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Background: Although recent research has reported an evolution in the level of medical care, little is known about secular trends in the medical discharge summary. Methods: The audit evaluated the evolution of discharge summary abstract over a decade in an acute medicine hospital among three successive periods of 1994, 2000, and 2005. Results: Of the 140 random samples of discharge summaries, significant between-cohort difference existed in the logarithm transformed length of discharge summary; the median length of discharge summary increased from 11 lines in 1994 to 26 lines in 2005 (p<0.001 corrected for multiple comparison). The closest univariate associations of discharge summary length were positively with the year of hospitalisation, length of stay, length of wordings about discharge plan and duplication of previous discharge summary, and negatively with clinical or planned admission (all p<0.01). In a multiple linear regression analysis, the year of patient admission correlated significantly with the length of discharge summary (p<0.001). Conclusions: Over the 10 year study period, significant secular trends were seen in the discharge summary length and discharge plan documentation. The causes and implications for these trends deserve further investigation. [ABSTRACT FROM AUTHOR]

This clinical report describes the clinical genetic evaluation of the child with developmental delays or mental retardation. The purpose of this report is to describe the optimal clinical genetics diagnostic evaluation to assist pediatricians in providing a medical home for children with developmental delays or mental retardation and their families. The literature supports the benefit of expert clinical judgment by a consulting clinical geneticist in the diagnostic evaluation. However, it is recognized that local factors may preclude this particular option. No single approach to the diagnostic process is supported by the literature. This report addresses the diagnostic importance of clinical history, 3-generation family history, dysmorphologic examination, neurologic examination, chromosome analysis (≥650 bands), fragile X molecular genetic testing, fluorescence in situ hybridization studies for subtelornere chromosome rearrangements, molecular genetic testing for typical and atypical presentations of known syndromes, computed tomography and/or magnetic resonance brain imaging, and targeted studies for metabolic disorders. [ABSTRACT FROM AUTHOR]

This research article is to survey the practice of biomedical waste such as collection, storage, transportation and disposal along with the amount of generated biomedical waste in various hospitals in Davangere city, and create awareness among the staff and patient about biomedical wastes. The survey result on biomedical waste generation, disposal and methods adopted in various hospitals of Davangere city are discussed. [ABSTRACT FROM AUTHOR]

The study was conducted to assess the effect of placental cord drainage on the duration of third stage of labour among intra natal women. The study design adopted was true experimental approach with two group post-test only research design. The base line clinical Proforma were used to collect the data from the women in control and experimental group. Data obtained in these areas were analysed by descriptive and inferential statistics. The study finding also revealed that there is a significant difference between the duration of 3rd stage of labour among experimental group and control group. & there is no significant association between the duration of third stage of labour and selected demographic variables among experimental group and control group. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the trends in fluoroquinolone-resistant Pseudomonas aeruginosa and to analyze the relationships to fluoroquinolone use. The study found that the use of fluoroquinolone use and fluoroquinolone-resistant Pseudomonas aeruginosa in the U.S. academic medical hospitals are declining. Study authors concluded that the use of fluoroquinolone should be used in a limited manner to decrease resistance.

Abstract: Objective: This study sought to determine the frequency of use and types of antidepressants used in IBD patients and to collect data with respect to any effect of antidepressants on the course of IBD in a usual care setting. Method: A case-note audit was conducted at an IBD Service in a public tertiary hospital. Included patients were those diagnosed with IBD by a gastroenterologist; and have had contact with the IBD Service in the last 6months. Descriptive statistics were used to summarise the data. Results: Overall, 313 patients were eligible and 287 had complete data. Overall, 51 (17.8%) patients were currently taking antidepressants and 71 (24.7%) previously received antidepressants. Eighty-three (28.9%) patients had used an antidepressant at some time. In terms of disease activity while on antidepressants, the majority of patients had inactive disease but presented with what were thought by their clinicians to be functional symptoms. Conclusion: Antidepressants are commonly prescribed in IBD patients. In our cohort, they appear to be mostly used for functional symptoms. The current data do not allow us to judge whether they improve IBD disease activity. Targeted studies are needed to answer this question and to improve practice and patient outcomes. [Copyright &y& Elsevier]

The present study was conducted in the Department of Forensic Medicine Government Medical College & Rajindra hospital Patiala. This study included 50 cases of fatal two wheeler accidents details of which had been recorded regarding the pattern and distribution of injuries. The data thus collected was analyzed statistically. [ABSTRACT FROM AUTHOR]

Background After enforcing the Labour Ordinance, hospital doctors must have 1 day off-work every week. In this study, we aimed to evaluate its impact on the discharge pattern from an acute medical hospital. [ABSTRACT FROM PUBLISHER]

Introduction: Recent rapid changes in medical cannabis policies and increases in medical use of cannabis have raised new research questions related to potential effects of medical cannabis legalization on cannabis use problems. In order to investigate such effects there is a need for screening tools that are sensitive to the fact that people may be using for medical and/or recreational purposes. This article critically assesses whether screening tools designed to measure cannabis use problems in recreational users are meaningful as measures of problems resulting from medical use.Results and Conclusions: It is possible that existing cannabis problem screening tools are not equally valid across medical and recreational users, since individual screening items have different implications for recreational and medical users. For instance, items that measure use that deviates from common patterns of recreational use (use before midday and use alone) reflect normative assumptions that non-problematic recreational use will occur in contexts of parties or social gatherings. However, use before midday and alone are how people typically take medication for chronic medical health problems. There is thus a need to develop and validate criteria for problematic use in medical cannabis patients. [ABSTRACT FROM AUTHOR]

Introduction: Patients referred by their GP with a suspected respiratory problem have a long wait for a specialist respiratory review which can have a detrimental effect on morbidity and mortality 1. Description of practice change implemented: In 2013 we developed an integrated nurse led respiratory clinic for patients referred by their general practitioner (GP) with new respiratory problems. A respiratory consultant screens all referrals for suitability. The assessment includes history taking, examination and education by the nurse. In one visit, the patient will have investigations such as spirometry with reversibility, alpha 1 antitrypsin testing, BNP, oxygen assessment (and ABG if appropriate), walking test, CXR and ECG. Subsequently, the nurse discusses findings with a respiratory consultant and develops a plan of care. A report is then sent to the GP. Aim and theory of change/Targeted population and stakeholders: The aims and objectives were to provide a high standard nursing service to patients that encompassed their physical, psychological and social needs. The service aimed to integrate primary and secondary care by providing rapid assessment for patients referred by their general practitioners with new respiratory symptoms. As a result this service was predicted to reduce the nine month waiting list for the physician led respiratory clinic. Highlights: (innovation, Impact and outcomes) Of the patients (320) reviewed, 57% had COPD, 21% had Asthma and the large majority of the remaining patients had no significant respiratory problem. There were two cases of idiopathic pulmonary fibrosis and three cases of lung cancer. 73% of patients were discharged back to their GP, 5% were referred to the physician-led clinic and the remaining 22% are still attending the clinic. Savings are generated through avoidance of multiple outpatient attendances, less dependence on physicians and optimisation of medication prescription and delivery. Patients benefitted through early diagnosis and treatment in a single visit to a clinic. Waiting times for physician review have now reduced from nine months in 2013 to two months in 2016). This service is transferable to all hospitals that provide specialist respiratory care. To ensure safety and quality it is recommended that the clinical nurse specialist that carries out the clinic be academically qualified up to masters level and have training in advanced health assessment skills. We conclude that integrated nurse led clinics are associated with high levels of patient satisfaction. [ABSTRACT FROM AUTHOR]

The article discusses the challenges facing the U.S. healthcare sector in 2017 in terms of uncertainty and leaders planning to change the fundamental structure and delivery system of the sector. It suggests that leaders need to step up and help others understand the overall scenario, by understanding where they want their hospital to be, what the issues are, and how they as individuals and the leaders of a critical department within their organization fit into the organizational structure.

Background: Traditional Oriental medicine is used in many Asian countries and involves herbal medicines, acupuncture, moxibustion, and cupping. We investigated the incidence and causes of hospital-acquired fever (HAF) and the characteristics of febrile inpatients in Oriental medical hospitals (OMHs).Methods: Patients hospitalized in two OMHs of a university medical institute in Seoul, Korea, were retrospectively reviewed from 2006 to 2013. Adult patients with HAF were enrolled.Results: There were 560 cases of HAF (5.0%). Infection, non-infection, and unknown cause were noted in 331 cases (59.1%), 109 cases (19.5%), and 120 cases (21.4%) of HAF, respectively. Respiratory tract infection was the most common cause (51.2%) of infectious fever, followed by urinary tract infection. Drug fever due to herbal medicine was the most common cause of non-infectious fever (53.1%), followed by procedure-related fever caused by oriental medical procedures. The infection group had higher white blood cell count (WBC) (10,400/mm3 vs. 7000/mm3, p < 0.001) and more frequent history of antibiotic therapy (29.6% vs. 15.1%, p < 0.001). Multivariate analysis showed that older age (odds ratio (OR) 1.67, 95% confidence interval (C.I.) 1.08-2.56, p = 0.020), history of antibiotic therapy (OR 3.17, C.I. 1.85-5.41, p < 0.001), and WBC > 10,000/mm3 (OR 2.22, C.I. 1.85-3.32, p < 0.001) were associated with infection.Conclusions: Compared to previous studies on HAF in Western medicine, the incidence of HAF in OMHs was not high. However, Oriental medical treatment does play some role in HAF. Fever in patients with history of antibiotic therapy, or high WBC was more likely of infectious origin. [ABSTRACT FROM AUTHOR]

Our research into community engagement, community partnerships and co-production asks the question "What does the community do for its community hospital, and what does the community hospital do for its community?" This study is part of a three-year programme involving three related studies and with teams working collaboratively. This study led by Professor Jon Glasby builds on earlier research which demonstrated integrated working in 48 community hospitals and in particular between local communities and the statutory sector (local NHS and Council). Case studies provided evidence of community-led initiatives including volunteering, funding equipment and buildings, instigating and promoting new services, supporting hospital developments, sharing in management in joint ventures and taking ownership of hospitals. There is an absence of research into communities and their community hospitals, despite community involvement being identified as a key feature of these small, local and often remote and rural facilities. This is often characterised by local people typically using the term "our hospital." In a mixed methodology approach, we are analysing financial and volunteer activity data for community hospitals in England, sourced from our databank from the University of Birmingham Third Sector Research Centre. This will enable us to scope and measure the level of support across the country. We are investigating the relationship between communities and their community hospitals in 9 case study sites through interviews and focus group and also through analysing local documentation. We are investigating how community support is mobilised and resourced, and with what results. This study will provide new knowledge on the contribution communities make to their community hospitals and the overall benefits. We will then assess whether this provides transferable learning for the wider NHS. [ABSTRACT FROM AUTHOR]

Background: An increasing amount of health care is now performed in a home setting, away from the hospital. While there is growing anecdotal evidence about the difficulty patients and caregivers have using increasingly complex health care devices in the home, there has been little systematic scientific study to quantify the global nature of home health care device usability in the field. Research has tended to focus on a handful of devices, making it difficult to gain a broad view of the usability of home-care devices in general. Objective: The objective of this paper is to describe a remote usability assessment method using the System Usability Scale (SUS), and to report on the usability of a broad range of health care devices using this metric. Methods: A total of 271 participants selected and rated up to 10 home health care devices of their choice using the SUS, which scores usability from 0 (unusable) to 100 (highly usable). Participants rated a total of 455 devices in their own home without an experimenter present. Results: Usability scores ranged from 98 (oxygen masks) to 59 (home hormone test kits). An analysis conducted on devices that had at least 10 ratings showed that the effect of device on SUS scores was significant (/P/<.001), and that the usability of these devices was on the low end when compared with other commonly used items in the home, such as microwave ovens and telephones. Conclusions: A large database of usability scores for home health care devices collected using this remote methodology would be beneficial for physicians, patients, and their caregivers. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Dix-Hallpike and roll test are two of the positional tests that provide information about posterior, anterior and lateral semicircular canals, especially when applied to patients with suspected benign paroxysmal positional vertigo (BPPV). Video head impulse test (vHIT) is a useful test gives information about vertical and horizontal canals, vestibular nucleus and vestibular nerve in both ears. This study was conducted to assess the relationship between Dix -- Hallpike/Roll Test and vHIT. MATERIALS and METHODS: 76 patients (47 female, 29 male) who was referred with a diagnosis of BPPV to Istanbul University Cerrahpasa Medical Faculty Hospital to Audiology Department and whose age between 21 and 57 has evaluated. All patients were evaluated with Dix-Hallpike/Roll Test and vHIT tests and results were compared. RESULTS: Acording to Dix-Hallpike/Roll test results, it was found posterior canal BPPV in 55, lateral canal 18 patients and anterior canal BPPV in 6 patients. Results will be discussed. [ABSTRACT FROM AUTHOR]

INTRODUCTION Obesity is a high prevalent disease with great impact in life quality and can become a risk factor to development of other health problems. Most of treatment programs usually focus on control of diet and exercise, with minimal long-term impact. The causal and maintenance role of psychological and emotional distress has been showed in recent literature. Including these factors in a multidisciplinary treatment could improve interventions effectiveness. Aims Obesity Unit of Psychiatry Department was created to offer first-class medical treatment to patients with obesity in a district of Madrid (Vallecas) since 2011. The main objective is to obtain diagnostic information about the patients in order to decrease the prevalence of obesity in our community. Methods We are presenting the data of the 100 first patients referred to our Unit, 5 people were excluded due to exclusion criteria. Sociodemographic and clinical data were obtained from evaluation interviews and were complemented by a battery of psychometric tests. Results The average BMI is 41 (SD 6.8). The average age, 41.7 (SD 12.7) and 76 patients were women. 85% of the patients were not able to maintain weight loss. 50% of the patients had consulted a physician before. 95% of patients have taken a pharmacological treatment. No one had followed a combined treatment, addressing physical and emotional aspects together. Conclusions A specific multidisciplinary treatment is recommended in these patients. In addition to pharmacological treatment, our integral attention program also includes a psychoeducational group one a month and a psychotherapy group one a week. [ABSTRACT FROM AUTHOR]

Background Although spirituality is among the important dimensions of human's existence and a lot of emphasis has been given to its role in promoting the level of health, the nursing care has been always focused on the physical dimension of the patients and little attention is being given to the spiritual needs. Objective the aim of this study is examining the attitude and performance of Spiritual Care among nurses working in Iran University of Medical sciences Hospitals. Design This was a cross-sectional study. Data gathering was done by using Nursing Spiritual Care Perspective Scale (NSCPS) questionnaires. One hundred and sixty six nurses participated in this study. Results The total mean of the nurses' attitude toward spiritual care (3.67±0.51) indicated the nurses' positive attitude toward spiritual care. The nurses' practices regarding spiritual interventions indicated that they tend to do half of the spiritual interventions. Conclusion Appropriate educational methods must be used for teaching spiritual merits and increasing the nurses’ competency in confronting with spiritual needs and offering spiritual care. [ABSTRACT FROM AUTHOR]