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1.
Afr Health Sci ; 22(Spec Issue): 63-67, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36321126

RESUMO

Academic Health Centers provide a network of clinical training facilities for high quality service delivery, within clinical training and research settings. At an academic health/medical center, education, research, and clinical care are combined to provide the best possible clinical care, which uses cutting-edge technologies, resources and therapies other community hospitals may not have available. This paper summarizes the network of teaching hospitals for health care training in the last century of Makerere University College of Health Sciences, its local and regional impact, lessons learned and future of actively engaging the network of academic health centers to expand clinical training and research opportunities to meet the needs of the 21st Century populations. Medical schools and training hospitals need to integrate of their roles in research, education, and patient care to provide evidence-based interventions and innovations to both treat illness and improve health.


Assuntos
Serviços de Saúde , Faculdades de Medicina , Humanos , Universidades , Hospitais de Ensino , Atenção à Saúde
2.
JBI Evid Implement ; 20(3): 209-217, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36373359

RESUMO

INTRODUCTION: The first case of the novel coronavirus disease (COVID-19) in Iran was officially announced on February 19, 2020, in Qom city. The prevalence of COVID-19 is higher among frontline healthcare workers (HCWs) due to their occupational exposure. OBJECTIVE: The aim of this evidence implementation project was to improve the protection of nurses against COVID-19 in the emergency department of a teaching hospital in Tabriz, Iran. METHODS: A clinical audit was undertaken using the JBI Practical Application of Clinical Evidence System (JBI PACES) tool. Ten audit criteria, representing the best practice recommendations for the protection of HCWs in the emergency department were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to evaluate changes in practice. RESULTS: The baseline audit results showed that the compliances for four (out of ten) audit criteria (criteria 4, 7, 8 and 9), were under 75%, which indicated poor and moderate compliance with the current evidence. After implementing plans such as running educational programs and meetings, major improvement was observed in 3 criteria, criterion 4 was improved from low to excellent (41-81%), criterion 7 was promoted from low to moderate (30-62%), criterion 8 was not promoted considerably (22-27%) and criterion 9 was improved from moderate to excellent (70-84%). CONCLUSION: The results of the audit process increased COVID-19 protection measures for nurses in the emergency department. It can be concluded that educational programs and tools, such as face-to-face training, educational pamphlets, workshops and meetings can facilitate the implementation of evidence into practice.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Prática Clínica Baseada em Evidências , Irã (Geográfico)/epidemiologia , Serviço Hospitalar de Emergência , Pessoal de Saúde , Hospitais de Ensino
3.
Rev Gaucha Enferm ; 43: e20210286, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-36350967

RESUMO

OBJECTIVE: To assess the satisfaction of puerperal women regarding labor and childbirth. METHOD: Analytical and cross-sectional research carried out with puerperal women at a teaching hospital. Data were collected from October to December 2020 by a sociodemographic and obstetric questionnaire and the Mackey Childbirth Satisfaction Rating Scale. The scale has 34 items divided into six domains, with a minimum score of 34 and a maximum of 170 points. RESULTS: The mean score was 141 points in a sample of 243 puerperal women, with a standard deviation of 16.8. There was high satisfaction among women in all domains of the scale and low adherence to the best practices in labor and childbirth care currently recommended. CONCLUSION: The women were satisfied upon the experience. The limitation of the health education process during prenatal care may reduce the parturient' discernment and critical judgment.


Assuntos
Satisfação do Paciente , Satisfação Pessoal , Gravidez , Feminino , Humanos , Estudos Transversais , Parto , Parto Obstétrico , Hospitais de Ensino , Inquéritos e Questionários
4.
Arch Argent Pediatr ; 120(6): 422-428, 2022 Dec.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-36374069

RESUMO

In order to explore whether there is a correlation between the learning climate (LC) and the selfperception of empathy by medical residents, we conducted an observational, cross sectional study in a teaching hospital using the D-RECT (Dutch Residency Educational Climate Test) and the Jefferson scale (empathy) in 140 residents from 9 specialties during 2019 and 2020. We documented a low to moderate and statistically significant correlation (Spearman's Rho: 0.34, p<0.0001) between both scores, with an acceptable reliability for both instruments (> 0.7). For every 10-point difference in the D-RECT scale, an average difference of 1.80 points in the Jefferson Scale was observed. This study provides new evidence regarding the correlation between the learning climate and self-perceived medical empathy during the residency program. Our findings suggest a trend that should be further studied in the future.


Con el objetivo de explorar si existe correlación entre el clima de aprendizaje (CA) y la propia empatía percibida por residentes médicos, realizamos en un hospital universitario un estudio observacional de corte transversal, utilizando las escalas D-RECT (evaluación del clima educacional) y Jefferson (empatía), en el que participaron 140 residentes de 9 especialidades durante 2019 y 2020. Documentamos una correlación baja-moderada y estadísticamente significativa (Spearman´s rho: 0,34 p<0,0001) entre ambos puntajes, con una confiabilidad aceptable de ambos instrumentos (>0,7). Por cada 10 puntos de diferencia en la escala D-RECT, observamos una diferencia promedio de 1,80 puntos en la escala Jefferson. Este trabajo aporta nuevos indicios respecto a la correlación entre el clima de aprendizaje y la empatía médica autopercibida durante la residencia. Nuestros hallazgos sugieren una tendencia que debería ser investigada con mayor profundidad en el futuro.


Assuntos
Internato e Residência , Humanos , Estudos Transversais , Empatia , Reprodutibilidade dos Testes , Hospitais de Ensino , Autoimagem
5.
J Ayub Med Coll Abbottabad ; 34(3): 515-518, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36377167

RESUMO

BACKGROUND: Folic acid deficiency is one of the most common deficiencies among women of childbearing age. It can lead to neural tube defects, a significant cause of disability and mortality among infants. Therefore, the main objective of this study was to determine a folic acid deficiency in women of childbearing age in Ayub Teaching Institute, Abbottabad. METHODS: This cross-sectional study was carried out in Ayub Teaching Institute, Abbottabad from January to June 2020. In this study, a total of 193 women of childbearing age were included through consecutive sampling. RESULTS: In this study 193 women of childbearing age were included. Mean age was 30±4.87 years. Out of 193 patients, 56.7% were found to be anemic and 38.9%were found to have folic acid deficiency. CONCLUSIONS: Our study concludes that the majority of women of child bearing age are anemic in our set up. Moreover, the frequency of folic acid deficiency is 38.9 % which is high.


Assuntos
Deficiência de Ácido Fólico , Humanos , Lactente , Feminino , Adulto , Deficiência de Ácido Fólico/epidemiologia , Estudos Transversais , Hospitais de Ensino
6.
BMC Med Educ ; 22(1): 785, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36376824

RESUMO

BACKGROUND: Evidence-based medicine (EBM) is to integrate the best research evidence with our clinical expertise, circumstances, and unique values of our patient. However, there are no studies about using EBM in clinical practice among resident doctors in Syria. In this study, we aimed to evaluate the self-reported knowledge, attitude and practice (KAP) of EBM by resident doctors throughout different teaching hospitals in Syria. METHODS: The study is a cross-sectional. A self-reported online questionnaire was used to collect data about KAP of EBM from 214 resident physicians working in secondary and tertiary teaching hospitals. The study was conducted between September 2021 and February 2022. All data were analyzed using SPSS, and non-parametric statistical tests were used to identify the correlation between different variables and make the necessary comparisons. RESULTS: Two hundred and fourteen physicians responded to the questionnaire with a response rate of 85.6%. The overall mean scores of KAP of EBM were 59.2, 74.3 and 53.9%, respectively. The participants displayed a low level of awareness of resources and statistical terms used in EBM. The most well-known resources for residents were Up To Date and PubMed. Among the participants, pediatric residents achieved the highest score in practicing EBM, while family medicine residents scored the lowest score. CONCLUSION: The overall impression about the KAP of EBM among Syrian residents was as following: weak awareness, neutral attitude and poor practice of EBM. Training workshops should be set up to teach residents the skills needed to move from opinion-based practice to evidence-based practice.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Médicos , Humanos , Criança , Estudos Transversais , Atitude do Pessoal de Saúde , Síria , Medicina Baseada em Evidências , Inquéritos e Questionários , Hospitais de Ensino
7.
Artigo em Inglês | MEDLINE | ID: mdl-36360667

RESUMO

In the healthcare environment, more and more people experience work-related stress. The Faculty of Medicine and Dentistry of Sapienza University of Rome, having observed the need to take care of healthcare professionals, has set itself the objective of providing useful tools such as additional and necessary personal protective equipment for healthcare professionals. OBJECTIVE: To promote health through better management, skills, and the use of strategies and solutions to identify, decompress, and neutralize those responsible for work-related stress mechanisms in order to take care of those who care (CURARE CURANTES). MATERIALS AND METHODS: A randomized controlled clinical trial was conducted. The participants were enrolled by three departments of the Department of Dental and Maxillofacial Sciences of Rome; in consideration of emotional involvement of health professionals who work there. A motivational program was offered. RESULTS: There were 17 and 16 healthcare professionals in the intervention and control groups, respectively. Levels of the mental composite score (MCS) varied both in the pre-post phase of the intervention group (p = 0.002), and between the intervention group and control group in the post phase (p = 0.006). No significant differences were observed for the physical composite score (PCS). Similarly, there were no significant differences regarding the positivity scale (PS) and the two dimensions of work-related stress (job demand and decision latitude). CONCLUSION: This study demonstrates the efficacy of yoga training practiced directly in the workplace and wearing work clothes, entering the work context, not weighing further on the healthcare workload, and being a way to carry out physical activity even in those cases in which professionals do not have the time to do it in their free time.


Assuntos
Estresse Ocupacional , Qualidade de Vida , Humanos , Promoção da Saúde , Cidade de Roma , Estresse Ocupacional/prevenção & controle , Estresse Ocupacional/psicologia , Hospitais de Ensino , Atenção à Saúde , Assistência Odontológica
8.
Artigo em Inglês | MEDLINE | ID: mdl-36360987

RESUMO

Since FY 2013, as a part of the Affordable Care Act (ACA) program, the Hospital Value-Based Purchasing (HVBP) program has adjusted Medicare's payments to hospitals based on the total performance score of the hospital. First, the program reduces a portion of the hospital's Medicare payments in a specific fiscal year, and then, by the end of the same fiscal year, the amount of the payment reductions will be awarded to the hospitals based on the total performance score; thus, the hospitals that do not receive the reward will lose the portion of money reduced by Medicare. In this research, we apply the theory of state dependence and use the dynamic random effect probit model to estimate this effect. The results show that the hospital payment adjustment dynamics have a very significant state dependence effect (0.341); this means that hospitals that received a reward in the previous year are 34.1% more likely to receive a reward this year than the ones that received a penalty in the previous year. Meanwhile, we also find that the state dependence effect varies significantly across hospitals with different ownership (proprietary/government owned/voluntary nonprofit), and the results show that voluntary nonprofit hospitals exhibit the largest effect of state dependence (0.370), while government-owned hospitals exhibit the lowest effect of state dependence (0.293), and proprietary hospitals are in the middle. Among the factors that influence the likelihood that a hospital receives a reward, we find that teaching hospitals with a large number of beds (>400) are less likely be rewarded; in terms of ownership, we find that voluntary nonprofit hospitals are more likely be rewarded; in terms of demographic factors, hospitals where the average household income are higher within the region are more likely be rewarded.


Assuntos
Sistema de Pagamento Prospectivo , Estados Unidos , Medicare , Patient Protection and Affordable Care Act , Hospitais de Ensino
9.
BMC Psychiatry ; 22(1): 716, 2022 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-36397028

RESUMO

INTRODUCTIONS: This study assessed the prevalence of cognitive impairment, the degree of impairment in individual cognitive domains and sociodemographic and clinical correlates among patients attending to psychiatry clinics at Teaching Hospital, Karapitiya, Sri Lanka. METHODS: A cross-sectional study was carried out at the psychiatry outpatient clinics of Teaching Hospital, Karapitiya, Sri Lanka. Their cognitive functions were assessed using the culturally validated Sinhala version of Addenbrooke's Cognitive Examination - III (ACE-III-S). ACE-III-S score below 85.5 was considered as significant cognitive impairment. Linear regression analysis was used to assess the factors associated with cognitive impairment. A P value of 0.05 is considered significant. RESULTS: One hundred forty patients with schizophrenia were assessed. Of this, 125 patients had significant cognitive impairment with a prevalence of 89.3% (95% CI:84.1-94.5). Impairment in each cognitive domain was as follows: 60% in attention, 65.7% in memory, 55% in fluency, 61.4% in language, and 63.6% in visuospatial skills. Impairment was not different between cognitive domains. Advancing age (P < 0.001), shorter duration of formal education (P = < 0.001), longer duration of illness (P = < 0.001) and not having a full-time employment (P = 0.020) showed a positive association with cognitive impairment. CONCLUSIONS: Nine out of ten patients with schizophrenia experienced significant cognitive impairment. Patients showed more than 50% impairment in all cognitive domains. The cognitive domains did not show disproportionate impairment. This study highlights the importance of introducing routine cognitive assessment protocols in patients with schizophrenia.


Assuntos
Disfunção Cognitiva , Esquizofrenia , Humanos , Esquizofrenia/complicações , Esquizofrenia/epidemiologia , Estudos Transversais , Testes Neuropsicológicos , Prevalência , Sri Lanka/epidemiologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/complicações , Hospitais de Ensino
10.
Womens Health (Lond) ; 18: 17455057221135493, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36411961

RESUMO

BACKGROUND: Prevalence of non-communicable diseases (NCDs) is increasing with women affected at an early age. The Mini Female Health Program (MFHP) is a simple screening package to detect NCDs in women. OBJECTIVE: Determine the prevalence of selected NCDs in a hospital-based outpatient setting using MFHP. METHODS: A cross-sectional observational study was conducted in an urban teaching hospital in India. MFHP included medical history, physical examination and investigations. NCDS of interest included anaemia, thyroid disorders, hypertension, diabetes, and obesity. Analysis was performed on groups stratified by age groups (18-30, 31-40 and > 41 years). Between group comparison and association of hypertension with other variables was undertaken. RESULTS: Final analysis included 468 women, of whom 49.8%, 29.9%, and 20.3% were between 18-30, 31-40, and >41 years, respectively. Central obesity was most common NCD (waist to height ratio (WHR) > 0.5 (72.7%), waist circumference (WC) > 80 cm (62.7%)) followed by generalized obesity (body mass index (BMI) > 25 kg/m2 (52.4%)), anaemia (52.6%), thyroid disorders (27.4%), hypertension (14.1%) and diabetes (5.1%). Half of the women between 18 and 30 years were either overweight (BMI: 23-25 kg/m2) or obese. Increasing age was associated with a significant increase in the prevalence of hypertension, diabetes, thyroid disorders and obesity, but not anaemia. Only 9.8% of women were without an NCD with 17.3% having one NCD and 72.8% reporting multiple NCDs. Hypertension was strongly associated with age and WHR in multivariate regression analysis. CONCLUSION: The MFHP has highlighted the high prevalence of NCDs in women, particularly in young women demonstrating the value of simple screening programme in routine clinical care.


Assuntos
Diabetes Mellitus , Hipertensão , Doenças não Transmissíveis , Feminino , Humanos , Adulto , Doenças não Transmissíveis/epidemiologia , Estudos Transversais , Fatores de Risco , Índia/epidemiologia , Obesidade/epidemiologia , Obesidade/complicações , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Hospitais de Ensino
11.
Ann Med ; 54(1): 2921-2928, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36371797

RESUMO

BACKGROUND: The burden of Sickle cell anaemia (SCA) is huge in Sub Sahara Africa as it affects 1-2% of the population. HbSS impacts negatively on the quality of life of the sufferers. The clinical manifestations start between 3 and 5 months of life as a result of reduction in foetal hemoglobin. OBJECTIVES: This study describes the clinical and laboratory characteristics of HbSS patients at presentation in steady state, vaso-occlusive and hemolytic crises states. MATERIAL AND METHOD: This was a cross sectional, analytical study. Ninety HbSS participants were divided into three groups; steady state, hemolytic and vaso-occlusive crises with 30 individuals in each group. The survey contained sections on bio-data and past medical history obtained from the patients' notes and results of laboratory tests. Data were analysed using SPSS version 23.0. Results were considered statistically significant if p < 0.05. RESULTS: Ninety participants were analysed in this study. The mean age of the participants was 29.4 ± 8.9 years. Only one-third of the participants were diagnosed within the first year of age. Forty-seven (52.2%) participants have steady state haematocrit in the range of 21-25%. All the participants experienced bone pain in a year, about 25% of these participants had more than three episodes of pain per year. There was a statistically significant difference in the mean values of PCV (p < .001), WBC (p < .001), platelet (p = .008), ANC (p < .001), ALC (p < .001), AMC (p < .001), reticulocyte count and ISC % among the different categories. CONCLUSION: This study established the fact that only a minority of the SCD patients are diagnosed in the first year of life and vaso-occlusive crisis is the most frequent reason for hospital presentation. We therefore recommend the institutionalisation by government policy, neonatal screening programme in Nigeria.KEY MESSAGESThe study highlight delay in early diagnosis of SCA due to unavailability of neonatal diagnosis program in our setting.Bone pain remains the major cause of presentation for SCA and most patients presented after a day of onset of pain to the hospital.


Assuntos
Anemia Falciforme , Hemoglobina Falciforme , Recém-Nascido , Humanos , Adulto Jovem , Adulto , Nigéria/epidemiologia , Estudos Transversais , Qualidade de Vida , Anemia Falciforme/complicações , Anemia Falciforme/diagnóstico , Anemia Falciforme/epidemiologia , Hospitais de Ensino , Dor
12.
BMJ Open Qual ; 11(4)2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36400722

RESUMO

INTRODUCTION: University Hospitals of Leicester (UHL) has co-developed and deployed a novel Electronic Prescribing and Medicines Administration (EPMA) application as part of the trust electronic patient record (EPR) programme that meets specific clinical demands and interoperability standards of the National Health Service (NHS) despite clinical pressures from the COVID-19 pandemic. METHODS: Following an initial limited pilot deployment, a big-bang whole site-based approach allowed transition of 1844 acute adult inpatients beds from an existing standalone EMPA to the new system. This project used a frontline driven and agile management strategy. Clinical risk was managed using a combination of standard risk logs, robust clinical prototyping and robust disaster recovery plans. Early engagement with clinical teams allowed for advanced product configuration before live deployment and reduced the need for sustained transition support for clinical staff. RESULTS: An iterative, well-governed approach, led by a combination of information technology (IT) and clinical staff with a responsive vendor, enabled a complex new EPMA system in a large acute NHS trust to be deployed with limited resources despite the ongoing COVID-19 pandemic. DISCUSSION: The development and deployment of EMPA and EPR systems across NHS trusts is a key enabler for better healthcare delivery. This case study shows it is possible to deploy a new clinical IT system at scale without interruption of clinical services and with a relatively modest deployment team. Sustainability of the project was also ensured through a clear clinically led governance structure to manage risk quickly and carry lessons learnt onto new developments.


Assuntos
COVID-19 , Prescrição Eletrônica , Adulto , Humanos , Medicina Estatal , Pandemias/prevenção & controle , Hospitais de Ensino
13.
Afr Health Sci ; 22(2): 736-744, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36407329

RESUMO

Background: Venous thromboembolism (VTE) is a common and lethal disease. Assessing the risk factors will help to modify exposures. Aim: This study, assessed VTE risk factors in hospitalized patients at the University of Nigeria Teaching Hospital, Enugu. Patients and Methods: This was an observational, case-control study. Three hundred and fifty (350) patients were recruited for the study: This comprised 150 medical patients, 140 surgical patients and a population of 60 healthy control group. Subjects were evaluated once using the Caprini risk assessment model (RAM). Results: Over 50% of all hospitalized patients, were at risk for VTE. Surgical patients were at a higher risk than medical patients. Hemoglobin concentration was associated with the risk of VTE in surgical patients, while d-dimer was associated with VTE risk in medical patients. Conclusion: This study shows a high prevalence of VTE risk factors among hospitalized patients at the University of Nigeria Teaching Hospital.


Assuntos
Tromboembolia Venosa , Humanos , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia , Estudos de Casos e Controles , Prevalência , Nigéria/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Hospitais de Ensino
14.
Afr Health Sci ; 22(2): 146-155, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36407350

RESUMO

Objective: This study determined the prevalence of ESBL genes amongst Klebsiella species isolated from patients' specimens attending a Tertiary Teaching Hospital, in Ile-Ife, Southwest Nigeria. Methods: A cross sectional study of presumptive isolates of Klebsiella (n=180) were collected, after ethical approval in the microbiology laboratory. Isolates were identified to species level by conventional biochemical tests and MicrobactTM 24E Identification Kits. Antibiotic susceptibility testing was performed by the Kirby Bauer's disk diffusion method. ESBL production was detected by the double disc synergy and ESBL genes by the multiplex PCR protocol. Results: The Klebsiella species identified were Klebsiella pneumoniae 95.6%, Klebsiella oxytoca 3.3%, Klebsiella ornithinolytica 0.6% and Klebsiella terrigena 0.6%. The prevalence of ESBL genes among the Klebsiella isolates was 47.2%, and the most common ESBL gene was blaSHV (38.9%), also 75% of the study isolates had MAR index greater than 0.2. Conclusions: The study establishes the prevalence of Extended Spectrum Beta-Lactamase producing Klebsiella sp in the hospital and identified the most prevalent ESBL genes circulating as blaSHV followed by blaTEM and blaCTX-M in this environment. This underscores the need for regular and continuous surveillance of antimicrobial resistance trend as a strong component of the antibiotics stewardship and infection prevention and control programs in the hospital.


Assuntos
Klebsiella , beta-Lactamases , Humanos , beta-Lactamases/genética , Prevalência , Estudos Transversais , Nigéria/epidemiologia , Klebsiella/genética , Hospitais de Ensino
15.
Afr Health Sci ; 22(2): 63-74, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36407396

RESUMO

Background: Chest Computerized Tomography (CT) features of Corona Virus Disease 2019 (COVID-19) pneumonia are nonspecific, variable and sensitive in detecting early lung disease. Hence its usefulness in triaging in resource-limited regions. Objectives: To assess the pattern of chest CT scan findings of symptomatic COVID-19 patients confirmed by a positive RT-PCR in Ghana. Methods: This study retrospectively reviewed chest CT images of 145 symptomatic RT-PCR positive COVID-19 patients examined at the Radiology Department of the Korle Bu Teaching Hospital (KBTH) from 8th April to 30th November 2020. Chi-Squared test was used to determine associations among variables. Statistical significance was specified at p≤0.05. Results: Males represent 73(50.3%). The mean age was 54.15±18.09 years. The age range was 5 months-90 years. Consolidation 88(60.7%), ground glass opacities (GGO) 78(53.8%) and crazy paving 43(29.7%) were the most predominant features. These features were most frequent in the elderly (≥65years). Posterobasal, peripheral and multilobe disease were found bilaterally. The most common comorbidities were hypertension 72(49.7%) and diabetes mellitus 42(29.2%) which had significant association with lobar involvement above 50%. Conclusion: The most predominant Chest CT scan features of COVID-19 pneumonia were GGO, consolidation with air bronchograms, crazy paving, and bilateral multilobe lung disease in peripheral and posterior basal distribution.


Assuntos
COVID-19 , Pneumonia , Humanos , Masculino , Idoso , Adulto , Pessoa de Meia-Idade , Lactente , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Estudos Retrospectivos , Gana/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Hospitais de Ensino
16.
BMC Health Serv Res ; 22(1): 1304, 2022 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-36309744

RESUMO

BACKGROUND: Adverse drug events are common during transitions of care. As part of the Smart Pillbox study, a cluster-randomized controlled trial of an electronic pillbox designed to reduce medication discrepancies and improve medication adherence after hospital discharge, we explored barriers to successful implementation and evaluation of this intervention. METHODS: Eligible patients were those admitted to a medicine service of a large teaching hospital with a plan to be discharged home on five or more chronic medications. The intervention consisted of an electronic pillbox with pre-filled weekly blister pack medication trays given to patients prior to discharge. Pillbox features included alarms to take medications, detection of pill removal from each well, alerts to patients or caregivers by phone, email, or text if medications were not taken, and adherence reports accessible by providers. Greater than 20% missed doses for three days in a row triggered outreach from a pharmacist. To identify barriers to implementation and evaluation of the intervention, we reviewed patient exit surveys, including quantitative data on satisfaction and free-text responses regarding their experiences; technical issue logs; and team meeting minutes. Themes were derived by consensus among the study authors and organized using the Consolidated Framework for Implementation Research. RESULTS: Barriers to implementation included intervention characteristics such as perceived portability issues with the pillbox and time required by pharmacists to enter medication information into the software; external policies such as lack of insurance coverage for early refills and regulatory prohibitions on repackaging medications; implementation climate issues such as the incompatibility between the rushed nature of hospital discharge with the time required to deploy the intervention; and patient issues such as denial of previous problems with medication adherence. We founds several obstacles to conducting the study, including patients declining study enrollment and limited attempts by the hospital to streamline logistics by building the intervention into usual care. Several solutions to address many of these challenges were implemented or planned. Despite these challenges, many patients with the pillbox were pleased with the service and believed the intervention worked well for them. CONCLUSIONS: In this evaluation, several barriers to implementing and conducting a study of the effectiveness of the intervention were identified. Our findings provide lessons learned for others wishing to implement and evaluate HIT-related interventions designed to improve medication safety during care transitions. TRIAL REGISTRATION: Clinicaltrials.gov NCT03475030.


Assuntos
Transferência de Pacientes , Farmacêuticos , Humanos , Alta do Paciente , Hospitais de Ensino , Eletrônica , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Pan Afr Med J ; 42: 246, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36303820

RESUMO

Introduction: acute urinary retention represents a significant and painful event in the natural history of benign prostatic hyperplasia. This study was to determine the value of intravesical prostatic protrusion in predicting the outcome of trial without catheter in patients presenting with acute urinary retention from benign prostatic hyperplasia. Methods: this was a prospective observational study carried out over a one-year period among 78 patients with acute urinary retention from benign prostatic hyperplasia who presented at the Accident and Emergency Department of Jos University Teaching Hospital. They were clinically evaluated, and a urethral catheter was passed to relieve the retention. Trans-abdominal ultrasound assessment of intravesical prostatic protrusion, was performed after relief of acute urinary retention. Patients were placed on tamsulosin tablets 0.4mg daily for three days and they had a trial without catheter on the third day. A receiver operating characteristic curve was used to determine the predictive power of intravesical prostatic protrusion on the outcome of trial without catheter in patients with acute urinary retention from benign prostatic hyperplasia. A p value of <0.05 was considered as significant. Results: seventy-eight patients were enrolled in the study. The mean age and was 65.00 (SD 7.28) years. The mean intravesical prostatic protrusion, voided volume and maximum flow rate were 13.04 (SD 10.94) mm, 89.46 (SD 6.14) mls and 7.63 (SD 5.69) ml/s respectively. Intravesical prostatic protrusion (area under the curve= 0.843, p=0.001) predicted the outcome of trial without catheter with a cut off mark of <7.4, using the receiver operating characteristic curve. Conclusion: intravesical prostatic protrusion significantly predicted the outcome of trial without catheter in patients with benign prostatic hyperplasia presenting with acute urinary retention. It is a useful tool in the initial evaluation of patients with benign prostatic hyperplasia presenting with acute urinary retention.


Assuntos
Hiperplasia Prostática , Retenção Urinária , Masculino , Humanos , Hiperplasia Prostática/complicações , Retenção Urinária/etiologia , Retenção Urinária/terapia , Universidades , Nigéria , Cateteres , Hospitais de Ensino
18.
Med Arch ; 76(4): 288-291, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36313945

RESUMO

Background: Axillary lymph node (ALN) involvement in breast cancer (BC) is considered to be a significant factor in determining the diseases' extent at the moment. The spreading capacity of cancerous cells may linearly correlate with its activity level, which in turn alter the coagulation function as commonly represented by fibrin degradation biomarker i.e., D-dimer. Although ALN metastatic status is eventually should be perceptible in physical examinations or other diagnostic modalities, an additional marker to estimate the lymph node extent should be considered in the pre-operative sessions. Objective: To provide the correlation between elevated D-dimer level and ALN metastatic status positivity among BC patients. Methods: This cross-sectional study was conducted at the Teaching Hospital of Universitas Sumatera Utara by retrieving outpatients' medical records from June 2018 to January 2019, encompassing 111 female patients. The ALN involvement status was recorded along with plasma D-dimer level in which the value of 500 ng/mL was considered to be elevated. Results: From the 102 eligible participants, 47.1% and 70.6% were confirmed with elevated D-dimer level and ALN involved respectively. Further analysis of those variables demonstrated a considerable diagnostic performance for sensitivity (64.4%), specificity (79.1%), PPV (80.9%), NPV (61.8%), accuracy (70.6%) and statistically significant results (P = .001). Conclusion: Elevated D-dimer level may be influenced by cancerous spread capacity in the lymphatic system, as it also eventually correlated with coagulation system dysregulation. Therefore, it is suggested that the role of D-dimer measurement is recommended to be explored further in BC diagnostic workup.


Assuntos
Neoplasias da Mama , Humanos , Feminino , Metástase Linfática , Estudos Transversais , Axila/patologia , Hospitais de Ensino , Biópsia de Linfonodo Sentinela
19.
Antimicrob Resist Infect Control ; 11(1): 122, 2022 10 03.
Artigo em Inglês | MEDLINE | ID: mdl-36192790

RESUMO

BACKGROUND: Antimicrobial resistance (AMR) is a major public health challenge with its impact felt disproportionately in Western Sub-Saharan Africa. Routine microbiology investigations serve as a rich source of AMR monitoring and surveillance data. Geographical variations in susceptibility patterns necessitate regional and institutional tracking of resistance patterns to aid in tailored Antimicrobial Stewardship (AMS) interventions to improve antibiotic use in such settings. This study focused on developing a cumulative antibiogram of bacterial isolates from clinical samples at the Cape Coast Teaching Hospital (CCTH). This was ultimately to improve AMS by guiding empiric therapy. METHODS: A hospital-based longitudinal study involving standard microbiological procedures was conducted from 1st January to 31st December 2020. Isolates from routine diagnostic aerobic cultures were identified by colony morphology, Gram staining, and conventional biochemical tests. Isolates were subjected to antibiotic susceptibility testing using Kirby-Bauer disc diffusion. Inhibitory zone diameters were interpreted per the Clinical and Laboratory Standards Institute guidelines and were entered and analysed on the WHONET software using the "first isolate only" principle. RESULTS: Overall, low to moderate susceptibility was observed in most pathogen-antibiotic combinations analysed in the study. Amikacin showed the highest susceptibility (86%, n = 537/626) against all Gram-negatives with ampicillin exhibiting the lowest (6%, n = 27/480). Among the Gram-positives, the highest susceptibilities were exhibited by gentamicin (78%, n = 124/159), with clindamycin having the lowest susceptibility (27%, n = 41/154). Among the Gram-negatives, 66% (n = 426/648) of the isolates were identified phenotypically as potential extended-spectrum beta-lactamase producers. Multiple multidrug-resistant isolates were also identified among both Gram-positive and Gram-negative isolates. Low to moderate susceptibility was found against first- and second-line antibiotics recommended in the National standard treatment guidelines (NSTG). Laboratory quality management deficiencies and a turnaround time of 3.4 days were the major AMS barriers identified. CONCLUSIONS: Low to moderate susceptibilities coupled with high rates of phenotypic resistance warrant tailoring NSTGs to fit local contexts within CCTH even after considering the biases in these results. The cumulative antibiogram proved a key AMS programme component after its communication to clinicians and subsequent monitoring of its influence on prescribing indicators. This should be adopted to enhance such programmes across the country.


Assuntos
Gestão de Antimicrobianos , Amicacina , Ampicilina , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Clindamicina , Gentamicinas , Gana/epidemiologia , Hospitais de Ensino , Humanos , Estudos Longitudinais , Testes de Sensibilidade Microbiana , beta-Lactamases
20.
Health Info Libr J ; 39(4): 377-384, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36239300

RESUMO

This study investigated the topic of the academic integrity among medical students and postgraduate trainees in the teaching hospitals of South Punjab, Pakistan. A cross-sectional survey was conducted involving 318 medical students and postgraduate trainees of teaching hospitals. The results found that medical students of pre-clinical years engaged in unethical behaviour, that is, exam cheating and plagiarism to cope with internal and external evaluation and the range of subjects needed to be studied. For postgraduate trainees, results showed trainees unintentionally engaged in the practice of plagiarism due to lack of understanding about what constitutes plagiarism, coupled with externally perceived pressures associated with expectations of research publication, promotions and tenured positions. To address these concerns, it is recommended that information literacy sessions for undergraduate and postgraduate medical students on plagiarism prevention and ethical practice be designed and facilitated by medical librarians in collaboration of faculty members.


Assuntos
Estudantes de Medicina , Humanos , Estudos Transversais , Paquistão , Plágio , Hospitais de Ensino
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