Mortality and morbidity among hospitalized adult patients with neurological diseases in Cameroon.

BACKGROUND: There is inadequate information on the morbidity and mortality (M&M) from neurological diseases in sub-Saharan Africa. OBJECTIVE: To record the M&M from neurological diseases in adults in Cameroon from 2013 to 2015 using a registry and surveillance from two urban health care centers. METHODS: Records from all adult admissions from two urban hospitals over a two year period were reviewed. Adult cases with neurological diagnosis as the main cause for admission were identified. The neurological diagnosis was made by a neurologist in all cases. Variables analyzed were: demographics, neurological diagnosis, medical history, medical center characteristics, morbidity and mortality (M&M). Neurological diseases were classified according to ICD-10. RESULTS: Among the 2225 neurological admissions of adults, death from neurological disease was recorded in 423 patients (19.01%), and disability in 819 of the survivors (53.6%). The factors that were significantly associated with death in the multivariate analysis were age, history of ischemic cardiac disease, and neurological diagnoses of CNS infection, cerebrovascular disease, and CNS tumor. Similarly, factors associated with disability were medical history of HIV, and cerebrovascular disease, and neurological diagnoses of cerebrovascular disease and CNS tumor. Higher educational level and epilepsy were associated with less disability. CONCLUSIONS: As expected in this sample, older patients with neurological diseases had more M&M. Morbidity was inversely associated with education, which given that cerebrovascular disease is by far the most common cause of morbidity, indicates the power of risk factor control in preventing neurological disability.

[Impact of an emergency department short-stay unit on clinical management and quality of hospital care indicators]. / Impacto de la creación de una unidad de corta estancia (UCE) dependiente orgánicamente de urgencias en la gestión clínica y la calidad asistencial hospitalaria.

OBJECTIVES: The primary aim was to study the impact that creating a short-stay unit (SSU) had on clinical management and quality of care indicators of a hospital overall and its conventional wards. The secondary aim was to establish values for those indicators and determine the level of satisfaction of patients admitted to the SSU. MATERIAL AND METHODS: Quasi-experimental before-after study of the impact of establishing a SSU in a tertiary care teaching hospital. The first period (without the SSU) was in 2012, the second (with the SSU) was from 2013 through 2015. To meet the first objective we selected cases in 2012 in which patients were hospitalized for problems related to the 5 diagnosis-related groups most often admitted to the SSU in the second period. To meet the second objective, we studied all patients admitted to the SSU in the second period Data related to quality of care and clinical management were analyzed retrospectively. and asked them to complete a questionnaire on patient satisfaction. RESULTS: A total of 76 241 admissions were included: 19 090 in the first period and 57 151 in the second (2705 admissions were to the SSU). The mean hospital stay decreased in the second period (incidence rate ratio [IRR], 0.93; 95% CI, 0.91-0.95); the mean stay also decreased on medical wards (IRR, 0.94; 95% CI, 0.92-0.96) with no impact on adverse outcomes. The mean stay in the SSU was under 3 days in spite of an increase in the weighted mean (IRR,1.08; 95% CI, 1.05-1.11). A total of 320 questionnaires were received (11.8% response rate); all aspects were assessed very highly. CONCLUSION: Our experience suggests that opening a SSU could improve clinical management and quality of care indicators for a hospital overall and for its conventional wards in the context of the GRDs that most frequently lead to admissions.

OBJETIVO: El objetivo principal fue estudiar el impacto de la creación de una unidad de corta estancia (UCE) en los indicadores de gestión clínica y de calidad asistencial del hospital y de las unidades de hospitalización convencional. El objetivo secundario fue conocer los resultados de estos mismos indicadores en la UCE y la satisfacción de los pacientes ingresados en ella. METODO: Estudio cuasiexperimental que comparó dos periodos de tiempo antes y después de la puesta en marcha de una UCE en un hospital universitario de tercer nivel: 1) Periodo 1: sin UCE (2012); 2) Periodo 2: con UCE (2013- 2015). Para el objetivo principal, se seleccionaron los episodios de pacientes ingresados en el hospital, pertenecientes a los cinco grupos relacionados con diagnóstico (GRD) que más frecuentemente ingresan en la UCE, desde 2012 a 2015. Para el objetivo secundario, se seleccionaron todos los episodios de pacientes ingresados en la UCE de 2013 a 2015. Se recogieron de forma retrospectiva datos de calidad y gestión clínica. Se realizó una encuesta de satisfacción en una muestra de pacientes ingresados en la UCE. RESULTADOS: Se incluyeron 76.241 ingresos hospitalarios. 19.090 en el periodo 1 y 57.151 en periodo 2, de los cuales 2.705 fueron en la UCE. En el periodo con UCE disminuyó la estancia media del hospital (IRR 0,93; IC95% 0,91-0,95) y de las áreas médicas (IRR 0,94; IC95% 0,92-0,96) sin un incremento en los resultados adversos. La estancia media de la UCE se ha mantenido por debajo de los 3 días con un incremento del peso medio (IRR 1,08; IC95% 1,05-1,11). Se contestaron 320 encuestas (11,8% del total de pacientes ingresados) y todos los aspectos fueron puntuados de forma muy sobresaliente. CONCLUSIONES: En nuestra experiencia, la apertura de una UCE podría contribuir a mejorar los indicadores de gestión clínica y de calidad asistencial del hospital y de las unidades de hospitalización convencional en aquellos GRD más frecuentemente ingresados en la UCE.

Impacto de la creación de una unidad de corta estancia (UCE) dependiente orgánicamente de urgencias en la gestión clínica y la calidad asistencial hospitalaria / Impact of an emergency department short-stay unit on clinical management and quality of hospital care indicators

Objetivo. El objetivo principal fue estudiar el impacto de la creación de una unidad de corta estancia (UCE) en los indicadores de gestión clínica y de calidad asistencial del hospital y de las unidades de hospitalización convencional. El objetivo secundario fue conocer los resultados de estos mismos indicadores en la UCE y la satisfacción de los pacientes ingresados en ella. Método. Estudio cuasiexperimental que comparó dos periodos de tiempo antes y después de la puesta en marcha de una UCE en un hospital universitario de tercer nivel: 1) Periodo 1: sin UCE (2012); 2) Periodo 2: con UCE (2013-2015). Para el objetivo principal, se seleccionaron los episodios de pacientes ingresados en el hospital, pertenecientes a los cinco grupos relacionados con diagnóstico (GRD) que más frecuentemente ingresan en la UCE, desde 2012 a 2015. Para el objetivo secundario, se seleccionaron todos los episodios de pacientes ingresados en la UCE de 2013 a 2015. Se recogieron de forma retrospectiva datos de calidad y gestión clínica. Se realizó una encuesta de satisfacción en una muestra de pacientes ingresados en la UCE. Resultados. Se incluyeron 76.241 ingresos hospitalarios. 19.090 en el periodo 1 y 57.151 en periodo 2, de los cuales 2.705 fueron en la UCE. En el periodo con UCE disminuyó la estancia media del hospital (IRR 0,93; IC95% 0,91-0,95) y de las áreas médicas (IRR 0,94; IC95% 0,92-0,96) sin un incremento en los resultados adversos. La estancia media de la UCE se ha mantenido por debajo de los 3 días con un incremento del peso medio (IRR 1,08; IC95% 1,05-1,11). Se contestaron 320 encuestas (11,8% del total de pacientes ingresados) y todos los aspectos fueron puntuados de forma muy sobresaliente. Conclusiones. En nuestra experiencia, la apertura de una UCE podría contribuir a mejorar los indicadores de gestión clínica y de calidad asistencial del hospital y de las unidades de hospitalización convencional en aquellos GRD más frecuentemente ingresados en la UCE (AU)

Objective. The primary aim was to study the impact that creating a short-stay unit (SSU) had on clinical management and quality of care indicators of a hospital overall and its conventional wards. The secondary aim was to establish values for those indicators and determine the level of satisfaction of patients admitted to the SSU. Material and method. Quasi-experimental before-after study of the impact of establishing a SSU in a tertiary care teaching hospital. The first period (without the SSU) was in 2012, the second (with the SSU) was from 2013 through 2015. To meet the first objective we selected cases in 2012 in which patients were hospitalized for problems related to the 5 diagnosis-related groups most often admitted to the SSU in the second period. To meet the second objective, we studied all patients admitted to the SSU in the second period Data related to quality of care and clinical management were analyzed retrospectively and asked them to complete a questionnaire on patient satisfaction. Results. A total of 76 241 admissions were included: 19 090 in the first period and 57 151 in the second (2705 admissions were to the SSU). The mean hospital stay decreased in the second period (incidence rate ratio [IRR], 0.93; 95% CI, 0.91-0.95); the mean stay also decreased on medical wards (IRR, 0.94; 95% CI, 0.92-0.96) with no impact on adverse outcomes. The mean stay in the SSU was under 3 days in spite of an increase in the weighted mean (IRR,1.08; 95% CI, 1.05-1.11). A total of 320 questionnaires were received (11.8% response rate); all aspects were assessed very highly. Conclusions. Our experience suggests that opening a SSU could improve clinical management and quality of care indicators for a hospital overall and for its conventional wards in the context of the GRDs that most frequently lead to admissions (AU)

The Burden of Movement Disorders in Cameroon: A Rural and Urban-Based Inpatient/Outpatient Study.

BACKGROUND: Because of rapid demographic changes, the prevalence of movement disorders (MDs) is expected to increase in Africa. The objective of this study was to estimate the prevalence of MDs in an inpatient/outpatient-based study of rural and urban health care centers in Cameroon. METHODS: In this retrospective medical chart review, the inpatient/outpatients settings covered an urban population (3,000,000) and a rural population (380,276). Neurological diseases were classified according to the International Statistical Classification of Diseases-Related Health Problems, 10th revision (ICD-10). Crude prevalence was calculated per 100 with 95% confidence intervals (CIs). RESULTS: Of 20,131 medical charts reviewed (13% from the rural area), 4187 patients (20.8%) with neurological complaints were identified. MDs were diagnosed exclusively from urban centers in 134 patients (3.2%): the mean patient age was 48.6 ± 18.6 years, and 54.7% were women. The most prevalent MDs were hyperkinetic movements (tremor, myoclonus, and drug-induced MDs [ICD-10 code G25]; prevalence, 1.19%; 95% CI, 1.192-1.194%), Parkinson's disease (ICD-10 code G20; prevalence, 0.78%; 95% CI, 0.785-0.787%), dystonia (ICD-10 code G24; prevalence, 0.61%; 95% CI, 0.612-0.613%), secondary parkinsonism (ICD-10 code G21; prevalence, 0.56%; 95% CI, 0.564-0.565%), Huntington's disease (ICD-10 code G10; prevalence, 0.09%; 95% CI, 0.091-0.092%), and ataxia (ICD-10 code R29; prevalence, 0.04%; 95% CI, 0.0451-0.0456). CONCLUSION: Although the burden of MDs is expected to increase, MDs are likely underdiagnosed in rural areas. High-quality movement disorder training is essential to tackle this need.