Ward Of Center Research Articles

Fetal Death in Utero at the Maternity Hospital of Koutiala in Mali

The aim was to assess the frequency of fetal death in utero; to describe the sociodemographic and clinical characteristics of patients; to identify risk factors for IUD; to describe its management and to determine the maternal prognosis. Material and Method: This was a descriptive, cross-sectional, analytical study of the prospective case/control cohort type from June 2021 to May 2022, i.e. a period of 12 months in the maternity ward of the Koutiala reference health center. Results: Fetal death in utero concerned 85 deliveries out of a total of 3024 deliveries, i.e. a frequency of 28.11 ‰. The epidemiological profile is that of a poor person (37.6%) between 25 and 29 years of age (31.8%), with a pregnancy of 28 to 37 weeks of amenorrhea; they came on their own in (64.7%) of cases. If, in 5.9% of cases, the cause of fetal death was not known in the study; arterial hypertension was the most common etiology with 37.6% of cases. Patients gave birth vaginally in 89.4% and presented complications of infections (endometritis) in 10.6% of cases.

Implication of Urban Domestic Water Distribution on Human Health in Machakos Central Ward, Machakos County

The world's water resources are running out, and this situation is made worse by how quickly people are populating new areas, particularly in developing nations. This has highlighted the critical requirement for prepared action to manage water resources for sustainable development efficiently. Increasing water demands due to climate change, global pressures from urbanization, the already-existing unsustainable variables, and challenges of water supply systems in urban centres pose a challenge in managing water resource effectively. The purpose of the study was to investigate the implication of urban domestic water supply on human health in Machakos Central Ward, Machakos County. Using a Survey Research Design (SRD) both primary and secondary data was collected by use of questionnaires, face-to-face interviews, photography, use of GIS, authors’ observation, and the review of relevant literature in order to (1) document household water supply, (2) determine water quality for the identified categories of households and domestic water supply systems, and (3) Determine how the distribution and coverage of domestic water in a household or home affects the prevalence of water-borne illnesses. The target population was 8,331 households, from which a sample size of 381 respondents was selected. These included households, water vendors and key informants from the Machakos Water and Sewerage Company. Questionnaires (for households and vendors), interview schedules (for water officers and chiefs) and observation schedules were used as instruments for data collection. Data was analysed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) software. The results revealed that the major factors attributed to lower accessibility are shortage of water, high cost of piped water connection, poor coordination, and participation of stakeholders, repairing of old and broken pipes. As a result, nearly half of the dwellers prefer to use alternative sources, exposing them to the risks of water-born diseases

Descriptive analysis of road traffic crashes encountered by Tanzanian motorcycle taxi drivers trained in first aid

IntroductionIn Dar es Salaam, Tanzania, death from road traffic crashes (RTC) occurs at roughly double the global rate. In this study, we sought to understand the locations and types of vehicles involved in RTC in Dar es Salaam encountered by a cohort of motorcycle taxi drivers previously trained in first aid. MethodsThis was a quasi-non-randomized interventional study, cohort subtype, with three-month follow-up. Some 186 motorcycle taxi drivers were selected by convenience sampling from 16 heavily populated, central wards and trained in a basic hemorrhage control course. Participants reported the location and types of vehicles involved in RTCs they encountered and intervened upon through performing bleeding control interventions. Surveys were designed on KoboToolbox and administered via phone call at monthly intervals over a three-month period. The main outcome measures were the location of crash encounters and types of vehicles involved. ResultsIn all 62 unique participants (33.3 %) encountered and provided bleeding control interventions to 83 injured individuals following 69 RTC in at least 31 distinct city wards, despite training only having occurred in 16 wards. Eight crash locations were not recorded. Crashes in distant wards typically contained major roads. Most commonly, crashes involved a motorcycle without the involvement of another vehicle (n=20), followed by motorcycle vs. car/three-wheeled vehicle (n=15), motorcycle vs. bus/van (n=10), motorcycle vs. motorcycle (n=9), motorcycle vs. pedestrian (n=7), pedestrian vs. bus/van (n=2), pedestrian vs. car/three-wheeled vehicle (n=1), motorcycle vs. bicycle (n=1), multi vehicle (n=1), and other (n=3). ConclusionsMotorcycle taxi drivers trained in hemorrhage control frequently encounter and intervene upon RTC in wards where they are based as well as in distant locations, commonly in wards containing major roads. Expanding first aid training for motorcycle taxi drivers could improve timely access to emergency care for RTC victims. Since most crashes involved motorcycles, road safety training should be integrated into future courses.

Effect of three different exercise trainings on functional capacity in early stage severe burn patients: A randomized controlled trial.

This study investigated the effects of three different exercise protocols on functional capacity in early-stage burn patients. A total of 25 patients hospitalized in the Burn Center (wards and intensive care unit) were included in the study. The individuals were divided into three groups by covariate adaptive randomization according to burn percentage and type: 1 - standard treatment, 2 - standard treatment + aerobic exercise training, 3 - standard treatment + combined exercise (aerobic and resistance) determined by metabolic status. Individuals were evaluated weekly for six weeks from the first day of hospitalization using the 6-minute walk test, physiological cost index, and Medical Research Council muscle-strength measurements to assess functional capacity. A portable metabolism tracker device measured the metabolic status of all patients. Aerobic exercises and combined exercise (aerobic and resistance), when added to standard treatment and determined by metabolic status, were more effective in enhancing functional capacity than standard treatment alone (p<0.05). Patients performing the combined exercise (aerobic and resistance) showed faster improvement in functional capacity determined according to metabolic status than those in the other two groups (p<0.05). Aerobic exercises, when added to standard treatment and combined with aerobic and resistance exercises based on metabolic status, are more effective at improving functional capacity than standard treatment alone. Further controlled studies are required to explore the potential long-term benefits of this approach.

Influence of nursing services and facilities on the satisfaction level of BPJS Patients in the inpatient ward of Wajo health Center

Overview: The research conducted at the Wajo Health Center in Baubau City in 2023 aims to evaluate the impact of nursing services and facilities on the satisfaction of BPJS patients. Using an analytical cross-sectional approach, this study involved 42 patients selected through accidental sampling. Primary data were collected through survey questionnaires, while secondary data were obtained from the health center's medical records. Body of Knowledge: This study evaluates the influence of nursing services and health facilities on BPJS patient satisfaction as a key indicator of the effectiveness of the National Health Insurance. The research highlights the importance of improving service quality and health infrastructure to achieve equitable health coverage in line with the WHO's Universal Health Coverage goals. Methods: The study employed an analytical cross-sectional design at the Wajo Health Center in Baubau City from May to June 2023. Out of a population of 55 patients, 42 were selected via accidental sampling. Primary data were gathered through questionnaires and analyzed using univariate, bivariate, and Chi-Square statistical methods. Ethical considerations were maintained by ensuring informed consent, anonymity, and data confidentiality. Results: The majority of respondents were female (81%), predominantly aged 20-29 years (54.8%), and had a high school education (57.1%). Most were housewives (66.7%). There was a high level of satisfaction with nursing care (71.4%) and health facilities (81%). Bivariate analysis showed a significant relationship between satisfaction with nursing services (X² = 10.438, p = 0.005) and health facilities (X² = 12.101, p = 0.003) and BPJS patient satisfaction. Recommendation: It is recommended to enhance service quality through regular training for medical personnel to improve interpersonal and clinical skills. Periodic evaluations of health infrastructure are necessary to ensure reliability. Continuous support from management is required for ongoing improvements, ensuring that health service standards meet BPJS patient expectations.

Time series analysis of COVID-19 stringency measures on the spatio- temporal dynamics of air pollution

Introduction: Execution of COVID-19 lockdown measures caused variations in air pollution worldwide. This paper investigates the impact of COVID-19 stringency measures on the spatio-temporal dynamics of air pollution in Mumbai, India, using a comprehensive two-and-a-half-year pandemic period dataset. Materials and methods: We classified the pandemic period into 7 phases and 21 sub-phases based on the severity of the Oxford COVID-19 Government Response Tracker (OxCGRT) Stringency Index (SI). Optimized Hotspot analysis (OHS) and Ordinary Least Square Regression models explored the spatio-temporal fluctuations and the effect of stringency measures on air quality. Results: The R2 value varied; with the best model R2 of 0.61 for Particulate Matters (PM10) and Nitrogen dioxide (NO2) and lowest of 0.23 for Sulfur dioxide (SO2). A 10-point increase in SI caused a 3-7% reduction in air pollutants. Substantial reduction in average PM10, PM2.5, NO2, and Carbon monoxide (CO) was observed throughout the COVID-19 phases. Meteorology and SI collectively caused maximum reduction of 82.6%, 72.7%, 53.8%, 52.2%, 49.1%, 28.4% for NO2, PM2.5, PM10, NH3, CO, and SO2 respectively, during complete or extreme lockdown phases. Except SO2, seasonality significantly influenced the pollutant concentrations. Winter was the worst period while monsoon was the best. OHS identified central Mumbai wards as hotspots and areas close to the national park as coldspots. Conclusion: PM10, NO2 and CO were more affected by SI measures than NH3 and SO2. For a rapid emergency response to high PM10, implementation of SI, very high (≥ 80 score) and above is advised. Findings of this study have significant public health policy implications, especially among global south nations.

Gender differences in Clinical Characteristics and Outcomes of Heart Failure with Reduced Ejection Fraction

Background and Objectives: Studies evaluating gender differences and outcomes in heart failure with reduced ejection fraction are limited in Iraq. The aim of this study was to assess the clinical characteristics, risk factors, outcomes and severity of heart failure with reduced ejection fraction in both genders. Patients and Methods: This is a prospective cohort study of 117 patients aged more than 18 years who had been admitted to the Hawler Cardiac Center or medical ward with heart failure with reduced ejection fraction for the period from December 2021 till 30th of October 2022. The clinical characteristics, severity of left ventricular systolic dysfunction and the outcomes over three months were compared between women and men. Results: One hundred seventeen patients were included in the study, 61 (52.1%) patients were male and 56 (47.9%) were female with male to female ration (1.09:1), p-value (0.017). Women presented with higher incidence of moderate left ventricular systolic dysfunction 36(64.2%), obesity 43 (76.8%) p-value=0.017*, dyslipidemia 27 (48.2%) p-value=0.038, pulmonary hypertension 4 (7.1%), atrial fibrillation 15(26.8%) and high cardiac hospitalization 12 (21.4%), while men have high incidence severe left ventricular systolic dysfunction 33(54.1% ) p-value=0.046, smoking 42 (68.9%); p-value &lt;0.001 and ST-segment elevation myocardial infarction 28 (45.9%) p-value &lt;0.001. the p-values off all above findings are less than &lt;0.05 respectively Conclusions: There are major differences in risk factors, clinical presentation and outcomes between both genders. The majority of women presented with moderate left ventricular systolic dysfunction and higher rate of cardiac hospitalization while men presented with severe left systolic dysfunction associated with high incidence of ST-elevation myocardial infarction.

Analysis of spatial pattern of water supply continuity in an Indian metropolis: a case study of Hyderabad

ABSTRACT Water supply continuity is a crucial indicator of service efficiency. Multiple South Asian cities have Intermittent Water Supply (IWS). Water supply equity in cities depends on the spatial patterns of intermittency. The present study used Kernel Density Estimation (KDE) to investigate the spatial pattern of water supply intermittency for 3071 localities of Hyderabad, India. Further, the relationship between population density and supply continuity has been examined in 146 wards of Hyderabad using Spatial Autocorrelation and Geographically Weighted Regression (GWR). Spatial Autocorrelation defines two distinct clusters of central wards for high continuity (12 wards) and population density (19 wards). However, the ward clusters are different for continuity and density, with only three central wards (2.06% of all wards) being common in both the high-high clusters. The results highlight that the water supply continuity in Hyderabad has minimal consideration for population density, resulting in a spatially inequitable water supply.

The Interrelationship of Benefit Finding, Demoralization, and Stigma among Patients with Parkinson's Disease and Their Caregivers.

Parkinson's disease (PD) is a debilitating neurodegenerative disease with a relentlessly progressive course of illness. This study aimed to assess the dyadic dynamics of benefit finding (BF), demoralization, and stigma on the depression severity of PD patients and their caregivers. This study used a cross-sectional design with purposive sampling. In total, 120 PD patients and 120 caregivers were recruited from the neurological ward or neurological outpatient clinic of a medical center in Taiwan from October 2021 to September 2022. PD patients and their caregivers were enrolled and assessed using the Mini International Neuropsychiatric Interview, the Benefit Finding scale, Demoralization Scale, Stigma Subscale of the Explanatory Model Interview Catalogue, and Taiwanese Depression Questionnaire. Among the 120 patients and 120 caregivers that successfully completed the study, 41.7% (N = 50) and 60% (N = 72) were female, respectively. The most common psychiatric diagnoses of both the PD patients (17.5%) and their caregivers (13.3%) were depressive disorders. Using structural equation modeling, we found that the stigma, BF, and demoralization of PD patients might contribute to their depression severity. Demoralization and stigma of PD patients' caregivers might also contribute to the depression severity of PD patients. Caregivers' BF and demoralization were significantly linked with their depression severity. PD patients' BF degree and their caregivers' BF degree had significant interactive effects. Both patients' and their caregivers' stigma levels had significant interactive effects. Clinicians should be aware of and manage these contributing factors between PD patients and their caregivers in order to prevent them from exacerbating each other's depression.

Effects of early warm water sitz bath on urinary retention and pain after haemorrhoidectomy: A randomized controlled trial

BackgroundHaemorrhoids are a common chronic anorectal disease, and haemorrhoidectomy is the standard treatment for advanced (grade III and IV) haemorrhoids. Warm water sitz has commonly been used to stimulate urination, cleanse wounds, and decrease pain. Although urinary retention and pain usually occur within the first 24 h after surgery, the warm water sitz bath is provided 24 h after haemorrhoidectomy, which might be a missed opportunity to optimize the quality and efficiency of the care provided. ObjectiveTo investigate the effect of early warm water sitz bath on the day of haemorrhoidectomy surgery on preventing urinary retention and reducing wound pain. DesignThis was a longitudinal double-blind study with a permuted block randomization design. Setting(s)This study was conducted in a surgical ward of a medical center. An average of 18 patients receiving hemorrhoid surgery in that ward every month. ParticipantsA total of 64 participants (32 each in the experimental and control groups) were enrolled. (The first recruitment date is January 16, 2020.) MethodsPatients who received haemorrhoidectomy for grade III or IV haemorrhoids from January to December 2020 were enrolled. The experimental and control groups received the same conventional treatment and care before the haemorrhoidectomy. The experimental group started warm-water sitz bath 6 h after the surgery, and the control group started warm water sitz bath on post-haemorrhoidectomy day 1 as usual. Urinary retention was defined as use of Foley catheter during the hospital stay or remaining urine volume ≧ 300 ml using the bladder scan. A numerical rating scale was used to rate the pain level. Each participant was evaluated 6 times in total until hospital discharge. The data were analysed by descriptive statistics, chi-square test, and independent samples t test. Generalized estimating equations and intention to treat were used to identify changes in urinary retention and pain over time and missing data, respectively. ResultsThere was no significant difference in the degree of change in the number of people with urinary retention between groups. A change in the wound pain index was noted; the study group had a statistically significant lower pain score than the control group (B = −0.81, 95 % CI: −1.44 to −0.18). ConclusionsEarly warm water sitz bath was a safe and effective strategy to decrease post-haemorrhoidectomy pain, but not urinary retention. Nurses could provide early warm water sitz bath for post-haemorrhoidectomy patients' comfort. RegistrationClinicalTrials.gov ID: NCT04535765

Effectiveness of Implementing Modified Early Warning System and Rapid Response Team for General Ward Inpatients.

This retrospective study assessed the effectiveness and impact of implementing a Modified Early Warning System (MEWS) and Rapid Response Team (RRT) for inpatients admitted to the general ward (GW) of a medical center. This study included all inpatients who stayed in GWs from Jan. 2017 to Feb. 2022. We divided inpatients into GWnon-MEWS and GWMEWS groups according to MEWS and RRT implementation in Aug. 2019. The primary outcome, unexpected deterioration, was defined by unplanned admission to intensive care units. We defined the detection performance and effectiveness of MEWS according to if a warning occurred within 24 h before the unplanned ICU admission. There were 129,039 inpatients included in this study, comprising 58,106 GWnon-MEWS and 71,023 GWMEWS. The numbers of inpatients who underwent an unplanned ICU admission in GWnon-MEWS and GWMEWS were 488 (.84%) and 468 (.66%), respectively, indicating that the implementation significantly reduced unexpected deterioration (p < .0001). Besides, 1,551,525 times MEWS assessments were executed for the GWMEWS. The sensitivity, specificity, positive predicted value, and negative predicted value of the MEWS were 29.9%, 98.7%, 7.09%, and 99.76%, respectively. A total of 1,568 warning signs accurately occurred within the 24 h before an unplanned ICU admission. Among them, 428 (27.3%) met the criteria for automatically calling RRT, and 1,140 signs necessitated the nursing staff to decide if they needed to call RRT. Implementing MEWS and RRT increases nursing staff's monitoring and interventions and reduces unplanned ICU admissions.

Factors related to sleep quality in hospitalized antepartum women: A cross-sectional study.

This study investigated the sleep quality and its psychological correlates among hospitalized antepartum women. A cross-sectional correlation study design and convenience sampling were conducted in the gynecological ward of a medical center in northern Taiwan. A total of 101 hospitalized antepartum women were recruited. A self-administered structured questionnaire including demographic profiles, State-Trait Anxiety Inventory (STAI), Antepartum Hospital Stressors Inventory (AHSI), and Pittsburgh Sleep Quality Index (PSQI) was used for the study. Bivariate and multiple linear regressions were used to analyze the data. A majority of the participants had poor sleep quality (82.8%), based on the global PSQI score. Sleep quality correlated with age, marital and employment status, parity, method of conception, multiple gestation, history of pregnant complications, anxiety symptom and hospital stressors which explained 21% of the variance in sleep quality. This study found a high prevalence of poor sleep quality in hospitalized antepartum women. Anxiety symptom was a significant predictor of sleep quality. Healthcare providers should be encouraged to assess sleep and emotional status in antepartum women during hospitalization and provide them appropriate interventions to improve sleep and reduce anxiety symptoms and hospital stressors.

Factors affecting quality of life among patients with corrosive injury.

This study aimed to investigate the factors influencing quality of life (QOL) among patients with corrosive injuries, considering the rising incidence of such cases, particularly in developing countries. Corrosive ingestion is a serious global public health problem and a common form of self-harm. This was a cross-sectional study using purposive sampling. A total of 82 patients with corrosive injuries who were admitted to the gastroenterology ward of a medical center in Taiwan between June 2018 and July 2020 completed the Perceived Stress Scale, Coping Strategy Scale, and World Health Organization Quality of Life Scale. We used an independent t-test and analysis of variance to examine the distribution and differences in demographic and disease characteristics, perceived stress, and the coping strategy scale. Multiple linear regression was then used to analyze the main predictors of QOL. The mean patient age was 58.2 (standard deviation = 2.4) years. A significant difference was observed between patients with a history of mental illness and perceived stress (P < .05). The patients were highly stressed and used emotional coping strategies to solve problems. Stress perception was significantly negatively correlated with overall QOL. Multiple linear regression analysis showed that a history of mental illness was a significant factor for overall QOL. The results of this study suggest that a history of mental illness significantly affects the QOL of patients with corrosive gastrointestinal injuries, and regular assessment and monitoring are essential.

A Ward Level Economic Topography of Sixteenth-Century Coventry

ABSTRACT Subsidy rolls of the 1540s and 1560s from the collection of Thomas Gregory, Coventry city clerk from 1528 to 1570, provide relative comparisons among Coventry’s wards over time. The various wards remained fairly consistent in relative wealth during the sixteenth century, and despite more diverse markets in the latter part of the century textiles still remained important. The central wards were the wealthiest, and wealth decreased moving towards the suburbs. The outer wards and suburbs were not necessarily poor, they just held few of the wealthiest merchants. The suburban wards of Spon and Gosford benefited from the growth of cap making. The incredibly wealthy wool and cloth merchants disappear by the mid-sixteenth century, but there is clear retention of the class of moderately wealthy gentry and merchants.

Factors Associated with Mortality in Children Aged 1 Month to 15 Years Hospitalized in the Pediatric Ward of the Kalaban-Coro Reference Health Center: Cross-Sectional Study

Factors Associated with Mortality in Children Aged 1 Month to 15 Years Hospitalized in the Pediatric Ward of the Kalaban-Coro Reference Health Center: Cross-Sectional Study

Impact of an antibiotic stewardship program on adherence to antibiotic prescription in children admitted with urinary tract infection.

Urinary tract infections (UTIs) are the most common bacterial infections in children. The high variability in pathogen susceptibility rates leads to the lack of clear guidelines for empiric and targeted therapies. In this view, local microbiological surveillance and locally adapted stewardship interventions need to be implemented. The study aims to describe the results of a pediatric antimicrobial stewardship program on antibiotic prescriptions for UTIs over 8 years in a pediatric general ward of a tertiary center. This quasi-experimental study was conducted between 2015 and 2022, with two different implementations, one in 2018 and one in 2021. Demographic, clinical, microbiological, and therapeutic data were retrieved from the electronic clinical records of included patients. The primary outcomes were adherence to local guidelines for empiric therapies and the adequacy of targeted therapy. Secondary outcomes were evaluating antibiotic prescription patterns stratified by antibiotics during hospital stay and at discharge, and assessing the microbiological characteristics of UTI episodes. During the study period, 7038 patients were admitted to the pediatric acute care unit (PACU), and 264 (3.7%) were included in this study. Adherence to local guidelines was highest immediately after the interventions, and it slightly decreased thereafter. Use of cephalosporins remained high throughout the 8 years but the changing microbiological scenario observed led to changing recommendations within the study period. An increase in E. coli strains resistant to co-amoxiclav was observed in the last years. Oral second-line agent consumption remained high but was adequate considering the prevalence of resistant bacteria. The variability of antimicrobial consumption reflects the changing resistance patterns for UTIs pathogens, underlying the importance of locally adapted, persevering antimicrobial stewardship interventions.

Automated Drugs Dispensing Systems in Hospitals: a Health Technology Assessment (HTA) Study Across Six European Countries.

Automated Drug Dispensing (ADD) systems are considered to be strategic hospital assets used to reduce errors and enhance economic and organizational sustainability. With regards to efficacy and safety, the literature evidence demonstrates the incremental benefits of centralised or decentralised systems compared to manual dispensing. Analyses about organisational and economic sustainability are still lacking and the present study aims to perform a Health Technology Assessment (HTA), producing multidimensional evidence on the use of ADD systems within hospitals. In 2023, a comprehensive HTA draws insights from healthcare professionals across six European nations: Italy, France, Germany, the Netherlands, the United Kingdom, and Belgium. This appraisal juxtaposed four drug dispensing scenarios: manual methods, centralized ADD systems, decentralized ADD systems, and integrated solutions employing cutting-edge technologies in both central pharmacies and wards. The study deployed an Activity-Based Costing approach that was combined with a cost-effectiveness and Budget Impact Analysis to evaluate economic impacts. Qualitative questionnaires were implemented to assess ethical, legal, organizational, safety, and efficacy aspects. From a multidimensional perspective, healthcare professionals acknowledged ADD manifold advantages of ADD systems. From an organizational perspective and within a 12-month timeframe, transitioning to automation may face initial challenges that are attributed to potential resistance from professionals and significant investments. However, 36 months past its adoption, automation's superiority over manual methods was recognized. Economically, savings burgeoned from +17.9% in UK to +26.6% in Belgian hospitals that adopted integrated systems in comparison to traditional manual approaches. Compared to traditional methods, implementing ADD systems could improve the logistic management of drug in the hospital setting, thereby enhancing safety and efficacy, streamlining the healthcare professionals' workflow, and bolstering financial stability.

HPB P37 Sustaining and rebuilding a laparoscopic cholecystectomy service in the COVID and post-COVID era

Abstract Background In the Belfast Trust (BHSCT), general surgery provision is complex- segregated into emergency and elective care, across multiple sites. The Emergency Surgical Unit (EmSU) provides ‘hot’ laparoscopic cholecystectomy (LC), and aside from a brief pause, continued throughout COVID. Elective LC was offered on another site in conjunction with the HPB service. This site became a COVID centre and surgical wards closed. Few cholecystectomies were performed during 2020/1. In an effort to restore provision, two ambulatory lists were established on the emergency site in December 2021. Subsequently, a regional ‘over-night stay’ unit opened on the original elective site in April 2023. Methods Previous BHSCT data demonstrated 300-350 elective LCs are undertaken annually with 66% as day cases. Since COVID, anecdotally significantly less LCs have been performed, and the length of stay (LOS) appeared greater. We performed a retrospective study looking at three time periods for comparison. “Pre-pandemic era” January 2019 to February 2020, “pandemic era” March 2020 to December 2021, and “pandemic recovery” from January 2022 to present. Patients were identified using the local HPB database and the electronic care record was reviewed for each patient. Information was gathered on demographics, day-case rate and LOS, as well as conversion and complication rates. Results In all, 827 patients have undergone cholecystectomy since the beginning of 2019. This is significantly less than the projected 1575, based on previous unit volume. Patient demographics are unchanged with mean age of 51.2 years, BMI of 30.27 and M:F ratio of 1:2.3. With the onset of the pandemic, we observed an increase in the average length of stay from 1.22 to 1.77 days with an associated fall in the day-case rate from 63.1% to 35.1%(figure 1). As demonstrated in figure 2, complication rates increased across the board and have been slow to fall in the recovery phase. Conclusions COVID decimated elective surgery globally. Locally, LC provision is an obvious example, with only urgent cases undertaken (76 in 2021 vs 363 in 2019). Unsurprisingly, conversion and complication rates increased. Despite attempts to reinstate the service, previous volume and outcomes have not been matched for multiple reasons. Increased time to surgery (waiting list &amp;gt;1600pts) means patients present with more severe disease. Ambulatory patients are nursed in EmSU where the environment is not orientated to rapid turnaround surgery. In addition, major losses of experienced nursing staff further impact theatre turnover and added to the challenge of setting up new elective facilities.

Impact of an integrated medication management model on the collaborative working relationship among healthcare professionals in a hospital: an explanatory mixed methods study

ABSTRACT An integrated medication management (IMM) model was implemented in a medical center ward to improve the delivery of clinical pharmaceutical services (CPSs). This model incorporated a ward-based clinical pharmacist who performed medication reconciliation and medication reviews. It was perceived to promote interprofessional collaboration between pharmacists and non-pharmacist healthcare professionals (NPHPs, including attending physicians, nurse practitioners, and registered nurses). This study aimed to evaluate the effects of the IMM on NPHPs’ intentions to collaborate with pharmacists and understand the mechanism of the impact of the IMM on interprofessional collaboration. A sequential explanatory mixed methods design was employed in the study. Initially, a questionnaire was administered to assess the effects of the IMM on NPHPs’ intentions to collaborate with pharmacists. The NPHPs’ experiences with the IMM were then documented using semi-structured interviews with inductive thematic analysis. Fifty-eight NPHPs completed the questionnaire, and NPHPs from the intervention ward reported a higher intention to discuss patient-related medication issues with pharmacists, indicating collaboration. Eleven NPHPs were interviewed, and they stated having better working relationships with pharmacists, experiencing more effective CPSs, and noting improved communication with pharmacists. The integration of quantitative and qualitative findings demonstrates that the critical mechanism of the IMM in promoting collaborative relationships is to integrate pharmacists into medical practice, which familiarizes NPHPs with pharmacists’ roles, improves communication, and enables pharmacists to identify NPHPs’ needs. To summarize, allowing ward-based pharmacists to engage in medical teams on a regular basis appears vital for improving interprofessional teamwork. Furthermore, stakeholders aiming to promote CPS in their institutions should consider the needs and communication channels among NPHPs.

Critical care capacity and care bundles on medical wards in Malawi: a cross-sectional study

IntroductionAs low-income countries (LICs) shoulder a disproportionate share of the world’s burden of critical illnesses, they must continue to build critical care capacity outside conventional intensive care units (ICUs) to address mortality and morbidity, including on general medical wards. A lack of data on the ability to treat critical illness, especially in non-ICU settings in LICs, hinders efforts to improve outcomes.MethodsThis was a secondary analysis of the cross-sectional Malawi Emergency and Critical Care (MECC) survey, administered from January to February 2020, to a random sample of nine public sector district hospitals and all four central hospitals in Malawi. This analysis describes inputs, systems, and barriers to care in district hospitals compared to central hospital medical wards, including if any medical wards fit the World Federation of Intensive and Critical Care Medicine (WFSICCM) definition of a level 1 ICU. We grouped items into essential care bundles for service readiness compared using Fisher’s exact test.ResultsFrom the 13 hospitals, we analysed data from 39 medical ward staff members through staffing, infrastructure, equipment, and systems domains. No medical wards met the WFSICCM definition of level 1 ICU. The most common barriers in district hospital medical wards compared to central hospital wards were stock-outs (29%, Cl: 21% to 44% vs 6%, Cl: 0% to 13%) and personnel shortages (40%, Cl: 24% to 67% vs 29%, Cl: 16% to 52%) but central hospital wards reported a higher proportion of training barriers (68%, Cl: 52% to 73% vs 45%, Cl: 29% to 60%). No differences were statistically significant.ConclusionDespite current gaps in resources to consistently care for critically ill patients in medical wards, this study shows that with modest inputs, the provision of simple life-saving critical care is within reach. Required inputs for care provision can be informed from this study.