[Optimizing the management of heart failure: structuring the care pathway]. / Optimisation de la prise en charge de l'insuffisance cardiaque : structuration du parcours de soins.

The incidence of chronic heart failure continues to rise in Western countries, justifying the implementation of an optimized multidisciplinary organization based on medical and nursing convergence. Around the main heart failure, assistance and transplantation unit at Toulouse University Hospital, several structures have been put in place to better manage heart failure patients and improve their care pathway.

Temporal and geographical variations in diagnostic imaging in Norway.

BACKGROUND: Unwarranted temporal and geographical variations are acknowledged as a profound problem for equal access and justice in the provision of health services. Even more, they challenge the quality, safety, and efficiency of such services. This is highly relevant for imaging services. OBJECTIVE: To analyse the temporal and geographical variation in the number of diagnostic images in Norway from 2013 to 2021. METHODS: Data on outpatient imaging provided by the Norwegian Health Economics Administration (HELFO) and inpatient data afforded by fourteen hospital trusts and hospitals in Norway. Data include the total number of imaging examinations according to the Norwegian Classification of Radiological Procedures (NCRP). Analyses were performed with descriptive statistics. RESULTS: More than 37 million examinations were performed in Norway during 2013-2021 giving an average of 4.2 million examinations per year. In 2021 there was performed and average of 0.8 examinations per person and 2.2 examinations per person for the age group > 80. There was a 9% increase in the total number of examinations from 2013 to 2015 and a small and stable decrease of 0.5% per year from 2015 to 2021 (with the exception of 2020 due to the pandemic). On average 71% of all examinations were outpatient examinations and 32% were conducted at private imaging centres. There were substantial variations between the health regions, with Region South-East having 53.1% more examinations per inhabitant than Region West. The geographical variation was even more outspoken when comparing catchment areas, where Oslo University Hospital Trust had twice as many examinations per inhabitant than Finnmark Hospital Trust. CONCLUSION: As the population in Norway is homogeneous it is difficult to attribute the variations to socio-economic or demographic factors. Unwarranted and supply-sensitive variations are challenging for healthcare systems where equal access and justice traditionally are core values.

[Utilité de la tomographie thoraco-abdomino-pelvienne chez les patients âgés hospitalisés pour altération de l'état général]. / Usefulness of thoracic-abdominal-pelvic tomography in older adults hospitalized with alteration of general state.

Alteration of the general state of health is a frequent clinical situation as reason for hospital admission of older adults, although there is no consensus on criteria of the diagnostic approach. Our objective was to study whether thorax, abdomen and pelvis tomography is useful for the diagnosis and determination of a specific care pathway for hospitalized patients over 80 years old with alteration of the general state without identified clinical explanation. retrospective observational monocentric study at a French University Hospital, with the inclusion of all hospitalized patients who had a tomography following for alteration of general state without identified clinical explanation between January 2019 and June 2020. The primary endpoint was the presence of a diagnosis on the tomography report. We studied 48 files of patients (aged 86.2 ± 3.4 years on average). Tomography provided a diagnosis in 60.4% of cases. Factors significantly related to usefulness of tomography were weight loss and duration of weight loss. Among the diagnosed patients, specific actions were taken for 86.2% of them. Our study suggests that thoracic-abdominal-pelvic tomography is useful to examine the alteration of general state in older patients without identified clinical explanation, particularly for those presenting with unintentional weight loss. That suggests that it is probably preferable to use the correct symptoms description instead of alteration of general state.

Reduction of elective lymph node volume in radiotherapy of early anal squamous cell cancer: a comparative study between two Swedish university hospitals.

BACKGROUND: Anal squamous cell cancer (ASCC) in early stages (T1-2N0M0) is treated with chemoradiotherapy with a 3-year overall survival (OS) exceeding 90%. In Swedish guidelines, it has been optional to include the external iliac and presacral lymph node (LN) stations in radiotherapy (RT) treatment fields in early ASCC. Two Swedish hospitals treating ASCC (SU: Sahlgrenska University Hospital; UU: Uppsala University Hospital) have chosen different approaches since 2010. MATERIAL AND METHODS: This study included consecutive patients with early ASCC (T1-2N0M0) treated between 2010 and 2017 at both sites (SU n = 70; UU n = 46). Data were retrieved from medical records and RT charts. RESULTS: At SU, the external iliac and presacral LN stations were included in elective LN irradiation in 96.8% (n = 60) and 95.2% (n = 59) patients compared to 2.4% (n = 1) and 29.3% (n = 12) at UU. The mean elective LN volume was 2,313 cc (interquartile range [IQR] 1,951-2,627) in the SU cohort compared to 1,317 cc (IQR 1,192-1,528) in the UU cohort, p < 0.0001. No case of regional LN recurrence was seen in either cohort. Disease specific survival (DSS) at 5 years was 95.7% (confidence interval [CI] 90.1-100.0) in the SU cohort and 97.8% (CI 93.2-100.0) in the UU cohort (p 0.55). OS at 5 years was 84.5% (CI 76.1-93.0) in the SU cohort and 82.6% (CI 69.6-89.1) in the UU cohort (p 0.8). INTERPRETATION: We found no differences in regional recurrence, DSS or OS between the cohorts treated with different elective LN volumes. In this population-based study, reduction of RT volume in early ASCC did not lead to inferior outcome.

Managing CBRN mass casualty incidents at hospitals-Find a simple solution for a complex problem: A pilot study.

OBJECTIVE: Chemical, biological, radiological, and nuclear (CBRN) incidents are a major challenge for emergency medical services and the involved hospitals, especially if decontamination needs to be performed nearby or even within the hospital campus. The University Hospital Wuerzburg has developed a comprehensive and alternative CBRN response plan. The focus of this study was to proof the practicability of the concept, the duration of the decontamination process, and the temperature management. METHODS: The entire decontamination area can be deployed 24/7 by the hospitals technical staff. Fire and rescue services are responsible for the decontamination process itself. This study was designed as full-scale exercise with 30 participants. RESULTS: The decontamination area was ready for operation within 30 minutes. The decontamination of the four simulated patients took 5.5 ± 0.6 minutes (mean ± SD). At the end of the decontamination process, the temperature of the undressed upper body of the training patients was 27.25 ± 1°C (81.05 ± 2°F) (mean ± SD) and the water in the shower was about 35°C (95°F). CONCLUSION: The presented concept is comprehensive and simple for a best possible care during CBRN incidents at hospitals. It ensures wet decontamination by Special Forces, while the technical requirements are created by the hospital.

Predictors of neonatal mortality among neonates admitted to the neonatal intensive care unit at Hawassa University Comprehensive Specialized Hospital, Sidama regional state, Ethiopia.

BACKGROUND: Despite promising efforts, substantial deaths occurred during the neonatal period. According to estimates from the World Health Organization (WHO), Ethiopia is among the top 10 nations with the highest number of neonatal deaths in 2020 alone. This staggering amount makes it difficult to achieve the SDG (Sustainable Development Goals) target that calls for all nations to work hard to meet a neonatal mortality rate target of ≤ 12 deaths per 1,000 live births by 2030. We evaluated neonatal mortality and it's contributing factors among newborns admitted to the Neonatal Intensive Care Unit (NICU) at Hawassa University Comprehensive Specialized Hospital (HUCSH). METHODS: A hospital-based retrospective cross-sectional study on neonates admitted to the NICU from May 2021 to April 2022 was carried out at Hawassa University Comprehensive Specialized Hospital. From the admitted 1044 cases over the study period, 225 babies were sampled using a systematic random sampling procedure. The relationship between variables was determined using bivariate and multivariable analyses, and statistically significant relations were indicated at p-values less than 0.05. RESULTS: The magnitude of neonatal death was 14.2% (95% CI: 0.099-0.195). The most common causes of neonatal death were prematurity 14 (43.8%), sepsis 9 (28.1%), Perinatal asphyxia 6 (18.8%), and congenital malformations 3 (9.4%). The overall neonatal mortality rate was 28 per 1000 neonate days. Neonates who had birth asphyxia were 7.28 times more probable (AOR = 7.28; 95% CI: 2.367, 9.02) to die. Newborns who encountered infection within the NICU were 8.17 times more likely (AOR = 8.17; 95% CI: 1.84, 36.23) to die. CONCLUSION: The prevalence of newborn death is excessively high. The most common causes of mortality identified were prematurity, sepsis, perinatal asphyxia and congenital anomalies. To avert these causes, we demand that antenatal care services be implemented appropriately, delivery care quality be improved, and appropriate neonatal care and treatment be made available.

Barriers and facilitators of implementation of new antibacterial technologies in patient care: an interview study with orthopedic healthcare professionals at a university hospital.

BACKGROUND: Antimicrobial resistance is a major global health threat. Therefore, promising new antibacterial technologies that could minimize our dependence on antibiotics should be widely adopted. This study aims to identify the barriers and facilitators of the adoption of new antibacterial technologies in hospital patient care. METHODS: Semi-structured interviews, based on the Consolidated Framework for Implementation Research, were conducted with healthcare professionals related to the orthopedics department of an academic hospital in The Netherlands. RESULTS: In total, 11 healthcare professionals were interviewed. Scientific evidence for the effectiveness of the technology was the most explicitly mentioned facilitator of adoption, but other (often contextual) factors were also considered to be important. At the level of the inner and outer setting, high costs and lacking coverage, competition from other firms, and problems with ordering and availability were the most explicit perceived barriers to adoption. Participants did not collectively feel the need for new antibacterial technologies. CONCLUSIONS: Barriers and facilitators of the adoption of new antibacterial technologies were identified related to the technology, the hospital, and external factors. The implementation climate might have an indirect influence on adoption. New antibacterial technologies that are scientifically proven effective, affordable, and easily obtainable will most likely be adopted.

Development of a scoring system to quantify errors from semantic characteristics in incident reports.

OBJECTIVES: Incident reporting systems are widely used to identify risks and enable organisational learning. Free-text descriptions contain important information about factors associated with incidents. This study aimed to develop error scores by extracting information about the presence of error factors in incidents using an original decision-making model that partly relies on natural language processing techniques. METHODS: We retrospectively analysed free-text data from reports of incidents between January 2012 and December 2022 from Nagoya University Hospital, Japan. The sample data were randomly allocated to equal-sized training and validation datasets. We conducted morphological analysis on free text to segment terms from sentences in the training dataset. We calculated error scores for terms, individual reports and reports from staff groups according to report volume size and compared these with conventional classifications by patient safety experts. We also calculated accuracy, recall, precision and F-score values from the proposed 'report error score'. RESULTS: Overall, 114 013 reports were included. We calculated 36 131 'term error scores' from the 57 006 reports in the training dataset. There was a significant difference in error scores between reports of incidents categorised by experts as arising from errors (p<0.001, d=0.73 (large)) and other incidents. The accuracy, recall, precision and F-score values were 0.8, 0.82, 0.85 and 0.84, respectively. Group error scores were positively associated with expert ratings (correlation coefficient, 0.66; 95% CI 0.54 to 0.75, p<0.001) for all departments. CONCLUSION: Our error scoring system could provide insights to improve patient safety using aggregated incident report data.

Workload reduction through automated documentation in intensive and intermediate care - a monocentric observational study.

OBJECTIVE: The global coronavirus pandemic has placed an unprecedented and enormous burden on health systems worldwide. In addition to a shortage of resources, nurses were also confronted with high levels of sick leave and an increasing exodus from the profession. Automating documentation obligations is an effective way of reducing the burden on the workplace. PATIENTS AND METHODS: The study was conducted at a tertiary university hospital. The time required for the manual documentation of administered medication and dose changes of syringe and infusion pumps was recorded using the patient data management system (PDMS) representing all intensive and intermediate care wards (n = 6). Subsequently, all medication administration - grouped into five classes - was evaluated from January 1st, 2019, until December 31st, 2022. RESULTS: A total of 1,373,340 drug applications were studied, treating 32,499 patients. Data were obtained from ICUs (68%) and IMC wards (32%). This corresponds to an overall time of 2,901 ± 233 hours per year. Based on publicly known national rates for intensive care nurses, an annual financial expenditure of approximately 83,300 € (~ USD 89,300) per year was estimated. CONCLUSIONS: A non-negligible part of the daily working time in the medical sector is spent on documentation duties. This aggravates the high workload, which has increased in recent years. Automated documentation systems can lead to considerable relief and the possibility of focusing primarily on the patient and on other core competencies and activities. This is even more important, as available staff will be a key resource in patient care for the foreseeable future.

Core stories of physicians on a Swiss internal medicine ward during the first COVID-19 wave: a qualitative exploration.

INTRODUCTION: The first COVID-19 wave (2020), W1, will remain extraordinary due to its novelty and the uncertainty on how to handle the pandemic. To understand what physicians went through, we collected narratives of frontline physicians working in a Swiss university hospital during W1. METHODS: Physicians in the Division of Internal Medicine of Lausanne University Hospital (CHUV) were invited to send anonymous narratives to an online platform, between 28 April and 30 June 2020. The analysed material consisted of 13 written texts and one audio record. They were examined by means of a narrative analysis based on a holistic content approach, attempting to identify narrative highlights, referred to as foci, in the texts. RESULTS: Five main foci were identified: danger and threats, acquisition of knowledge and practices, adaptation to a changing context, commitment to the profession, and sense of belonging to the medical staff. In physicians' narratives, danger designated a variety of rather negative feelings and emotions, whereas threats were experienced as being dangerous for others, but also for oneself. The acquisition of knowledge and practices focus referred to the different types of acquisition that took place during W1. The narratives that focused on adaptation reflected how physicians coped with W1 and private or professional upheavals. COVID-19 W1 contributed to revealing a natural commitment (or not) of physicians towards the profession and patients, accompanied by the concern of offering the best possible care to all. Lastly, sense of belonging referred to the team and its reconfiguration during W1. CONCLUSIONS: Our study deepens the understanding of how physicians experienced the pandemic both in their professional and personal settings. It offers insights into how they prepared and reacted to a pandemic. The foci reflect topics that are inherent to a physician's profession, whatever the context. During a pandemic, these foundational elements are particularly challenged. Strikingly, these topics are not studied in medical school, thus raising the general question of how students are prepared for the medical profession.

[Respiratory infections: when a horse is actually a zebra]. / Infections respiratoires : quand un cheval est en fait un zèbre.

While most episodes of community-acquired pneumonia are caused by Streptococcus pneumoniae and respiratory viruses, other atypical pathogens can also be responsible for lung infections. The Infectious Diseases Service of the Lausanne University Hospital (CHUV) organizes an annual meeting aimed at general practitioners, during which interesting clinical cases are presented. In this article, we summarize five cases of community-aquired respiratory infection due to atypical pathogens that were presented during the 2023 meeting, each with a particular teaching point. Although these infections are rare, expanding the differential diagnosis in cases of suboptimal response to therapy or particular exposures is warranted.

La plupart des épisodes de pneumonie acquise en communauté sont causés par Streptococcus pneumoniae et des virus respiratoires, mais d'autres agents pathogènes atypiques peuvent également être responsables d'infections pulmonaires. Le Service des maladies infectieuses du Centre hospitalier universitaire vaudois (CHUV) organise une réunion annuelle destinée aux médecins généralistes, au cours de laquelle des cas cliniques intéressants sont présentés. Dans cet article, nous résumons cinq cas d'infections respiratoires communautaires dus à des agents pathogènes atypiques présentés lors de la réunion de 2023, chacun avec un enseignement particulier. Bien que ces infections soient rares, élargir le diagnostic différentiel en cas de réponse thérapeutique suboptimale ou d'expositions particulières est justifié.

Optimizing remote and rural prehospital resources using air transport of thrombectomy candidates.

BACKGROUND: In Finland, the yearly number of mechanical thrombectomies for acute stroke is increasing and more patients are transported over 100 km to the comprehensive stroke centre (CSC) for definitive care. This leaves the rural townships without immediate emergency medical services (EMS) for hours. In this study we compare the EMS' estimated return times to own station after the handover of a thrombectomy candidate between two transport methods: (1) using ground transportation with an ambulance to the CSC or (2) using a hydrid strategy starting the transportation with an ambulance and continuing by air with a helicopter emergency medical services unit (HEMS). METHODS: We reviewed retrospectively all thrombectomy candidates' transportations from the hospital district of South Ostrobothnia to definitive care at the nearest CSC, Tampere University Hospital from June 2020 to October 2022. The dispatch protocol stated that a thrombectomy candidate's transport begins immediately with an ambulance and if the local HEMS unit is available the patient is handed over to them at a rendezvous. If not, the patient is transported to the CSC by ground. Transport times and locations of the patient handovers were reviewed from the CSC's EMS database and the driving time back to ambulance station was estimated using Google maps. The HEMS unit's pilot's log was reviewed to assess their mission engagement time. RESULTS: The median distance from the CSC to the ambulances' stations was 188 km (IQR 149-204 km) and from the rendezvous with the HEMS unit 70 km (IQR 51-91 km, p < 0.001). The estimated median driving time back to station after the patient handover at the CSC was 145 min (IQR 117-153 min) compared to the patient handover to the HEMS unit 53 min (IQR 38-68 min, p < 0.001). The HEMS unit was occupied in thrombectomy candidate's transport mission for a median of 136 min (IQR 127-148 min). CONCLUSION: A hybrid strategy to transport thrombectomy candidates with an ambulance and a helicopter reallocates the EMS resources markedly faster back to their own district.

SARS-CoV-2 seroprevalence among healthcare workers in a highly vaccinated Japanese medical center from 2020-2023.

Infection-induced SARS-CoV-2 seroprevalence has been studied worldwide. At Juntendo University Hospital (JUH) in Tokyo, Japan, we have consistently conducted serological studies using the blood residue of healthcare workers (HCWs) at annual health examinations since 2020. In this 2023 study (n = 3,594), N-specific seroprevalence (infection-induced) was examined while univariate and multivariate logistic regression analyses were performed to compute ORs of seroprevalence with respect to basic characteristics of participants. We found that the N-specific seroprevalence in 2023 was 54.1%-a jump from 17.7% in 2022, and 1.6% in 2021-with 37.9% as non-PCR-confirmed asymptomatic infection cases. Those younger than 50 (adjusted OR = 1.62; p < .001) and recipients with 4 doses or less of vaccine had a higher risk to be N-positive, ranging from 1.45 times higher for the participants with 4 doses (p < .001) to 4.31 times higher for the participants with 1 dose (p < .001), compared to those with 5 or more doses. Our findings indicate that robust vaccination programs may have helped alleviate symptoms but consequently caused asymptomatic spread in this hospital, especially among younger HCWs. Although having four doses or less was found to be associated with higher risk of infection, the optimal constitution and intervals for effective booster vaccines warrant further investigations.

Functional Disability and Social Support in Older Patients attending Chief Tony Anenih Geriatrics Center (CTAGC) University College Hospital, Ibadan Southwestern, Nigeria.

BACKGROUND: Beyond clinical evaluation, additional significant areas of well-being for older people include the emotional, social, material, and functional domains. OBJECTIVES: The study assessed the functional status and its relationship with social support of older patients attending the Geriatric Centre, UCH. METHODOLOGY: A cross-sectional study of 396 randomly selected patients aged 65 years and above was undertaken to assess their functional status (by scoring their basic activities of daily living using the Barthel index) and social support (using the Multidimensional scale of perceived social support). An interviewer-administered questionnaire was used to obtain the socio-demographic data, anthropometric measurements, and morbidities of each patient. Data collected was analysed using the Statistical Package for Social Sciences (SPSS) version 20. The level of significance of analysis was set at p ≤0.05. RESULTS: Participants in the study had a male-to-female ratio of 1:1.6, and their mean age (SD) was 73.2 ± 6.3 years. Functional dependency was seen in 87.4% of cases. Majority of older patients (81.1%) expressed a moderate perception of social support. The Most common morbidities among the responders were osteoarthritis, cataracts, and hypertension. Functional dependency was found to increase with an increase in family and romantic partner social support, high educational levels, and increased age. {adjusted odds ratio (AOR):1.05;95%confidence interval [CI]:1.00-1.11. (P=0.049) The odds of being functionally dependent were higher for respondents who received at least 30,000 naira ($100) in financial support from their children (AOR:2.24; 95% CI:1.06-4.77) (P=0.022). CONCLUSION: This study showed that functional dependency worsened with increased social support in older patients. The results indicated the need for a multi-factorial evaluation of functional dependence in older patients.

CONTEXTUALISATION: Au-delà de l'évaluation clinique, d'autres domaines importants du bien-être des personnes âgées comprennent les aspects émotionnels, sociaux, matériels et fonctionnels. OBJECTIFS: L'étude a évalué l'état fonctionnel et le soutien social des patients âgés fréquentant le Centre Gériatrique de l'UCH. MÉTHODOLOGIE: Une étude transversale portant sur 396 patients sélectionnés de manière aléatoire, âgés de 65 ans et plus, a été réalisée pour évaluer leur état fonctionnel (en évaluant leurs activités de base de la vie quotidienne à l'aide de l'indice de Barthel) et leur soutien social (à l'aide de l'échelle multidimensionnelle du soutien social perçu). Un questionnaire administré par un enquêteur a été utilisé pour obtenir les données sociodémographiques, les mesures anthropométriques et les morbidités de chaque patient. Les données recueillies ont été analysées à l'aide du logiciel Statistical Package for Social Sciences (SPSS) version 20. Le niveau de signification de l'analyse a été fixé à p ≤0,05. RÉSULTATS: Les participants à l'étude présentaient un ratio hommes-femmes de 1 pour 1,6, et leur âge moyen (écart type) était de 73,2 (6,3) ans. Une dépendance fonctionnelle a été observée chez 87,4 % des cas. La majorité des patients âgés (81,1 %) ont exprimé une perception modérée du soutien social. Les morbidités les plus courantes parmi les répondants étaient l'arthrose, la cataracte et l'hypertension. Une dépendance fonctionnelle a été constatée pour augmenter avec l'augmentation du soutien social de la famille et du partenaire romantique, les niveaux d'éducation élevés et l'âge accru {rapport de cotes ajusté (AOR) : 1,05 ; intervalle de confiance à 95 % [IC] : 1,00-1,11}(P=0.049). Les chances de dépendance fonctionnelle étaient plus élevées pour les personnes qui recevaient au moins 30 000 nairas (100 $) de soutien financier de leurs enfants (AOR : 2,24 ; IC à 95 % : 1,06-4,77)(P=0.022). CONCLUSION: Cette étude a montré une prévalence élevée de la dépendance fonctionnelle et du soutien social chez les patients âgés. Les résultats ont indiqué la nécessité d'une évaluation multifactorielle de la dépendance fonctionnelle chez les patients âgés. MOTS-CLÉS: Incapacité fonctionnelle, Soutien social, Patients âgés, Gériatrie.

A dangerous tradition: retrospective analysis of celebratory gunfire-related injuries in three tertiary hospitals.

BACKGROUND: Firing guns into the air during celebrations is a tradition that poses significant risks to public safety. These falling bullets, often referred to as tired bullets, can attain high velocities during their descent and have the potential to cause serious injury or death to people and animals, or significant damage to property upon impact. METHODS: This study aimed to retrospectively detect and analyze incidents of celebratory gunfire-related injuries (CGRI) that were admitted to three different hospitals in two cities in Turkey over a 10-year period from 2014 to 2023. RESULTS: Data collected from Trabzon Kanuni Training and Research Hospital, Karadeniz Technical University Faculty of Medicine Farabi Hospital, and Yeditepe University Kozyatagi Hospital revealed 48 cases of injuries attributed to celebratory gunfire. Of these cases, 64.6% involved male victims. Children aged 0-17 years were the most affected demographic, with the head, neck, and face being the most frequently injured areas. The majority of incidents occurred in rural areas. Eight cases (16.7%) resulted in fatalities. The reasons for gunfire in 43.8% of the cases could not be determined. CONCLUSION: Sociologically, gun ownership is often associated with prestige and can trigger the use of firearms in celebrations, such as weddings, in some societies. However, this tradition can result in tragic consequences worldwide. Stricter regulations and legal frameworks are necessary to prevent the use of unlicensed weapons. Collaborative efforts are crucial for effectively addressing the societal normalization of celebratory gunfire. Future prospective studies can comprehensively evaluate the incidence of CGRI and identify effective preventive strategies to safeguard public health.

Use of unlicensed drugs in a Swiss Pediatric University Hospital and associated prescribing error rates - a retrospective observational study.

AIMS OF THE STUDY: Unlicensed drugs are frequently used in paediatric care. To what extent they are prescribed in hospital care in Switzerland is unclear. Because prescribing errors seem to occur more frequently with unlicensed drugs, we aimed to assess the prevalence of unlicensed drug prescriptions in two study periods (2018 and 2019) at the University Children's Hospital Zurich, compare these periods and investigate whether unlicensed drugs were more prone to prescribing errors than licensed drugs. METHODS: We conducted a sub-analysis of a retrospective single-centre observational study and analysed 5,022 prescriptions for a total of 1,000 patients from 2018 and 2019 in paediatric general wards. The rate of unlicensed drugs, consisting of imported or formula drugs, was investigated. The prescriptions from 2019 were further analysed on prescribing errors to see whether errors occurred more often in unlicensed or licensed drug use. RESULTS: Of all prescriptions, 10.8% were unlicensed drugs, with around half each being imported and formula drugs. Among all patients, 34% were prescribed at least one unlicensed drug. Younger paediatric patients were prescribed more unlicensed drugs than older paediatric patients (newborns: 15.8% of prescriptions, infants: 13.4%, children: 10.6%, adolescents: 7.1%). Ibuprofen suppositories, midazolam oral solution and gentamicin i.v. solution were the most frequently prescribed imported drugs. Macrogol powder, lisinopril oral suspension and potassium chloride i.v. solution were the most frequently prescribed formula drugs. The most common drug forms in unlicensed use were oral liquid forms and i.v. SOLUTIONS: Unlicensed drugs had a significantly higher rate of prescribing errors than licensed drugs (31.6 errors per 100 prescriptions [95% CI: 26.1-37.0] versus 24.3 errors per 100 prescriptions [95% CI: 22.3-26.2], p = 0.024). In particular, formula drugs carried a higher risk (36.4 errors per 100 prescriptions, p = 0.012). CONCLUSIONS: Unlicensed drugs are frequently prescribed in this paediatric hospital setting in Switzerland. Around every tenth prescription is an unlicensed drug. Because unlicensed drugs showed a significantly higher rate of prescribing errors, licensed drugs are favourable in terms of medication safety and should be prescribed whenever possible. If no licensed drug is available, imported drugs should be favoured over formula drugs due to lower prescribing error rates. To increase medication safety in paediatrics in Switzerland, efforts are necessary to increase the number of suitable licensed drug formulations for paediatric patients, including developing new innovative drug formulations for children.

Adherence to Medications in Patients with Ischaemic Heart Disease in Oman.

Objectives: This study aimed to evaluate the level of adherence to medication among patients with ischaemic heart disease (IHD) in Oman and assess the related factors. Methods: This cross-sectional questionnaire-based study among patients with IHD attending the outpatient clinic at Sultan Qaboos University Hospital, Muscat, Oman, was performed between January and December 2021. Results: A total of 105 patients (mean age = 49.9 ± 11.1 years, 78.1% male) were recruited. Most of the patients (80%) reported taking the medications by themselves; 77 (73.3%) patients said that over the preceding 2 weeks, they had missed at least 3 doses of their medication. The reasons for missing the medications included forgetting (100%), having to take too many tablets (57%), feeling that the tablets are not effective (48%) and having to take the tablets too often each day (23%). The factors responsible for patients failing to take medications could not be identified. Conclusion: Medication adherence was low among patients with IHD in Oman, with high pill burden being the most common reason for non-adherence. Physicians must bear this in mind when reviewing patients.

Factors Affecting the Early Maturation of Arteriovenous Fistulae Created at a Tertiary Centre in Oman.

Objectives: This study aimed to determine the risk factors associated with the failure of arteriovenous fistulae (AVF) maturation. Methods: This retrospective cohort study was conducted from January 2014 to December 2018 in Sultan Qaboos University Hospital, Muscat, Oman. Patients were followed-up 3 months after surgery, and their electronic medical records were accessed for demographic and clinical data. Univariate analysis was used to determine the risk factors associated with early AVF maturation and multivariant analysis was used to determine the predictive factors for AVF failure. Results: A total of 269 patients were included. Female gender was a significant factor affecting AVF maturity (P = 0.049), while age (P = 0.626), diabetes (P = 0.954), hypertension (P = 0.378), dyslipidaemia (P = 0.907), coronary artery disease (P = 0.576), cerebrovascular accident (P = 0.864), congestive heart failure (P = 0.685), previous central venous catheterisation (P = 0.05), fistula type (P = 0.863) and fistula site (P = 0.861) did not affect AVF maturation. Binary logistic regression showed that all the risk factors were insignificant. Failure of early AVF maturation affected 11.5% in the cohort. Conclusion: This study found that the proportion of early AVF maturation at our hospital is at par with that in the international literature. Failure of AVF maturation was significantly associated with the female gender. These findings can help nephrologists and vascular surgeons prognosticate AVF maturation rates. However, a larger study is needed for definitive conclusions.

Risk factors for acquiring BMR infections: Analytical study.

INTRODUCTION: In recent years, there has been a considerable increase in the prevalence of bacteria increasingly resistant to multiple families of antibiotics, which constitutes a major problem for public health. AIM: To determine the prevalence and different risk factors for the acquisition of multi-resistant bacteria. METHODS: This is an analytical and prospective study including patients hospitalized in the Batna University Hospital during the period from January 2023 to March 2023 presenting a documented infection with isolation of sensitive or multi-resistant strains. An operating sheet based on the different risk factors for acquiring multi-resistant bacteria has been established. RESULTS: We collected 250 patients. There are 160 men and 90 women with an average age of 44 years. Of all the strains that were identified, 100 isolates were multi-resistant bacteria. ESBL-producing Enterobacteriaceae are the most frequently isolated multi-resistant bacteria. Multivariate logistic regression analysis identified four risk factors that are significantly related to the risk of acquiring multi-resistant bacteria infection: prior antibiotic therapy [P = 0,029], use of invasive medical care [P = 0,024], the nosocomial origin of the infection [P = 0,036] and the use of public toilets [P = 0,015]. CONCLUSION: Our results clearly demonstrate that the inappropriate use of antibiotics, especially broad-spectrum antibiotics, and hand-held cross-transmission play a major role in the spread of multi-resistant bacteria in our hospital.

A comparison between centralized and asynchronous federated learning approaches for survival outcome prediction using clinical and PET data from non-small cell lung cancer patients.

BACKGROUND AND OBJECTIVE: Survival analysis plays an essential role in the medical field for optimal treatment decision-making. Recently, survival analysis based on the deep learning (DL) approach has been proposed and is demonstrating promising results. However, developing an ideal prediction model requires integrating large datasets across multiple institutions, which poses challenges concerning medical data privacy. METHODS: In this paper, we propose FedSurv, an asynchronous federated learning (FL) framework designed to predict survival time using clinical information and positron emission tomography (PET)-based features. This study used two datasets: a public radiogenic dataset of non-small cell lung cancer (NSCLC) from the Cancer Imaging Archive (RNSCLC), and an in-house dataset from the Chonnam National University Hwasun Hospital (CNUHH) in South Korea, consisting of clinical risk factors and F-18 fluorodeoxyglucose (FDG) PET images in NSCLC patients. Initially, each dataset was divided into multiple clients according to histological attributes, and each client was trained using the proposed DL model to predict individual survival time. The FL framework collected weights and parameters from the clients, which were then incorporated into the global model. Finally, the global model aggregated all weights and parameters and redistributed the updated model weights to each client. We evaluated different frameworks including single-client-based approach, centralized learning and FL. RESULTS: We evaluated our method on two independent datasets. First, on the RNSCLC dataset, the mean absolute error (MAE) was 490.80±22.95 d and the C-Index was 0.69±0.01. Second, on the CNUHH dataset, the MAE was 494.25±40.16 d and the C-Index was 0.71±0.01. The FL approach achieved centralized method performance in PET-based survival time prediction and outperformed single-client-based approaches. CONCLUSIONS: Our results demonstrated the feasibility and effectiveness of employing FL for individual survival prediction in NSCLC patients, using clinical information and PET-based features.