Urology Ward Research Articles

Effectiveness of an education program on nurses’ knowledge concerning nursing management of percutaneous nephrostomy tube at Baghdad Teaching Hospitals

To assess the effectiveness of education program on nurses’ knowledge concerning percutaneous nephrostomy tube management at baghdad teaching hospital. To identify the relationship between some demographic variables such as (age, gender, level of education) and e effectiveness of education program. The randomized sample consists of (60) nurses at urology wards in Baghdad Teaching Hospital from 23th of October 2017 to 1th of July 2018, which is divided into two equal groups, (25) nurses are assigned as study group while another (25) nurses were as control group and (10) as pilot study but only the study group were exposed to the educational program. To evaluate nurses’ knowledge the researcher used a questionnaire composed of (35) multiple choice question and the validity of the questionnaire was determined by a panel of experts. The findings of the study indicated that the urology nurses have inadequate or deficit in some aspects relative to nursing knowledge concerning nursing management in urology wards. No Significant relationship was found between urology nurses’ knowledge and their demographic variables such as (age, gender, level of education) for both groups (study and control).

Pain intensity among patients undergoing laparoscopic, scopic, and opensurgeries for genito-Urological disorders.

Pain is the fifth vital signs and also is one of the most commonly expressed symptom in the postoperative patients. This study aims to compare the incidence of pain intensity among patients undergoing three different types of genito urinary surgery admitted in general urology ward of Christian medical college, Vellore.

A multifaceted intervention to reduce guideline non-adherence among prescribing physicians in Dutch hospitals

Background Despite the potential of clinical practice guidelines to improve patient outcomes, adherence to guidelines by prescribers is inconsistent. Objective The aim of the study was to determine whether an approach of introducing an educational programme for prescribers in the hospital combined with audit and feedback by the hospital pharmacist reduces non-adherence of prescribing physicians to key pharmacotherapeutic guidelines. Setting This prospective intervention study with a before–after design evaluated patients at surgical, urological and orthopaedic wards. Method An educational program covering pain management, antithrombotics, fluid and electrolyte management, prescribing in case of renal insufficiency, application of radiographic contrast agents and surgical antibiotic prophylaxis was presented to prescribers on the participating wards. Hospital pharmacists performed medication safety consultations, combining medication review of patients who are at risk for drug related problems with visits to ward physicians. Main outcome measure The outcome measure was the proportion of the admissions of patients in which the physician did not adhere to one or more of the included guidelines. Difference was expressed in odds ratios (OR) with 95% confidence intervals (CI). Multivariable logistic regression analysis was performed. Results 1435 Admissions of 1378 patients during the usual care period and 1195 admissions of 1090 patients during the intervention period were included. Non-adherence was observed significantly less often during the intervention period [21.8% (193/886)] as compared to the usual care period [30.5% (332/1089)]. The adjusted OR was 0.61 (95% CI 0.49–0.76). Conclusion This study shows that education and support of the prescribing physician can reduce guideline non-adherence at surgical wards.

Monitoring the air fungal contamination load in two educational hospitals in Sanandaj, Iran

Opportunistic fungal pathogens are known to increase infection in the health care workers and patients with immune deficiency. This study aimed to investigate the qualitative and quantitative airborne fungal contamination load in two Sanandaj hospitals. In this cross-sectional study, 112 biological samples from 15 different hospital wards were collected for 6 months by using the single-stage Anderson sampler in Sabouraud’s dextrose agar. Data were analyzed for the descriptive and analytical tests using IBMSPSS V.21 software and the air fungal contamination load (AFCL) was calculated (cfu/m3). The average hospital AFCL in Besat and Tovhid was 21.13 and 14.51 cfu/m3, respectively. No statistically significant differences were observed between AFCL and relative humidity (RH) in the two hospital samples (p = 0.495) according to independent t-test, whereas this difference in the average temperature in the hospital wards was significant (p < 0.001). Highest AFCL was observed in the surgical ward for females (AFCL = 35.34 cfu/m3) and the lowest was observed in the surgical and urology wards (AFCL = 2.2 cfu/m3) in the two hospitals. The frequency of Penicillium was the maximum with 77.6 and 65.25% in the Besat and Tovhid hospitals, respectively. In wards such as oncology, gynecological surgery, and operating room, further studies are needed to better control environmental conditions and fungal contamination. Thus, utilizing highly efficient air purification systems and regular monitoring of the biological risk for both patient and health care employees is recommended.

Falls Awareness on the Urology Ward

Falls Awareness on the Urology Ward

Improving venous thromboembolism risk assessment rates in a tertiary urology department.

Venous thromboembolism (VTE) is a significant cause of mortality and morbidity among hospitalised patients. A VTE risk assessment reduces this through facilitating correct prophylaxis. Since 2010, the Commissioning for Quality and Innovation payments framework dictates that >95% adult inpatients must have a VTE risk assessment within 24 hours of admission. This target is not currently being met by the urology department at Guy’s and St. Thomas’ Trust (GSTT). Following analysis, a quality improvement project aimed to increase VTE risk assessment rates for patients admitted under urology at GSTT. Two series of interventions were introduced following the Plan, Do, Study, Act structure aimed at urology theatres and wards, respectively. These boosted awareness of the VTE risk assessment and streamlined it into routine surgical workload. Despite not reaching the 95% target, the project increased rates among patients admitted directly to surgical units by 5%–8%. It highlighted the difficulties in driving a change in established routine and demonstrated a need for firmer interventions with effective communication.

Evaluation of Carbapenem Resistance Mechanisms and Its Association with Pseudomonas aeruginosa Infections in the Northwest of Iran.

The aims of this study were to determine carbapenem resistance mechanisms, molecular epidemiological relationship, clinical impact, and patient outcome of carbapenem-resistant Pseudomonas aeruginosa (CRPA) infections. A total of 42 nonduplicated CRPA were recovered from Urmia, Iran. Antimicrobial susceptibility tests were carried out using phenotypic methods. The carbapenem resistance mechanisms such as carbapenemase genes, efflux pump hyperexpression, AmpC overproduction, and OprD gene downregulation were determined by phenotypic and molecular methods. Eighteen metallo-β-lactamase (MBL) producer isolates were found to be sensitive to amikacin. Among the CRPA, 52.3%, 26.1%, 26.1%, and 59.5% were identified as carbapenemase, efflux pump hyperexpression, AmpC overproduction, and reduced expression OprD gene, respectively. Random Amplified Polymorphic DNA analysis yielded 25 distinct profiles. Most MBL-positive isolates were recovered from patients hospitalized in urology and internal wards with urinary tract infections. Most of the strains showed downregulation of porin. The clonal distribution of the strains was related to carbapenem resistance mechanisms (most of MBL producers belong to the same clones) and the same hospital wards where the isolates were collected. The study demonstrates that the main risk factor of MBL-related infections was hospitalization in non-intensive wards. Amikacin was considered a very efficient antibiotic to treatment of MBL-producing CRPA isolates. Our results showed that OprD downregulation and IMP-type MBL are the main carbapenem resistance mechanisms in CRPA isolates from northwest of Iran.

'Be courageous and stand up for what you believe is right'.

What is your job? I am a practice facilitator on an acute colorectal and urology ward in Ysbyty Gwynedd Hospital, part of Betsi Cadwaladr University Health Board (BCUHB). My main role is to support newly qualified nurses and students.

Prognostic Value of p53 Expression Intensity in Urothelial Cancers.

To determine association of immunohistochemical expression intensity of p53 with grade and stage of urothelial cancers. Descriptive cross-sectional analytical study. Pathology Department, King Edward Medical University, Lahore, from January to December 2016. Data of transurethral resection/radical cystesctomy urinary bladder biopsies was collected. Clinical, radiological and cystoscopic findings of patients were noted from patients' charts in the Urology Ward. Biopsies were graded histologically according to WHO 2004 grading system. TNM system was used for pathological staging. On selected slides, immunoshistochemistry for p53 was applied. Nuclear immunoreactivity was considered positive if present in >10% of tumor cells and negative if <10% of tumor cells. Intensity was considered weak (less than 15% cells) and strong (more than 15% cells). Data was analyzed by SPSS version 21. Linear-by-linear association was calculated between p53 expression and stage of urothelial tumors, Chi-Square test was used to see association between grade and intensity of p53. Qualitative variables, like grade and stage of carcinoma along with p53 expression, were calculated in terms of frequencies and percentages. P ≤ 0.05 was taken as significant. Out of the 70 patients, 61 (87%) were males and 9 (13%) females. Out of 25 low grade lesions, 4 (16%) cases were p53 positive; and out of 45 high grade lesions, 41 (91%) cases were p53 positive. There was 33% (2/6 cases) positivity in Tis, 55% (16/29 cases) in T1, 72% in T2 (21/29), and 100% in T3a (5/5 cases) and T3b (1/1 case). Strong intensity of p53 staining was noted to be 5.4% (n=25) of low grade and 94.6% (n=45) of high grade tumors. p53 expression was greater and more frequently strong in higher grade and stage of urothelial carcinoma. It can be used as a prognostic marker in predicting higher grade and stage of bladder cancer.

MP92-18 A STUDY OF UROLOGY RESIDENT SLEEP PATTERNS IN RELATION TO VOLUME AND CATEGORY OF OVERNIGHT PAGES IN A HOME CALL SYSTEM

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II1 Apr 2017MP92-18 A STUDY OF UROLOGY RESIDENT SLEEP PATTERNS IN RELATION TO VOLUME AND CATEGORY OF OVERNIGHT PAGES IN A HOME CALL SYSTEM Adam Ludvigson, Gregory Mills, Stephen Ryan, Graham VerLee, and Moritz Hansen Adam LudvigsonAdam Ludvigson More articles by this author , Gregory MillsGregory Mills More articles by this author , Stephen RyanStephen Ryan More articles by this author , Graham VerLeeGraham VerLee More articles by this author , and Moritz HansenMoritz Hansen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2879AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Mitigating resident fatigue is central to the design and implementation of residency programs, especially when using a home call system. Existing studies of resident sleep habits and fatigue are mostly limited to in-house call and rely on self-reporting. We quantified time spent asleep for residents employing a home call system, and examined how the volume and type of pages received affected sleep nightly. METHODS Urology residents in a single-institution residency were provided with a FitBit Charge HR device to collect objective sleep data over a six-month period. Each page received during this period after 16:00 and before 08:00 was counted and categorized as either ″clinic″ (outpatient calls from the after-hours answering service), ″floor″ (calls from the inpatient Urology ward), and ″other″ (calls regarding off-floor consults). Data analysis was carried out using IBM® SPSS® Statistics 23 and Numbers. RESULTS Residents received a total of 1068 overnight pages while on call. The least senior resident received 321 pages (avg. 7.0/night), followed by 288 (avg. 6.0/night), 265 (avg. 6.3/night), and 194 (avg. 5.0/night) for the next three more senior residents, respectively. On average, residents slept 400 minutes while on call, compared to 434 minutes while not on call (p<0.05). Increased total volume of pages was associated with 4.71 fewer minutes asleep nightly per page for all residents (r=-0.32, n=145, p<0.05). Pages in the ″other″ category were associated with 7.74 fewer minutes asleep per page for all residents (r=-0.24, n=145, p<0.05). On individual analysis, pages to the least senior resident from the ″floor″ category were associated with 9.02 fewer minutes asleep (r=-0.35, n=44, p<0.05). This correlation did not reach significance for the other residents. CONCLUSIONS The most senior resident received the least average pages and the least senior resident received the most, an interesting finding given that call nights were evenly distributed. Residents slept less on call in general. Time asleep was reduced with increasing page volume, most severely when pages were from the ″other″ category, suggesting residents needed more time to address pages regarding patients they were unfamiliar with. Calls from the floor were most detrimental to sleep for the least senior resident, suggesting experience is a factor in efficient overnight call management. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1234 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Adam Ludvigson More articles by this author Gregory Mills More articles by this author Stephen Ryan More articles by this author Graham VerLee More articles by this author Moritz Hansen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD46-07 SIMULATED WARD ROUNDS- A UNIQUE APPROACH TO TEACH NON-TECHNICAL SURGICAL SKILLS FOR NEWLY APPOINTED RESIDENTS IN UROLOGY

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment III1 Apr 2017PD46-07 SIMULATED WARD ROUNDS- A UNIQUE APPROACH TO TEACH NON-TECHNICAL SURGICAL SKILLS FOR NEWLY APPOINTED RESIDENTS IN UROLOGY Sanjay Rajpal, Uwais Mufti, Andy Myatt, Craig Mcllhenny, Chandra Shekar Biyani, and Sunjay Jain Sanjay RajpalSanjay Rajpal More articles by this author , Uwais MuftiUwais Mufti More articles by this author , Andy MyattAndy Myatt More articles by this author , Craig McllhennyCraig Mcllhenny More articles by this author , Chandra Shekar BiyaniChandra Shekar Biyani More articles by this author , and Sunjay JainSunjay Jain More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2379AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Residents encounter a step change in responsibility during their entry into speciality training and are often expected to run a ward round but are seldom given a formal training for its effective conduct. Along with technical skills, it is increasingly recognised that non-technical skills such as communication, team working and leadership play a vital role in reducing adverse events in surgery. Simulation based learning can be used to complement training. METHODS A ward round scenario was designed as one of the modules during a urology simulation boot camp for newly appointed trainees in urology. This module comprised simulated patients with typically encountered urological problems along with a nurse and intern. To test the non-technical skills, various interruptions and distractions were introduced. We assessed this module using structured feedback forms; self-reported confidence scores (5 point Likert scale) and also uniquely performed a cognitive load assessment using the NASA- Task load index (NASA TLX) multi-dimensional assessment tool. RESULTS 32 delegates attended the boot camp of which 19 were males. At the conclusion of this module, 83% delegates felt 'more confident' in running an acute urology ward round. 90% delegates felt challenged in decision making skills during the simulation and believed that they would change their behaviour in ward settings. A vast majority felt that the scenario helped them think critically, develop better insight into teamwork, improved communication skills and learn the importance of handover. 96% delegates enjoyed the exercise and would recommend to other trainees at their level. The cognitive load assessment using the NASA TLX (table 1) showed that among the six domains, performance and mental demand were the most challenging aspects in this module with mean scores of 12.1 and 11.9 respectively. Physical demand scored the least with mean score of 6.3. CONCLUSIONS We have demonstrated that simulation can improve the confidence of newly appointed residents in leading the ward rounds which in turn could result in improved patient care and better team working. The NASA TLX scale helps to identify the residents cognitive workload in different working environments and can facilitate learning technical and non-technical skills. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e892-e893 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sanjay Rajpal More articles by this author Uwais Mufti More articles by this author Andy Myatt More articles by this author Craig Mcllhenny More articles by this author Chandra Shekar Biyani More articles by this author Sunjay Jain More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A Ten-Year Study of Prostate Cancer: A Southern Iranian Experience

Prostate cancer is the most common malignancy among the male population in the United States and the 3rd most common non-skin cancer among men in Iran. Its prevalence has shown a rising trend in recent decades. The aim of this study was to report the epidemiological features of prostate cancer in patients referred for prostate biopsy in the south of Iran and to evaluate the accuracy of the levels of the prostate-specific antigen (PSA) and the PSA-density (PSAD) as well as the extension of the disease in the prediction of the biological behavior of prostate cancer. This is a retrospective study on the medical records of 1982 consecutive patients who underwent transrectal ultrasound-guided biopsy due to an abnormal digital rectal examination and/or an elevated PSA level following referral from the Urology Ward to the Radiology Department of Shahid Faghihi Hospital in Shiraz, southern Iran, between December 2003 and July 2014. The overall cancer detection rate was 33.1%. Although the cancer was more prevalent among the elderly patients, a significant fraction (7%) of the patients were aged < 55 years. The sensitivity and specificity of the PSA were 97.4% and 8.7% and those of the PSAD were 82.9% and 52%, respectively. Of the 637 patients with prostate cancer, 250 (39.2%) had unilateral disease, 378 (59.4%) had bilateral disease, and 9 (1.4%) had inner-gland involvement. Most of the patients with bilateral involvement had high-grade Gleason scores. Our study underlines the relationship between age and the frequency of cancer; the levels of the PSA and the PSAD and the Gleason score; and the extent of tumor involvement and the grade of prostate cancer and also highlights the significance of screening, especially in younger patients.

80 - Five-year prospective study evaluating healthcare-associated infections (HAIs) in a urology ward: Risk factors, microbiological characteristics and resistance patterns

80 - Five-year prospective study evaluating healthcare-associated infections (HAIs) in a urology ward: Risk factors, microbiological characteristics and resistance patterns

Prospective study analyzing risk factors and characteristics of healthcare-associated infections in a Urology ward.

PurposeHealthcare-associated infections (HAIs) in urological patients have special features due to specific risk factors. Our objective was to evaluate the characteristics and risk factors for HAIs in patients hospitalized in a Urology ward.Materials and MethodsWe evaluated prospectively, from 2012 to 2015, the incidence, types and risk factor for HAIs, microbiological and resistance patterns.ResultsThe incidence of HAIs was 6.3%. The most common types were urinary infections (70.5%) and surgical site infections (22.1%). Univariate analysis showed an increased risk of HAIs among patients with American Society of Anesthesiologists physical status classification system III–IV (odds ratio [OR], 1.39; p<0.001), immunosuppression (OR, 1.80; p=0.013), previous urinary infection (OR, 4.46; p<0,001), and urinary catheter before admission (OR, 1.74; p<0.001). The surgical procedures with the highest incidence of HAIs were radical cystectomy (54.2%) and renal surgery (8.7%). The most frequently isolated microorganisms were Escherichia coli (25.1%), Enterococcus spp. (17.5%), Klebsiella spp. (13.5%) and Pseudomonas aeruginosa (12.3%). Enterococcus sp was the most common microorganism after radical cystectomy and in surgical site infections, E. coli showed resistance rates of 53.5% for fluoroquinolones, 9.3% for amikacin. The percentage of extended-spectrum betalactamase producing E. coli was 24.7%. Klebsiella spp. showed resistance rates of 47.8% for fluoroquinolones, 7.1% for amikacin and 4.3% for carbapenems. Enterococcus spp showed resistance rates of 1.7% for vancomycin and; P. aeruginosa of 33.3% for carbapenems and 26.2% for amikacin.ConclusionsComorbidities, previous urinary infections, and urinary catheter are risk factors for HAIs. The microorganisms most commonly isolated were E. coli, Enterococcus and P. aeruginosa. Prospective monitoring may decrease the incidence of infections.

Physico-chemical assessment of indoor air quality of a tertiary hospital in South–South Nigeria

Background: Good ventilation is one of the structural designs used to reduce the risk of transmission of airborne infections in hospitals. This is, however, rarely observed in Nigeria as hospital designs used to shut out the inclement weather in temperate countries are copied without much modification. This study assessed the physico-chemical air quality at different areas of the University of Port Harcourt Teaching Hospital, Port Harcourt, to ascertain the level of pollutants in the ambient air. Methods: The study was carried out in July, 2015, in randomly selected inpatient wards, outpatient clinics and clinical laboratories of the hospital, using the appropriate measuring equipment. The study tested for the presence of particulate matter 2.5 (PM2.5), volatile organic compounds (VOCs) and nitrogen dioxide (NO2) in the ambient air; as well as the prevailing micrometeorological indices of relative humidity, temperature, wind direction and speed of the study sites. Results: A total of 36 air quality measurements were carried out in nine study sites in the hospital. The assessed pollutants were present in the ambient air of most of the study sites but were within the regulatory limits. The concentration of NO2in the study sites ranged from 133 μg/m[3] in the immunisation clinic to 151 μg/m3 in the gynaecology ward, with a mean concentration of 141 μg/m3; while PM2.5was not detected in the gynaecology and urology wards and present in very low levels in the other study sites. There was, however, greater variability in the levels of VOCs, ranging from 236.57 mg/m3 in the HIV clinic to 530.77 mg/m3 in the male surgical ward. Conclusion: The levels of the assessed pollutants were within regulatory levels, even as there were evidence of poor ventilation in several of the study sites.

Evaluation of Satisfaction in Hospitalized Patients in Urology Ward at the Hamedan Medical Sciences University, Shahid Beheshti Hospital during First and Second Half Year of 2013

Evaluation of Satisfaction in Hospitalized Patients in Urology Ward at the Hamedan Medical Sciences University, Shahid Beheshti Hospital during First and Second Half Year of 2013

Comparison of two disinfectant solutions deconex 53 plus 2% and glutaraldehyde (Cidex) 2% on reduction of medical equipment contamination in the operating room of urology ward

Introduction and Goal: Operating rooms are a great source of hospital infections caused by a variety of microorganisms. The use of different disinfectants is one of the most effective methods to reduce or eliminate the microbial load of the equipment and facilities that are in the hospital. This study aimed to compare two disinfectant solutions deconex 53 plus 2% and glutaraldehyde (Cidex) 2% on reduction of medical equipment contamination in the operating room of urology ward in Shahid Beheshti Hospital of Yasuj to microbes such as Staphylococcus aureus, Citrobacter, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella. Materials and Methods: Experimental study was conducted to investigate the effects of disinfectant solution with microbes including S. aureus, Citrobacter, P. aeruginosa, E. coli, and Klebsiella. Sixty-two metal and nonmetal tools used by qualified research (sterile conditions with disinfectants) were sampled. Collected data using SPSS version 22 and Chi-square and t-tests were analyzed. Results: In this study, contamination intervention with disinfectant solution deconex before the intervention, with E. coli, Pseudomonas and Citrobacter, S. aureus, and Klebsiella was 53%, 28%, 21%, 18% and 12% respectively. Moreover, the contamination of microbes in interventional suites with a solution of glutaraldehyde was 14%. Conclusion: Use of the disinfectant substance deconex 53 plus 2% and glutaraldehyde 2% for disinfection of equipment of urology operating room with respect to conditions and factors affecting disinfections such as concentration, reaction time, and learning the correct disinfection procedures showed that S. aureus, Citrobacter, P. aeruginosa, E. coli, and Klebsiella are completely removed.

The relationship between serum and urinary Fetuin-A levels and kidney stone formation among kidney stone patients.

IntroductionMineralization inhibitors are required to prevent the precipitation of minerals and inhibit the formation of kidney stones and other ectopic calcifications. In laboratory studies, Fetuin-A as a glycoprotein has inhibited hydroxyapatite precipitation in calcium and phosphate supersaturated solutions; however, information about patients with kidney stones is limited. The aim of this study was to investigate the association of serum and urinary Fetuin-A levels with calcium oxalate kidney stones.Material and methodsIn this case-control study, 30 patients with kidney stones and 30 healthy individuals without any history of urolithiasis who were referred to the urology ward of Sina Hospital of Tehran, Iran, in 2015 were entered into the study. All patients underwent computerized tomography scans. After collecting demographic information, serum and urine levels of Fetuin-A and some other calcification inhibitors and promoters, were measured and compared using T-test, Mann-Whitney and logistic regression between the two study groups.ResultsPatients with kidney stones, on average, had lower levels of Serum Fetuin-A (1522.27 ±755.39 vs. 1914.64 ±733.76 μg/ml; P = 0.046) as well as lower levels of Urine Fetuin-A (944.62 ±188.5 vs. 1409.68 ±295.26 μg/ml; P <0.001). Multivariate logistic analysis showed that urinary calcium and serum creatinine are the risk factors and Fetuin-A is a urinary protective factor for kidney stones.ConclusionsPFC Our study showed that patients with kidney stones had lower serum and urinary levels of Fetuin-A. In the logistic regression model, urinary Fetuin-A was reported as a protective factor for kidney stones.

English

Extended spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae causing urinary tract infection (UTI) constitutes a significant therapeutic challenge. The aim of this study was to investigate the frequency of ESBL producing Escherichia coli and Klebsiella pneumoniae isolated from urine samples. Clinical isolates of multidrug resistant Gram negative rods (n=102) were taken from urine specimens from tertiary care hospital Lahore. Micro-organisms were identified on the basis of their morphology, cultural characteristics, and confirmed using API 20E. Identified E. coli and K. pneumoniae were subjected to susceptibility testing using Kirby-Bauer disc diffusion method as per CLSI guidelines. Furthermore, phenotypic confirmation of ESBL production was done according to CLSI guidelines. Out of 102 multidrug resistant Gram negative rods 97 (95%) were ESBL producers isolated from different urine specimens from different wards of hospitals (emergency, ICU, urology ward); among these 64 (66%) were E. coli and 33 (34%) were K. pneumoniae. Antimicrobial susceptibility pattern of ESBL producing pathogens showed that 75% of these pathogens were resistant to ciprofloxacin whereas most effective drug was meropenem and pipracillin+tazobactam. Meropenem could be used as an alternative treatment option for UTI related to ESBL producing E. coli and K. pneumoniae. High prevalence of these ESBL producing pathogens are alarming and need special consideration. Key words: Extended spectrum β-lactamases, urinary tract infection, Escherichia coli, Klebsiella pneumoniae.

A multifaceted intervention to reduce drug-related complications in surgical patients.

The P-REVIEW study was a prospective, multicenter, open intervention study, designed to determine whether a multifaceted intervention of educating the prescriber combined with medication review and pharmaceutical visits to the ward by the hospital pharmacist could lead to a reduction in drug-related complications among surgical patients. A total of 6780 admissions of 5940 patients to surgical, urological and orthopaedic wards during the usual care period and 6484 admissions of 5711 patients during the intervention period were included. An educational programme covering pain management, antithrombotics, fluid and electrolyte management, prescription in case of renal insufficiency and antibiotics was developed. National and local hospital guidelines were included. Hospital pharmacists performed medication safety consultations, combining medication review of high-risk patients and a visit to the physician on the ward. A significantly lower proportion of admissions with one or more clinically relevant, potentially preventable, drug-related problems (including death, temporary or sustained disability, increased length of hospital stay or readmission within 30 days) occurred in the intervention period (1.1% (73/6484) compared to the usual care period [1.6% (106/6780)] (P=0.029). The relative risk (RR) was 0.72 (95% CI 0.53-0.97). Several types of drug-related problems occurred less frequently. Costs incurred as result of time spent on study-related activities were not different before and after the intervention. The P-REVIEW study shows that education and support of the prescribing physician with respect to high-risk patients in surgical departments leads to a significant, clinically relevant benefit for patients without generating additional costs.