Secondary Hospital Research Articles

A Telemedicine System Using the Remote Diagnostic Imaging App "Join" for Emergency Medicine Throughout Wakayama Prefecture in Japan.

Background Telemedicine is expected to play an increasingly important role in building universal emergency medical systems without geographical disparities in the future. To eliminate healthcare disparities between regions, Wakayama Prefecture in Japan has been promoting telemedicine for closer inter-hospital coordination with secondary and tertiary emergency medical care hospitals. The "Join" diagnostic image-sharing app has been used since November 2018 for operating a remote emergency support system that shares medical images of emergency patients between 13 secondary and tertiary emergency medical care hospitals in Wakayama Prefecture. In this study, we investigated the effects of remote emergency medicine between hospitals after the introduction of Join. Methodology Four medical specialties use the remote emergency support system, namely, cardiovascular medicine, cardiovascular surgery, neurosurgery, and emergency care medicine. We investigated the results from 497 cases for which the system was used between November 2018 and February 2023. Results Of the 497 cases, treatment for 148 (29.8%) patients was continued in the same hospital, without a transfer. Emergency medicine was the group with the largest number of uses, in 232 cases. Of the 211 patients in the neurosurgery group, 88 (41.7%) were not transferred, the statistically significantly largest number of patients among the usage group (p < 0.01). An estimated transportation cost of 6,973,900 yen was saved due to 148 patients not being transferred. Tertiary emergency medical care hospitals were most frequently consulted, but secondary emergency medical care hospitals located long distances from tertiary emergency medical care hospitals also received large numbers of consultations from neighboring rural hospitals. Conclusions The Wakayama Prefecture remote emergency support system using Join has made it possible to communicate accurate information quickly between hospitals. This has contributed to fewer non-essential transfers to tertiary medical centers, reduced medical transport costs, and more effective distribution of medical resources to secondary medical institutions because ambulance transport was not necessary.

Artificial intelligence-clinical decision support system for enhanced infectious disease management: Accelerating ceftazidime-avibactam resistance detection in Klebsiella pneumoniae

BackgroundEffective and rapid diagnostic strategies are required to manage antibiotic resistance in Klebsiella pneumonia (KP). This study aimed to design an artificial intelligence-clinical decision support system (AI-CDSS) using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and machine learning for the rapid detection of ceftazidime-avibactam (CZA) resistance in KP to improve clinical decision-making processes. MethodsOut of 107,721 bacterial samples, 675 specimens of KP with suspected multi-drug resistance were selected. These specimens were collected from a tertiary hospital and four secondary hospitals between 2022 and 2023 to evaluate CZA resistance. We used MALDI-TOF MS and machine learning to develop an AI-CDSS with enhanced speed of resistance detection. ResultsMachine learning models, especially light gradient boosting machines (LGBM), exhibited an area under the curve (AUC) of 0.95, indicating high accuracy. The predictive models formed the core of our newly developed AI-CDSS, enabling clinical decisions quicker than traditional methods using culture and antibiotic susceptibility testing by a day. ConclusionsThe study confirms that MALDI-TOF MS, integrated with machine learning, can swiftly detect CZA resistance. Incorporating this insight into an AI-CDSS could transform clinical workflows, giving healthcare professionals immediate, crucial insights for shaping treatment plans. This approach promises to be a template for future anti-resistance strategies, emphasizing the vital importance of advanced diagnostics in enhancing public health outcomes.

Application of the Statin-Associated Muscle Symptoms-Clinical Index to a Cohort of Patients with Type 2 Diabetes Mellitus Undergoing Phlebotomy at an Endocrinology Clinic

Background Statin-associated muscle symptoms (SAMS), the commonest statin-induced adverse effects, could hinder patient adherence and possibly lead to discontinuation of therapy, which then increases patients’ risks for developing cardiovascular events. Although statins are the most frequently prescribed lipid-lowering medication, the occurrence and severity of SAMS among the Malaysian population are less known. Objectives To examine the likelihood and types of muscle symptoms attributable to statins, and the risk factors for developing the symptoms among statins users. Materials and Methods This was a cross-sectional study conducted with convenience sampling of patients with type 2 diabetes mellitus undergoing phlebotomy at an endocrinology clinic of a secondary hospital in a suburban city. Demographic and clinical data for the evidence of SAMS were retrieved from the hospital information system. A total of 214 patients were screened, and 50 subjects were recruited for interviews based on the study’s inclusion and exclusion criteria. Muscle symptoms that were evident through clinician notes, and self-reported signs and symptoms by patients during the interview were assessed to determine whether they were SAMS or not. This was done using a pre-structured published questionnaire via patient interview, and the likelihood was then determined using the SAMS-clinical index (SAMS-CI) tool. Results In this cohort, the probability of having had a statin-associated muscle adverse event was 0.48, i.e., 48% “probable” and “possible” likelihood of SAMS having occurred for a patient who consumed a statin. The mean SAMS-CI score was 6.32 ± 0.470 (±7.4%) [CI: 5.85–6.79], which fell under an “unlikely” category. The most frequent type of muscle symptom was myalgia, which was experienced as muscle aches, stiffness, cramps, symptoms worsening after exercise, muscle tenderness, and trouble moving knees or arm joints. These symptoms were proximal and symmetrical in nature and commonly involved large muscle groups such as the thighs, buttocks, calves, and back muscles. An elevation in creatinine kinase was not commonly observed. Conclusion A minority (6%) of the patients that we sampled experienced SAMS, which were probably attributable to statins. Nevertheless, caution must be exercised for female patients with a familial history of heart disease being prescribed with the lipophilic statins, atorvastatin, and simvastatin, and those who report aches in the large muscle groups.

A nationwide survey on the management of neonatal respiratory distress syndrome: insights from the MUNICH survey in 394 Chinese hospitals

BackgroundAt present, preterm infants with respiratory distress syndrome (RDS) in China present higher mortality and morbidity rates than those in high-income countries. The aim of this nationwide survey was to assess the clinical management of RDS in China.MethodsA nationwide cross-sectional survey to assess adherence to RDS management recommendations was performed. One neonatologist per hospital was randomly selected. The primary outcome was the key care of RDS management.ResultsAmong the 394 participating hospitals, 88·3% were birthing centres. The number of doctors and nurses per bed were 0·27 and 0·72, respectively. Antenatal corticosteroids (any dose) were administered to 90% of the women at risk of preterm birth at < 34 weeks of gestation (90·0% inborn vs. 50·0% outborn, p < 0·001). The median fraction of inspired oxygen (FiO2) for initial resuscitation was 0·30 for babies born at ≤ 32 weeks of gestation and 0·25 for those born at > 32 weeks. T-piece resuscitators were available in 77·8% of delivery rooms (DRs) (tertiary hospitals: 82·5% vs. secondary hospitals: 63·0%, p < 0·001). Surfactant was used in 51·6% of the DRs. Less invasive surfactant administration (LISA) was used in 49·7% of the hospitals (tertiary hospitals: 55·3% vs. secondary hospitals: 31·5%, p < 0·001). Primary non-invasive ventilation was initiated in approximately 80·0% of the patients. High-frequency oscillation ventilation was primarily reserved for rescue after conventional mechanical ventilation (MV) failure. Caffeine was routinely used during MV in 59·1% of the hospitals. Bedside lung ultrasonography was performed in 54·3% of the health facilities (tertiary hospitals: 61·6% vs. secondary hospitals: 30·4%, p < 0·001). Qualified breast milk banks and Family Integrated Care (FICare) were present in 30·2% and 63·7% of the hospitals, respectively.ConclusionsSignificant disparities in resource availability and guidelines adherence were evident across hospitals. Future strategies should address DR facilities and medication access, technical training, staff allocation, and ancillary facility development for a better management of RDS patients in China.

Development and validation of frailty risk prediction model for elderly patients with coronary heart disease

ObjectiveTo analyze the influential factors of frailty in elderly patients with coronary heart disease (CHD), develop a nomogram-based risk prediction model for this population, and validate its predictive performance.MethodsA total of 592 elderly patients with CHD were conveniently selected and enrolled from 3 tertiary hospitals, 5 secondary hospitals, and 3 community health service centers in China between October 2022 and January 2023. Data collection involved the use of the general information questionnaire, the Frail scale, and the instrumental ability of daily living assessment scale. And the patients were categorized into two groups based on frailty, and χ2 test as well as logistic regression analysis were used to identify and determine the influencing factors of frailty. The nomograph prediction model for elderly patients with CHD was developed using R software (version 4.2.2). The Hosmer–Lemeshow test and the area under the receiver operating characteristic (ROC) curve were employed to assess the predictive performance of the model. Additionally, the Bootstrap resampling method was utilized to validate the model and generate the calibration curve of the prediction model.ResultsThe prevalence of frailty in elderly patients with CHD was 30.07%. The multiple factor analysis revealed that poor health status (OR = 28.169)/general health status (OR = 18.120), age (OR = 1.046), social activities (OR = 0.673), impaired instrumental ability of daily living (OR = 2.384) were independent risk factors for frailty (all P < 0.05). The area under the ROC curve of the nomograph prediction model was 0.847 (95% CI: 0.809 ~ 0.878, P < 0.001), with a sensitivity of 0.801, and specificity of 0.793; the Hosmer- Lemeshow χ2 value was 12.646 (P = 0.125). The model validation results indicated that the C value of 0.839(95% CI: 0.802 ~ 0.879) and Brier score of 0.139, demonstrating good consistency between predicted and actual values.ConclusionThe prevalence of frailty is high among elderly patients with CHD, and it is influenced by various factors such as health status, age, lack of social participation, and impaired ability of daily life. These factors have certain predictive value for identifying frailty early and intervention in elderly patients with CHD.

Incidence, antimicrobial susceptibility & out of pocket expenditure of severe enteric fever in Chandigarh, north India.

Background & objectives Burden estimates of enteric fever are required to make policy decisions on introducing typhoid vaccine in India. Incidence, antimicrobial susceptibility, and out-of-pocket expenditure (OOPE) of enteric fever are estimated in Chandigarh, India. Methods A hybrid (facility and community-based) surveillance system was set up at a secondary care hospital to enrol patients above six months of age, hospitalized with fever, from a defined catchment population from May 2018 to March 2020. Blood samples were collected and cultured using an automated system (BD BACTECTM blood culture system). The Salmonella Typhi and S. Paratyphi isolates were characterized for antimicrobial susceptibility. OOPE was recorded after 14 and 28 days of discharge. Results Blood samples were collected from 97 per cent of the 1650 study participants enrolled. The incidence of enteric fever was 226.8 per 1,00,000 person-years (PY), severe typhoid fever 156.9 per 1,00,000 PY, and severe paratyphoid fever 69.9 per 1,00,000 PY. Salmonella was highly susceptible to ampicillin, azithromycin, and ceftriaxone (99.25%) and least susceptible to ciprofloxacin (11.3%). The OOPE due to hospitalization of individuals infected with S. Paratyphi [INR 8696.6 (USD 116)] was significantly higher than the individuals infected with S. Typhi [INR 7309 (USD 97.5), P=0.01], and among cases who were hospitalized for more than seven days [INR 12,251 (USD 163.3)] as compared with those with a stay of 3-7 days [INR 8038.2 (USD 107.2)] or less than three days [INR 5327.8 (USD 71), P<0.001]. Interpretation & conclusions There was a high incidence of enteric fever, high OOPE, and resistance to ciprofloxacin.

The efficiency evaluation of traditional Chinese medicine hospitals by data envelopment analysis in Zhengzhou, China.

This study aimed to evaluate the operational efficiency of traditional Chinese medicine (TCM) hospitals in China. Pearson's analysis was used to test the correlation between the input and output variables. Data envelopment analysis (DEA) was utilized to analyze the input and output variables of 16 TCM hospitals, and each hospital efficiency score was computed by Deap 2.1, assuming variable return to scale (VRS), which is an input-oriented model. t tests were conducted to confirm the significant difference of efficiency scores at the hospital level and by hospital type, and ANOVA was used to test for significant differences in efficiency scores according to hospitals' size. The correlation coefficient of the input and output indicators was between 0.613 and 0.956 (p < 0.05). The difference in number of doctors (ND) and numbers of pharmacists (NP) were statistically significant (p < 0.05) at the hospital level. The mean efficiency scores for technical efficiency (TE), pure technical efficiency (PTE), and scale efficiency (SE) in secondary TCM hospitals were 0.766, 0.919, and 0.838, respectively. Additionally, the lowest TE, PTE, and SE were 0.380, 0.426, and 0.380, respectively. Eight TCM hospitals in this study were DEA efficient, with an efficiency score of 1. There were no statistically significant differences in TE, PTE, and SE among hospital levels, hospital types or hospital sizes groups (p > 0.05). This study revealed that tertiary TCM hospitals had a greater level of efficiency than secondary TCM hospitals. In our study, 50% of TCM hospitals had inefficient management. Therefore, to activate the new development power of TCM hospitals, it is necessary to reform and improve the management system and mechanism of TCM hospitals, optimize the development environment of TCM hospitals and formulate development plans and measures based on local conditions.

Predictors of Chronic Dizziness in Acute Unilateral Vestibulopathy: A Longitudinal Prospective Cohort Study.

Chronic dizziness after acute unilateral vestibulopathy (AUVP) causes significant social and economic burdens. This study aims to identify predictors of chronic dizziness. Prospective, longitudinal cohort study. ENT departments from secondary and tertiary hospitals. Participants meeting the Barany Society's diagnostic criteria for AUVP were included. Evaluations occurred within 0 to 21 days (T1), and at 4 (T2) and 10 weeks (T3) postonset. The primary outcome measure was the Dizziness Handicap Inventory (DHI) at 6 months, with a score >30 indicating chronic dizziness. Five clusters of predictors were assessed at T1-3: central vestibular compensation, visual dependence, movement exposure, psychological factors, and balance performance. Separate linear regression models for T1, T2, and T3 were constructed to explain the variability in the 6-month DHI score. Receiver operating characteristics analyses were conducted to predict chronic dizziness. From June 2021 to January 2024, 103 participants (55.2 ± 16.6 years old, 49 women) were included. The regression models explained the variability in the 6-month DHI score by 33.0% at T1, 47.6% at T2, and 64.0% at T3 (P < .001), including psychological factors (T1, T2, T3), visual dependence (T2, T3), and static balance performance (T3). Cutoff values for the Vestibular Activities Avoidance Instrument (23/54), Visual Vertigo Analog Scale (33.5/100), and Hospital Anxiety and Depression Scale-Anxiety (7.5/21) at 10 weeks postonset predicted chronic dizziness. Higher psychological burden, increased visual dependence, and poorer static balance performance were associated with chronic dizziness. Cutoff values were determined to identify individuals with AUVP at risk for chronic dizziness.

Time to Treat First Acute Attack of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

A proportion of people with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) have a relapsing disease course and persistent anti-myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) seropositivity. Few studies have investigated whether treatment of the first MOGAD attack is associated with the long-term disease course and/or MOG-IgG seronegative conversion. To investigate the association of time to treat the first acute MOGAD attack with relapse risk and MOG-IgG serostatus. This was a retrospective, nationwide, multicenter cohort study involving 14 secondary or tertiary hospitals in South Korea between November 2009 and August 2023. People with adult-onset MOGAD, who either had a relapse or were followed up for more than 12 months after disease onset and had a detailed medical record of their first attack, were included. Individuals were excluded for adolescent-onset MOGAD or short disease duration. Patients were categorized based on the time to treat the first acute MOGAD attack: early (<5 days), intermediate (5-14 days), and late (not treated within 14 days). A multivariable analysis for clinical and treatment factors associated with relapsing disease course and/or MOG-IgG seronegative conversion. Further subgroup analyses were conducted among those without long-term nonsteroidal immunosuppressant (NSIS) maintenance treatment. Among the 315 individuals screened, 75 were excluded. A total of 240 patients (median [IQR] age at onset, 40.4 [28.8-56.1] years; 125 female [52.1%]) with median (IQR) disease duration of 3.07 (1.95-6.15) years were included. A total of 110 of 240 patients (45.8%) relapsed after a median (IQR) of 0.45 (0.18-1.68) years, and 29 of 116 patients (25.0%) experienced a conversion to seronegative MOG-IgG. Both the time to treatment of the first MOGAD attack (late vs early: adjusted hazard ratio [aHR], 2.64; 95% CI, 1.43-4.84; P = .002; intermediate vs early: aHR, 2.02; 95% CI, 1.10-3.74; P = .02) and NSIS maintenance treatment (aHR, 0.24; 95% CI, 0.14-0.42; P < .001) were independently associated with the risk of relapse. In a subgroup without NSIS maintenance, the time to treat of the first MOGAD attack was still associated with higher risk of relapse (late vs early: aHR, 3.51; 95% CI, 1.64-7.50; P = .001; intermediate vs early: aHR, 2.68; 95% CI, 1.23-5.85; P = .01). Lastly, the time to treat of the first MOGAD attack was also associated with MOG-IgG seronegative conversion (early vs late: adjusted odds ratio, 7.04; 95% CI, 1.58-31.41; P = .01), whereas NSIS maintenance treatment was not. Results of this cohort study suggest that early treatment of the first acute MOGAD attack was associated with a reduction in the proportion of relapsing disease course and an increase in the likelihood of MOG-IgG seronegative conversion. These data suggest that timing of acute phase treatment for the first MOGAD attack can be associated with the long-term prognosis and autoimmune status of patients.

Evaluation of a digital patient education programme in patients with coronary artery disease, a survey-based study

IntroductionPatient education programmes focusing on risk factor modification and lifestyle changes are well established as part of cardiac rehabilitation in patients with coronary artery disease (CAD). As participation rates are low, digital patient education programmes (DPE) are interesting alternatives to increase access. Understanding patients’ perceptions of DPE are important in terms of successful implementation in clinical practice but are not well known. Therefore, the aim of this study was to assess patients’ perceptions of using a DPE in terms of end-user acceptance and usability, perceived significance for lifestyle changes and secondary preventive goal fulfilment in patients with CAD.MethodsThis was a cross-sectional survey-based study. The survey was distributed to all 1625 patients with acute coronary syndrome or chronic CAD with revascularisation, who were registered users of the DPE between 2020 and 2022 as part of cardiac rehabilitation. The survey contained 64 questions about e.g., acceptance and usability, perceived significance for making lifestyle changes and secondary preventive goal fulfilment. Patients who had never logged in to the DPE received questions about their reasons for not logging in. Data were analysed descriptively.ResultsA total of 366 patients (mean age: 69.1 ± 11.3 years, 20% female) completed the survey and among those 207 patients (57%) had used the DPE. Patients reported that the DPE was simple to use (80%) and improved access to healthcare (67–75%). A total of 69% of the patients were generally satisfied with the DPE, > 60% reported that the DPE increased their knowledge about secondary preventive treatment goals and approximately 60% reported having a healthy lifestyle today. On the other hand, 35% of the patients would have preferred a hospital-based education programme. Among the 159 patients (43%) who had never used the DPE, the most reported reason was a perceived need for more information about how to use the DPE (52%).ConclusionsThis study shows an overall high level of patient acceptance and usability of the DPE, which supports its continued development and long-term role in cardiac rehabilitation in patients with CAD. Future studies should assess associations between participation in the DPE and clinical outcomes, such as secondary preventive goal fulfilment and hospitalisation.

Impact of Panvascular Disease on Exercise Capacity and Clinical Outcomes in Patients with Heart Failure with Reduced Ejection Fraction

BackgroundThe aim of this study was to assess the impact of panvascular disease (PVD) on quality of life (QOL), exercise capacity, and clinical outcomes, in patients with heart failure (HF) with reduced ejection fraction (HFrEF). MethodsWe performed a post hoc analysis of the Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION; NCT00047437). Patients with PVD were defined as those having coronary heart disease, stroke, or peripheral vascular disease at baseline. Multivariable Cox proportional hazard models were constructed to evaluate the effect of PVD on the primary endpoint (all-cause mortality or hospitalization) and secondary endpoints (all-cause mortality, cardiovascular (CV) mortality or CV hospitalization, and CV mortality or HF hospitalization). Generalized estimating-equation models were constructed to evaluate the effect of PVD on QOL (Kansas City Cardiomyopathy Questionnaire score) and exercise capacity (peak oxygen consumption and 6-minute walk test distance). ResultsOf 2119 patients with chronic HFrEF, 1202 (56.7%) had comorbid PVD. PVD was associated significantly with reduced exercise capacity (P < 0.001). Patients with PVD had a higher risk of all-cause mortality or hospitalization (hazard ratio [HR] 1.15, 95% confidence interval [CI]: 1.02-1.29), CV mortality or CV hospitalization (HR 1.22, 95% CI: 1.07-1.39), and CV mortality or HF hospitalization (HR 1.25, 95% CI: 1.05-1.48), compared with the risk for patients without PVD. Aerobic exercise training did not significantly improve the prognosis of HFrEF patients, in either the PVD or the non-PVD subgroups. ConclusionsPVD may adversely affect the QOL, exercise capacity, and prognosis of patients with chronic HFrEF.

Construction and Evaluation of a Predictive Model for Grassroots Nurses' Risk Perception of "Internet + Nursing Services": A Multicenter Cross-Sectional Study.

The development of "Internet + nursing services" can effectively solve the problem of population aging, and grassroots nurses are the primary providers of such services in rural areas. This study aimed to analyze the factors affecting grassroots nurses' risk perception of "Internet + nursing services" and construct a predictive model. A multicenter cross-sectional study of 2220 nurses from 27 secondary hospitals and 36 community health centers in Hubei Province was conducted from August to December 2023 using a multi-stage cluster sampling method. Information was collected through a structured anonymous questionnaire. A Chi-square test, a Welch t-test, and binary logistic regression analyses were employed to determine independent risk factors for grassroots nurses' risk perception of "Internet + nursing services", and a nomogram was constructed. Receiver operating characteristic curves, calibration curves, and decision curves were plotted to evaluate the discrimination, calibration, and clinical effectiveness of the nomogram. A total of 2050 valid questionnaires were collected, demonstrating that 51.95% of grassroots nurses thought that "Internet + nursing services" was a medium-high risk. Age, other sources of income, knowledge about "Internet + nursing services", personal safety, physical function, occupational exposure, social psychosocial, and time risk (P<0.05) were independent risk factors for grassroots nurses' risk perception. The area under the receiver operating characteristic curve of the nomogram was 0.939. The calibration and decision curve analyses demonstrated good calibration ability and clinical application values. The prediction model constructed in this study has good prediction ability. Most grassroots nurses believe that "Internet + nursing services" are risky and influenced by several factors. It is suggested that the government and hospitals should formulate a unified charging standard, improve the safety guarantee, and gradually eliminate the concerns of grassroots nurses.

The implementation of the guideline for the management of pediatric off-label use of drugs in China: a cross-sectional study.

Previously, we developed the Guidelines for the Management of Pediatric Off-Label Use of Drugs in China in addressing the need for standardization of pediatric off-label drug use. As the implementation of recommendations in Guidelines among healthcare professionals is weak, it is important to identify barriers to guideline implementation for developing appropriate strategies for specific settings and target groups. This study aimed to assess the difficulty and urgency in implementing the recommendations in the Guideline, identifying the factors affecting the implementation of these recommendations to realize the clinical translation of the Guideline. A cross-sectional study was conducted from March 1 to June 17, 2022. Pediatricians, pharmacists, and health managers from all 31 mainland Chinese provinces were involved. The electronic questionnaires were distributed nationwide by The Clinical Pharmacology Group of the Pediatric Society of the Chinese Medical Association and the National Clinical Research Center for Child Health. Data analysis, including frequency, percentages, averages, and standard deviations was performed using Microsoft Excel 16.54. Chi-squared tests, multi-factor logistic regression, and linear regression were analyzed in SPSS 23.0. A Sankey diagram was constructed using R software. A total of 869 valid questionnaires were collected from 491 participating organizations. More than half of the recommendations were implemented, and 12 recommendations were implemented more in tertiary hospitals than in secondary hospitals. The mean urgency scores of all 21 recommendations were over 5. The mean difficulty scores of all 21 recommendations were over 4. The percentage of the most urgent was 44.33%, and the least urgent was 1.45%. The most difficult portion was 12.03%, and the least difficult was 5.74%. Factors impacting the urgency and difficulty of guideline implementation were different, with common influences including the position, education level of clinicians and hospital level. The recommendations in the Guideline for the Management of Pediatric Off-Label Use of Drugs are considered highly urgent for implementation in China. Nevertheless, the study revealed challenges in applying all 21 recommendations within clinical practice. The key factors affecting implementation include the position, education, experience, and hospital level of healthcare professionals. It is recommended to facilitate implementing the recommendations by sharing experience across various hospital levels, starting from high-level hospitals and extending to primary healthcare settings. Moreover, adjustments to the professional structure within hospitals are needed to enhance the management of off-label drug use in pediatric patients.

The clinical characteristics associated with the ratio between the main pulmonary artery and ascending aorta diameter in patients with acute exacerbation of chronic obstructive pulmonary disease.

A pulmonary artery-to-aorta (PA/A) ratio of ≥1 is a reliable indicator of pulmonary hypertension and is associated with an increased risk of acute exacerbation of chronic obstructive pulmonary disease (COPD) and long-term mortality in patients with stable COPD. However, it is unclear whether a PA/A ratio of ≥1 is associated with mortality in patients hospitalized with acute exacerbation of COPD. The purpose of this study was to evaluate the clinical course and mortality of patients with PA/A ratios of ≥1 who were hospitalized with acute exacerbation of COPD. We retrospectively reviewed the medical charts of patients admitted to a tertiary referral hospital and a secondary hospital with acute exacerbation of COPD between 2016 and 2021. Chest computed tomography was used to measure the pulmonary artery (PA), aorta (A) diameter, and the PA/A ratio. The study involved 324 and 111 patients with PA/A ratios <1 and ≥1, respectively. The average age in the two groups was 74.1 and 74.5 years, which was not significantly different. When compared with the group with PA/A ratios of <1, the group with PA/A ratios of ≥1 had a lower proportion of males (71.2% vs. 89.5%, P<0.001), more patients with type 2 respiratory failure (35.1% vs. 18.8%), higher high-flow nasal cannula use (10.8% vs. 4.6%), higher use of non-invasive ventilation (NIV) (21.6% vs. 7.7%), and longer hospital stay (10.9 vs. 9.5 days). In-hospital mortality was not significantly different between the two groups. A PA/A ratio of ≥1 was identified as an independent predictor of the need for high-flow nasal cannula, NIV, and intubation in COPD patients. Patients with PA/A ratios of ≥1 had a high incidence of type 2 acute respiratory failure and required advanced treatment, including high-flow nasal cannula, NIV, and intubation. Therefore, hospitalized patients with acute exacerbation of COPD and PA/A ratios of ≥1 require more aggressive treatment.

ISOLATION AND CHARACTERIZATION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS IN SELECTED HOSPITALS OF DUTSE METROPOLIS, JIGAWA STATE, NIGERIA

The purpose of this study was to examine the equipment used in five hospitals located in Jigawa state. Finding Methicillin-Resistant Staphylococcus aureus (MRSA) on hospital equipment in a few Dutse metropolitan hospitals was the main goal. Three hundred and fifty hospital instruments in all were swabbed and then examined. Tests for antibiotic susceptibility were conducted after S. aureus was isolated and identified. The isolates were most effectively treated by gentamicin and ciprofloxacin, according to the results. Primary healthcare facilities contained 31 S. aureus isolates and 16.67% MRSA isolates, whereas secondary healthcare hospitals had 48 S. aureus isolates and 55.56% MRSA isolates. There were 25 S. aureus isolates and 27.78% MRSA isolates from tertiary healthcare facilities. The mecA and blaZ genes' polymerase chain reaction (PCR) analyses revealed amplicons of 336 bp and 400 bp, respectively, which were in line with control samples. Six of the 11 isolates that were tested tested positive for mecA, suggesting resistance to methicillin, and nine tested positive for blaZ, indicating the synthesis of B-lactamase. In conclusion, patients, medical staff, and the general public are seriously threatened by the MRSA infection that exists in these facilities.

Diabetes self-management and its influencing factors among adults with type 2 diabetes mellitus in rural Sri Lanka: A cross-sectional study.

Diabetes Self-Management (DSM) is pivotal in managing diabetes. However, poor engagement in DSM has been observed in rural Sri Lankan settings. Thus, identifying factors influencing DSM is crucial for nurses and other healthcare professionals. This study aimed to describe DSM among adults with Type 2 Diabetes Mellitus (T2DM) in rural Sri Lanka and to examine whether perceived stress, health literacy, self-efficacy, and family support can predict DSM among adults with T2DM in rural Sri Lanka. This correlational predictive study used a simple random sampling technique to recruit 160 adults with T2DM from an outpatient clinic at a secondary care hospital in a rural area of Sri Lanka. Data were collected from March to April 2024 using socio-demographic and standardized questionnaires to examine predictive factors of DSM, including perceived stress, health literacy, self-efficacy, and family support. Data analysis was conducted using descriptive statistics and standard multiple linear regression analysis. Approximately half of the participants had uncontrolled T2DM (Fasting Plasma Glucose (FPG) >126) and sub-optimal DSM. The analysis revealed that all variables could explain 39.3% of the variance in DSM among rural Sri Lankan adults with T2DM. However, DSM was significantly predicted by self-efficacy (β = 0.530, p = 0.001), harmful family involvement (β = -0.169, p = 0.038), and health literacy (β = -0.162, p = 0.020). The findings emphasized the need for further development of interventions to increase self-efficacy and reduce harmful family involvement to enhance DSM among adults with T2DM. Nurses and other healthcare providers should target family members' engagement to improve self-efficacy among this population.

SARS-CoV-2 infections in patients, health care workers and hospital outbreaks during the first 3 waves of the pandemic: a retrospective analysis in a secondary care hospital network in Germany

BackgroundHospital infections with SARS-CoV-2 continued during the initial waves of the pandemic worldwide. So far, Data on the dynamics of these infections and the economic burden of outbreaks are rare.MethodsWe retrospectively analysed SARS-CoV-2 infections in patients, hospital employees and nosocomial infections resulting in outbreaks in two hospitals of a secondary care hospital network in Germany during the initial 3 pandemic waves (03/2020–06/2021). In addition to hospital infections, we evaluated infection prevention strategies and the economic burden of hospital outbreaks.ResultsA total of 396 patients with SARS-CoV-2 infection were hospitalized in both hospitals. The risk factors for severe disease and death increased with age, male sex and a CRB-65 score > 0. The most frequent symptom was dyspnoea (30.1%). Sixty-five patients died, most of whom were in the 2nd wave. A total of 182 (12.5%) hospital employees were infected, 63 (34.6%) of whom were involved in outbreaks. An occupational risk of infection during outbreaks was particularly common among nurses and HCWs working on regular wards. Eleven hospital outbreaks led to high economic impact on both hospitals through the loss of manpower as result of infected employees, temporary locked wards, blocked beds, a reduced number of total hospitalized patients and increased personnel costs.ConclusionContinuously adaptation of infection prevention strategies is a valuable tool to keep hospitals safe places for patients and employees. We do need more analyses of the different pandemic waves and applied infection prevention strategies to learn from weak points.Trial registrationThis research was conducted in accordance with the Declaration of Helsinki and national standards. The study protocol was approved by the relevant ethics committee of the Chamber of Physicians Westphalia-Lippe and University of Münster (no. 2021–475-f-S). The study was registered on 25th August 2021 at the German Clinical Trials Register (DRKS00025865).

Estimating the cost for obstetric fistula repair in hospitals of Mozambique: a low-income country

BackgroundObstetric fistula is incident and prevalent in low-income countries. Globally, about 100,000 women develop fistula annually. In Mozambique, more than 2,000 fistulas are reported annually. A national strategy to combat obstetric fistula has been implemented in Mozambique from 2012–2020. This strategy is under review, making it opportune to generate evidence that reflects the course of the strategy implemented to subsidize/optimize the definition of priorities of the new strategy to achieve universal health coverage. In Mozambique, information on the costs incurred to treat fistula is scarce. This study aims to estimate the mean unit cost of repair/treatment of simple and complex obstetric fistula in Mozambique.MethodsWe carried out a retrospective evaluation, from the provider’s perspective, using the Ingredient and Stepdown approaches. The mean unit cost was obtained by the sum of individual and shared ingredients to treat fistula. Cost dimensions included Direct Medical Costs (personnel, drugs, and supplies), Overhead and Capital Costs (administration and capital assets’ costs, respectively). The average exchange rate was USD 1 = MZN 61.47. Data were collected in secondary, tertiary, and quaternary hospitals of Zambézia and Nampula provinces in 2021. Costs borne by patients and their families and loss of productivity were not included.ResultsThe mean cost for Simple Obstetric Fistula repair was MZN 14,937.21 (USD 243) and Complex Obstetric Fistula was MZN 21,145.68 (USD 344) per person operated. Regardless of the type of fistula, the repair cost was MZN 18,072.18 (USD 294).ConclusionWithout neglecting that prevention is better than plasty, the results show feasible levels of fistula repair costs for mobilization of funds. For the estimated 2,000 fistulas reported annually, the government needs an average MZN 36,144,360 (USD 588,000).

Ayushman Bharat Yojana – A Beneficiary Level Study

Ayushman Bharat Yojana, a nationwide public health insurance initiative administered by the Indian government, aims to provide free health insurance coverage to low-income individuals in the country. It is also referred to as PMJAY or Pradhan Mantri Jan Arogya Yojana. Launched on September 23, 2018, this program is designed to achieve the Sustainable Development Goals (SDGs) and their underlying commitment. Under the Ayushman Bharat scheme, approximately 100 million impoverished and vulnerable families in India will be covered, offering up to Rs. 5lakhs per family per year for secondary and tertiary care hospitalizations. Additionally, the initiative proposes the establishment of 150,000 health and wellness centers nationwide, providing comprehensive primary healthcare services. Both public and privately affiliated medical facilities are eligible to offer healthcare services to beneficiaries of the insurance program. This program stands as one of the largest publicly funded health insurance initiatives globally. This paper is based on a combination of primary and secondary data sources. Primary data was collected from selected respondents in the study village of Parakuchi in the Kamrup Rural District of Assam. Secondary data was obtained from various online reports and articles. Among the 80 sample respondents, 38 individuals have already received their Ayushman Bharat cards, while 42 are still awaiting theirs. However, none of the respondents have utilized their cards yet, as they have recently received them and do not currently experience any major health issues.

Twenty-year review of the bariatric programme at Te Whatu Ora Waitematā.

Obesity is a significant health issue. Te Whatu Ora Waitematā serves a population of 650,000 patients across the North Shore, Waitākere and Rodney areas. The Waitematā bariatric service at North Shore Hospital was introduced in October 2001. The aim of this study was to review the development and impact of the service over the last 20 years, and identify whether equivalent bariatric services could viably be introduced into other hospitals in Aotearoa New Zealand. A retrospective audit was conducted of the 20-year results of the Waitematā bariatric surgical service to identify the impact of technology, teaching and research on service provision. Since its inception, the Waitematā bariatric service has launched minimally invasive surgery, multiple operative options and an enhanced recovery after surgery (ERAS) protocol. Approximately 100 cases are performed per year. Of these, 3.4% of patients require admission to the intensive care unit/high dependency unit (ICU/HDU), with an average length of stay (LOS) of 0.66 days. The 1-year mortality rate is 0.39%. Eleven surgical fellows have undergone post-fellowship training with the service, which is a recognised training unit for the post-fellowship AANZGOSA/ANZMOSS programme. Bariatric surgery can be performed safely and has good long-term outcomes. The Waitematā bariatric service is dedicated to providing excellent care within the resource constraints of a public healthcare system. The high number of procedures, low requirement for ICU/HDU and low mortality rate suggest that bariatric surgery could be safely performed within a public setting in secondary and regional hospitals across the country.