Standard Ward Research Articles

Coinfections among hospitalized patients with covid-19 in the first pandemic wave

BackgroundCOVID19 is the novel respiratory illness caused by SARS-CoV-2. The presence of other potentially pathogenic microorganisms could worsen the prognosis of these patients. Aim: The study aims to describe coinfections in COVID-19 patients and contrast it between standard ward and critical care patients at Hospital Central de la Defensa Gómez Ulla (HCDGU). MethodsA retrospective study was carried out of patients with COVID-19 confirmed with RTPCR admitted to the HCDGU from March 5, 2020 to May 7 of 2020. FindingsOf a total of 703 patients with COVID-19, 75(10.7%) had other microbiologically confirmed infections: 9% (58/648) in standard ward patients and 31.5%(17/54) in critical care patients. In total 86 samples of the 75 patients presented some microorganism; clinically relevant bacteraemias, 50%, respiratory cultures, 32.6% and pneumococcal positive antigens, 17.4%. ConclusionsWe found a low frequency of microorganism coinfection in COVID-19 patients, however in critical care these coinfections increased considerably.

Surgical Management of Facial Fractures in Geriatric Patients.

Facial fractures comprise a substantial part of traumatology. Due to aging of the population, over the last 20 years, there has been a pattern of redistribution of these fractures with a higher incidence at an older age. The aim of this study was to retrospectively analyze the epidemiology, pattern, and surgical management of facial fractures in geriatric patients presenting at a single tertiary trauma center.This study included patients aged ≥70 years who presented with facial bone fractures between 2008 and 2017 and were treated with surgical interventions. Parameters such as age, sex, American Society of Anesthesiologists classification, Glasgow Coma Scale score, fracture type, fracture mechanism, concomitant injuries, duration of hospitalization, and postoperative complications were evaluated.A total of 300 patients were included: 118 men (39.3%) and 182 women (60.7%). The mean age was 78.8 years. An orbital floor fracture was the most common injury (35.1%). The most common cause of fracture was a fall at home (67%). A total of 113 patients (37.7%) had 162 concomitant injuries, 35 patients (11.7%) suffered from polytrauma, and 7 patients developed postoperative complications. The average length of stay was 1.67 days in the intensive care unit and 5.50 days in the standard ward. Polytrauma, pre-existing medical conditions, and oral anticoagulation had a significant impact on the duration of hospitalization.Facial fractures are common in combination with other injuries. Women are more often affected than men, and falling at home is the most common cause of facial injuries. Postoperative complications are rare.

PET/MRI, Part 1: Establishing a PET/MRI Facility.

The emergence of PET and MRI as a hybrid modality has generated widespread interest in the technology and techniques. Although adoption and use are unlikely to be as expansive as for PET and CT hybrid systems, PET/MRI is an important modality that requires broad insight for nuclear medicine professions generally and deeper insight for those engaged in PET/MRI practice. This article provides insight into the considerations and challenges associated with establishing a PET/MRI facility. Each clinical site will present unique requisites for establishing a PET/MRI facility, and indeed, each PET/MRI vendor will have specific site requirements. Nonetheless, this article provides general insight into common considerations but should not be considered exhaustive. Here, development of the facility, staffing of the facility, and implications of both radiation and MRI safety are considered from the context of facility design. Given that the nature of PET is well established among the readership of this journal, the article provides an emphasis on MRI factors. This article is the first in a 4-part integrated series sponsored by the PET/MR and Publication Committees of the Society of Nuclear Medicine and Molecular Imaging-Technologist Section. In the subsequent 3 parts, PET/MRI will be explored on the basis of technology principles (part 2), protocols and procedures (part 3), and applications and clinical cases (part 4).

A pilot multicentre randomised controlled trial of lidocaine infusion in women undergoing breast cancer surgery.

Chronic postoperative pain is common after breast cancer surgery. Peri-operative lidocaine infusion may prevent the development of chronic postoperative pain, but a large-scale trial is required to test this hypothesis. It is unclear whether a pragmatic, multicentre trial design that is consistent with expert guidance, addresses the limitations of previous studies, and overcomes existing translational barriers is safe, effective and feasible. We conducted a double-blind, randomised controlled pilot study in 150 patients undergoing breast cancer surgery across three hospitals in Western Australia. Patients received lidocaine, or equivalent volumes of saline, as an intravenous bolus (1.5mg.kg-1 ) and infusion (2mg.kg-1 .h-1 ) intra-operatively, and a subcutaneous infusion (1.33mg.kg-1 .h-1 ) postoperatively for up to 12h on a standard surgical ward, with novel safety monitoring tools in place. The co-primary outcomes were: in-hospital safety events; serum levels of lidocaine during intravenous and subcutaneous infusion; and annualised enrolment rates per site with long-term data capture. In-hospital safety events were rare, and similar in the placebo and lidocaine arms (3% vs. 1%). Median (IQR [range]) serum lidocaine levels during intravenous (2.16 (1.74-2.83 [1.12-6.06])µg.ml-1 , n=41) and subcutaneous (1.52 (1.28-1.83 [0.64-2.85])µg.ml-1 , n=48) infusion were comparable with previous trials reporting improved pain outcomes. Annualised enrolment approximated 50 patients per site per year, with high levels of protocol adherence and ≥99% capture of outcomes at 3 and 6months. The adjusted odds ratio (95%CI) for postoperative pain at 6months in the lidocaine arm was 0.790 (0.370-1.684). We conclude that this trial, as designed, is safe, effective and feasible in patients undergoing breast cancer surgery, and a larger-scale trial is planned.

Postoperative infectious complications in elderly patients after elective surgery in China: results of a 7-day cohort study from the International Surgical Outcomes Study.

Despite initiatives to increase elderly patients' access to surgical treatments, the prevalence and impact of postoperative infectious complications (PICs) in elderly patients in China are poorly described. The aim of our study was to describe PICs and associated mortality in elderly patients undertaking elective surgery in China. We analyzed data about elderly patients from China during the International Surgical Outcomes Study (ISOS), a 7-day prospective cohort study of outcomes after elective surgery in in-patient adults. All elderly patients (age ≥60 years) from 28 hospitals in China included in the ISOS study were included in this study as well. A review of 2014 elderly patients who underwent elective surgery in April 2014 was conducted. Of 2014 elderly patients, 209 (10.4%) developed at least one postoperative complication. Infectious complications were most frequent, affecting 154 patients (7.6%); there was one death, or 0.6% 30-day mortality, which was a significantly higher rate than among patients without PICs (0%). The most frequent infectious complication was superficial surgical-site infection (3.3%). The length of hospital stay was longer in elderly patients with PICs than in those without PICs. Moreover, a total of 142 elderly patients (7.1%) were routinely sent to critical care after surgery, of whom 97 (68.3%) developed PICs. Compared to elderly patients admitted to a standard ward, those admitted to critical care immediately after surgery had a higher postoperative complication rate and critical care admission rate to treat complications. The present prospective, multicentre study found that 7.6% of elderly patients in China had PICs after elective surgery that could prolong hospital stay and increase 30-day mortality. The clinical effectiveness of admission to critical care after surgery on elderly patients is not identified. Initiatives to increase elderly patients' access to surgical interventions should also enhance safe perioperative care to reduce PICs in China.

Effects of the intermediate care unit on the oldest-old general surgical patients: a retrospective, pre- and postintervention study

Whether the intermediate care unit (IMCU) is beneficial for the oldest-old (aged ≥ 80years) general surgical patients still remains unknown. We aimed to investigate the impacts of IMCU on the clinical outcomes and cost in this population. A retrospective, pre- and postintervention study was performed in this population in a university teaching hospital. The primary outcome was the occurrence of life-threatening complications including death or unplanned ICU admission after the surgeries. Secondary outcomes included the comparisons of the hospitalization expenses, the hospital length of stay (LOS) and the postoperative LOS between the pre-IMCU group and the IMCU group. Two hundred and seventeen patients were enrolled, including 98 in the pre-IMCU group and 119 in the IMCU group. After the introduction of IMCU, the occurrence of life-threatening complications significantly dropped from 11.2 to 2.5% (P = 0.012). The total hospitalization expenses showed a nonsignificant decreasing trend in the IMCU group (pre-IMCU group: 85856.3 ± 66583.7 RMB vs IMCU group: 78936.4 ± 36710.4 RMB). The treatment fee was much lower in the IMCU group (IMCU group: 4930.0 ± 4280.2 RMB vs pre-IMCU group: 7378.2 ± 10096.7 RMB, P = 0.017). Both the hospital LOS (IMCU group: 20.3 ± 10.3days vs pre-IMCU group: 19.5 ± 9.0days) and the postoperative hospital LOS (IMCU group: 12.0 ± 8.1days vs pre-IMCU group: 11.2 ± 7.0days) were not statistically different in the two groups. The allocation of the oldest-old surgical patients who do not need organ support therapy in the ICU to IMCU rather than in the standard wards was associated with a significant decrease in postoperative life-threatening complications and treatment fee. This study was registered at https://www.chictr.org.cn (ChiCTR2000030639).

Perspective: The Practice of Vascular Surgery in The ‘New Normal Times’

Perspective: The Practice of Vascular Surgery in The ‘New Normal Times’

Cutaneous Complications Secondary to Haemostasis Abnormalities in COVID-19 Infection.

We describe the case of a patient hospitalized for acute decompensated heart failure in a standard medical ward. During hospitalization, he was diagnosed with COVID-19 and transferred to a special unit. The clinical course was marked by worsening of the respiratory disease, the development of right parotiditis and thrombosis of the left internal jugular vein. Therapeutic anticoagulation was initiated and 2 days later, the minimal dermatoporosis lesions previously present in the upper extremities evolved to haemorrhagic bullae with intra-bullae blood clots and dissecting haematomas. Surgical management of the dissecting haematomas was difficult in the context of haemostasis abnormalities. The patient died 29 days after hospital admission.LEARNING POINTSSingle room accommodation should be preferred to double room accommodation in standard wards during the COVID-19 pandemic.Anticoagulation therapy and the presence of lupus anticoagulant may induce cutaneous complications during COVID-19 infection.The discontinuation of anticoagulation therapy did not help improve the management of cutaneous lesions.

Jak léčit diabetes během hospitalizace

Patients with diabetes represent around 25 % of hospitalized persons. Treatment of diabetes patient is more complicated. Modification or initiation of antidiabetic treatment is often a significant problem during hospitalization on standard medical ward. The aim of this article is to present basic recommendations for in-patient diabetes treatment.

Evaluation of severity of pain after removal of impacted third molar by comparing two flap designs.

Objectives: To evaluate the severity of post-operative pain after surgical extraction of impacted mandibular third molar using two different techniques i.e. comma incision and standard Wards incision. Study Design: Interventional study. Setting: Department of Oral surgery, Isra Dental College Hospital. Period: From January 2016 to June 2016. Material & Methods: A sample of 50 patients of impacted third molar was selected by non-probability purposive sampling for tooth extraction either by conventional technique or by coma shaped incision. Post-operative amount of pain was measured on 1st, 3rd and 7th day respectively. Results: Mean ± SD age in group A and B was noted as 28.5 ± 4.32 and 27.2 ± 4.39 years respectively. Male and female in groups A and B were noted as 16 (64%) and 9 (36%), & 14 (56%) and 11 (44%) respectively. Right and left lower mandibular teeth extraction in groups A and B were noted 11 and 14, & 10 and 15 respectively. Pain was measured after extraction at day 1, day 3 and day 7. Conclusion: The Coma incision was preferable over the conventional method- the standard Ward`s incision because of lesser degree of post-operative pain.

A clinical study on the management of five vital signs in patients with pain

Objective To explore the feasibility of five vital signs of pain patients on a body temperature sheet. Methods From March 2017 to June 2018, a total of 100 inpatients with a pain score greater than 7 and receiveing opioid treatment for the first time were selected and were randomly divided into the experimental group and the control group, 50 cases of each, according to the order of admission.In the control grup, three forms of routine pain assessment form, pain care sheet and body temperature sheet were used to display the five vital signs, while in the experimental group, a body temperature sheet was used to display the five vital sighs after improvement.The 10 forms filling time on the first day of hospitalization, the number of forms used in the first 3 weeks of hospitalization and the feasibility of clinical application were compared between the two groups. Results The experimental group was significantly better than the control group in the aspects of simple, convenient and feasible clinical application(P<0.05). Conclusions Through the improvement of the body temperature sheet, the management of the single system of five vital signs saves time, labor and paper, and the clinical application is simple and convenient, providing form support for the establishment of standardized cancer pain ward. Key words: Cancer pain; Vital signs; Management

Do patients of integrative anthroposophic pediatric inpatient departments differ? Comparative analysis to all pediatric inpatients in Germany considering demographic and clinical characteristics

BackgroundIntegrative medicine (IM) is a patient-centered, evidence-based, therapeutic paradigm which combines conventional and complementary approaches. The use of IM in pediatrics has increased in the past two decades and parents’ demand for it is growing. An IM whole systems approach is anthroposophic medicine. Considering the growing demand for integrative approaches in children, it is relevant from a public health perspective to find out which kind of children use IM in Germany and whether they differ from the entirety of pediatric inpatients in Germany. Moreover, it would be interesting to known, whether these patients are willing to travel a longer distance to gain integrative treatment.MethodsThe present study investigates the standard ward documentation datasets of 29,956 patients of all German integrative anthroposophic pediatric inpatient wards from 2005 to 2016 and compares them systematically to collect data of the entirety of all pediatric inpatient wards in Germany. Apart from patients’ age and gender, and the ICD-10 admission diagnoses, the geographical catchment area of the hospitals were analyzed.ResultsSociodemographic characteristics of pediatric inpatients in the integrative anthroposophic departments (IAH) did not differ from the entirety of all pediatric inpatients. Regarding clinical characteristics, higher frequencies were found for endocrine, nutritional and metabolic diseases (IAH: 7.24% vs. 2.98%); mental, behavioral, and neurodevelopmental disorders (IAH: 9.83% vs. 3.78%) and nervous diseases (IAH: 8.82% vs. 5.16%) and lower frequencies for general pediatric diseases such as respiratory diseases (IAH: 17.06% vs. 19.83%), digestive diseases (IAH: 3.90% vs. 6.25%), and infectious and parasitic diseases (IAH: 12.88% vs. 14.82%) in comparison to the entirety of all pediatric inpatients in Germany. The IAH showed a broad catchment area, with most patients being from former, Western federal republic of Germany. Large catchment areas (> 100 km) for the IAH are merely covered by severe and chronic diseases.ConclusionPediatric inpatients of IAH do not differ from the entirety of pediatric inpatients in Germany regarding sociodemographic characteristics but show differences regarding clinical characteristics. Parents are willing to travel further distance to get specialized integrative anthroposophic medical care for children with severe and chronic diseases.

Contemporary stroke care delivered in a specialised stroke bay, a neurology ward and a medical ward in Greece

Introduction: Currently in Greece there are only two ‘stroke bays’ (SBs) and their efficacy compared to standard ward treatment has not been evaluated.Aim: To provide baseline data on stroke case-mix and compare death rates in two Greek hospitals (A+B, i.e. with &amp; without a SB).Material and Methods: One hundrend sixty four acute stroke patients from two hospitals were consecutively selected in order to explore approaches to stroke care in three different types of care delivery settings. A descriptive design with group comparisons was employedand data gathering included patient case mix, age and length of stay (LOS), neurological status and death rates. Kaplan-Meier curves we reused for survival analysis and independent samples t test and Z test for group comparisons at p&lt;0.05.Results: Of the 164 patients, 88 (44.4%, female) werein hospital A and 76 (42.1%, female) in hospital B. The mean age was 65.7 and 69.1 years respectively, LOS was 7.6 (3-18) and 7.3 days (1-26), while death rate was 6.8% and 10.5% respectively.Discussion: Survival analysis for the two hospitalsshowed that there are no statistically significant differences regarding death and survival rates between the two hospitals, even when one had a SB. Yet, the SB shows a statistically significant reduction in overall LOS.Conclusions: In societies where stroke units are not yet established, a SB might be an economical way of making use of (limited) available resources and raising nursing and medical standards of care by motivating the full potential of staff involved.

ASSESSMENT OF SWELLING IN PATIENTS AFTER EXTRACTION OF IMPACTED THIRD MOLARS.

Aims: To assess swelling after surgical extraction of impacted mandibular third molar using two different techniques i.e. comma incision and standard Wards incision. Study Design: Cross sectional study. Setting: Dental OPD of Isra Dental College, Isra University. Period: February to August 2017. Materials and Methods: A sample of 70 patients with impacted third molar was selected by non-probability purposive sampling. Patients were distributed in either conventional technique or by coma shaped incision groups. All procedure was carried out at the Department of Oral surgery, Isra Dental College Hospital. Post-operative measurement of swelling was measured on 1st, 3rd and 7th day respectively. Results: Mean ± SD was noted as 28.70 ± 3.89 years respectively. Age distribution was from 20 – 35 years. Gender distribution in group A was 11 (31.4%) males and 24 (68.6%) females while in group B was 17 (48.5%) males and 18 (51.5%) females respectively with X2 = 2.14 and p= 0.22. Swelling was measured after surgical extraction at day 1, day 3 and day 7. Conclusion: The results of this study showed that the swelling was to some extent reduced in the Coma incision in comparison to the standard Ward`s incision. Further research with newer flap designs like the comma design, which might lessen the post-operative problems, ought to be measured in the extraction of impacted third molar surgery.

Outpatient Total Joint Arthroplasty in Dedicated Daycare Facility vs Standard Patient Ward

Outpatient Total Joint Arthroplasty in Dedicated Daycare Facility vs Standard Patient Ward

A service evaluation of the implementation of dedicated chefs on a specialist adult cystic fibrosis unit

In 2014 the Wolfson Cystic Fibrosis Centre (WCFC) opened for admission of adults and young people with Cystic Fibrosis (CF). Prior to this this people with CF were admitted to general respiratory wards and received general hospital food, whilst this is nutritionally adequate it is not always the comforting food people need during regular and repeated hospital admissions(1). The WCFC offers fresh, cooked-to-order, bespoke, flexible meal service which is more appetising and encourages people to complete intravenous antibiotics when needed. People with CF may require up to twice the calories a healthy person may need(2,3), at a time when they may feel up to eating the least. Frequent respiratory exacerbations requiring hospital admission, causing shortness of breath and reduced appetite can impact on oral intake making it difficult to maintain the caloric intake required (CF Trust 2016). The result can be suboptimal nutritional status which may negatively impact on lung function(2,4,5). This service evaluation aimed to compare standard ward (OC) based catering with the implementation of dedicated catering facilities and chefs on a newly built adult CF ward (NC).

Comparative Study Between Standard Ward’s Incision and Coma Shaped Incision and its Postoperative Outcome on Impacted Mandibular Third Molars Extraction in Bangladeshi Population

Objective: To evaluate the postoperative outcome in standard Comma Shaped incision and Ward’s incision on postoperative complications in surgical removal of impacted mandibular third molar. Material and Methods: In this study, 100 patients with impacted mandibular third molar were selected for study. The patients were divided in to two groups. Each group contains 50 patients. A standard Ward’s incision was made on one group and a Comma incision was made on another group to reflect the mucoperiosteal flap, after the common steps for removal of impacted third molars were followed. The postoperative parameters were recorded immediately on the postoperative days 1, 3 and 7. For bivariate analyses, Chi square and Student t test were used. The significance level was set at 5%. Results: The pain and swelling scores were found to be significantly lower in the surgical area with Comma incisions, which was recorded on days 1, 3 and 7 as compared to the area where standard Ward’s incision were made. In mouth opening, there was a sufficiently great difference seen between the two incisions on first postoperative day, but on day 3 and 7 there was no statistical significance. Conclusion: the Comma Shaped incision design was preferable over the standard Ward’s incision, considering the lesser degree of postoperative complications.

Comparison of comma incision with Ward's incision in third molar extraction in terms of postoperative sequel - A clinical study.

Objective:The objective of the study was to compare standard Ward's incision and comma-shaped incision and its influence on postoperative complications in surgical removal of impacted mandibular third molar.Materials and Methods:This was a prospective study. Fifty individuals divided into two groups with impacted mandibular third molars were recruited for the study. Twenty-five individuals were allocated to each group: a standard Ward's incision was made in Group A and a comma incision was made in Group B to reflect the mucoperiosteal flap, after which the common steps for removal of impacted third molars were followed. The postoperative parameters were recorded immediately on the postoperative days 1, 3, and 7.Observation and Results:The pain scores which were recorded on days 1, 3, and 7 in the surgical area with comma incisions were found to be significantly lower as compared to the pain scores in the area where standard incisions were made. Similarly, swelling was lesser with comma incision than with standard Ward's incision. There was a significant difference in mouth opening between the two incisions on day 1, but no significance was seen on days 3 and 7. All of these findings showed significant statistical differences.Summary and Conclusions:The results of the study showed that the new comma-shaped incision design was preferable over the conventional method (Ward's incision), considering the lesser degree of postoperative complications.

Examining the need for routine intensive care admission after surgical repair of nonsyndromic craniosynostosis: a preliminary analysis.

OBJECTIVEAt British Columbia Children's Hospital (BCCH), pediatric patients with nonsyndromic craniosynostosis are admitted directly to a standard surgical ward after craniosynostosis surgery. This study's purpose was to investigate the safety of direct ward admission and to examine the rate at which patients were transferred to the intensive care unit (ICU), the cause for the transfer, and any patient characteristics that indicate higher risk for ICU care.METHODSThe authors retrospectively reviewed medical records of pediatric patients who underwent single-suture or nonsyndromic craniosynostosis repair from 2011 to 2016 at BCCH. Destination of admission from the operating room (i.e., ward or ICU) and transfer to the ICU from the ward were evaluated. Patient characteristics and operative factors were recorded and analyzed.RESULTSOne hundred fourteen patients underwent surgery for single-suture or nonsyndromic craniosynostosis. Eighty surgeries were open procedures (cranial vault reconstruction, frontoorbital advancement, extended-strip craniectomy) and 34 were minimally invasive endoscope-assisted craniectomy (EAC). Sutures affected were sagittal in 66 cases (32 open, 34 EAC), coronal in 20 (15 unilateral, 5 bilateral), metopic in 23, and multisuture in 5. Only 5 patients who underwent open procedures (6%) were initially admitted to the ICU from the operating room; the reasons for direct admission were as follows: the suggestion of preoperative elevated intracranial pressure, pain control, older-age patients with large reconstruction sites, or a significant medical comorbidity. Overall, of the 107 patients admitted directly to the ward (75 who underwent an open surgery, 32 who underwent an EAC), none required ICU transfer.CONCLUSIONSOverall, the findings of this study suggest that patients with nonsyndromic craniosynostosis can be managed safely on the ward and do not require postoperative ICU admission. This could potentially increase cost savings and ICU resource utilization.

Optimal settings for childbirth.

Many studies highlight how health is influenced by the settings in which people live, work, and receive health care. In particular, the setting in which childbirth takes place is highly influential. The physiological processes of women's labor and birth are enhanced in optimal ("salutogenic," or health promoting) environments. Settings can also make a difference in the way maternity staff practice. This paper focuses on how positive examples of Italian birth places incorporate principles of healthy settings. The "Margherita" Birth Center in Florence and the Maternity Home "Il Nido" in Bologna were purposively selected as cases where the physical-environmental setting seemed to reflect an embedded model of care that promotes health in the context of childbirth. Narrative accounts of the project design were collected from lead professional and direct inspections performed to elicit the key salutogenic components of the physical layout. Comparisons between cases with a standard hospital labor ward layout were performed. Cross-case similarities emerged. The physical characteristics mostly related to optimal settings were a result of collaborative design decisions with stakeholders and users, and the resulting local intention to maximize safe physiological birth, psychosocial wellbeing, facilitate movement and relaxation, prioritize space for privacy, intimacy, and favor human contact and relationships. The key elements identified in this paper have the potential to inform further investigations for the design or renovation of all birth places (including hospitals) in order to optimize the salutogenic component of any setting in any country.