Seroprevalence, trends, and risk factors of hepatitis B and C among family replacement blood donors; a 7-year retrospective study at Sunyani Municipal Hospital, Ghana.

Hepatitis B and C cause chronic infections which develop into liver-related sequelae, like cirrhosis and liver carcinoma. This study determined the seroprevalence, trends, and risk factors of HBV and HCV among family replacement donors. A retrospective review of primary data on blood donors screened between January 2015 and December 2021 was conducted at Sunyani Municipal Hospital. The data were assessed for seroprevalence, trends, and odds ratios using SPSS. Of 6847 donors, the majority were males (88.1% [6033]), ≤24 years (27.4% [1874]), O blood type (69.8% [4776]), and Rh-positive (89.9% [6154]). The seroprevalences of HBV and HCV were 3.2% and 1.9%, respectively, with more males infected with HBV and HCV (3.4% vs 2.0%). Males were 2.842 times (p = .001) and 2.399 times (p = .025) more susceptible than females to HBV and HCV, respectively. In the rainy season, donors were 1.489 times (p = .041) more susceptible to HCV. HBV and HCV seroprevalence declined over the period (slope: -0.5464, p ≤ .001 vs slope: -0.6179, p ≤ .001). Male gender and rainy season were significant determinants of both infections. The seroprevalence of HBV was higher than HCV despite the significant decline in both infections. We, recommend health authorities intensify health education among males and during the rainy season.

Autopsy Case Report of Severe COVID-19 Pneumonia at a General Municipal Hospital.

We present the autopsy procedure and findings of severe coronavirus disease 2019 (COVID-19) pneumonia in an 85-year-old man. The patient required intubation immediately after admission for severe COVID-19 pneumonia. He had severe hypoxia that did not improve despite treatment with remdesivir, corticosteroids, and appropriate mechanical ventilation. On day 13, the patient developed sudden hypercapnia. His renal dysfunction subsequently worsened and became associated with hyperkalemia, and he passed away on day 15. An autopsy was performed to clarify the cause of the hypercapnic hypoxia. None of the medical personnel involved in the autopsy developed symptoms of COVID-19. Histologic examination showed various stages of diffuse alveolar damage throughout the lungs, with intra-alveolar hemorrhage in the upper zones. Microscopic examination of the kidneys revealed acute tubular necrosis. There was no significant systemic thrombosis. The autopsy findings were consistent with those typical of COVID-19.

Bacterial Colonization on Healthcare Workers' Mobile Phones and Hands in Municipal Hospitals of Chongqing, China: Cross-contamination and Associated Factors.

BACKGROUND: Mobile phones are widely used in clinical settings and could be colonized by potential pathogenic bacteria which may lead to hospital-acquired infections (HAIs) transmission. This study aimed to determine the prevalence of bacterial contamination of healthcare workers' (HCWs) mobile phones, identify bacterial isolates, and assess the factors associated with mobile phone contamination. METHODS: Self-administered questionnaire was used to collect the information on the demographic characteristics and the use of mobile phones. A total of 111 HCWs' hands and their mobile phones were swabbed, then bacterial culture, isolation, and identification were performed. Univariate and multivariable logistic regression were applied to identify factors associated with mobile phone bacterial contamination. RESULTS: Totally 106 (95.5%) of the 111 mobile phones investigated were contaminated with bacteria. Staphylococcus epidermidis (13/111), Acinetobacter baumannii (4/111) and Staphylococcus aureus (3/111) were the predominant bacterial isolates from HCWs' mobile phones. Univariate analyses showed that age, gender, profession and the frequency of mobile phone utilization were significantly associated with the number of bacterial colonization. Frequency of phone utilization (OR 8.366; 95% CI 1.496-46.797) was found to be the most significant factors associated with the qualified rate of mobile phones bacterial load. In addition, phone cover using was associated with the increased risk of mobile phone bacterial contamination. CONCLUSION: There was cross-contamination between hands and phones. It is necessary to develop guidelines for mobile phone cleaning. Special attention needs to be paid to the disinfection of mobile phone covers to reduce contamination and transmission of pathogens.

[Liability for chronic working time violations in medicine: when does the risk of fines and imprisonment loom?] / Haftung für chronische Arbeitszeitverstöße in der Medizin ­ wann drohen Bußgelder und Freiheitsstrafen?

Against the background of the changes in the collective bargaining agreement-for municipal hospitals in the version of January 1, 2021, and for university hospitals in the version of March 7, 2020-this article deals with the legal consequences of chronic violations of the German Working Hours Act in medicine, but especially in surgical specialties such as urology. It includes an overview of current law and sanctions for violations and highlights responsibilities as well as exceptions. It is important to clarify the distribution of responsibilities with regard to working hours in the institution concerned in order to avoid fines and, in the worst case, imprisonment. It should also be clear who is liable in specific cases for persistent working time violations. When changing duty models, it is important to bear in mind that this can lead to a considerable deterioration in the opportunities for further training and education of physicians, meaning that in the long term the compatibility of further training in line with working hours can only be achieved with sufficient staffing of the hospitals. In some cases, this is diametrically opposed to economic interests in the health care system and thus presents an almost insoluble dilemma. In the view of the working group, structural changes in the diagnosis-related group (DRG)-based inpatient sector are needed in the near future.

Multipronged Programmatic Strategy for Preventing Secondary Fracture and Facilitating Functional Recovery in Older Patients after Hip Fractures: Our Experience in Taipei Municipal Wanfang Hospital.

Background and Objectives: The study assessed the effectiveness of a fracture liaison service (FLS) after 1 year of implementation in improving the outcomes of hip fracture surgery in older adult patients at Taipei Municipal Wanfang Hospital. Materials and Methods: The Wanfang hospital's FLS program was implemented using a multipronged programmatic strategy. The aims were to encourage the screening and treatment of osteoporosis and sarcopenia, to take a stratified care approach for patients with a high risk of poor postoperative outcomes, and to offer home visits for the assessment of environmental hazards of falling, and to improve the patient's adherence to osteoporosis treatment. The clinical data of 117 and 110 patients before and after FLS commencement, respectively, were collected from a local hip fracture registry; the data were analyzed to determine the outcomes 1 year after hip fracture surgery in terms of refracture, mortality, and activities of daily living. Results: The implementation of our FLS significantly increased the osteoporosis treatment rate after hip fracture surgery from 22.8% to 72.3%, significantly decreased the 1-year refracture rate from 11.8% to 4.9%, non-significantly decreased 1-year mortality from 17.9% to 11.8%, and improved functional outcomes 1 year after hip fracture surgery. Conclusions: Implementation of our FLS using the multipronged programmatic strategy effectively improved the outcomes and care quality after hip fracture surgery in the older adult population, offering a successful example as a valuable reference for establishing FLS to improve the outcomes in vulnerable older adults.

[Research on the Ratio of Anti-Cancer Drug Purchase Costs at Municipal Hospitals in the Aichi Prefecture].

We performed a study on the ratio of anti-cancer drug purchase costs at municipal hospitals in Aichi using meeting materials from the 2020 Aichi Prefectural Public Hospital Pharmacy Directors' Association. The ratio of anti-cancer drug purchase costs to all drug purchase costs at 17 hospitals was 41.5%(average)and 37.1%(median). In addition, we confirmed a positive correlation between all drug purchase costs and the ratio of anti-cancer drug purchase costs for each hospital(r= 0.537, 95%CI: 0.076-0.809, p=0.026). Furthermore, we conducted a univariate analysis on the background of hospitals where the ratio of anti-cancer drug purchase costs is ≥40%. As a result, we confirmed a significant difference(p<0.05)in the cases where there are more than 500 beds, with the approval of designated cancer hospitals, and with the department of hematology. This study clarified that hospitals with active anti-cancer drug treatment tended to increase drug purchase costs.

Analysis of SARS-CoV-2 PCR and Chest CT Findings at a Single Facility in Tokyo (Machida Municipal Hospital).

INTRODUCTION: The SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test is useful for diagnosing COVID-19, and the RT-PCR positive rate is an important indicator for estimating the incidence rate and number of infections. COVID-19 pneumonia is also associated with characteristic findings on chest CT, which can aid in diagnosis. METHODS: We retrospectively evaluated patient background characteristics, the number of cases, the positivity rate, and chest CT findings for positive and negative cases in 672 patients who underwent RT-PCR for suspected COVID-19 at our hospital between April 3 and August 28, 2020. In addition, we compared trends in the positive rates at approximately weekly intervals with trends in the number of new infections in Machida City, Tokyo. RESULTS: The study included 323 men and 349 women, with a median age of 46 years (range: 1 month-100 years). RT-PCR findings were positive in 37 cases, and the positive rate was 5.51%. Trends in the positive rate at our hospital and the number of new COVID-19 cases in the city were similar during the study period. Among patients with positive results, 15 (40.5%) had chest CT findings, and 14 had bilateral homogeneous GGOs. Among patients with negative results, 190 had chest CT findings at the time of examination, and 150 were diagnosed with bacterial pneumonia or bronchitis, with main findings consisting of consolidations and centrilobular opacities. Only 11 of these patients exhibited bilateral homogeneous GGOs. CONCLUSION: Bilateral homogeneous GGOs are characteristic of COVID-19 pneumonia and may aid in the diagnosis of COVID-19.

Qualitative exploration of the challenges and the benefits of the nursing process in clinical practice: A study among registered nurses in a municipal hospital in Ghana.

AIM: This study aims to explore the challenges and benefits of using the nursing process in a Ghanaian Hospital. DESIGN: The study employed a qualitative descriptive design to explore the challenges and the benefits of the utilization of the nursing process. METHODS: Twelve (12) Registered Nurses were recruited for the study using purposive sampling. Recorded in-depth interviews were conducted and data were analysed using thematic analysis. RESULTS: The study found a low nurse-to-patient ratio, inadequate knowledge, apathy, inadequate logistics, poor supervision as challenges. However, quality and cost-effective care improved nurse-patient relationships, and job satisfaction was found to be the benefits of nursing process use. Interventions to improve its utilization should be targeted towards improving the nurse-to-patient ratio, provision of adequate resources and inclusion of the nursing care plan in patient folders.

Terapia ciega: Lo que la pandemia nos dejó

Experiencia del equipo de salud mental del Hospital Vélez Sarsfield, de la Ciudad de Buenos Aires, que ante la aparición de la pandemia de Covid-19, cambió la modalidad de atención, mayormente por llamadas telefónicas a los pacientes, donde se atendió a pacientes que no el equipo no conocía, en sesiones de home office, con el celular del profesional. Esta experiencia se emparenta con una obra de teatro ciego, donde el analista es el actor de la consulta terapéutica.

Prevalence of infectious diseases in a municipal hospital in Belem, northern Brazil / Prevalência de doenças infecciosas em um hospital municipal em Belém, Norte do Brasil / Prevalencia de enfermedades infecciosas enun hospital municipal de Belém, norte de Brasil

Background and objectives: Infectious diseases are still a public health problem in Brazil. Therefore, this study aimed to determine the prevalence of infectious diseases in a reference hospital in the city of Belem, Para, Brazil. Methods: From May 2018 to August 2019, the number of cases of individuals with compulsory infections was observed. Results: Regarding the research period in which data were obtained from May 2018 to August 2019, a total of 263 cases were affected in the hospital and in 2019 there was an increase in the number of cases and 373 records were reported. The following results were obtained: in 2018, the highest rate of infection was caused by influenza at the rate of 17%, and in 2019 it remained at the same percentage rate and ranked secondly. Conclusion: These data are very important for the epidemiological knowledge of the population, elucidating the highest case rates and lowering other diseases related to this study, as well as their harms and treatment.(AU)

Justificativa e objetivos: As doenças infecciosas ainda são um problema de saúde pública no Brasil. Por isso, este estudo teve como objetivo determinar a prevalência de doenças infecciosas em um hospital de referência na cidade de Belém, Pará, Brasil. Métodos: Foi observado, no período de maio de 2018 a agosto de 2019, número de casos de indivíduos acometidos com infecções de caráter compulsório. Resultados: Em relação ao período da pesquisa, no qual foram obtidos os dados de maio de 2018 a agosto de 2019, os resultados apontam que, nos meses de maio a dezembro de 2018, foram acometidos 263 casos no hospital e, em 2019, houve o aumento do número de casos, sendo notificados 373 registros. Obtiveram-se os seguintes resultados: no ano de 2018, a maior taxa de infecção foi causada pela influenza, com a taxa de 17%; em 2019, se manteve com a mesma taxa de percentual, ficando em segundo lugar. Conclusão: Esses dados são de suma importância para o conhecimento epidemiológico da população, elucidando sobre os maiores índices de casos e o decréscimo de outras doenças relacionadas a este estudo, bem como seus agravos e tratamento.(AU)

Justificacción y objetivos: las enfermedades infecciosas si guen siendoun problema de salud pública en Brasil. Por lo tanto, este estudio tuvo como objetivo determinar la prevalencia de enfermedades infecciosas en un hospital de referencia en la ciudad de Belém, Pará, Brasil. Métodos: desde mayo de 2018 hasta agosto de 2019, se observó el número de casos de personas con infecciones obligatorias. Resultados: En cuanto al período de la encuesta en el que se obtuvieron datos de mayo de 2018 a agosto de 2019, los resultados indican que de mayo a diciembre de 2018, 263 casos fueron afectados en el hospital y en 2019 huboun aumento enel número de casos y se reportaron 373 registros. Se obtuvieron lo ssiguientes resultados: en 2018, la tasa más alta de infección fue causada por la influenza a una tasadel 17%, y en 2019 se mantuvoenlamismatasa porcentual y ocupó el segundo lugar. Seguido de tuberculosis, donde el 15% de los casos notificados se registraron en 2018. En comparación con 2019 (19%) hu boun aumento del 4% en el número de personas afectadas, ocupando el primer lugar enel ranking de enfermedades notificadas. Seguido por el virus del SIDA donde se registró el 8% de los casos registrados, en comparación con 2019 (6%) se observó hasta ahora una disminución del 2% en el número de casos. Conclusión: Estos datos son muy importantes para el conocimiento epidemiológico de la población, ya que dilucidan las tasas de casos más altas y disminuy en otras enfermedades relacionadas con este estudio, sus enfermedades y su tratamiento.(AU)

Should a Healthcare System Facilitate Racially Concordant Care for Black Patients?

Addressing racial disparities in health outcomes is an urgent priority for many health care organizations, leading health care managers to explore the potential for organization-level interventions to yield substantive health gains. In recent literature, it is suggested that Black patients who are treated by Black physicians may achieve superior health outcomes in some settings. In this case discussion, we consider a case in which a medical director considers implementing a voluntary program to promote racially concordant care for Black patients. Commentators consider the precedent for such a program, both in current informal care networks and 20th century medical history, as well as the burden such a program may place on Black physicians and the risks of reducing patients' intersectional identities to be solely about race. A subset of commentators suggest that these risks are mitigated by the voluntary nature of the program, whereas others offer caution about relying solely on Black physicians to remedy health disparities. Others view multiple paths as morally defensible but emphasize the need for managers to take proactive steps to communicate and evaluate their choices in the face of such a complex social challenge.

[Transition from a municipal hospital to a modern university clinic : The Urological Clinic Ulm under the direction of Prof. Dr. Hans-Dieter Marquardt]. / Der Wandel vom städtischen Krankenhaus zur modernen Universitätsklinik : Die Urologische Klinik Ulm unter Leitung von Prof. Dr. Hans-Dieter Marquardt.

On 1 September 1958, Prof. Dr. med. Hans-Dieter Marquardt was appointed chief physician of the largest urological hospital in Germany in terms of beds at the time. As the head of the clinic from 1958 until 1983; his skills and guidance were paramount for the smooth transition from a municipal hospital to a urological department of the University of Ulm; under his direction, the clinic developed into a well-known training center with special expertise in transurethral prostate surgery and a regionally and nationally important center for patient care. Professor Marquardt was a gifted physician and surgeon. He can be ranked as one of the pioneers in the field of endoscopic prostate surgery.

Missed opportunities for tuberculosis investigation in a municipal hospital in Ghana: evidence from patient exit interviews.

BACKGROUND: We assessed coverage of symptom screening and sputum testing for tuberculosis (TB) in hospital outpatient clinics in Ghana. METHODS: In a cross-sectional study, we enrolled adults (≥18 years) exiting the clinics reporting ≥1 TB symptom (cough, fever, night sweats or weight loss). Participants reporting a cough ≥2 weeks or a cough of any duration plus ≥2 other TB symptoms (per national criteria) and those self-reporting HIV-positive status were asked to give sputum for testing with Xpert MTB/RIF. RESULTS: We enrolled 581 participants (median age 33 years [IQR: 24-48], 510/581 [87.8%] female). The most common symptoms were fever (348, 59.9%), chest pain (282, 48.5%) and cough (270, 46.5%). 386/581 participants (66.4%) reported symptoms to a healthcare worker, of which 157/386 (40.7%) were eligible for a sputum test per national criteria. Only 31/157 (19.7%) had a sputum test requested. Thirty-two additional participants gave sputum among 41 eligible based on positive HIV status. In multivariable analysis, symptom duration ≥2 weeks (adjusted odds ratio [aOR] 6.99, 95% confidence interval [CI] 2.08-23.51) and previous TB treatment (aOR: 6.25, 95% CI: 2.24-17.48) were the strongest predictors of having a sputum test requested. 6/189 (3.2%) sputum samples had a positive Xpert MTB/RIF result. CONCLUSION: Opportunities for early identification of people with TB are being missed in health facilities in Ghana.

El papel de hospitales municipales y provinciales en España desde una perspectiva histórica / The role of municipal and provincial hospitals in Spain from a historical perspective

Los hospitales municipales y provinciales representaron un papel clave en la confi-guración histórica del sistema hospitalario en España hasta la segunda mitad del siglo XX. Su papel estratégico en la beneficencia del siglo XIX para la cobertura de los pobres se modificó con el avance y la configuración del hospital moderno ubicado en nuevos edificios y técnicas de gestión, con una estructura interna jerarquizada y avances en ámbito diagnóstico-terapéutico para la cobertura de cada vez más porcentaje de población. Partiendo de esta idea, este trabajo se centra en el estudio histórico de las infraestructuras hospitalarias públicas vinculadas a los municipios y diputaciones en España con dos objetivos. De un lado, trata de analizar cómo se configuraron, qué servicios prestaron y cómo afrontaron su financiación hasta la dictadura de Franco. De otro, aborda los efectos que tuvo la puesta en marcha del Seguro Obligatorio de Enfermedad (SOE), en 1944, y la construcción de su propia red de hospitales, conocidos como residencias sanitarias, en el funcionamiento y supervivencia de estas viejas infraestructuras municipales y provinciales. Finalmente se analiza su práctica desaparición tras la cesión de las competencias sanitarias en la transición democrática (AU)

Tecnologia educativa sobre cuidados domiciliares com o recém-nascido de baixo risco / Educational technology on home care with low-risk newborns / Tecnología educativa para el cuidado del hogar con recién nacidos de bajo riesgo

Objetivo: identificar dúvidas de puérperas e familiares sobre cuidados domiciliares com o recém-nascido de baixo risco e analisar a roda de conversa, mediada por simulador realístico de baixa fidelidade, como uma tecnologia educativa para o preparo de famílias no processo de alta da maternidade. Método: pesquisa qualitativa, incluindo dezenove familiares de recém-nascidos de baixo risco em um hospital municipal de Rio das Ostras, Rio de Janeiro, de maio a outubro de 2018, por entrevista semiestruturada. Dados submetidos à Análise Temática. Resultados: as dúvidas dos familiares versaram sobre cuidados com higiene, alimentação, ambiente, afeto, saúde, sono e doenças. A roda de conversa com simulador de baixa fidelidade foi considerada uma estratégia positiva para mediar o aprendizado. Conclusão: a tecnologia educativa revelou-se útil na instrumentalização de famílias no processo de alta da maternidade, visto que o cuidador fortalece suas potencialidades, retira dúvidas e troca informações e experiências no grupo.

Objective: to identify puerperal and family members' questions about home care with low-risk newborns and to analyze the conversation circle, mediated by a realistic low fidelity simulator, as an educational technology for the preparation of families in the maternity discharge process. Method: qualitative research conducted with nineteen relatives of low-risk newborns in the municipal hospital in Rio das Ostras, Rio de Janeiro, Brazil, from May to October 2018, through semi-structured interview. Data submitted to thematic analysis. Results: the family members' doubts were about care with hygiene, food, environment, affection, health, sleep and diseases. The conversation wheel with low fidelity simulator was considered a positive strategy to mediate learning. Conclusion: the educational technology proved to be useful in the instrumentalization of families in the maternity discharge process, as the caregiver strengthens their potential, removes doubts and exchanges information and experiences in the group.

Objetivo: identificar dudas puerperales y familiares sobre atención domiciliaria con recién nacidos de bajo riesgo y analizar el círculo de conversación, mediado por simulador realista de baja fidelidad, como una tecnología educativa de preparación de familias en el proceso de alta de la maternidad. Método: investigación cualitativa, con diecinueve familiares de recién nacidos de bajo riesgo en un hospital municipal en Río das Ostras, Río de Janeiro, de mayo a octubre de 2018, a través de entrevistas semiestructuradas. Se utilizó a Análisis temático. Resultados: las dudas fueron sobre higiene, alimentación, medio ambiente, afecto, salud, sueño y enfermedades. El círculo de conversación con simulador se consideró una estrategia positiva para mediar en el aprendizaje. Conclusión: la tecnología educativa demostró ser útil en la instrumentalización de familias en el proceso de alta de la maternidad, porque el cuidador fortalece su potencial, elimina dudas e intercambia información y experiencias en el grupo.

Associations between characteristics of the patients at municipal acute bed unit admission and further transfer to hospital: a prospective observational study.

BACKGROUND: As an alternative to acute hospitalisations, all communities in Norway are required to provide inpatient care in municipal acute bed units (MAUs) for patients who can be treated at the primary care level. Patient selection is challenging, and some patients need transfer from MAUs to hospitals. The aim of this study was to examine associations between characteristics of the patient at admission to MAU and further transfer to hospital. METHODS: In a prospective observational study on all admissions to a large MAU, March 2016-August 2017, information was obtained on patient age, gender, comorbidities, drug use, reason for stay and Triage Early Warning Score (TEWS) on admission and at discharge, and length of stay. Comparison between admissions resulting in discharge to hospital, nursing home or own home were performed with chi-square and ANOVA tests. Estimated relative risks (RR) with 95% confidence interval for transfer to hospital versus being retained at primary care level was estimated for age, gender, comorbidity and TEWS in generalized linear models, crude and adjusted. RESULTS: Two thousand seven hundred forty-four admissions were included. Mean age of the patients was 69.5 years (SD 21.9), 65.2% were women. In 646 admissions (23.6%), the patients were transferred to hospital. Male gender and TEWS > 2 were associated with transfer to hospital. Most transfers to hospital occurred within 24 h, and these patients had unchanged or increasing TEWS during their stay at MAU. When transferred to hospital 41.5% of the patients had the same reason for stay as on MAU admission, 14.9% had another reason for stay, 25.2% had a medical condition outside the treatment scope of MAU, and 18.4% needed further diagnostic clarification in hospital. CONCLUSIONS: Likelihood of transfer to hospital increased with male gender and higher TEWS on admission. Main reasons for transfer to hospital were lack of improvement and identification of clinical conditions that needed hospital care. TEWS > 2 at admission should make physicians alert to the need of close monitoring for lack of improvement.

Bacteria isolated from hospital, municipal and slaughterhouse wastewaters show characteristic, different resistance profiles.

Multidrug-resistant bacteria cause difficult-to-treat infections and pose a risk for modern medicine. Sources of multidrug-resistant bacteria include hospital, municipal and slaughterhouse wastewaters. In this study, bacteria with resistance to 3rd generation cephalosporins were isolated from all three wastewater biotopes, including a maximum care hospital, municipal wastewaters collected separately from a city and small rural towns and the wastewaters of two pig and two poultry slaughterhouses. The resistance profiles of all isolates against clinically relevant antibiotics (including ß-lactams like carbapenems, the quinolone ciprofloxacin, colistin, and trimethoprim/sulfamethoxazole) were determined at the same laboratory. The bacteria were classified according to their risk to human health using clinical criteria, with an emphasis on producers of carbapenemases, since carbapenems are prescribed for hospitalized patients with infections with multi-drug resistant bacteria. The results showed that bacteria that pose the highest risk, i. e., bacteria resistant to all ß-lactams including carbapenems and ciprofloxacin, were mainly disseminated by hospitals and were present only in low amounts in municipal wastewater. The isolates from hospital wastewater also showed the highest rates of resistance against antibiotics used for treatment of carbapenemase producers and some isolates were susceptible to only one antibiotic substance. In accordance with these results, qPCR of resistance genes showed that 90% of the daily load of carbapenemase genes entering the municipal wastewater treatment plant was supplied by the clinically influenced wastewater, which constituted approximately 6% of the wastewater at this sampling point. Likewise, the signature of the clinical wastewater was still visible in the resistance profiles of the bacteria isolated at the entry into the wastewater treatment plant. Carbapenemase producers were not detected in slaughterhouse wastewater, but strains harboring the colistin resistance gene mcr-1 could be isolated. Resistances against orally available antibiotics like ciprofloxacin and trimethoprim/sulfamethoxazole were widespread in strains from all three wastewaters.

Acute and transitional care or rehabilitation? Retrospective analysis of discharge planning from a municipal hospital in Switzerland.

BACKGROUND: Due to rising health care costs, in 2012 Switzerland introduced SwissDRG, a reimbursement system for hospitals based on lump sum per case. To circumvent possible negative consequences like reduction in length of stay, acute and transitional care (ATC) was anchored into the law (Federal act on health insurance) in 2011. ATC as a discharge option is applicable to patients who physicians deem will not fulfill rehabilitation criteria, but are unable to return home and are in need of temporary professional nursing care. ATC is associated with higher out of pocket costs to the patient than rehabilitation. Since social service workers are responsible for organizing discharge for patients with ongoing care needs after hospitalization, the aim of this study was to investigate how social service workers manage patient discharge in light of the new discharge option ATC. METHODS: Data was collected from 423 medical records of inpatients from Zurich's municipal hospital, Triemli, discharged to ATC or rehabilitation, in 2016. We compared the two groups using inferential statistics and qualitatively analyzed written statements from social service workers. RESULTS: Our results showed that patients discharged to rehabilitation had a higher total number of discussions, but a shorter duration of discussions. Patients discharged to rehabilitation faced more delays, mainly due to unavailability of beds in rehabilitation centers. Conflicts concerning discharge arose mainly because of costs, discharge placement and too early discharge. CONCLUSIONS: Our findings demonstrate how important social service workers are in providing information to patients about different discharge options. The newness of SwissDRG and ATC is still likely to cause longer discussion times and, consequently, more workload for social service workers. Only a small fraction of patients disagreed with their place of discharge, mostly due to financial reasons.

Continuation Rate, Safety and Efficacy of Hydroxychloroquine Treatment in a Retrospective Cohort of Systemic Lupus Erythematosus in a Japanese Municipal Hospital.

Objective We investigated the continuation rate, safety and efficacy of treatment with hydroxychloroquine (HCQ) in a retrospective cohort of systemic lupus erythematosus (SLE) in a Japanese municipal hospital. Methods All of the patients with SLE who started treatment with HCQ were included in this study. A retrospective chart review was performed. Our primary outcomes were the continuation rate of HCQ treatment for 1 year and adverse events (AEs) during the treatment. We also investigated the efficacy of HCQ treatment in cases in which treatment with immunosuppressive therapies remained unchanged for the preceding six months. Results Forty-seven patients with SLE were included in this study. Twenty-five patients (53.2%) had AEs. Eleven (64.7%) of the 17 patients who tried the readministration of HCQ could continue HCQ treatment. The continuation rate of HCQ for a period of 1 year was 78.3% (36 of 46 patients). The development of cutaneous lesions was the most frequent adverse event (25.5%) followed by gastrointestinal symptoms (8.5%). In the 16 cases in which the immunosuppressive therapies remained unchanged for at least six months prior to starting HCQ treatment, the SLE disease activity index, anti-DNA antibody, immune complex, and serum complement activity significantly decreased over a period of 1 year, while the prednisolone dose significantly decreased. Conclusion The continuation rate of HCQ treatment was high in an SLE cohort of a Japanese municipal hospital. Although more than half of the patients experienced AEs, the readministration of HCQ was often successful. HCQ treatment provided benefits regarding the clinical and immunological findings in Japanese patients with SLE, which would likely lead to glucocorticoid tapering.