Child and adolescent Liaison-Consultation Psychiatry and Psychosomatic Medicine in a Clinical-Teaching Hospital. / Psiquiatría de Enlace y Medicina Psicosomática Infanto Juvenil en un Hospital Clínico-Docente.

Psychosomatic medicine explores the psychological, behavioral, and social elements that influence people's health and quality of life. This discipline develops skills and knowledge used in the evalua tion and management of psychosocial elements interfering in the process of illness and healing. The Child and Adolescent Consultation-Liaison Psychiatry (CACLP) is a discipline that has been empi rically installed in order to favor adherence to treatments and recovery of children and teenagers du ring the process of illness. There is a need for developing this discipline in Chile, but so far there are limited national and international records and literature dedicated to it. The objective of this article is to update the concepts of structure and describe how a CACLP unit in a high complexity teaching hospital works in general, discussing the clinical challenges involved in these issues.

Successfully controlling the incidence of multidrug-resistant Pseudomonas aeruginosa through antibiotic stewardship and infection control programmes at a Chinese university hospital.

WHAT IS KNOWN AND OBJECTIVE: The purpose of this study was to investigate the effect of imposing infection control programmes (ICPs) and antimicrobial stewardship (AMS) by monitoring the antimicrobial resistance of Pseudomonas aeruginosa. METHODS: Antimicrobial susceptibility testing was performed in accordance with the Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines. ICPs and AMS were initiated at the Fourth Hospital from 2013 to 2018. RESULTS AND DISCUSSION: A total of 2,886 P. aeruginosa isolates were assessed. The antimicrobial resistance trends of the P. aeruginosa strains improved after the intervention measures. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) P. aeruginosa contributed to 18.5% and 3.5% of the total P. aeruginosa strains, respectively. Colistin was the most effective antibiotic against 97.6% of XDR-P. aeruginosa and 99.41% of MDR-P. aeruginosa. The consumption of alcohol-based hand gel (ABHG) increased from 0.6 L to 10.8 L per 1,000 patient-days (PD) (p = 0.005). The yearly consumption of antibiotics decreased from 45 to 37.5 defined daily doses (DDD) per 1,000 PD(p = 0.04). After 2013, the incidence rate of MDR-P. aeruginosa showed a significant decrease from 22% to 14.1% (p = 0.04), and XDR-P. aeruginosa decreased from 5.8% to 0.9%. The use of ABHG was negatively related to MDR-P. aeruginosa morbidity (r = -0.86; p = 0.021). The consumption of antibiotics was positively related to MDR-P. aeruginosa morbidity (r = 0.86; p = 0.021). WHAT IS NEW AND CONCLUSION: Successful control of MDR-P. aeruginosa resistance was achieved by imposing comprehensive ICPs and AMS.

First Into the Lifeboats: Protecting Medical Student Education During the Hahnemann University Hospital Closure.

The announcement of the closure of Philadelphia's Hahnemann University Hospital in June 2019 sent shock waves through the academic community. The closure had a devastating impact on the residents and fellows who trained there, the patients who had long received their care there, and faculty and staff who had provided care there for decades. Since its beginnings, the hospital, established as part of Hahnemann Medical College in 1885, was a major site for medical student education. The authors share the planning before and actions during the crisis that protected the educational experiences of third- and fourth-year medical students at Drexel University College of Medicine assigned to Hahnemann University Hospital. The lessons they learned can be helpful to leadership in academic health systems in the United States facing a diminishing number of clinical training sites for medical and other health professions students, a situation that is likely to worsen as the COVID-19 pandemic continues to weaken the health care ecosystem.

A Qualitative Study of the Experiences of Complementary and Alternative Medicine Use in Patients With IBS-C.

The aim of this study was to explore the experiences of complementary and alternative medicine (CAM) among patients with constipation irritable bowel syndrome (IBS-C). This qualitative study consisted of a total of 30 patients who were admitted to a university hospital in Turkey. Data were collected using a descriptive questionnaire and a semistructured interview. Data analysis identified 5 main themes: (1) the constipation-associated difficulties experienced because of IBS; (2) the feeling that CAM is natural and useful; (3) the effect of environmental stimuli in preferring the use of CAM; (4) the feeling that CAM is not negative and relieves symptoms; and (5) suggesting the use of CAM. In conclusion, it was determined that all the patients with IBS-C used various CAM methods. It may be recommended that health care professionals should raise awareness among patients about CAM methods that may be useful.

The intervention by an antimicrobial stewardship team can improve clinical and microbiological outcomes of resistant gram-negative bacteria.

Antibiotic stewardship (AS) improves patient outcomes and rates of antibiotic susceptibilities. However, the long-term effect of AS programs (ASPs) on mortality is unclear. This study aimed to assess the impact of bedside interventions by an AS team (AST) on clinical and microbiological outcomes. This retrospective study enrolled patients with bloodstream infections (BSI) and long-term use of broad-spectrum antibiotics (more than 7 days). The main outcomes were 30-day and in-hospital mortality of patients with BSI. The secondary outcomes were the day of therapy (DOT) and susceptibility of antipseudomonal agents. Cases were classified into two groups: the pre-ASP group comprised cases between 2011 and 2013 and the post-ASP group, between 2014 and 2016. The outcomes were then compared between the two groups. Among the patients with all BSI (n = 1187), no significant differences in 30-day mortality were observed between those in the pre-ASP and post-ASP groups. However, in-hospital mortality was significantly lower in the post-ASP group than that in the pre-ASP group (24.8% vs. 18.0%; P = 0.004). Furthermore, the 30-day and in-hospital mortality of resistant gram-negative bacteraemia was significantly lower (20.4% vs.10.5%; P = 0.04 and 28.0% vs.16.1%; P = 0.03). The DOT of broad-spectrum antibiotics decreased except that of tazobactam/piperacillin. The susceptibilities of tazobactam/piperacillin, ceftazidime, cefepime, sulbactam/cefoperazone, gentamicin, ciprofloxacin levofloxacin, imipenem and meropenem were significantly better. Interventions by the AST can improve the clinical and microbiological outcomes, especially resistant gram-negative bacteria. Furthermore, this effect of our ASP can continue for a long term.

Secondary prevention of osteoporotic fractures: evaluation of the Lille University Hospital's Fracture Liaison Service between January 2016 and January 2018.

The purpose of this study was to assess the performance of our Fracture Liaison Service (FLS) over a period of 2 years. Osteoporosis medication was prescribed for 243 patients, and zoledronic acid was the main drug prescribed (60.2%). INTRODUCTION: A Fracture Liaison Service (FLS) was implemented at Lille University Hospital in 2016. The main purpose of this study was to assess the performance of the FLS using criteria proposed by the International Osteoporosis Foundation (IOF). METHODS: The criteria used were patient identification, patient evaluation, post-fracture assessment timing, vertebral-fracture identification, blood and bone mineral density (BMD) testing, falls prevention, multifaceted health and lifestyle risk-factor assessment, and medication initiation and review. RESULTS: Between January 2016 and January 2018, 736 patients (≥ 50 years old) with a recent history of fragility fracture (≤ 12 months) were identified. The identification rate for hip fractures was 74.2%. However, patient evaluation for all type of fractures was quite low (30.3%) since many patients failed to attend the FLS unit. The reasons for non-attendance were refusal, agreed but subsequently failed to attend, and still waiting to be seen. In all, 256 patients (76.6% female, mean (SD) age 74.3 (11.0) years) were seen at the FLS. Mean (SD) post-fracture assessment timing was 13.3 (9.3) weeks. Of the 139 patients seen for a non-vertebral fracture, 103 were assessed for vertebral fractures, and at least one new vertebral fracture was found in 45 of them (43.7%). Osteoporosis medication was prescribed for 243 (94.9%) patients. The main osteoporosis drug prescribed was zoledronic acid (60.2%). CONCLUSIONS: Secondary prevention of osteoporotic fractures has improved since the implementation of the FLS. However, patient identification, patient evaluation, and post-fracture assessment timing still need to be improved.

How a Vision Was Made to Come True.

A kidney transplant program was started at Innsbruck University Hospital in 1974. This was followed by the first liver transplant in 1977 and the first combined pancreas-kidney transplant in 1979. Because these 3 programs were quite successful, the idea was born to try to establish a unit that could provide temporary and permanent replacement for the loss of all kinds of organ function. In 1993, a special unit for transplant was opened. Dialysis was incorporated as part of available treatment right from the beginning. The new ward made it possible to routinely treat patients in need of bioartificial livers, to provide ventricular assist devices and later total artificial hearts, and to provide extracorporeal membrane oxygenation. The first heart transplant was performed in 1983, the first heart-lung in 1985, the first double-lung in 1987, followed by the first multivisceral transplant in 1989, the first isolated bowel in 1994, and finally the first double-hand transplant was performed in 2000. Thus, our vision of such a unit has become true.

Mediating effect of interpersonal coping on meaning in spirituality and quality of life and the influences of depression and anxiety thereon in cancer patients.

OBJECTIVE: This study aimed to investigate associations among spirituality, coping strategies, quality of life (QOL), and the effects of depression and anxiety thereon in cancer patients. METHOD: In total, 237 cancer patients referred to a psycho-oncology clinic at a university hospital in Korea were enrolled. After identifying predictors of patient QOL in a stepwise regression model, we developed a hypothetical path model wherein interpersonal coping was considered as a mediating variable between spirituality (meaning/peace) and QOL and wherein depression and anxiety affected each of these three variables. RESULT: The direct effect of spirituality (meaning/peace) on QOL was 36.7%. In an indirect model, interpersonal coping significantly mediated the relationship between spirituality (meaning/peace) and QOL. Depression exerted the largest negative effect on spirituality (meaning/peace), interpersonal coping, and QOL. Anxiety had negative effects on spirituality (meaning/peace) and QOL, but a positive effect on interpersonal coping. SIGNIFICANCE OF RESULTS: Interpersonal coping strategies work as a partial mediator of the relationship between meaning/peace subscales of spirituality and QOL. Effective management of depression may help in achieving better outcomes associated therewith. Greater attention and efforts to improve social connectedness and meaning of life in spiritual well-being may improve the QOL of cancer patients.

Hospital Amic / Hospital Amic

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Understanding factors affecting collaboration between midwives and other health care professionals in a birth center and its affiliated Quebec hospital: a case study.

BACKGROUND: A better understanding of the processes of collaboration between midwives who work in the birthing centers, and hospital-based obstetricians, family physicians and nurses may promote cooperation among professionals providing maternity care in both institutions. The aim of this research was to explore the barriers and facilitators of the interprofessional and interorganizational collaboration between midwives in birthing centers and other health care professionals in hospitals in Quebec. METHODS: A case study design was adopted. Data were collected through semi-structured interviews with midwives, multidisciplinary professionals and administrators, through direct observation of activities in maternity units and field notes, and a variety of organizational and policy documents and archives. A qualitative thematic analysis method was used for analyzing transcribed verbatim. RESULTS: The study suggests the close intertwinement between interactional, organizational and systemic factors in regard to barriers and opportunities for collaboration between midwives in birthing centers, and physicians and nurses in hospitals in Quebec. At interactional level, our findings show a conflict in scope of midwifery practice, myth about midwives, pre-judgment, and lack of communication skills between health care providers in the studied birthing center and hospital. At the organizational level, this investigation shows that although midwives have complete access to the hospital with which a formal agreement was signed, they were not integrated in hospital because of lack of interest of midwives and differences in philosophy and scope of practice among healthcare professionals as well as the culture of organizations. At a systemic level, in spite of excessive demand for midwifery care, there are not enough midwives to cover these demands. CONCLUSION: Maternity care professionals require taking a collaborative approach in working and the boundaries of responsibility need to be redrawn. The inter-professional collaborative work between midwives and other maternity care professionals is crucial to improve access and women's choices for maternity care in Canada. Although having collaborative and multidisciplinary teamwork is a goal of maternity care systems, it is hard to achieve.

[Establishment of an Animal Based Therapy at a University Hospital for Psychiatry: Results of a Preliminary Study and Future Prospects]. / Etablierung tiergestützter Therapie an einer psychiatrischen Universitätsklinik: Ergebnisse der Vorstudie und Ausblick.

Objective: Dogs have been integrated in human society over centuries. This process has selected unique social and communicative skills. Dogs are thus able to represent social substitutes for human counterparts in cases of social withdrawal. Furthermore, dogs act as "social catalysts" in promoting interhuman encounters. Thus, the integration of dogs in psychotherapeutic concepts addressing social and interpersonal deficits may be of special interest. Methods: The present investigation reports the results of a pilot study to establish animal-assisted therapy (dogs) at a psychiatric department. The animal-assisted intervention straddled the following areas: (1) contact making, communication and orientation to needs, (2) recreation and play, (3) outward orientation, (4) release and farewell. The sample comprised 22 subjects. Results: The results demonstrated in particular that the animal-assisted intervention significantly promoted unspecific aspects of positive affectivity and wellbeing. Evaluation of the overall acceptance of the dog on the psychiatric ward revealed very positive feedback. Conclusions: We conclude that animal-assisted therapies represent a significant enchrichment of the therapeutic context, that may be used to enhance the patients' openness and adherence to conventional therapies.

[Effectiveness of an early discharge program after normal childbirth]. / Efectividad de un programa de alta precoz tras parto normal.

OBJECTIVE: To implement a program of early hospital discharge after an uncomplicated birth, in order to improve the effectiveness, as well as ensuring clinical safety and patient acceptability. MATERIAL AND METHODS: Descriptive study of the effectiveness of an early discharge program after uncomplicated delivery between February 2012 and September 2013. The populations are post-partum women and newborns admitted to the University Hospital of Fuenlabrada, with a duration of less than 24h after uncomplicated delivery that met the defined inclusion criteria. Satisfaction was assessed using a Likert scale. The effectiveness of the program was monitored by safety indicators, productivity, adaptation, and continuity of care. RESULTS: A total of 20% of cases capable of early discharge from Fuenlabrada University Hospital completed the program. Almost all (94%) were normal deliveries. The 188 cases included were from 911 patients with uncomplicated childbirth, accounting for 6.5% of the 2,857 total births. The mean stay of patients included showed a decrease of 50% (2.4 to 1.2 days). All patients received continuity of care after hospital discharge. The review consultation was reprogrammed for 4.8% of cases, with 2% of patients re-admitted within 96h. with no serious problems. Four newborns (2%) required attention in the emergency department (mother or newborn) before 96h. The assessment of patient satisfaction achieved a score of 4.5 out of 5. CONCLUSIONS: The program achieved a decrease in the average stay by 50%, favouring the autonomy of midwives. This acceptance level is in line with similar interventions. The deployment of the program may be useful for other changes in care processes.

Understanding Preprocedure Patient Flow in IR.

PURPOSE: To quantify preprocedural patient flow in interventional radiology (IR) and to identify potential contributors to preprocedural delays. MATERIALS AND METHODS: An administrative dataset was used to compute time intervals required for various preprocedural patient-flow processes. These time intervals were compared across on-time/delayed cases and inpatient/outpatient cases by Mann-Whitney U test. Spearman ρ was used to assess any correlation of the rank of a procedure on a given day and the procedure duration to the preprocedure time. A linear-regression model of preprocedure time was used to further explore potential contributing factors. Any identified reason(s) for delay were collated. P < .05 was considered statistically significant. RESULTS: Of the total 1,091 cases, 65.8% (n = 718) were delayed. Significantly more outpatient cases started late compared with inpatient cases (81.4% vs 45.0%; P < .001, χ(2) test). The multivariate linear regression model showed outpatient status, length of delay in arrival, and longer procedure times to be significantly associated with longer preprocedure times. Late arrival of patients (65.9%), unavailability of physicians (18.4%), and unavailability of procedure room (13.0%) were the three most frequently identified reasons for delay. The delay was multifactorial in 29.6% of cases (n = 213). CONCLUSIONS: Objective measurement of preprocedural IR patient flow demonstrated considerable waste and highlighted high-yield areas of possible improvement. A data-driven approach may aid efficient delivery of IR care.

A introduçao da penicilina nos hospitais da universidade de Coimbra, Portugal (1944-1946) / The introduction of penicilin in Coimbra university hospitals, Portugal (1944-1946)

A importação regular de penicilina para Portugal iniciou-se em Setembro de 1944 através da Cruz Vermelha Portuguesa. Até Junho de 1945 a importação e distribuição do medicamento foram controladas por esta instituição humanitária mas a partir desta data, com o aumento da produção mundial, a penicilina começou a ser importada por intermédio da indústria farmacêutica. No Arquivo da Universidade de Coimbra consultamos papeletas (processos individuais) de doentes internados nos Hospitais da Universidade de Coimbra desde Setembro de 1944 até Agosto de 1946. A investigação realizada permitiu-nos recolher informações sobre a introdução da penicilina e sobre os primeiros tratamentos efetuados com o medicamento nestes hospitais. Com base nos dados recolhidos pretendemos, pelo presente artigo, mostrar como foi feita a receção da penicilina num hospital central de grande dimensão, um dos principais hospitais portugueses, saber a frequência com que era prescrita, as patologias mais comuns em que era empregue, as doses administradas, a posologia e o tempo de tratamento assim como os clínicos responsáveis pela sua prescrição (AU)

The Portuguese Red Cross began to import of penicillin regularly following September 1944. Until June 1945, the humanitarian institution controlled the distribution of the antibiotic, subsequently, due to the increase in world production penicillin began to be imported by means of the pharmaceutical industry. We consulted and analyzed files of patients admitted to Coimbra University Hospitals between September 1944 and August 1946. These files, located in Coimbra University Archive, enabled us to collect information on the introduction of penicillin and on the first cases treated with the antibiotic at these hospitals. In the present paper, we aim to shed some light upon how penicillin was received in one of the main Portuguese central hospitals, the frequency with which it was prescribed, the most common diseases in which the antibiotic was utilized, the dosage administrated, the length of the treatment and the physicians responsible for prescribing the antibiotic (AU)

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Unidades de Desarrollo Infantil, Neuropediatría, Genética clínica y Dismorfología: Atención integrada como factor clave / Child Development, Neuropediatries, Clinieal Geneties and Dysmorphology Units: Comprehensive care as a key factor

En este capítulo describimos brevemente la práctica diaria en las Unidades de Desarrollo Infantil, Neuropediatría, Genética clínica, y Dismorfología. Enumeramos las situaciones de riesgo y patologías más frecuentemente atendidas, y hacemos especial hincapié en la creación de equipos multidisciplinares. Estos equipos son imprescindibles para el diagnóstico preconcepcional y prenatal. Un aspecto clave de nuestra actividad es la detección precoz y prevención de las discapacidades en la infancia. Se requiere para ello una atención coordinada entre los servicios y recursos para una intervención temprana, lo que ofrecemos a través de un proceso de atención integrada centrado en las necesidades de los niños y sus familias. Este proceso incluye en este momento también niños y niñas y sus familias con enfermedades poco frecuentes (AU)

In this chapter we describe briefly the daily practice in Units of Child Development, Pediatric Neurology, Clinical Genetics and Dysmorphology. We list the situations of risk and pathologies most often served, and we make special emphasis on the creation of multidisciplinary teams. These teams are essential for preconception and prenatal diagnosis. A key aspect of our activity is the early detection and prevention of disabilities in children. Resources and services coordination tasks are required for early intervention, what we offer through a process of integrated care centered on the needs of children and their families. This process also includes children and their families with rare diseases at this time (AU)

Sección de Urgencias de Pediatría y Cuidados Intensivos pediátricos: Atención infantil integral ambulatoria y atención al paciente crítico / Pediatric Emergency and Pediatric Intensive Care Section: Comprehensive outpatient child care and critical patient care

El documento presenta la situación de la Sección de Urgencias-Cuidados Intensivos Pediátricos (CIP). Tras una introducción que pretende enmarcar la sección en su contexto histórico y demográfico, se describe la misión, visión, valores y la cartera de servicios de la sección. Posteriormente se detalla la actividad asistencial, la labor docente y los proyectos y líneas de investigación. Para finalizar, se explica brevemente nuestro compromiso con la calidad y seguridad del paciente y nuestras líneas estratégicas para la integración con atención primaria (AU)

The paper presents the status of the Section of Emergency-CIP. Alter an introductory section aims to frame the historical and demographic background, mission, vision, values and the range 01 services described in section. Subsequently those services, the teaching and research projects and detailed lines. To conclude briefly describes our commitment to quality and patient safety and lar our strategic integration lines with primary care (AU)

[Interface between university medicine and patient care]. / Schnittstelle universitäre Medizin und Patientenversorgung.

The working profile of university hospitals includes medical education, research and implementation of medical innovations as well as large volume patient care. University hospitals offer inpatient, day care and outpatient care which are of essential value for many patients. Besides their primary role in treating rare and orphan diseases and complex cases, they increasingly support general patient care. There are different kinds of outpatient access and treatment options available. The funding of university hospitals and clinics is based on general university funding, income from third party funds for research, income from patient care and funding from the federal states for investments. In recent years these institutions have suffered more and more from economic deficits, a lack of investment and inadequate funding whereby high performance medicine cannot be sufficiently supported. Professors are developing into scientific managers and are frequently assessed by economic outcome and competitiveness. At the same time they are embedded in the structures of the university and are not in the position to make decisions on their own, in contrast to doctors in private practices. Therefore, processes, necessary investments and restructuring are significantly delayed. There is a need to develop strategies for long-term funding and providing university hospitals and clinics with the means to deliver the necessary services.