Morbidity Pattern in the Medical Wards of a Nigerian Teaching Hospital During the COVID-19 Pandemic.

BACKGROUND: Morbidity patterns change due to emerging and re-emerging infections. Information obtained from alteration in patterns of morbidity is vital in structuring and providing safe health care services. OBJECTIVES: To determine disease patterns and highlight the prevalent disease entity in the medical wards at the University of Benin Teaching Hospital, Benin City, during the COVID-19 pandemic. METHODS: This was a retrospective study of 430 patient case records recruited between January 1st to 31st December 2020. The diagnosis was made during their hospital stay and classified using the International Classification of Disease Version 11. The demographics of the patients were also recorded in the data collection form. The data were analyzed descriptively. RESULTS: A total of 430 case records were evaluated during the study period, and the final diagnoses were noted. The commonest diagnostic classes were diseases of the nervous system (90, 20.9%), diseases of the respiratory system (78, 18.1%), diseases of the digestive system (67, 15.6%), and diseases of the circulatory system (61, 14.2%). The least prevalent was neoplasm (1, 0.2%), and the most prevalent disease entity was hypertension (48.5%). There was a statistical significance between age and the number of morbidities (Χ²=79.0, p=<0.01), but there was no statistical significance between the gender of the patient and the international classification of disease version 11 (Χ²=16.9, p=0.12). CONCLUSION: The study showed a higher trend in diseases of the nervous system during this period. Furthermore, this trend in morbidity appeared to be influenced by the number of morbidities, age, and gender.

CONTEXTE: Les schémas de morbidité changent en raison des infections émergentes et ré-émergentes. Les informations obtenues à partir de l'altération des schémas de morbidité sont essentielles pour structurer et fournir des services de santé sûrs. OBJECTIFS: Déterminer les schémas de maladies et mettre en évidence l'entité pathologique prévalente dans les services de médecine de l'Hôpital d'Enseignement de l'Université de Benin, à Benin-City, pendant la pandémie de COVID-19. MÉTHODES: Il s'agissait d'une étude rétrospective de 430 dossiers de patients recrutés entre le 1er janvier et le 31 décembre 2020. Le diagnostic a été établi pendant leur séjour à l'hôpital et classé selon la Classification Internationale des Maladies, 11ème version. Les données démographiques des patients ont également été enregistrées dans le formulaire de collecte de données. Les données ont été analysées de manière descriptive. RÉSULTATS: Un total de 430 dossiers de cas ont été évalués pendant la période d'étude, et les diagnostics finaux ont été notés. Les classes diagnostiques les plus courantes étaient les maladies du système nerveux (90, 20,9 %), les maladies du système respiratoire (78, 18,1 %), les maladies du système digestif (67, 15,6 %), et les maladies du système circulatoire (61, 14,2 %). La moins prévalente était le néoplasme (1, 0,2 %), et l'entité pathologique la plus prévalente était l'hypertension (48,5 %). Il y avait une signification statistique entre l'âge et le nombre de morbidités (Χ²=79,0, p=<0,01), mais il n'y avait pas de signification statistique entre le sexe du patient et la classification internationale des maladies version 11 (Χ²=16,9, p=0,12). CONCLUSION: L'étude a montré une tendance accrue dans les maladies du système nerveux au cours de cette période. De plus, cette tendance de la morbidité semblait être influencée par le nombre de morbidités, l'âge et le sexe. MOTS-CLÉS: Schéma de Morbidité, Hôpitaux d'Enseignement, COVID-19.

Strengthening of District/Taluk Level Hospitals Through Implementation of Post-graduate Medical Courses in Karnataka, India.

The World Health Organization (WHO) recommends the requirement of human resource for health (HRH) stands at 44.5 skilled health workers per 10,000 population. WHO recognizes India as one of the countries which has HRH crisis. Karnataka, a southern state in India, has the highest number of medical colleges yet faces the shortage of specialists in the public hospitals. We conducted desk review to understand the HRH crisis, particularly the medical specialists in India. Simultaneously, we conducted secondary research to explore the initiatives taken by the Government of Karnataka (GoK) to mitigate the shortage of medical specialists in the rural areas. GoK scaled up the National Board of Examination in Medical Sciences (NBEMS) postgraduate and super-speciality courses such as Diplomate of National Board (DNB), Diploma, and Doctorate of National Board (DrNB) in district hospitals (minimum 250-500 bedded) and taluk hospitals (minimum 100 bedded) by utilizing the existing resources. Karnataka is the first state in India to expand the NBEMS (DNB and Diploma) courses in taluk hospitals and to begin DrNB courses in district hospitals. The paper documents the process of implementation of the NBEMS courses at district and taluk hospitals of Karnataka, which has supported in strengthening these hospitals in the state.

Examining the Applicability of Surgical Coaching Rules for Resident Autonomy in Non-teaching Hospitals.

INTRODUCTION: This retrospective study aims to analyze the impact of standardized rules for teaching in university hospitals on surgical resident autonomy and patient safety, as measured by patient outcomes, and also examines the learning curves for residents and their impact on patient outcomes in a non-teaching hospital. METHODS: The data for the study was collected retrospectively from medical records of 2000 adult patients who went through surgical procedures from January 2020 to December 2022. Participants were categorized into two groups based on the supervision level provided by attending surgeons and residents. Appropriate statistical methods were used to analyze the data. RESULTS: It was observed that operative times of cases handled by both attending and resident surgeons were less than those handled by residents alone. On the other hand, the former group had a significantly higher burden of comorbidities and higher rate of perioperative complications than the latter. These results have important implications for the training of medical residents and the overall delivery of healthcare services in university hospitals. CONCLUSION: The findings will also help towards better understanding of the effectiveness of these rules and their potential for improving the quality of care provided by residents in these settings.

A Gap in Mission: The Disparate Missions of Medical Schools and Teaching Hospitals.

Objective: The social contract mandates that in return for the government-funded labor of residents and fellows, the medical profession trains, to the best of its ability, the physicians of our future. This contract obligates graduate medical education (GME) to utilize all available information to create an optimal learning environment for its trainees. Business research has determined that a clearly defined mission statement is associated with improved employee engagement, retention, and wellness. Given that GME trainees are situated at the intersection of at least two institutions, each with its own separate mission, trainees could potentially be hindered by incongruent missions in the learning environment. The literature on mission statements has analyzed medical schools and hospitals separately; however, investigations comparing the statements of these affiliated institutions have not been conducted. Therefore, we plan to compare the content and assess the consistency of mission statements from affiliated medical schools and hospitals to determine if incongruencies exist. Methods: In 2023, the mission statements from the Association of American Medical Colleges (AAMC) medical schools and affiliated teaching hospitals (n = 163) were aggregated from their public websites. The content of each mission statement was thematically analyzed to assess variation. Results: According to content analysis of the mission statements from 163 AAMC medical school members and affiliated teaching hospitals, less than half of their top priorities are shared by their affiliated hospitals (45%). Additionally, themes of diversity, religion, and global care were found to be contrasting priorities between affiliated institutions. Conclusion: Given the precedence within the business and the observed discrepancies in mission, further research is needed to determine whether collaborating medical schools and hospitals could provide a more favorable graduate training environment by uniting their priorities and identifying shared goals.

Better Together: Development and Implementation of Fellow Group Evaluations of Faculty.

Background: High-quality trainee evaluations of faculty are essential for meaningful faculty development and for improving the clinical learning environment. However, concerns about anonymity can limit usefulness of trainee evaluations, particularly in smaller programs, such as subspecialty fellowships. Objective: To develop and implement a fellow-driven group evaluation process to enhance trainee confidentiality and generate high-quality feedback for pulmonary and critical care medicine faculty. Methods: A novel process was developed for faculty evaluation and feedback consisting of quarterly, structured, fellow-led group evaluation sessions focused on collecting confidential, behaviorally oriented, actionable feedback for faculty. Upper-year fellow moderators utilized a standard format to structure discussion, generating strengths and areas for growth for each faculty member while explicitly asking for input from fellows with divergent perspectives. Moderators compiled anonymized session notes for the program director, who delivered feedback to individual faculty. After the first six sessions, an electronic survey was distributed to assess fellow perceptions of the group evaluation model. Results: Thirty-seven faculty members were evaluated in 11 group sessions over 42 months. Fellows rated group-generated feedback as more confidential, more specific, more accurate, more efficient, more actionable, and less biased when compared with individual written evaluations (P < 0.01 for all categories). Conclusion: The authors successfully developed and implemented a process for fellow-led group evaluation of faculty, designed to facilitate fellow confidentiality and enrich the quality of feedback. Fellows preferred the group evaluation process and perceived group-generated feedback more favorably compared with individual written evaluations.

Evaluation of medication errors in nursing during the COVID-19 pandemic and their relationship with shift work at teaching hospitals: a cross-sectional study in Iran.

Introduction: Medication errors in nursing negatively affect the quality of the provided health-treatment services and society's mentality about the health system, threatening the patient's life. Therefore, this study evaluates medication errors in nursing during the COVID-19 pandemic and their relationship with shift work at teaching hospitals. Materials and methods: All the nurses working at teaching hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences (southwest of Iran) comprised the statistical population of this research (260 participants). Data were collected using three questionnaires: a demographic characteristics questionnaire, a medication error questionnaire, and the standard Circadian Type Inventory (CTI) for a normal physiological cycle. Results: At least one medication error was observed in 83.1% of nurses during their work span. A medication error was found in 36.2% of nurses during the COVID-19 pandemic (over the past year). Most medication errors (65.8%) occurred during the night shift. A significant relationship was detected between medication errors and shift work. Medicating one patient's drug to another (28.84%) and giving the wrong dose of drugs (27.69) were the most common types of medication errors. The utmost medication error was reported in emergency wards. The fear of reporting (with an average of 33.06) was the most important reason for not reporting medication errors (p < 0.01). Discussion and conclusion: Most nurses experienced a history of medication errors, which were increased by shift work and the COVID-19 pandemic. Necessary plans are recommended to reduce the fatigue and anxiety of nurses and prevent their burnout, particularly in critical situations. Efforts to identify risky areas, setting up reporting systems and error reduction strategies can help to develop preventive medicine. On the other hand, since the quality of people's lives is considered the standard of countries' superiority, by clarifying medical errors, a higher level of health, satisfaction and safety of patients will be provided.

Analysis of Cesarean Section Rates in a Public Tertiary Hospital During Teaching and Non-teaching Periods Using the Robson Ten Group Classification System.

INTRODUCTION: The rising cesarean section (CS) rate is a global concern. One of the hospital characteristics that may explain the variation in CS among hospitals is hospital teaching status. This study aims to assess the rate of CS in a tertiary hospital during the teaching and non-teaching periods and to conduct an analysis using the Robson ten-group classification system. METHODS: This study is a retrospective cohort that assessed pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas. The study population was divided into two groups: those who gave birth during the hospital's teaching period (November 1st, 2019 to October 30th, 2020) and those who gave birth after that (November 1st, 2020 to October 30th, 2021). The primary outcome was the rate of CS according to Robson's classification system. The secondary outcome was the contributions of each group of Robson to the overall CS rate. Data were extracted by trained collectors from the "Iranian Maternal and Neonatal Network (IMaN Net)," a valid national system, using electronic patient records. RESULTS: Of the total number of births (8382), 62.9 % occurred during the teaching period and 37.1 % during the non-teaching period. A 7% increase in CS was observed during the teaching period of the hospital compared to the non-teaching period (p<0.01). CS rate in Robson groups 1,2,4,7, and 10 differs significantly between teaching and non-teaching periods. According to the findings, Groups 5, 10, and 2 were the three most significant contributors to overall CS in our hospital during the study period. CONCLUSION: The efforts to reduce the overall CS rate should be focused on groups 2,5, and 10 of Robson.

Current distribution of medical colleges in India and its potential predictors: A public domain data audit.

Background: A teaching hospital or medical college may help provide better health care delivery to the people of the vicinity. Hence, building new medical colleges and upgrading existing hospitals to teaching hospitals are being implemented in India. Objective: This study aimed to observe the current distribution of medical colleges in Indian states and find correlation with area, population, and net state domestic product (NSDP). Methods: We collected data from public domain websites provided by government agencies. The State-wise number of government and private medical colleges and their annual intake were obtained from the National Medical Commission website. The state-wise number of medical colleges, geographical area, and population were calculated as the percentage of total Indian colleges, area, and population, respectively. Spearman's correlation was calculated to find any correlation of colleges and annual intake versus parameters such as area, population, and NSDP. Results: India has a total of 612 [321 (52.45%) government-run and 291 (47.55%) private] medical colleges. Tamil Nadu (70), Uttar Pradesh (67), Karnataka (63), Maharashtra (62), and Telangana (34) are the top five states with 296 (48.37%) medical colleges. States and union territories such as Karnataka, Kerala, Maharashtra, Puducherry, Tamil Nadu, and Telangana have higher medical colleges, and states such as Assam, Bihar, Odisha, Madhya Pradesh, Rajasthan, and Uttar Pradesh have lower medical colleges when compared with their population percentages. There was significant positive correlation of number of medical colleges with area (rs = 0.769, P < 0.0001), population (rs = 0.91, P < 0.0001), and NSDP (rs = 0.91, P < 0.0001). Conclusion: The current distribution of medical colleges in India is clustered over some states. Although geographical area and population are major predictors of medical colleges in Indian states, a more population-based balanced distribution of medical colleges would help distribute quality health care to the majority of the population.

The experiences of hospitals in changing the function of a non-teaching hospital to a teaching hospital: Short-Communication.

Background: In recent years, there have been many non-teaching hospitals that have become teaching hospitals. Although the decision to make this change is made at the policy level; But the unknown consequences can create many problems. The present study investigated the experiences of hospitals in changing the function of a non-teaching to a teaching hospital in Iran. Methods: A Phenomenological qualitative study was conducted using semi-structured interviews with 40 hospital managers and policy makers who had the experience of changing the function of hospitals in Iran through a purposive sampling in 2021. Thematic analysis using inductive approach and MAXQDA 10 was used for data analysis. Results: According to the results extracted 16 main categories and 91 subcategories. Considering the complexity and instability of command unity, understanding the change of organizational hierarchy, developing a mechanism to cover client's costs, considering increase management team' legal and social responsibility, coordinating policy demands with Providing resources, funding the teaching mission, organizing the multiple supervisory organizations, transparent communication between hospital and colleges, understanding the complexity of processes, considering change the performance appraisal system and pay for performance were the solutions for decrease problems of changing the function of non-teaching to teaching hospital. Conclusion: Important matter about the improvement of university hospitals is evaluating the performance of hospitals to maintain their role as progressive actors in hospital network and also as the main actors of teaching future professional human resources. In fact, in the world, hospital becoming teaching is based on the performance of hospitals.

Epidemiology and early mortality patterns of acute promyelocytic leukemia in the United States.

There is a lack of contemporary population-based data on the epidemiology of acute promyelocytic leukemia (APL) in the United States. In this study, we aim to elucidate the demographics and early mortality patterns of APL hospitalizations utilizing the National Inpatient Sample database from 2016-2019. APL's annual age-adjusted incidence rate was 0.28/100,000, and the incidence increased with age, with the peak incidence in the 75-79 age group at 0.62/100,000. Whites constituted the majority of admissions at 67.7%, followed by Hispanics at 15.3%, the youngest racial group with a median age of 40 years. The median length of stay was 31 days for patients age < 60 years and 25 days for age ≥ 60 years (p < 0.001). After adjusting for confounders, the mean length of stay was 7 days higher in teaching hospitals compared to non-teaching hospitals (p 0.001). Overall mortality was 12.1% (22.2% for age ≥ 60 and 6.4% for < 60 years {p < 0.001}), and 56.5% of deaths happened before 7 days, with the median time to death being 6 days. The proportion of early deaths (< 7 days) in non-teaching hospitals was higher than late deaths (≥ 7 days) (19.2% vs. 5%; p 0.03), and admission to a teaching hospital was associated with lower mortality (adjusted odds ratio 0.27; p 0.01). Therefore, optimal treatment strategies need to be explored to mitigate this significant early mortality, especially in non-teaching hospitals.

No "July Effect" in the management and outcomes of acute myocardial infarction: An 18-year United States national study.

BACKGROUND: There has been conflicting reports on the effect of new trainees on clinical outcomes at teaching hospitals in the first training month (July in the United States of America). We sought to assess this "July effect" in a contemporary acute myocardial infarction (AMI) population. METHODS: Adult (>18 years) AMI hospitalizations in May and July in urban teaching and urban nonteaching hospitals in the United States were identified from the HCUP-NIS database (2000-2017). In-hospital mortality was compared between May and July admissions. A difference-in-difference analysis comparing a change in outcome from May to July in teaching hospitals to a change in outcome from May to July in nonteaching hospitals was also performed. RESULTS: A total of 1,312,006 AMI hospitalizations from urban teaching (n = 710,593; 54.2%) or nonteaching (n = 601,413; 45.8%) hospitals in the months of May and July were evaluated. May admissions in teaching hospitals, had greater comorbidity, higher rates of acute multiorgan failure (10.6% vs. 10.2%, p < 0.001) and lower rates of cardiac arrest when compared to July admissions. July AMI admissions had lower in-hospital mortality compared to May (5.6% vs. 5.8%; adjusted odds ratio 0.94 [95% confidence interval 0.92-0.97]; p < 0.001) in teaching hospitals. Using the difference-in-difference model, there was no evidence of a July effect for in-hospital mortality (p = 0.19). CONCLUSIONS: There was no July effect for in-hospital mortality in this contemporary AMI population.

A implementação do Projeto Apice On no Programa de Residência em Enfermagem Obstétrica: percepções de enfermeiras / La implementación del Proyecto Apice On en un Programa de Residencia em Enfermería Obstétrica: percepciones de enfermeras / The implementation of Apice On Project in the Obstetric Residency Program: Nurses' perceptions

Resumo Objetivo Descrever a percepção de egressas e da coordenação do Programa de Residência em Enfermagem Obstétrica sobre a implantação da enfermeira obstétrica em sala de parto de uma Instituição de Ensino, Pesquisa e Assistência integrante do projeto Apice On. Método Investigação descritiva, exploratória com abordagem qualitativa, realizada com cinco ex-residentes em Enfermagem Obstétrica e uma coordenadora do Programa que vivenciaram a execução desta proposta política em 2019. Após aprovação do Comitê de Ética em Pesquisa, realizou-se entrevista semiestruturada entre setembro a outubro de 2021, e os dados foram submetidos à análise de conteúdo. Resultados O cuidado da enfermeira obstétrica e sua formação profissional encontram-se sustentados nas evidências científicas. No entanto, constatou-se desafios a serem superados entre residentes, enfermeiras obstétricas e médicos obstetras no que tange a educação e as relações interprofissionais que favoreçam a consolidação do modelo colaborativo em Hospitais de Ensino. Considerações finais e implicações para a prática A Enfermagem obstétrica no cotidiano necessita avançar em soluções gerenciais que promovam melhor divulgação, conhecimento e envolvimento multiprofissional com este projeto ministerial, bem como na valorização do cuidado específico desenvolvido pela enfermeira obstétrica, membro integrante da equipe multiprofissional que atua no campo do parto e nascimento em hospitais de ensino.

Resumen Objetivo Describir la percepción de egresas ​​y de la coordinación del Programa de Residencia en Enfermería Obstétrica sobre la implementación de enfermeras obstétricas en la sala de partos de una Institución de Enseñanza, Investigación y Asistencia que forma parte del proyecto Apice On. Método Investigación descriptiva, exploratoria con abordaje cualitativo con cinco exresidentes de Enfermería Obstétrica y una coordinadora del Programa que vivieron la ejecución de esta propuesta política en 2019. Se realizó entrevista semiestructurada entre septiembre y octubre de 2021 y los datos fueron sometidos a análisis de contenido. Resultados El cuidado de la enfermera obstétrica y su formación profesional están respaldadas por evidencia científica. Sin embargo, hay que superar desafíos entre residentes, enfermeros obstétricos y obstetras en cuanto a la educación y relaciones interprofesionales que favorezcan la consolidación del modelo colaborativo en Hospitales de Enseñanza. Consideraciones finales e implicaciones para la práctica La enfermería obstétrica en el cotidiano necesita avanzar en soluciones gerenciales que promuevan una mejor difusión, conocimiento e involucramiento multiprofesionales con esta política de salud, así como la valorización del cuidado específico desarrollado por la enfermera obstétrica, integrante del equipo multiprofesional que actúa en el campo del trabajo de parto y nacimiento en hospitales de enseñanza.

Abstract Objective To describe the perception of graduates and the coordination of the Obstetric Nursing Program on the implementation of obstetric nurses in the delivery room of a Teaching, Research and Assistance Institution that is part of the Apice On Project. Method Descriptive, exploratory research with a qualitative approach carried out with five former residents in Obstetric Nursing and a Program Coordinator who experienced the execution of this health policy in 2019. A semi-structured interview was carried out between September and October 2021 and the data was submitted to content analysis. Results The obstetric nurse's care and their professional training are supported by scientific evidence. However, there are challenges to overcome among residents, obstetric nurses and obstetricians regarding interprofessional education and relationship that help the consolidation of the collaborative model in Teaching Hospitals. Final considerations and implications for practice Obstetric Nursing in everyday life needs to advance in management solutions which promote better publicity, knowledge and multiprofessional participation in this health project, as well as the valorization of the specific care developed by the obstetric nurse, a member of the multidisciplinary team who works in the field of labor and birth in teaching hospitals.

Exploring the Information Sources Consulted by Doctors at the Point of Care in Four Selected South African Referral Hospitals.

BACKGROUND: To provide an understanding of the clinical information sources consulted by teaching or referral hospital-based doctors in four South African provinces. METHODS: A quantitative cross-sectional survey design was used. To identify provinces, hospitals, and participants, simple random sampling was adopted. This study targeted a total of 276 doctors from all the four hospitals working across different departments within the hospitals. This study was conducted in four selected South African public referral/teaching hospitals in four different provinces, namely Nelson Mandela Academic Hospital in the Eastern Cape province; Witbank Hospital in Mpumalanga province; Robert Mangaliso Sobukwe Hospital in Northern Cape province and lastly, Pietersburg Hospital in Limpopo province. RESULTS: Overall, 221 doctors were surveyed. Doctors relied more on colleagues as formal and informal sources of information. They seldomly relied on newspapers, reference, and library books, or used hospital computers to access the internet. They seldomly attended training workshops organised by the district or provincial office. Protocols and clinical guidelines which are kept in the hospitals and easily accessible were often (27.9%) or always (51.1%) used. CONCLUSIONS: Teaching hospitals need to strengthen information resources to ensure that even when colleagues are used as an information source, they are an accessible means to validate the correctness of the information provided.

Effect of Hospital Teaching Status on Mortality and Procedural Complications of Percutaneous Paracentesis in the United States: A Four-Year Analysis of the National Inpatient Sample.

Objectives Numerous previous studies investigated the impact of medical training settings on outcomes of hospitalized patients. However, the impact of teaching hospital status on outcomes of percutaneous paracentesis, to the best of our knowledge, has never been studied before. Methods Hospitalized patients who underwent percutaneous paracentesis were identified from the National Inpatient Sample database from 2016 to 2019 across the United States (US) teaching and non-teaching hospitals. Outcomes studied were differences in risk of mortality, postprocedural outcomes, and healthcare resource utilization. Multivariate logistic analysis was performed using STATA software (StataCorp LLC, College Station, Texas, US) and results were adjusted for patient and hospital characteristics and comorbidities. Results Inpatient mortality rates were significantly higher in patients undergoing paracentesis at US teaching hospitals (adjusted odds ratio (aOR) 1.29, 95%CI 1.23-1.35, p<0.001) compared to non-teaching hospitals. Similarly, higher risk of procedural complications including hemoperitoneum (aOR 1.90, 95%CI 1.65-2.20, p<0.001), hollow viscus perforation (aOR 1.97, 95%CI 1.54-2.51, p<0.001), and vessel injury/laceration (aOR 15.3, 95%CI 2.12-110.2, p=0.007) were noticed in the study group when compared to controls. Furthermore, hospital teaching status was associated with prolonged mean length of stay (9.33 days vs 7.42 days, adjusted mean difference (aMD) 1.81, 95%CI 1.68-1.94, p<0.001) and increased charge of care ($106,014 vs $80,493, aMD $24,926, 95%CI $21,617-$28,235, p <0.001) Conclusion Hospitalized patients undergoing paracentesis in US teaching hospitals have an increased risk of mortality, postprocedural complications, prolonged length of stay, and increased charge of care when compared to non-teaching hospitals.

Sepsis: emerging pathogens and antimicrobial resistance in Ethiopian referral hospitals.

BACKGROUND: Sepsis due to multidrug resistant (MDR) bacteria is a growing public health problem mainly in low-income countries. METHODS: A multicenter study was conducted between October 2019 and September 2020 at four hospitals located in central (Tikur Anbessa and Yekatit 12), southern (Hawassa) and northern (Dessie) parts of Ethiopia. A total of 1416 patients clinically investigated for sepsis were enrolled. The number of patients from Tikur Anbessa, Yekatit 12, Dessie and Hawassa hospital was 501, 298, 301 and 316, respectively. At each study site, blood culture was performed from all patients and positive cultures were characterized by their colony characteristics, gram stain and conventional biochemical tests. Each bacterial species was confirmed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI TOF). Antimicrobial resistance pattern of bacteria was determined by disc diffusion. Logistic regression analysis was used to assess associations of dependent and independent variables. A p-value < 0.05 was considered as statistically significant. The data was analyzed using SPSS version 25. RESULTS: Among 1416 blood cultures performed, 40.6% yielded growth. Among these, 27.2%, 0.3% and 13.1%, were positive for pathogenic bacteria, yeast cells and possible contaminants respectively. Klebsiella pneumoniae (26.1%), Klebsiella variicola (18.1%) and E. coli (12.4%) were the most frequent. Most K. variicola were detected at Dessie (61%) and Hawassa (36.4%). Almost all Pantoea dispersa (95.2%) were isolated at Dessie. Rare isolates (0.5% or 0.2% each) included Leclercia adecarboxylata, Raoultella ornithinolytica, Stenotrophomonas maltophilia, Achromobacter xylosoxidans, Burkholderia cepacia, Kosakonia cowanii and Lelliottia amnigena. Enterobacteriaceae most often showed resistance to ampicillin (96.2%), ceftriaxone (78.3%), cefotaxime (78%), cefuroxime (78%) and ceftazidime (76.4%). MDR frequency of Enterobacteriaceae at Hawassa, Tikur Anbessa, Yekatit 12 and Dessie hospital was 95.1%, 93.2%, 87.3% and 67.7%, respectively. Carbapenem resistance was detected in 17.1% of K. pneumoniae (n = 111), 27.7% of E. cloacae (n = 22) and 58.8% of Acinetobacter baumannii (n = 34). CONCLUSION: Diverse and emerging gram-negative bacterial etiologies of sepsis were identified. High multidrug resistance frequency was detected. Both on sepsis etiology types and MDR frequencies, substantial variation between hospitals was determined. Strategies to control MDR should be adapted to specific hospitals. Standard bacteriological services capable of monitoring emerging drug-resistant sepsis etiologies are essential for effective antimicrobial stewardship.

Magnitude and pattern of anxiety levels with gender wise predilection of coping strategies amid resident doctors of emergency department.

Objectives: To screen and assess the severity level of anxiety, its influencing factors along with the gender-wise predilection of coping strategies among resident doctors working in accident and emergency departments. Methods: A transverse study was conducted amongst 260 resident doctors of accident and emergency department of different teaching hospitals of Karachi from October 2020 until March 2021. A demographic sheet containing questions related to factors, GAD-7 (Generalized Anxiety Disorder) and Brief COPE were used to measure the severity level of anxiety and coping strategies. Data was scored according to the standard scoring procedure for each subscale and for further statistical analysis SPSS Version 21 was used. Results: Out of all participants, 68.1% were <30 years of age, 63.1% were females while 54.2% were single. The findings of the study showed the prevalence of anxiety within the range of normal (38.1%), mild (35.0%), moderate (16.9%) and severe (10.0%). Gender (p= 0.001), marital status (p= 0.040) and job satisfaction (p= 0.007) among resident doctors were significantly associated with level of anxiety. Deemed to coping strategies, the most frequently were planning (n=145, 90.0%), acceptance (n=141, 87.6%), and religion (n=137, 85.1 %). All coping strategies were mostly opted by females except substance abuse. Conclusion: More than a half of the resident doctors manifested with mild to severe anxiety disorder, which highlights the need for psychological support programs to minimize anxiety levels and to ensure a healthy environment at workplace for the health practitioners.

Evaluation of the American Hospital Association Annual Survey for health services research in emergency medicine.

Objectives: Emergency department (ED) data are often used to address questions about access to and quality of emergency care. Our objective was to compare one of the most commonly used data sources for national ED information, the American Hospital Association (AHA) Annual Survey, with a criterion database: the National Emergency Department Inventory (NEDI)-USA data set. Methods: We compared the 2015 and 2016 AHA surveys to the following 3 criterion standards: (1) the 2015 and 2016 NEDI-USA databases, which have information about all US EDs, including merged data from (2) Council of Teaching Hospitals (COTH) and (3) the Critical Access Hospital (CAH) program. We present descriptive results about the number of EDs in each data set; total and median visit volumes; locations in rural areas; and COTH, CAH, and freestanding ED (FSED) status. Results: The AHA survey identified 3893 US EDs in 2015. These EDs had a total annual visit volume of 129,197,493 visits, with a median of 22,772 visits (interquartile range, 8311-47,938). Compared with the NEDI-USA, the AHA included 1433 fewer EDs (-27%; 95% confidence interval [CI], -28% to -26%) and 23,615,163 (-15%) fewer visits. Specifically, AHA was missing 245 (-22%; 95% CI, -24% to -19%) of those located in rural areas, 268 (-20%; 95% CI, -22% to -18%) in a CAH, and 240 (-47%; 95% CI, -51% to -42%) FSEDs. We saw similar results using 2016 data. Conclusions: Although several aggregated results were similar between the compared data sources, the AHA data set excluded many US EDs, including many rural EDs and FSEDs. Consequently, the AHA underreported total ED visits by 15%. We encourage data users to be cautious when interpreting results from any 1 ED data source, including the AHA.

Differences and their contexts between teaching and nonteaching hospitals in Iran with other countries: A concurrent mixed-methods study.

BACKGROUND: In terms of missions, hospitals are divided into teaching and nonteaching. In addition, differences in health-care systems in countries will lead to differences in hospitals' operation. Iran, as a specific health-care system, is different from other countries. Hence, the present study investigated differences between teaching and nonteaching hospitals and their differences in Iran and the world. MATERIALS AND METHODS: A concurrent mixed-methods study was conducted in two stages. The first stage was a narrative review of studies (2000-2020). Using narrative inquiry and reflective analysis, the content was analyzed and the categories were extracted. The second stage was a qualitative study conducted using semi-structured interviews with forty Iranian hospital managers and policymakers through a purposive sampling in 2020. Content analysis was made using deductive approach, and MAXQDA 12 was used for data analysis. RESULTS: According to the first stage, categories were extracted as follows: service quality, type of cases, patient satisfaction, efficiency, performance indicators, patient safety, personnel, use of drugs, access to services, technologies, justice in the type of services received, using guidelines, processes, and number of services. In the second stage, 8 main categories, 17 categories, and 45 subcategories were extracted. The extracted main categories were as follows: mission and target, management and behavioral organizations, supply chain and chain of results, human resources, costs and budget, policy demands, clients' satisfaction and patients' right, and integration of medical education. CONCLUSION: Unlike other countries, in Iran, the combination of missions and the complete dependence of teaching hospitals on the government has caused differences. Reducing the treatment mission of teaching hospitals; differences in the budget and development of its indicators; lower tariffs for teaching hospitals; developing a cost-income management model and supply chain; preventing uncertainty other than medical students except medicine; considering the clients' right to choose hospital; and organizing research missions in hospitals were the solutions for decrease differences.

Antibiotic dispensing knowledge and practice among dispensing staff working in pharmacies near teaching hospitals in Kathmandu Valley, Nepal.

OBJECTIVES: To assess antibiotic dispensing knowledge and practice among dispensing staff who may or may not have a formal pharmacy qualification working in pharmacies near teaching hospitals in Kathmandu Valley, Nepal. METHODS: A face-to-face cross-sectional study was conducted among 220 dispensing staff. The data were analysed using SPSS 20 to measure descriptive statistics and logistic regressions. KEY FINDINGS: Among 220 participants, half of them (50.0%) had inadequate knowledge and slightly less than half of the participants (46.4%) had poor antibiotics dispensing practices. CONCLUSIONS: The government authority should develop and implement a plan for continuous professional education programmes and frequent monitoring of pharmacies to address inadequate antibiotic dispensing knowledge and poor practice.

Conflict of Interest Policies at Medical Schools and Teaching Hospitals: A Systematic Review of Cross-sectional Studies.

BACKGROUND: This systematic review aims to estimate the proportion of medical schools and teaching hospitals with conflicts of interest (COI) policies for health research and education, to describe the provisions included in the policies and their impact on research outputs and educational quality or content. METHODS: Experimental and observational studies reporting at least one of the above mentioned aims were included irrespective of language, publication type or geographical setting. MEDLINE, Scopus, Embase and the Cochrane Methodology Register were searched from inception to March 2020. Methodological study quality was assessed using an amended version of the Joanna Briggs Institute's checklist for prevalence studies. RESULTS: Twenty-two cross-sectional studies were included; all were conducted in high-income countries. Of these, 20 studies estimated the prevalence of COI policies, which ranged from 5% to 100% (median: 85%). Twenty studies assessed the provisions included in COI policies with different assessment methods. Of these, nine analysed the strength of the content of medical schools' COI policies using various assessment tools that looked at a range of policy domains. The mean standardised summary score of policy strength ranged from 2% to 73% (median: 30%), with a low score indicating a weak policy. North American institutions more frequently had COI policies and their content was rated as stronger than policies from European institutions. None of the included studies assessed the impact of COI policies on research outputs or educational quality or content. CONCLUSION: Prevalence of COI policies at medical schools and teaching hospitals varied greatly in high-income countries. No studies estimated the prevalence of policies in low to middle-income countries. The content of COI policies varied widely and while most European institutions ranked poorly, in North America more medical schools had strong policies. No studies were identified on impact of COI policies on research outputs and educational quality or content.