Knowledge, attitude and practices of lifestyle modification and associated factors among hypertensive patients on-treatment follow up at Yekatit 12 General Hospital in the largest city of East Africa: A prospective cross-sectional study.

BACKGROUND: Hypertension is a devastating global public health challenge; studies indicated that Ethiopia has been affected by the burden of hypertension especially in urban areas. The overall prevalence of hypertension in Ethiopia was estimated to be 19.6% (23.5% in urban and 14.7% in rural population). Along with medical management of hypertension, appropriate lifestyle modification is a crucial and inexpensive means of hypertension control. The main purpose of the study was therefore to assess knowledge, attitude and practice of lifestyle modification among patients on follow up for hypertension treatment at Yekatit 12 General Hospital. METHODS: A prospective cross-sectional study design was applied in Yekatit 12 General Hospital from October 28, 2018, to February 28, 2019, by allotting proportionate samples from the two chronic outpatients departments (OPD). Using single proportion sampling techniques, the study participants were selected and the total sample size calculated was 405. Primarily, clinical measurements were made according to the international standard set to verify true hypertensive patient's inclusions. Then, data about socio-demographic characteristics, lifestyle modification related to knowledge, attitude and practices were comprehensively collected using an interviewer-administered structured questionnaire. The collected data was entered into Epi-data exported to SPSS Window version of 22 for analysis. All variables with ρ-value less than 0.05 in the final model were considered as independently associated with knowledge, attitude and practices of patients' lifestyle modification. The strength of association was described by Odds Ratio (OR) at the corresponding CI of 95%. RESULTS: The overall sampled hypertensive patients as compared to the planned sample size was 95.5% (n = 387), out of which 53.5% (n = 207) was male patients. The mean age was 50 years with a standard deviation of 14.4. The study revealed that 67.7% [95% CI (65.32%, 70.08%)] were knowledgeable; and 54.0% [95% CI (51.34%, 56.6%)] were reported to have favorable attitude towards lifestyle modification. Regarding their practices, 38% [95% CI (19.91%, 57.49%] of the respondents had good practices. Their monthly income [AOR = 2.39, 95% CI (1.12, 5.11)] and duration on-treatment follow up since diagnosed with hypertension [AOR = 4.39, 95% CI (1.20, 16.03)] were independently associated with knowledge. Concerning their damned practices, age [AOR = 7.71, 95% CI (2.4, 24.8)] and knowledge [AOR = 3.94, 95% CI (2.01, 7.72)] were independently associated with the practices. CONCLUSION: Though the encouraging high knowledge status and favourable attitudes towards lifestyle modification among hypertensive patients, the practices are among the lowest findings report in all standards. Hence, older patients, jobless patients, and low-income patients and patients on long-term treatment follow up who were diagnosed with hypertension before 10 years needs special attention and interventions by the country NCDs policy formulators to rise their non-pharmacological practices to control high blood pressure and its consequences.

Gastric-type endocervical adenocarcinoma and cervical cytology: Experience at a general hospital and review of the literature.

INTRODUCTION: Gastric-type endocervical adenocarcinoma (GAS) is an uncommon type of endocervical adenocarcinoma that is not associated with human papillomavirus infection. This diagnosis is relatively rare and may portend a worse prognosis than usual-type endocervical adenocarcinoma. Subtle morphological features make it an under-recognised diagnostic challenge. Study of the cytological features of individual cases is valuable in order to increase awareness of this entity. METHODS: The pathology database of our institution was searched for the diagnosis of GAS and all cytological and surgical specimens for each patient were reviewed. The original cytological interpretation was compared to a retrospective central review interpretation. Clinical history and follow-up results were obtained from the electronic medical record. RESULTS: Four cases of GAS were identified. The findings on initial cervical cytology varied, with GAS found in both patients with negative cervical cytology and those with atypical glandular cells. Cytological findings included endocervical cells arranged in three-dimensional clusters and honeycomb sheets with abundant vacuolar cytoplasm, and in two patients, moderate nuclear atypia with irregular nuclear membranes, coarse chromatin, hyperchromatic nuclei, and prominent nucleoli. In one patient, GAS was incidentally discovered via thorough sampling of a cystic lesion in the superior portion of the endocervical canal. CONCLUSIONS: GAS is an aggressive human papillomavirus-independent type of endocervical adenocarcinoma with subtle morphological features and, as our study shows, varying clinical presentation. Given the aggressive nature of GAS and the difficulties in initial diagnosis, increased awareness of this entity among pathologists is crucial.

Repensando(nos) en tiempos de pandemia / Rethinking ourselves in times of pandemic

En Marzo de 2020, ante el aislamiento social obligatorio decretado por la pandemia por Covid-19, el equipo de residentes de Psicopedagogía con sede en el Hospital General de Agudos Carlos Durand, de la Ciudad de Buenos Aires se repreguntó sobre su actividad y la manera de prestar acciones de atención y formación en el hospital. Se describen las tareas de capacitación realizadas, y la modalidad en que se continuó con el tratamiento psicopedagógico de los pacientes.

The association between self-declared acute care surgery services and critical care resources: Results from a national survey.

PURPOSE: We examined differences in critical care structures and processes between hospitals with Acute Care Surgery (ACS) versus general surgeon on call (GSOC) models for emergency general surgery (EGS) care. METHODS: 2811 EGS-capable hospitals were surveyed to examine structures and processes including critical care domains and ACS implementation. Differences between ACS and GSOC hospitals were compared using appropriate tests of association and logistic regression models. RESULTS: 272/1497 hospitals eligible for analysis (18.2%) reported they use an ACS model. EGS patients at ACS hospitals were more likely to be admitted to a combined trauma/surgical ICU or a dedicated surgical ICU. GSOC hospitals had lower adjusted odds of having 24-h ICU coverage, in-house intensivists or respiratory therapists, and 4/6 critical-care protocols. CONCLUSIONS: Critical care delivery is a key component of EGS care. While harnessing of critical care structures and processes varies across hospitals that have implemented ACS, overall ACS models of care appear to have more robust critical care practices.

[The differential diagnosis for novel coronavirus pneumonia and similar lung diseases in general hospitals].

Novel coronavirus pneumonia was a novel coronavirus infection that has dominated pulmonary infection since December 2019. The main manifestations were fever, dry cough, shortness of breath, normal or leukopenia in peripheral blood and changes in chest CT and in severe cases, multiple organ failure might occur. The National Health Commission, PRC has revised the consensus on diagnosis and treatment seven times in a short period of time, indicating the growing understanding of the disease. Patients with novel coronavirus pneumonia usually had history of travelling or living in the epidemic area including Wuhan within 14 days before onset, or have been exposed to patients who had fever or respiratory symptoms from the epidemic area, or had clustering diseases. However, novel coronavirus pneumonia was becoming more and more blurred after vanishing epidemic. The diagnosis and differential diagnosis of novel coronavirus pneumonia were challenges not only because of large number of tourists increasing dramatically after the relieving of epidemic, but also patients with other diseases from different areas to search for medical care. In this article, the clinical and chest imaging features of the novel coronavirus pneumonia were reviewed and compared with other infections and non-infectious diffuse pulmonary diseases. We try to find the similarities and differences among them, and to identify clues to the diagnosis of novel coronavirus pneumonia, so as to ensure accurate diagnosis and treatment.

Rituximab in multiple sclerosis at general hospital level.

OBJECTIVES: The use of rituximab (RTX) in multiple sclerosis (MS) is a rapidly increasing choice of disease-modifying therapy. Efficacy outside specialized university hospital-based care is not yet systematically investigated. Our aim was to evaluate off-label RTX treatment for MS at a general hospital in Sweden. MATERIALS AND METHODS: Subjects with definite MS with at least one rituximab infusion were eligible for inclusion in this retrospective, observational study. Effect was evaluated by monitoring clinical disability, annual relapse rate, new lesions on MRI, and safety by the incidence and severity of adverse events. RESULTS: Among the 83 included subjects, 15 had clinical worsening of disease during the median 23.5 (1-76) months of follow-up after RTX initiation: 7/66 with relapsing-remitting multiple sclerosis (RRMS) and 8/17 with progressive subtypes (PMS). Cumulative survival without worsening was 86% in RRMS and 30% in PMS. The annual relapse rate before RTX vs follow-up dropped from 0.38 to 0.05 (P < .00001). Subjects with new enhancing lesions on MRI during the first year before RTX initiation vs the year after dropped from 0.94 to 0.024 (P < .00001) and was only seen in RRMS (1.05-0.31, P = .00003). Adverse events were mainly mild. Thirty-six out of 53 non-infusion-related adverse events were infections, of which four were serious, including a case of pneumonia with concomitant late-onset neutropenia. CONCLUSIONS: Rituximab was as effective and safe when given at a general hospital outpatient clinic compared with results from previous university hospital-based studies. Vigilance is required concerning severe adverse events.

Corpus callosotomy for drug-resistant spasms associated with tuberous sclerosis complex.

BACKGROUND: Corpus callosotomy (CC) has recently been adopted for the treatment of drug-resistant epileptic spasms and tonic spasms. In the present study, we investigated CC outcomes among patients with drug-resistant epileptic spasms or tonic spasms associated with tuberous sclerosis complex (TSC). METHODS: We retrospectively collected data from seven patients (3 women, 4 men) with diagnosed TSC and who were treated using CC at Seirei Hamamatsu General Hospital in Japan. All patients had experienced drug-resistant epileptic spasms (<3 s of muscular contraction) or tonic spasms (>3 s) prior to CC, which were confirmed via video-electroencephalogram monitoring. RESULTS: All patients exhibited multiple bilateral cortical tubers on brain magnetic resonance imaging. The main seizure types were epileptic spasms in four, tonic spasms in one, and both seizure types in two patients. Patients underwent total CC between the ages of 25 months and 21.5 years. Additional resection or disconnection was performed in two patients. The follow-up period after CC ranged between 9 months and 3.5 years. Three patients achieved remission from spasms following CC alone. Two other patients became free from spasms several months after CC but required an additional focus disconnection or medical treatment. The remaining two patients continued to show spasms or asymmetrical tonic seizures. CONCLUSION: Total CC resulted in freedom from drug-resistant epileptic or tonic spasms in several patients with TSC. Stepwise progression from CC to additional resection or disconnection surgery may aid in the treatment of spasms secondary to TSC.

Sustainability drivers of Canada's most health-promoting hospital.

Sustaining large health promotion interventions in hospitals is notoriously difficult, and our understanding of sustainability enablers remains peripheral. This case study examined sustainability of Canada's largest hospital based health promotion facility: The Wellness Institute at Seven Oaks General Hospital in Winnipeg. Seven sustainability enablers were identified: (1) Community support and ownership; (2) Consistent, supportive, visionary leadership; (3) Well-managed operations; (4) Limited service overlap and duplication; (5) Alignment with the healthcare system; (6) Consistent, professional staffing; (7) Leading-edge facilities and services. Four sustainability barriers were identified: (1) Alignment with the healthcare system; (2) Limited funding; (3) Service duplication; (4) Sub-optimal location. Results can support leaders with future planning and implementation of health promotion programming.

Cure for increasing health care costs: The Bernhoven case as driver of new standards of appropriate care.

Containing costs is a major challenge in health care. Cost and quality are often seen as trade-offs, but high quality and low costs can go hand-in-hand as waste exists in unnecessary and unfounded care. In the Netherlands, two healthcare insurers and a hospital collaborate to improve quality of care and decrease healthcare costs. Their aim is to reduce unnecessary care by shifting the business model and culture from a focus on volume to a focus on quality. Key drivers to support this are taking time for integrated diagnosis ('first time right'), the right care at the right place and shared decision making between doctor and patient. Conditions to realize this are 1) contract innovation between the hospital and insurers to move away from fee-for-service reimbursement, 2) a culture change within the organization with emphasis on collaboration and empowerment of medical leadership and physicians to change daily practice, and 3) a reorganization of the hospital organization structure from a large number of medical departments to four business units related to the fundamental underlying patient need (acute care, solution shop, intervention unit and chronic care). Results from this whole-system-approach experiment show it is possible to provide better care (as experienced by patients) with lower volumes (16% lower DRG claims after 3 years) and provides valuable lessons for further healthcare reform.

A Rasch analysis of the Conley Scale in patients admitted to a general hospital.

Purpose: The Conley Scale (CS) is a widely used tool for assessing the risk of falling for inpatients. The purpose of this study was to assess its unidimensionality, internal construct validity, targeting and reliability using Confirmatory Factor Analysis (CFA) and Rasch analysis (RA).Methods: The CS was administrated to a sample of 58,370 subjects admitted to a general hospital.Results: The CFA supported the unidimensionality of the CS (Root Mean Square Error of Approximation (RMSEA) = 0.040) only after adjusting for local dependency between two items. The scale did not fit the Rasch model (χ218 = 4688.5; p = 0.0000) and this was confirmed notwithstanding adjusting for type-I error (by creating 10-subsample of 250 subjects) and extensive post-hoc modifications. The analysis of targeting showed a marked floor effect (47.1%), whereas the reliability appeared adequate for group measurement (0.800) only after adjusting for the skewed distribution of the calibrating sample.Conclusion: The results of this study suggested that the CS, although unidimensional, could not provide interval-scale measurement of the risk of falling, had a measurement range that mismatched the ability range of the population being measured, and had a reliability inadequate for individual person measurements. Given these findings, the use of the CS to identify inpatients at risk of falling is not recommended.Implications for rehabilitationThe Conley Scale is a unidimensional tool according to Confirmatory Factor Analysis.However, Rasch analysis demonstrated that the tool could not provide interval-scale measurement of the risk of falling, had a measurement range that did not fit the ability range of the population being measured, and had a level of reliability which was inadequate for its intended purpose, that is individual person measurement.The diagnostic utility of the known published cutoff is severely hampered by the severe mistargeting and reduced reliability of the tool.Given these shortcomings, the Conley Scale cannot be recommended to identify inpatients at risk of falling.

Implementing evidence-based medicine in a busy general hospital department: results and critical success factors.

Implementing evidence-based medicine (EBM) in a busy hospital department is challenging, but when successful, may contribute to quality of care. This paper is a narrative review of the successes and challenges of deliberate implementation of EBM in a paediatric department in a general teaching hospital in Zwolle, the Netherlands. Key elements in this project were providing basic EBM education to the entire team of consultants and nurse practitioners, structurally embedding EBM activities into our weekly schedule and development of local practice guidelines. This deliberate practice of EBM principles has changed the way we treat common paediatric problems. It likely reduced unwarranted practice variation and promoted a reserved attitude towards the use of unnecessary diagnostics, which might improve delivery of effective, cost-conscious care. The project also positively influenced our group culture and learning environment. In accordance with previous reports, lack of time and reluctance to change routines and habits hindered the practice of EBM in our department. In our experience, these barriers can be overcome by promoting a team-wide endorsement of EBM, a willingness to acknowledge uncertainty and by deliberate practice. If these can be achieved, systematic application of EBM principles in a busy hospital department is feasible and worthwhile.

Yield of family screening in patients with isolated bicuspid aortic valve in a general hospital.

AIM: To determine the prevalence of unidentified bicuspid aortic valve (BAV) or aortic dilatation (>40mm) in first degree relatives (FDR) of patients with isolated BAV in a general hospital. METHODS AND RESULTS: Patients with isolated BAV received information advising cardiac screening of their FDR. Referred and screened were 134 FDR of 54 adult index patients with isolated BAV (median 2 per index patient). FDR's mean age was 49years (range 16-83years) and 41% were male. They comprised 5 parents (3.7%), 52 siblings (39%) and 77 offspring (57%). Among these FDR, the prevalence of BAV was 6.0% (8 patients). In FDR without BAV, 10 (7.5%) had aortic dilatation. 'Familial BAV' was present in 9/54 families (17%). CONCLUSION: In a general hospital, screening of FDR of patients with isolated BAV resulted in a substantial yield of 13% new cases with BAV or aortic dilatation without BAV.

[QTc interval in the neonatal period in a Mexican population. A pilot study]. / Situación del intervalo QTc en el período neonatal en un hospital del occidente de México, estudio piloto.

INTRODUCTION: QT interval prolongation is associated with ventricular arrhythmias and sudden death syndrome. OBJECTIVE: To determine the value of QTc interval in healthy newborns in a general hospital in Jalisco, Mexico, and their outcome during their first months of life. METHODS: The study included healthy newborns from March to November 2016, in the Hospital General of Occidente in Jalisco, Mexico. A 12-lead electrocardiogram was performed at a speed of 25mm/s during the first 48h of life. The QT interval was measured in lead DII, and the QTc interval was calculated using the Bazett formula. Patients detected with QTc prolongation were assessed monthly with an ECG and echocardiogram. If they persisted with prolonged QTc interval, they were re-evaluated at 6 months with an ECG, 24h Holter, and electrocardiography study on parents and siblings. Those who persisted with prolonged QTc interval were evaluated with an ECG at 9 months. RESULTS: The study included 548 patients. The mean QTc interval at birth was 459 ms; during this period 33 patients has a QTc greated that 470 ms; which were evaluated monthly with a new electrocardiographic study, obtaining a mean QTc interal of 446 ms. At 6 months 16 patients were evaluated, with a mean QTc interval of 434ms. At 9 months, 6 patients were found to have a mean QTc interval of 438ms, and only 4 patients persisted with a prolonged QTc interval. CONCLUSIONS: The QTc interval in our population is prolonged compared to other populations and with a gradual return to normal.

Discrepant Views of Oncologists and Cancer Patients on Complementary and Alternative Medicine in a Chinese General Hospital.

PURPOSE: Complementary and alternative medicine (CAM) has been widely used by cancer patients but rarely discussed by oncologists. This study was designed to evaluate the communication gap between China's oncologists and cancer patients on CAM. METHODS: Two parallel cross-sectional studies assessed 83 oncologists and 402 cancer patients on CAM communication between patients and oncologists, and attitudes toward CAM use and clinical decisions about CAM. RESULTS: A majority (75.1%) of the cancer patients (302/402) were identified as CAM users within the most recent three months while 77.6% of the cancer patients (312/402) were identified as CAM users since diagnosis of cancer. Oncologists and patients responded differently ( P < .001) on CAM communications. Both oncologists and patients expected that CAM could improve the immune system. They both agreed that oncologists usually discouraged their patients from using CAM. Regarding the effectiveness of CAM, cancer patients were more likely to believe that CAM was effective while oncologists had more concerns about adverse effects of CAM use. CAM use by patients was predicted by disease duration (≥9 months) in the multivariable logistic regression model. CONCLUSION: China's oncologists and cancer patients may hold discrepant views on CAM. China's oncologists are encouraged to improve their knowledge on CAM and to initiate more discussions with their patients regarding effective and the safe use of CAM.

Situación del intervalo QTc en el período neonatal en un hospital del occidente de México, estudio piloto / QTc interval in the neonatal period in a Mexican population. A pilot study

Resumen Introducción: La prolongación del intervalo QT se asocia con arritmias ventriculares y muerte súbita. Objetivo: Determinar el valor del intervalo QTc en recién nacidos sanos y evaluar su comportamiento durante los primeros meses de vida. Métodos: Recién nacidos sanos a término de marzo-noviembre 2016 en el Hospital General de Occidente del Estado de Jalisco, México. Se les practicó un electrocardiograma de 12 derivaciones a una velocidad de 25 mm/s durante las primeras 48 h. Se midió el intervalo QT en DII y se calculó el QTc mediante la fórmula de Bazett. Los pacientes a los que se detectó prolongación del QTc en sus primeras 48 h se valoraron al mes con ECG y ecocardiograma. Si persistieron con QTc alargado se revaloraron a los 6 meses con ECG, Holter de 24 h y estudio electrocardiográfico a padres y hermanos. Los que persistieron con QTc alargado se revaloraron a los 9 meses con ECG. Resultados: Se incluyeron 548 pacientes. La media del intervalo QTc al nacimiento fue de 459 ms; durante este período 33 pacientes presentaron un QTc mayor de 470 ms, los cuales fueron evaluados al mes mediante un nuevo estudio electrocardiográfico, obteniendo una media del intervalo QTc de 446 ms. A los 6 meses se evaluaron 16 pacientes, con una media del intervalo QTc de 434 ms. A los 9 meses se evaluaron 6 pacientes, con una media del intervalo QTc de 438 ms, y solo 4 pacientes persistieron con QTc prolongado. Conclusiones: El intervalo QTc en nuestros pacientes es más prolongado en comparación con otras poblaciones y muestra una normalización paulatina.

Abstract Introduction: QT interval prolongation is associated with ventricular arrhythmias and sudden death syndrome. Objective: To determine the value of QTc interval in healthy newborns in a general hospital in Jalisco, Mexico, and their outcome during their first months of life. Methods: The study included healthy newborns from March to November 2016, in the Hospital General of Occidente in Jalisco, Mexico. A 12-lead electrocardiogram was performed at a speed of 25 mm/s during the first 48 h of life. The QT interval was measured in lead DII, and the QTc interval was calculated using the Bazett formula. Patients detected with QTc prolongation were assessed monthly with an ECG and echocardiogram. If they persisted with prolonged QTc interval, they were re-evaluated at 6 months with an ECG, 24 h Holter, and electrocardiography study on parents and siblings. Those who persisted with prolonged QTc interval were evaluated with an ECG at 9 months. Results: The study included 548 patients. The mean QTc interval at birth was 459 ms; during this period 33 patients has a QTc greated that 470 ms; which were evaluated monthly with a new electrocardiographic study, obtaining a mean QTc interal of 446 ms. At 6 months 16 patients were evaluated, with a mean QTc interval of 434 ms. At 9 months, 6 patients were found to have a mean QTc interval of 438 ms, and only 4 patients persisted with a prolonged QTc interval. Conclusions: The QTc interval in our population is prolonged compared to other populations and with a gradual return to normal.

Quality of Care during Neonatal Resuscitation in Kakamega County General Hospital, Kenya: A Direct Observation Study.

BACKGROUND: Birth asphyxia is the leading cause of neonatal mortality in Kenya. Quality care during neonatal resuscitation (NR) can contribute to a reduction in neonatal mortality related to birth asphyxia by 30 percent. This study assessed the quality of care (QoC) during NR for newborns with birth asphyxia. METHODS: Direct observations of 138 newborn resuscitations were done in labor ward and maternity theatre. Twenty-eight healthcare providers were observed 3-5 times using a structured checklist. Descriptive and inferential statistics were calculated and quality of care scores computed. Ordered logistic regression model identified HCPs characteristics associated with the QoC scores during NR. RESULTS: Overall QoC scores were good for airway clearance (83%). Suctioning in meconium presence (40%) was poorly performed. Years of experience working in maternity were associated with good drying/stimulation (ß = 1.86, P = 0.003, CI = 0.626-3.093) and airway maintenance (ß = 1.887, P = 0.009, CI = 0.469-3.305); nurses were poor compared to doctors during initial bag and mask ventilation (ß = -2.338, P = 0.05, CI = -4.732-0.056). CONCLUSION: Key steps in NR are poorly performed during drying and warmth, airway maintenance in meconium presence, and ventilation. Mentorship with periodic refresher training can improve the care provided during NR.

Actividad ortogeriátrica en un hospital general de Castilla-La Mancha / Orthogeriatric activity in a general hospital of Castilla-La Mancha, Spain

Objetivo. Describir la actividad ortogeriátrica en ancianos con fractura de cadera en el Hospital Mancha Centro basándonos en las recomendaciones de las principales guías clínicas. Material y método. Estudio prospectivo observacional. Se incluyen todos los pacientes mayores de 65 años ingresados en traumatología con fractura de cadera desde abril de 2015 a diciembre de 2015. El paciente ingresa a cargo de traumatología y se interconsulta a geriatría, que realiza una valoración geriátrica preoperatoria y un seguimiento postoperatorio. Resultados. La estancia media prequirúrgica fue de 48h y la estancia media global de 10,3±8,2 días. Los pacientes que sufrieron delirium (42,1%) evolucionaron peor y se derivaron más a residencias. Se transfundieron el 54,7% de los pacientes a pesar de que el 53,5% recibieron hierro intravenoso y/u oral en el postoperatorio. Al alta se pautó calcio y vitamina D al 79% de los pacientes. Fueron valorados por rehabilitación el 36% de los pacientes, recuperando su situación funcional previa el 4,8% y parcialmente el 16,7%. Al alta, un 55% de los pacientes volvieron a su domicilio y un 22% fueron derivados a estancias temporales. Discusión. En este artículo se detalla el manejo de los principales problemas clínicos en nuestro hospital en ancianos con fractura de cadera basándonos en las recomendaciones de las principales guías y resultados de publicaciones al respecto. Conclusiones. En nuestro hospital se siguen las recomendaciones de las guías. Aspectos a mejorar son el manejo de la anemia durante el ingreso y la rehabilitación (AU)

Aim. To describe the orthogeriatric activity in the elderly with hip fractures in the Hospital Mancha Centro, based on the recommendations of the main guidelines. Material and method. Observational prospective study, comprising all patients over 65 years of age admitted to the Traumatology Unit with a hip fracture between April 2015 and December 2015. Patients were admitted under the care of the Traumatology Unit with cross-consultation carried out with the Geriatrics Department, which then carried out a pre-operative geriatric assessment and the post-operative follow-ups. Results. The mean pre-surgery waiting time was 48h and the overall time in hospital was 10.3±8.2 days. Patients who suffered from delirium (42.1%) did not improve as well, and were referred to nursing homes. Blood transfusions were received by 54.7% of the patients, despite 53.5% of them having received intravenous and/or oral iron after the surgery. Treatment with calcium and vitamin D was prescribed in 79% of the patients on discharge. The Rehabilitation Unit assessed 36% of the patients, with 4.8% fully, and 16.7% partially recovering their prior functional status. Upon discharge, 55% of the patients returned to their homes, and 22% were referred to short-term assisted living facilities. Discussion. This article describes how the main clinical problems are handled in the elderly with hip fractures in our hospital, based on recommendations of the main guidelines and publications. Conclusions. Our hospital follows the recommended guidelines. Aspects for improvement include the management of anaemia during admission and rehabilitation (AU)

Liaison psychiatry professionals' views of general hospital care for patients with mental illness: The care of patients with mental illness in the general hospital setting.

OBJECTIVE: Explore the experiences of liaison psychiatry professionals, to gain a greater understanding of the quality of care patients with mental illness receive in the general hospital setting; the factors that affect the quality of care; and their insights on interventions that could improve care. METHODS: A survey questionnaire and qualitative in depth interviews were used to collect data. Data collection took place at the Royal College of Psychiatrists Faculty of Liaison Psychiatry Annual conference. Qualitative analysis was done using thematic analysis. RESULTS: Areas of concern in the quality of care of patients with co-morbid mental illness included 'diagnostic overshadowing', 'poor communication with patient', 'patient dignity not respected' and 'delay in investigation or treatment'. Eleven contributing factors were identified, the two most frequently mentioned were 'stigmatising attitudes of staff towards patients with co-morbid mental illness' and 'complex diagnosis'. The general overview of care was positive with areas for improvement highlighted. Interventions suggested included 'formal education' and 'changing the liaison psychiatry team'. CONCLUSION: The cases discussed highlighted several areas where the quality of care received by patients with co-morbid mental illness is lacking, the consequences of which could be contributing to physical health disparities. It was acknowledged that it is the dual responsibility of both the general hospital staff and liaison staff in improving care.

[Efficacy of Management for Rational Use of Antibiotics in Surgical Departments at a Multi-Disciplinary Hospital: Results of a 7-year Pharmacoepidemiological Research].

Background: Irrational medicine use including excessive use and abuse of antibiotics remains a crucial problem for the healthcare systems. In this regard, studies examining approaches to improving the clinical use of medicines are highly important. Aim: to assess the efficacy rate of management for the rational use of antibiotics in surgical departments of a multi-disciplinary hospital. Material and Methods: The intervention complex combined the research, educational, and methodological activities: local protocols for perioperative antibiotic prophylaxis (PABP) for various surgical departments were developed; local PABP protocols were discussed with the physicians of specialized surgical departments; official order on implementation of PABP was issued; the list of drug prescriptions for registration of the first pre-operative antibiotic dose was changed; audit and feedback processes were introduced as well as consultations of a clinical pharmacologist were implemented. We assessed the efficacy rate of the interventions basing on the changes in consumption of antibiotics (both quantitatively and qualitatively) at surgical departments of a hospital using ATC/DDD methodology. Comparison of the studied outcomes was performed before and after the intervention implementation and between the departments (vascular and abdominal surgery). The consumption of antibacterial agents (ATCJ01) was measured as a number of defined daily doses (DDD) per 100 bed-days (DDD/100 bed-days, indicator recommended by the World Health Organization, WHO) and DDD per 100 treated patients (DDD/100 treated patients). Results: From 2006 to 2012, a decrease in antibacterial consumption in surgical departments by 188 DDD/100 treated patients was observed. We obtained the opposite results when using an indicator of DDD/100 bed-days (increase by 2.5 DDD/100 bed-days) which could be explained by the dependence on indices of overall hospital work and its changes during the examined period. Observed changes in antibacterial consumption varied in different surgical departments. The most pronounced positive changes were noted in the department of vascular surgery: decrease in total antibacterial consumption by 298 DDD/100 treated patients, decrease in the use of cephalosporins of the III generation from 141 to 38 DDD/100 treated patients. These positive changes were accompanied by the same (low) level of consumption/use of reserve antibiotics. In the department of abdominal surgery, there was no decrease in total antibiotic consumption, as well as in consumption of broad-spectrum cephalosporins of the III generation and fluoroquinolones, and we observed an increase in the use of reserve antibiotics (carbapenems) during the study period. Positive changes in antibiotic consumption were associated with the positive attitude of the manager/head of the department towards interventions: we observed the most pronounced decrease in antibiotic consumption straight after the publication of the administrative order on perioperative antibacterial prophylaxis. Conclusion: The combination of scientific, educational, and methodological interventions is effective for improving antibiotic application. The study results provide the rationale for analyzing the drug consumption using the DDD/100 treated patients measure in addition to the WHO-recommended indicator of DDD/100 bed-days which depends on overall hospital performance.