumin and C-reactive protein (CRP) tested were included. The mGPS was calculated based on their admission values and discharge values. Based on their score (0-2), groups were compared using univariate and multivariate Cox regression analysis for prognostication. Kaplan-Meier survival plots and median survival time from admission and discharge were constructed. A total of 170 patient records were reviewed of which 95 had admission and discharge mGPS scores available for analysis. Of those, 86 had died at the time of data analysis. The median survival for admission mGPS 0, 1, 2 was 168,156 and 74 days. For discharge mGPS 0, 1, 2 medians were 168,119 and 70 days. On multi variate analysis admission mGPS 2 showed Hazard ratio of 2.29 (95% CI 1.16-4.56, p -0.02) and discharge mGPS 2 of 2.07 (95% CI 0.95-4.50, p value 0.07). In this study, mGPS was able to differentiate cancer patients into various prognostic groups. Further studies in regional acute hospitals could validate this prospectively with a multi-center larger sample size.

Which factors influence the decision to transfer patients with traumatic brain injury to a neurosurgery unit in a major trauma network?

Objectives: Within the pan London Major Trauma System many patients with minor or non-life threatening traumatic brain injury (TBI) remain at their local hospital and are not transferred to a major trauma centre (MTC). Our aim was to identify factors that influence the decision to transfer patients with TBI to a neurosurgical centre.Methods: This is a single centre prospective cohort study of all patients with TBI referred to our neurosurgery unit from regional acute hospitals over a 4-month period (Sept 2016–Jan 2017). Our primary outcome was transferred to a neurosurgical centre. We identified the following factors that may predict decision to transfer: patient demographics, transfer distance, antithrombotic therapy and severity of TBI based on initial Glasgow Coma Scale (GCS) and Marshall CT score. A multivariable logistic regression analysis was performed.Results: A total of 339 patients were referred from regional hospitals with TBI and of these, 53 (15.6%) were transferred to our hospital. The mean age of patients referred was 70.6 years, 62.5% were men and 43% on antithrombotic drugs. Eighty-six percent of patients had mild TBI (GCS 13–15) on initial assessment and 79% had a Marshall CT score of 2. The adjusted analysis revealed only higher age, higher Marshall Score, the presence of chronic subdural haematoma (CSDH), the presence of contusion(s) and fracture(s) predicted transfer (p<.05). Subgroup analysis consistently showed a higher Marshall score predicted transfer (p<.05).Conclusions: In our cohort higher Marshall score consistently predicted transfer to our neurosurgical centre. Presenting GCS, transfer distance and antithrombotic therapy did not influence decision to transfer.

34 Geriatricians in Intermediate Care Settings: A Modern Approach to Geriatric Medicine

Abstract Introduction Due to growing older population with increasing medical complexity and care needs, over-reliance on acute hospitals for care delivery, disconnect between social and medicalised care and challenging national health services (NHS) financial climate, it is essential to provide much of this care to our older patients outside the acute hospital before they reach crisis point. This prevents unnecessary hospital admissions and outpatient referrals especially to our geriatric services. Therefore, newer and innovative care models are required to cater the needs of our aging population especially within the community settings. The North West Surrey clinical commissioning group (CCG) catchment area is divided into three localities, namely SASSE Locality in Spelthorne, Thames Medical Locality in Runnymede/West Elmbridge, and the Woking Locality (Bedser hub) in Woking. Locality hub model of integrated care led by GP with multidisciplinary (MDT) input along with wellbeing coordinators was introduced to address above issue. Objectives Our mission was to find a way to manage the challenges we face from a growing older population within an integrated GP-led community service and in a manner that promotes independence, reduce social isolation, improve patient experience and safely deliver appropriate acute care in the community whilst reducing dependency on regional acute hospitals. A fully qualified geriatrician input was introduced within the hub model at Bedser hub. Results Total savings: £16,484, Geriatricians input cost: £16,500 Cost neutral intervention Conclusions Newer models of collaborative healthcare within the community dwellings with GP and geriatrician input along with multidisciplinary approach are essential to deliver safe and high quality care to our older population, thus reducing reliance on our ever so stretched local acute NHS hospitals. Our intervention has resulted in reduction of referrals to geriatric outpatient clinic and enabled us to provide the required care to our older population closer to home. It has also led GPs to build their skills in managing the very frail patients with complex needs safely and effectively. In the long run, the intervention will be cost effective with further projected reduction in referrals.

Demographics, Psychological Distress, and Pain From Pressure Injury.

There is a knowledge gap regarding factors that influence the intensity of pain associated with pressure injuries. We examined the influence of age, gender, race, and comorbidity on the relationships between pressure injuries, psychological distress, and pain intensity in hospitalized adults. This study was a cross-sectional, retrospective secondary analysis using data from a regional acute hospital's electronic health records from 2013 to 2016. A sample of 454 cases met the inclusion criteria and were analyzed using path analysis. The hypothesized model (Model A) and two alternative models (Models B and C) were tested and demonstrated adequate model fit. All tested models demonstrated statistically significant independent direct effects of age on the severity of pressure injury (p < .001) and pain intensity (p = .001), as well as independent direct effects of gender (p ≤ .005), race (p < .001), and comorbidity (p = .001) on psychological distress. Pain management for individuals with pressure injuries should include not only the treatment of wounds but also the individual characteristics of the patient such as demographics, comorbidity, and psychological status that may affect pain. Given the limitations of secondary analyses, further studies are suggested to validate these findings.

Clinical handover practices among healthcare practitioners in acute care services: A qualitative study.

To examine clinical handover practices in acute care services in Ireland. Objectives were to examine clinical handover practices between and within teams and between shifts, to identify resources and supports to enhance handover effectiveness and to identify barriers and facilitators of effective handover. Clinical handover is a high-risk activity, and ineffective handover practice constitutes a risk to patient safety. Evidence suggests that handover effectiveness is achieved through staff training and standardised handover protocols. The study design was qualitative-descriptive using inductive analysis. The study involved a series of focus group discussions and interviews among a sample of healthcare practitioners recruited from 12 urban and regional acute hospitals in Ireland. A total of 116 healthcare professionals took part in 28 interviews and 13 focus group discussions. We analysed the data using the directed content analysis method. Data collection generated rich qualitative data, yielding five categories from which two broad themes emerged: "policy and practice" and "handover effectiveness." The themes and their associated categories indicate that there is limited organisational-level policy and limited explicit training in clinical handover, that medical and nursing handovers are separate activities with somewhat different purposes and different modes of execution, and that several factors in the acute care setting, including location, timing and documentation, act as either barriers or enablers to handover effectiveness. The evidence in the current study suggests that clinical handover merits increased level of prominence in hospital policies or operating procedures. Medical and nursing handover practices represent distinct activities in their content and execution that may be related to cultural and organisational factors. Achieving multidisciplinary team handover requires a change in embedded traditional practices. Several aspects of the clinical handover activities of nursing and medical staff appear to diverge from best-practice evidence.

Predictors of the success and failure of emergency pelvic artery embolisation for primary postpartum haemorrhage: a 12-year review.

This study aimed to identify predictors of the outcome and clinical efficacy of emergency pelvic artery embolisation (PAE) for primary postpartum haemorrhage (PPH) and to assess the post-embolisation fertility of PAE patients in a regional hospital setting. A 12-year retrospective study of patients undergoing emergency PAE was conducted at a regional acute general hospital. Clinical and procedural parameters, clinical outcomes and post-embolisation pregnancy success rates were analysed. There were 47,221 deliveries at the hospital during the study period, of which 33 patients required urgent PAE for primary PPH. The technical success rate of embolisation was 97.0% (n = 32). Clinically adequate haemostasis was achieved by a single embolisation procedure in 24 (72.7%) patients; the remaining eight eventually required surgery to achieve cessation of bleeding. Among the parameters studied, multivariate logistic regression analysis showed that pre-embolisation platelet count (p = 0.036) and maternal age (p = 0.019) were the only significant independent predictors of embolisation failure. Only two patients successfully conceived after PAE, although one of them had an ectopic pregnancy. Emergency PAE is an effective measure to arrest life-threatening bleeding in patients with primary PPH. As low pre-embolisation platelet count and advanced maternal age are associated with higher odds of embolisation failure, careful post-embolisation monitoring may be required for such patients. Embolisation also allows subsequent pregnancy. However, further studies are required to assess the outcomes of post-embolisation pregnancies.

Enhanced Recovery After Surgery (ERAS) implementation at an acute regional hospital in Australia: A prospective trial

Enhanced Recovery After Surgery (ERAS) implementation at an acute regional hospital in Australia: A prospective trial

Effect of proactive infection control measures on benchmarked rate of hospital outbreaks: An analysis of public hospitals in Hong Kong over 5 years

BackgroundHospital outbreaks of epidemiologically important pathogens are usually caused by lapses in infection control measures and result in increased morbidity, mortality, and cost. However, there is no benchmark to compare the occurrence of hospital outbreaks across hospitals.MethodsWe implemented proactive infection control measures with an emphasis on timely education of health care workers and hospitalized patients at Queen Mary Hospital, a teaching hospital. Our benchmarked performance (outbreak episodes per 1 million patient discharges and 1 million patient-days) was compared with those of other regional public hospitals without these additional proactive measures in place between 2010 and 2014.ResultsDuring the study period, Queen Mary Hospital had 1 hospital outbreak resulting in 1.48 and 0.45 outbreak episodes per 1 million patient discharges and patient-days, respectively, values significantly lower than the corresponding overall rates in the 7 acute regional hospitals (24.26 and 6.70 outbreak episodes per 1 million patient discharges and patient-days, respectively; P < .001) and that of all 42 public hospitals in Hong Kong (41.62 and 8.65 outbreak episodes per 1 million patient discharges and patient-days, respectively; P < .001).ConclusionsThe results of this large study on benchmarked rate of hospital outbreaks per patient discharges or patient-days suggests that proactive infection control interventions may minimize the risk of hospital outbreaks.

An experience of the introduction of a blood bank automation system (Ortho AutoVue Innova) in a regional acute hospital

This paper reports on an evaluation of the introduction of a blood bank automation system (Ortho AutoVue® Innova) in a hospital blood bank by considering the performance and workflow as compared with manual methods. The turnaround time was found to be 45% faster than the manual method. The concordance rate was found to be 100% for both ABO/Rh(D) typing and antibody screening in both of the systems and there was no significant difference in detection sensitivity for clinically significant antibodies. The Ortho AutoVue® Innova automated blood banking system streamlined the routine pre-transfusion testing in hospital blood bank with high throughput, equivalent sensitivity and reliability as compared with conventional manual method.

An Innovative Community Geriatrics Elective to Teach Year 4 Medical Students About Nursing Home Care

In Singapore, Geriatrics is core curriculum in medical undergraduate training. Year two medical students are introduced to aging in a four hour program based in a nursing home. In their final year they spend one month in geriatric medicine as part of their 3 month internal medicine posting. In the fourth year there is an elective period of six weeks where they choose postings that they would like to spend time to learn more about the subject. There are 65 NHs in Singapore with 9495 beds as compared to 6 acute hospitals with 7500 beds. The NHs have more patients for students to learn from. The residents are also more stable to engage the students and participate in their learning. The NH also has unique aspects of Long Term care like managing severely disabled individuals including dementia, tube feeding, decision making and choices, ethics, pain, reversible conditions like delirium, depression and functional decline. In 2010, a course to teach medical care of older people in nursing homes was developed. The aims of the course were to teach geriatric medicine in the nursing home environment, to understand aspects of end-of-life care such as tube feedings, pain and symptom control, ethics, families' and residents' goals. Twenty students have enrolled, and the course has been fully subscribed each year. This is a description of the course and its effects on students. Aims: to describe the content and implementation of the course. The course was funded by the University of Singapore Medical School and organized by the Division of Community Geriatrics of Changi General Hospital, a regional acute hospital in collaboration with two nursing homes in the healthcare cluster. The elective in Community Geriatrics was put up on the students' website stating objectives, content, outcomes, duration (two weeks) and the periods offered (12 weeks block). Supervisors were consultants with interest in community geriatrics and actively involved in community eldercare programs PLUS strong interest in teaching. There were four consultants. The 'syllabus' comprised of: a)reading materials; b) site visit: clerk two cases and discussion, one lecture, see ten types of cases and discuss care issues: 3 physical disability (Parkinson, stroke, spinal), dementia with disruptive behaviour, chronic pain, resident on feeding tube, recurrent faller, pneumonia, diabetes; c) keep a log book; d) a short clinical project (optional) - either an audit or an observational study (e.g., caregiving, environments); f) participate in a meal with residents and answer a few questions after that; and g) a short 10 question test. At the end of the 2 week elective there was a closing session with students and their respective tutors/teachers which included debriefing, reflection and mutual feedback given by and received from students.

Effectiveness of Emergency Medicine Wards in reducing length of stay and overcrowding in emergency departments

ObjectiveThis study aims to evaluate the effectiveness of an Emergency Medicine Ward (EMW) in reducing the length of stay (LOS) in the emergency department, length of hospitalization, emergency medical admission rate, and the hospital bed occupancy rate. MethodsThis study is a cross-sectional, observational study with a retrospective, quantitative record review conducted at the EMW of a regional acute hospital in Hong Kong from January 2009 to June 2009. ResultsDuring the study, a retrospective audit was conducted on 1834 patient records. The five main groups of patients admitted into EMW suffered from cardiac disease (26.5%), pneumonia (19.6%), dizziness (16.2%), Chronic Obstructive Pulmonary Disease (12.3%), and gastroenteritis (7.9%). The mean LOS in the EMW was 1.27days (SD=0.59). The average emergency medical admission rate within the six-month period was significantly reduced relative to that before the EMW became operational (January 2008 to June 2008). Clinically, the medical in-patient bed occupancy was significantly reduced by 6.2%. The average LOS during in-patient hospitalization after the EMW was established decreased to 4.13days from the previous length of 5.16days. ConclusionsEMWs effectively reduce both the LOS during in-patient hospitalization and the avoidable medical admission rate.

Severity of airflow limitation, co-morbidities and management of chronic obstructive pulmonary disease patients acutely admitted to hospital

To assess the disease spectrum, severity of airflow limitation, admission pattern, co-morbidities, and management of patients admitted for acute exacerbations of chronic obstructive pulmonary disease. Case series. An acute regional hospital in Hong Kong. Adult subjects admitted during January 2010 to December 2010 with the principal discharge diagnosis of chronic obstructive pulmonary disease. In all, the records of 253 patients with physician-diagnosed chronic obstructive pulmonary disease were analysed. The majority were old (mean age, 78 years). The median number of admissions per patient for this condition in 2010 was two. About two thirds (64%) had had spirometry at least once. Mean forced expiratory volume in one second predicted was 55%. Almost 90% had moderate-to-very severe airflow limitation by spirometry. Overall, long-acting bronchodilators (beta agonists and/or antimuscarinics) were being prescribed for only 21% of the patients. Most of the patients admitted to hospital for acute exacerbations of chronic obstructive pulmonary disease were old, had multiple co-morbidities, and the majority had moderate-to-severe airflow limitation by spirometry. Almost half of them (around 46%) had two or more admissions in 2010. Adherence to the latest treatment guidelines seemed inadequate, there being a low prescription rate of long-acting bronchodilators. Chronic obstructive pulmonary disease patients warranting emergency admissions are at risk of future exacerbations and mortality. Management by a designated multidisciplinary team is recommended.

P374: Enhanced hospital hygienic monitoring program 2011-2012 in a acute regional hospital in Hong Kong

There is increasing evidence to show that contaminated environment does play a role in transmission of healthcare associated infection. Improvement in the effectiveness of daily and terminal cleansing of high touch surfaces is identified as one of the crucial element in hospital infection prevention. In view of the growing challenge of infections caused by multi-drugs resistant organisms, an infection prevention program for cleansing staff was initiated by infection control team (ICT) in Princess Margaret Hospital.

Cost-effectiveness of a health-social partnership transitional program for post-discharge medical patients

BackgroundReadmissions are costly and have implications for quality of care. Studies have been reported to support effects of transitional care programs in reducing hospital readmissions and enhancing clinical outcomes. However, there is a paucity of studies executing full economic evaluation to assess the cost-effectiveness of these transitional care programs. This study is therefore launched to fill this knowledge gap.MethodsCost-effectiveness analysis was conducted alongside a randomized controlled trial that examined the effects of a Health-Social Transitional Care Management Program (HSTCMP) for medical patients discharged from an acute regional hospital in Hong Kong. The cost and health outcomes were compared between the patients receiving the HSTCMP and usual care. The total costs comprised the pre-program, program, and healthcare utilization costs. Quality of life was measured with SF-36 and transformed to utility values between 0 and 1.ResultsThe readmission rates within 28 (control 10.2%, study 4.0%) and 84 days (control 19.4%, study 8.1%) were significantly higher in the control group. Utility values showed no difference between the control and study groups at baseline (p = 0.308). Utility values for the study group were significantly higher than in the control group at 28 (p < 0.001) and 84 days (p = 0.002). The study group also had a significantly higher QALYs gain (p < 0.001) over time at 28 and 84 days when compared with the control group. The intervention had an 89% chance of being cost-effective at the threshold of £20000/QALY.ConclusionsPrevious studies on transitional care focused mainly on clinical outcomes and not too many included cost as an outcome measure. Studies examining the cost-effectiveness of the post-discharge support services are scanty. This study is the first to examine the cost-effectiveness of a transitional care program that used nurse-led services participated by volunteers. Results have shown that a health-social partnership transitional care program is cost-effective in reducing healthcare costs and attaining QALY gains. Economic evaluation helps to inform funders and guide decisions for the effective use of competing healthcare resources.

Coping strategies used by children hospitalized with cancer: an exploratory study

The treatment of cancer is a stressful and threatening experience, particularly for children. Knowing how children cope with cancer is a crucial step toward designing appropriate psychological interventions that help them ease the burden of cancer treatment. The purpose of this study was to examine the coping strategies used by Chinese children hospitalized with cancer, an area of research that is under-represented in the existing literature. Hong Kong Chinese children (9-16-year olds) admitted for cancer treatment to the pediatric oncology units of two different regional acute public hospitals were invited to participate. A short one-to-one structured interview was conducted with each participant. Content analysis was conducted to analyze the interview data. A convenience sample of 88 children was recruited and participated in the interviews during an 8-month period. The coping strategies used by Chinese children hospitalized with cancer did not differ according to gender and diagnosis, but only according to age, with younger children using less problem-focused and more emotion-focused coping strategies than older children. The overall results indicated that 30% of these Chinese patients used problem-focused coping strategies, while 70% used emotion-focused coping. Findings from this study indicated that children use different coping strategies at different developmental stages. The study also revealed that Chinese children used more emotion-focused than problem-focused coping strategies than their Western counterparts. The information derived from this study will help health-care professionals design and shape appropriate psychological interventions that can help reduce the burden of cancer treatment. Copyright © 2010 John Wiley & Sons, Ltd.

ICU nurses’ perceptions of potential constraints and anticipated support to practice defibrillation: A qualitative study

The study examines the experience of intensive care nurses in caring for patients in cardiac arrest, and their perceptions of introducing nurse-led defibrillation. This was a descriptive, exploratory and qualitative study at an intensive care unit (ICU) of an acute regional hospital in Hong Kong. Twelve registered nurses were purposefully selected for interview. Although all the participants were trained in basic life support, only 50% were trained in advanced cardiac life support (ACLS), and those trained in ACLS described having limited opportunities to apply their defibrillation knowledge. Whilst participants believed that they were theoretically prepared to influence the patient's resuscitation outcomes, newly qualified nurses were reluctant to be accountable for defibrillation. In contrast, experienced nurses were more willing to perform nurse-led defibrillation. Support from management, cooperation between nurses and doctors, regular in-hospital 'real-drill' programmes, sponsorship for training, and the use of alternative defibrillation equipment should be considered to encourage nurse-led defibrillation in ICU settings. Nurse-led defibrillation is an approach of delivering prompt care to critically ill patients, and a way ahead for intensive care nursing in Hong Kong. Emphasis on a consistent policy to promote nurse-led defibrillation practice is needed.

Level of psychological distress and social support among patients with limb fractures in Hong Kong

To explore the relationship between psychological distress and social support and examine its association with various socio-demographic and clinical characteristics. Psychological distress is a common experience in patients after limb fractures. In this regard, a lower level of psychological distress is associated with better social support among patients with various types of diseases. However, there is a paucity of studies examining the relationship between social support and psychological distress among patients with limb fractures. More so, no such study has been conducted in the Chinese population. A cross-sectional and correlational design. A convenience sample of participants with upper limb fractures (n = 43) or lower limb fractures (n = 43) was recruited from two orthopaedic wards of a regional acute public hospital in Hong Kong. Data were obtained through face-to-face interview. The Impact of Event Scale was used to measure the level of psychological distress, while the Social Support Questionnaire Short-Form (SSQ6) was used to measure social support. Approximately two-thirds of the participants (n = 54) suffered from medium to high level of psychological distress. Majority of them were fairly satisfied with their social support, with their children being the most common support persons. Furthermore, there was no significant difference in the level of distress between the participants with lower or upper limb fractures. No significant correlation was found between psychological distress and social support. Those who were women, had lower education level and lower monthly income were significantly associated with a higher level of psychological distress. Patients with fractured limb suffered from a high level of psychological distress. Therefore, a comprehensive assessment of psychological distress should be incorporated as routine assessment. Also, assessing the socio-demographic characteristics of patients should enable nurses to identify patients at risk of developing a high level of psychological distress.

Foreign Material in Histological Specimens from Living Intravenous Drug Abusers (IVDA) — Illustration of 3 Cases

Drug addicts using the injection mode for drug delivery often suffer from complications relating to non-sterile needle pricks besides unintentional effects of the drugs such as anaphylaxis and other organ damage. Non-sterile injections lead to infections of all kinds, most common being viral such as Hepatitis B &amp; C and HIV infections; besides the usual bacterial and fungal infections. The evidence for this habit however, resides in the inert fillers they inject into their bodies together with the drug. Particles phagocytosed by macrophages in the body constitute permanent evidence of their past demeanor. The present write-up serves to illustrate the presence of injected crystalline material in various organs/tissues of 3 living subjects as seen at routine diagnostic histology in a regional acute hospital. The findings at autopsies of those who die from illicit drug abuse are well documented in the forensic literature1.