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Nurses serve as the backbone of medical hospital settings, playing a pivotal role in ensuring high-quality patient care, promoting positive health outcomes, and fostering a supportive healthcare environment. This article highlights the multifaceted responsibilities of nurses in medical hospitals, encompassing direct patient care, patient advocacy, interdisciplinary collaboration, and quality improvement initiatives. Through a comprehensive review of the literature, this article explores the diverse contributions of nurses in addressing the complex needs of patients, optimizing care delivery processes, and navigating challenges within the healthcare system. Additionally, the article discusses the importance of ongoing education, professional development, and self-care practices to empower nurses in fulfilling their essential role in medical hospital settings. By recognizing and supporting the critical contributions of nurses, healthcare organizations can cultivate a culture of excellence, compassion, and patient-centered care, ultimately improving the overall quality of healthcare delivery. [ABSTRACT FROM AUTHOR]

Abstract Background The German health care system is faced with a serious shortage of nurses. This is associated, amongst other things, with difficult working conditions and work-related health burdens. Workplace health promotion (WHP) is considered a promising approach to promote the health of nurses. The present review aims to give an overview on existing interventions in different nursing settings (acute care hospitals, long-term care (LTC) facilities and home-based long-term care) in Germany. Methods A systematic literature search was conducted in PubMed and PubPsych. Studies were included if published after 2010 and provided data of intervention studies on workplace health promotion among nurses in Germany (RCTs, non-RCTs, non-controlled intervention studies and pilot studies). The setting in which the study was conducted (acute medical care hospital, inpatient LTC facilities, home-based LTC, cross-setting) as well as the health issue assessed (physical health, mental health and/or violence experience) were extracted. The intervention was reported against the background of the quality criteria for prevention measures of the statutory health insurers in Germany. The results of the studies were presented according to the RE-AIM framework. Results Eleven studies on WHP for nurses were included, whereof seven studies were conducted in acute medical care hospitals and four in LTC facilities. No study reported results on WHP for nurses working in the setting of home-based LTC. Most studies aimed at improving mental health. The intervention contents and forms of implementation were heterogeneous. According to the RE-AIM criteria, the reporting of most studies showed several limitations, especially a lack of reporting on Implementation and Adoption. Most studies showed no statistically significant effect on the respective outcomes (Effectiveness). Four studies reported results on Maintenance indicating a sustained effectiveness. Conclusion Despite the high relevance for health promotion for nurses, our review showed a striking lack of intervention studies in this field. From this we derive a high need of tailored interventions, taking into account the setting-specific development, implementation of WHP interventions for nurses. With regard to the evaluation, the RE-AIM criteria should be taken more into account in order to meet the requirements of evaluating complex interventions and thus contribute to evidence development of WHP in nursing. In terms of content, the topic of violence prevention and dealing with experiences of violence should also be taken into account. Regarding the settings, the working conditions and health burdens in LTC facilities, home-based LTC and acute medical hospitals must be considered. Trial registration PROSPERO registration number: CRD42021231891

Background: The German health care system is faced with a serious shortage of nurses. This is associated, amongst other things, with difficult working conditions and work-related health burdens. Workplace health promotion (WHP) is considered a promising approach to promote the health of nurses. The present review aims to give an overview on existing interventions in different nursing settings (acute care hospitals, long-term care (LTC) facilities and home-based long-term care) in Germany. Methods: A systematic literature search was conducted in PubMed and PubPsych. Studies were included if published after 2010 and provided data of intervention studies on workplace health promotion among nurses in Germany (RCTs, non-RCTs, non-controlled intervention studies and pilot studies). The setting in which the study was conducted (acute medical care hospital, inpatient LTC facilities, home-based LTC, cross-setting) as well as the health issue assessed (physical health, mental health and/or violence experience) were extracted. The intervention was reported against the background of the quality criteria for prevention measures of the statutory health insurers in Germany. The results of the studies were presented according to the RE-AIM framework. Results: Eleven studies on WHP for nurses were included, whereof seven studies were conducted in acute medical care hospitals and four in LTC facilities. No study reported results on WHP for nurses working in the setting of home-based LTC. Most studies aimed at improving mental health. The intervention contents and forms of implementation were heterogeneous. According to the RE-AIM criteria, the reporting of most studies showed several limitations, especially a lack of reporting on Implementation and Adoption. Most studies showed no statistically significant effect on the respective outcomes (Effectiveness). Four studies reported results on Maintenance indicating a sustained effectiveness. Conclusion: Despite the high relevance for health promotion for nurses, our review showed a striking lack of intervention studies in this field. From this we derive a high need of tailored interventions, taking into account the setting-specific development, implementation of WHP interventions for nurses. With regard to the evaluation, the RE-AIM criteria should be taken more into account in order to meet the requirements of evaluating complex interventions and thus contribute to evidence development of WHP in nursing. In terms of content, the topic of violence prevention and dealing with experiences of violence should also be taken into account. Regarding the settings, the working conditions and health burdens in LTC facilities, home-based LTC and acute medical hospitals must be considered. Trial registration: PROSPERO registration number: CRD42021231891 [ABSTRACT FROM AUTHOR]

Nowadays, eHealth service has become a booming area, which refers to computer-based health care and information delivery to improve health service locally, regionally and worldwide. An effective disease risk prediction model by analyzing electronic health data benefits not only to care a patient but also to provide services through the corresponding data-driven eHealth systems. In this paper, we particularly focus on predicting and analysing diabetes mellitus, an increasingly prevalent chronic disease that refers to a group of metabolic disorders characterized by a high blood sugar level over a prolonged period of time. K-Nearest Neighbor (KNN) is one of the most popular and simplest machine learning techniques to build such a disease risk prediction model utilizing relevant health data. In order to achieve our goal, we present an optimal KNearest Neighbor (Opt-KNN) learning based prediction model based on patient's habitual attributes in various dimensions. This approach determines the optimal number of neighbors with low error rate for providing better prediction outcome in the resultant model. The effectiveness of this machine learning eHealth model is examined by conducting experiments on the real-world diabetes mellitus data collected from medical hospitals. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this manuscript is to review the available strategies in the international literature to efficiently and safely return to both normal orthopaedic surgical activities and to normal outpatient clinical activities in the aftermath of a large epidemic or pandemic. This information would be beneficial to adequately reorganize outpatient clinics and hospitals to provide the highest possible level of orthopaedic care to our patients in a safe and efficient manner.Methods: A literature search was performed for relevant research articles. In addition, the World Health Organisation (WHO), the US Centers for Disease Control (CDC), American Association of Orthopaedic Surgeons (AAOS), the EU CDC and other government health agency websites were searched for any relevant information. In particular, interest was paid to strategies and advise on managing the orthopaedic patient flow during outpatient clinics as well as surgical procedures including the necessary safety measures, while still providing a high-quality patient experience. The obtained information is provided as a narrative review.Results: There was not any specific literature concerning the organization of an outpatient clinic and surgical activities and the particular challenges in dealing with a high-volume practice, in the afterwave of a pandemic.Conclusion: As the COVID-19 crisis has abruptly halted most of the orthopaedic activities both in the outpatient clinic and the operating room, a progressive start-up scenario needs to be planned. The exact timing largely depends on factors outside of our control. After restrictions will be lifted, clinical and surgical volume will progressively increase. This paper offers key points and possible strategies to provide the highest level of safety to both the orthopaedic patient and the orthopaedic team including administrative staff and nurses, during the start-up phase.Level Of Evidence: Review, Level V. [ABSTRACT FROM AUTHOR]

Purpose: This article aims to share northern Italy's experience in hospital re-organization and management of clinical pathways for traumatic and orthopaedic patients in the early stages of the COVID-19 pandemic.Methods: Authors collected regional recommendations to re-organize the healthcare system during the initial weeks of the COVID-19 pandemic in March, 2020. The specific protocols implemented in an orthopaedic hospital, selected as a regional hub for minor trauma, are analyzed and described in this article.Results: Two referral centres were identified as the hubs for minor trauma to reduce the risk of overload in general hospitals. These two centres have specific features: an emergency room, specialized orthopaedic surgeons for joint diseases and trauma surgeons on-call 24/7. Patients with trauma without the need for a multi-disciplinary approach or needing non-deferrable elective orthopaedic surgery were moved to these hospitals. Authors report the internal protocols of one of these centres. All elective surgery was stopped, outpatient clinics limited to emergencies and specific pathways, ward and operating theatre dedicated to COVID-19-positive patients were implemented. An oropharyngeal swab was performed in the emergency room for all patients needing to be admitted, and patients were moved to a specific ward with single rooms to wait for the results. Specific courses were organized to demonstrate the correct use of personal protection equipment (PPE).Conclusion: The structure of the orthopaedic hubs, and the internal protocols proposed, could help to improve the quality of assistance for patients with musculoskeletal disorders and reduce the risk of overload in general hospitals during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Copyright of Acta Balneologica is the property of Wydawnictwo ALUNA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Performance evaluation is important for improving medical quality and services. But, there is a lack of research for medical quality in traditional Chinese medicine (TCM) hospitals. This study examines the medical quality and various indicators of tertiary public traditional Chinese medicine hospitals in Gansu Province, to establish a foundation for improving the medical and management standards of these hospitals. This study collected performance assessment data from 10 tertiary TCM hospitals in Gansu Province from 2019 to 2022. Thirteen indicators with TCM characteristics were selected and categorized into 3 aspects: control of medical costs, internal operational dimensions, and comprehensive management. The level of medical quality in different hospitals and in different years were determined using the TOPSIS method for ranking and the RSR method for grading. Firstly, in terms of TCM characteristic indicators, hospital H had the highest control of medical costs and comprehensive management among different hospitals, with 45.87% and 24.20% respectively. The highest values for control of medical costs and comprehensive management were observed in 2020, with 40.65% and 18.69% respectively among different years. When evaluating the medical quality of different hospitals using the TOPSIS method, it was found that hospital H had the highest ranking from 2020 to 2022, with C i values of 0.725, 0.778, and 0.667 respectively. Additionally, the RSR method indicated that hospital H had a high level of grading from 2020 to 2022, with P i values of 0.687, 0.690, and 0.723 respectively. These findings suggest that the medical quality of hospital H is at a high and stable level of development. Based on the TOPSIS method to evaluate the performance appraisal results and ranking of different hospitals from 2019 to 2022. The results showed that the highest ranking was hospital B(C i  = 0.913) in 2019. The highest ranking was hospital C(C i  = 0.809)in 2020. The highest ranking was hospital D(C i  = 0.689) in 2021. The highest ranking was hospital J(C i  = 0.865) in 2022. The RSR method indicated that high grading level were hospitals B(P i  = 0.899),F(P i  = 0.795) in 2019. The highest grading level was hospital C(P i  = 0.809) in 2020. The highest grading level were hospitals A(P i  = 0.868), D(P i  = 0.813), E(P i  = 0.689), G(P i  = 0.873), J(P i  = 0.813), K(P i  = 0.842) in 2022. Based on the above results indicate that there is a large variation in the medical quality profile of different hospitals from 2019 to 2022. By comparing the results of TOPSIS and RSR method from 2019 to 2022, we found that the hospitals with identical ranking were D and J, and the hospitals with ≤2 difference in ranking was A,B,C,E in 2019, the hospitals with >2 ranking was A, F in 2020, the hospitals with >2 ranking were C, G in 2021, and the hospitals with identical ranking results were B,D,E,G,J in 2022. Comparing the ranking results of TOPSIS and RSR methods, showed that the hospitals with identical rankings were B, F from 2019 to 2022. The difference in ranking results ≤2 were A, C, D, E, G, H, J, K, indicating that high consistency between TOPSIS and RSR methods and credible results. The findings reveal significant fluctuations in medical quality across different years, while the overall level of medical quality remains relatively stable among the various hospitals. It is recommended that TCM hospitals focus on improving management efficiency, optimizing hospital operations, enhancing the utilization of medical resources, and fostering the efficient development of hospitals., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Copyright of European Review of Public Law is the property of European Public Law Organization and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The need for antifungal stewardship is gaining recognition with increasing incidence of invasive fungal infection (IFI) and antifungal resistance alongside the high cost of antifungal drugs. Following an audit showing suboptimal practice we initiated an antifungal stewardship programme and prospectively evaluated its impact on clinical and financial outcomes.Patients and methods: From October 2010 to September 2016, adult inpatients receiving amphotericin B, echinocandins, intravenous fluconazole, flucytosine or voriconazole were reviewed weekly by an infectious diseases consultant and antimicrobial pharmacist. Demographics, diagnosis by European Organization for Research and Treatment of Cancer (EORTC) criteria, drug, indication, advice, acceptance and in-hospital mortality were recorded. Antifungal consumption and expenditure, and candidaemia species and susceptibility data were extracted from pharmacy and microbiology databases.Results: A total of 432 patients were reviewed, most commonly receiving AmBisome® (35%) or intravenous fluconazole (29%). Empirical treatment was often unnecessary, with 82% having no evidence of IFI. Advice was given in 64% of reviews (most commonly de-escalating or stopping treatment) and was followed in 84%. Annual antifungal expenditure initially reduced by 30% (£0.98 million to £0.73 million), then increased to 20% above baseline over a 5 year period; this was a significantly lower rise compared with national figures, which showed a doubling of expenditure over the same period. Inpatient mortality, Candida species distribution and rates of resistance were not adversely affected by the intervention.Conclusions: Provision of specialist input to optimize antifungal prescribing resulted in significant cost savings without compromising on microbiological or clinical outcomes. Our model is readily implementable by hospitals with high numbers of at-risk patients and antifungal expenditure. [ABSTRACT FROM AUTHOR]

El artículo presenta un informe sobre el sistema de atención médica en Venezuela en el siglo XXI. Afirma que en Venezuela, sistemas hospitalarios son tales que tienen la capacidad de pensar en el nivel más básico hasta el nivel superior. Menciona que aunque no tienen vínculos con varios sistemas pero su funcionamiento es estable.

Highlights • Charcot–Marie–Tooth disease, type 4C is the most common recessive CMT in Norway. • We identified six new mutations in the SH3TC2-gene causing CMT4C. • Scoliosis, sensory ataxia and early debut were present in almost all CMT4C patients. • About 50% of CMT4C patients had proximal paresis and cranial nerve affection. Abstract Autosomal recessive Charcot–Marie–Tooth disease (CMT) is considered rare and phenotypic descriptions are scarce for the different subgroups. Mutations in the SH3TC2 gene, causing recessive demyelinating CMT type 4C have been found in several Norwegian CMT patients over the last years. We aimed to estimate a minimum prevalence and to study the genotypic and phenotypic variability of CMT4C in Norway. Patients were selected from diagnostic registries in medical genetic centers in Norway for cases of CMT4C. All patients were invited to complete a questionnaire and give medical consent to the use of clinical data from medical hospital records. A total of 35 patients from 31 families were found with CMT4C, which gives a minimum prevalence of 0.7/100,000 in Norway. Six new mutations were identified. Most patients had debut in the first decade with foot deformities, distal limb paresis, sensory ataxia and scoliosis. Proximal lower limb paresis and cranial nerve involvement was seen in about half of the patients. CMT4C is the most common recessive CMT in Norway. In addition to the classic distal limb affection, early debut, scoliosis, proximal paresis, cranial nerve affection and sensory ataxia are the most prominent features of CMT4C. [ABSTRACT FROM AUTHOR]

A study was carried out with an objective to ascertain the information source, identify the barriers and determine the facilitating factors to Internet use for information seeking in clinical practice. A survey was conducted in the two teaching hospitals i.e. the Children’s Hospital and the Institute of Child Health, Multan, and Nishtar Medical College and Hospital, Multan. The population of the study was doctors and nurses of the participating hospitals. A self-administered questionnaire was developed to collect the data on variables such as Internet use, use of information sources, barriers and facilitating factors to Internet use for information seeking A five-point Likert type scale (‘always’, ‘very often’, ‘sometimes’, ‘rarely’, and ‘never’) was used. The questionnaire was distributed among the respondents through convenience sampling. The collected data analyzed using Statistical Package for Social Sciences (SPSS-20) and presented in frequency, percentage, mean, standard deviation, and graphs. The results of the study concluded that majority of the respondents had access to Internet at their consultation/ nursing stations. They use Internet very often with the purpose of getting up-to-date information, to carry out research, teaching, and to find clinical information that in not available elsewhere. They very often seek information from books, printed journals, guidelines, web/Internet information documents, and medical representative. However, the barriers that prevented their use of Internet very often for information seeking from their practice settings were too much information to scan, toe slow Internet connection, and unreliability of the information. [ABSTRACT FROM AUTHOR]

Using a qualitative research approach, this study focuses on the major medical systems; traditional and western medical practices in the Atiwa District of Ghana from 1960 to 2010 with particular emphasis on western medicine. The people of Atiwa District accessed the two medical systems to combat diseases and also to ensure a healthy life. Before the advent of western medical practice in the Atiwa District, people travelled to Nkawkaw, Koforidua, and Kyebi for medical treatment. Upon the establishment of health centres and hospitals with related impediments, that is, lack of access to health facilities due to long distance, bad roads and low levels of finance from the indigenous population among other things, the local population were not entirely convinced from discontinuing to access the services of traditional medical practitioners in addition to these basic neo-medical facilities. Diseases that were common among the people were malaria, skin diseases and stomach pains among others. However, new and different diseases in other regions also gradually infected the people within the district. They include cerebro-spinal meningitis (CSM), tuberculosis and HIV/AIDS among others within the period under review. [ABSTRACT FROM AUTHOR]

This article analyzes one kind of colonial equipment designed in the early twentieth century for the purpose of providing medical assistance to the indigenous populations of Angola and Mozambique. I will refer to it as a 'hut-hospital', although it had several forms and designations. The layout of hut-hospitals consisted of a main building and a number of hut-like units that were supposedly more attractive to the indigenous population and therefore more efficient than the large, rectangular buildings of the main colonial hospitals. Using different sources, including three-dimensional plaster models of hut-hospitals, photographs, legal documents, and 1920s conference papers and articles, I will investigate the relatively obscure history of this colonial artifact while exploring the use of imitation as part of the repertoire of colonial governance. [ABSTRACT FROM AUTHOR]

Objective To develop a set of field tent hospital system to further enhance campaign-level medical support service. Methods The system had its service orientation, functional requirements, component unit and modular elements determined with system analysis. The technical architecture was realized with tent combined with boxes, and the system modules were designed with the method of integrated box and instruments. Results The system had its design executed from the aspects of layout, composition of grid tent, medical functional units, support unit and packaging unit, which was applied in a series of military medical support operations in foreign countries and China as well as in the construction of national medical emergency rescue forces. Conclusion The system gains advantages in modularity, integration, completing, informatization and standardization, and thus greatly enhances the military medical support ability and national emergency medical rescue ability in China. [ABSTRACT FROM AUTHOR]

Introduction: Primigravida is one, who is pregnant for the first time. A successful well managed vaginal delivery first time around usually leads to subsequent deliveries being relatively uneventful. Conversely, a poorly managed first labour can add to subsequent obstetric problems. Therefore, utmost care and expertise is a predominant factor for a successful delivery. Aims and objectives: Objectives of this study is to enhance the rate of safer delivery for primigravida through monitoring progress of labour, mode of delivery and fetomaternal outcome. Methodology: This prospective study was carried out at labour ward in the Department of obstetrics and Gynaecology of Dhaka Medical College & Hospital from January, 2007 to June 2007. Hundred cases of primigravida were selected for this study. Data had been collected through questionnaires. Results : Largest number of patients (50%) had age group 20-24 years and likely to have normal vaginal delivery. Sixty percent patients had regular antenatal check up. Risk factors like PIH, Breech presentation, Face presentation, Rh negative, Jaundice and Pyrexia were found in 23% cases. About 96% fetuses presented by vertex, among them 52% had non engaged head. Sixty patients came with cervix at or less 3 cm dilated and 40 patients were at cervical dilatation 4 cm or more. Progress of labour was monitored by modified WHO partograph. Sixty two percent patient delivered vaginally, among them 3% patients need instrumental delivery. Thirty eight patients pregnancy were terminated by caesarean section. Ninety nine percent babies were live birth and 1% was still birth. Conclusion: Safest age group for delivery of primigravida in this study between 20-24 years. So, women should be encouraged to have their 1st child at this age. People should be made aware of the benefits of proper antenatal check up and choosing safest place for delivery. [ABSTRACT FROM AUTHOR]

Recent work has shown improved outcomes with new models of psychiatric consultation in the general medical hospital. Classic studies demonstrated that psychiatric consultation can improve hospital length of stay. New models emphasize proactive consultation in which all patients are screened for needed care, embedded consultation where providers interact closely with the medical team, and multidisciplinary consultation that uses the skill sets of different types of providers efficiently. The latest work has expanded the consultative role further, emphasizing coordination with outpatient care, other hospital services, and diagnosis-specific pathways. Similar trends are evidenced in geriatric medical consultation in hospitals. New collaborative and integrated care approaches will transform hospital consultation. These new approaches re-emphasize the traditional "liaison" component of consultation- liaison psychiatry. [ABSTRACT FROM AUTHOR]

The article looks at trends in labor market outcomes for registered nurses in the U.S. from 2002 to 2015. Data from the Occupational Employment Statistics survey revealed increases in nursing employment and wages during the Great Recession from 2007 to 2009. Also discussed are employment opportunities for registered nurses in general medical and surgical hospitals and in offices of physicians.

The aim of the present study is to compare the quality of life among diabetic and asthmatic patients. The two most common chronic diseases worldwide are diabetes and asthma. It is a major public health concern in developing countries (Azevedo & Alia, 2008). Asthma and diabetes are chronic conditions and were considered earlier as having a psychosomatic origin. In the past, prominent psychoanalysts such as Menninger (1935) and Dunbar (1936) claimed that diabetes was a part of psychosomatic disease caused by emotional stress. Quality of life is a phrase used to refer to an individual's total well-being The purpose of this study was to see quality of life among diabetes and asthmatics patients. The sample size is 90 in total, where 30 diabetic and 30 asthmatic patients from different medical hospitals of Raipur and Chandigarh and 30 non-patients group has been taken for the study through purposive sampling. The tools used for assessing the variables are Sociodemographic data sheet, WHO Quality of Life - BREF (1996) and General Health Questionnaire- GHQ (Shamsunder et al., 1986). All the groups differ significantly on Quality of life domains i.e. physical health, psychological, social relationship and environmental factors. [ABSTRACT FROM AUTHOR]

Background and rationale: Antibiotic resistance is a global problem. Many factors are complexly related to the issue in multiple dimensions. Bangladesh is right in the middle of this great calamity, and is seeing the rise in resistant strains of several bacteria. Very sadly, the prevalent malpractice of abusing antibiotics in Bangladesh contributes to add complexity to the danger which may prove to be possibly the greatest threat humans have ever faced. There is much scarcity of medical literature in Bangladesh, on the antibiotic sensitivity pattern and prevalent microorganisms. Moreover, antibiotic sensitivity pattern changes over time and place. Again, most of the studies done in Bangladesh, concentrate on a single disease, pathogen, or specimen. This study attempts to see the prevalent microorganisms and the antibiotic sensitivity pattern in multiple types of specimens collected from Dhaka Medical College Hospital. This study also attempts to establish a way of presentation of the relevant findings which can be used in future to ensure easy comparability and contrasting of findings. Methods: The specimens were collected from the adult patients (age >12 years) admitted in the Internal Medicine ward of Dhaka Medical College Hospital, Dhaka, over a period of 6 months. The sampling technique was consecutive sampling method. Specimens which were culture positive, were only included in the study for analysis. Multiple specimens were taken. Results: S. aureus was 100% sensitive to amikacin, moxifloxacin, imipenem, meropenem, piperacillin+tazobactum combination, vancomycin, doxycycline, tetracycline, tigecycline, nitrofurantoin, azactum, linezolid and 100% resistant to cefixime. Enterobacter was 100% sensitive to penicillin, amikacin, gentamicin, netilmicin, doxycycline, tetracycline, tigecycline and 100% resistant to cefixime, ceftazidime, ceftriaxone, cefepime, cotrimoxazole, levofloxacin, vancomycin. E. coli was 100% sensitive to imipenem, meropenem, vancomycin, tigecycline and 100% resistant to mecillinam, aztreonam. Klebsiella was 100% sensitive to flucloxacillin, colistin, vancomycin, tigecycline, linezolid and 100% resistant to nalidixic acid. Proteus was 100% sensitive to cephradine, cefoxitin, cefixime, ceftazidime, ceftriaxone, cefepime, cotrimoxazole, amikacin, ciprofloxacin, imipenem, meropenem, netilmicin, piperacillin+tazobactum combination, tetracycline, tigecycline, azithromycin, azactum and 100% resistant to doxycycline, tetracycline, chloramphenicol and cefuroxime. Pseudomonas was 100% sensitive only to amikacin, netilmicin, and 100% resistant to cefixime, ceftazidime, ceftriaxone, cefepime, cotrimoxazole, gentamicin, ciprofloxacin, levofloxacin, imipenem, meropenem, doxycline, tetracycline, chloramphenicol. Salmonella typhi was 100% sensitive to amoxicillin, cefoxitin, cefixime, ceftriaxone, cefepime, cotrimoxazole, amikacin, netilmicin, azithromycin, chloramphenicol, azactum and 100% resistant to cephradine, doxycycline, tetracycline, nalidixic acid. MRSA was 100% sensitive to imipenem, vancomycin, teicoplanin, nitrofurantoin, linezolid and 100% resistant to cefpirome, cefoxitin, ceftazidime, cotrimoxazole, clindamycin, gentamicin, ciprofloxacin, netilmicin, tetracycline, clarithromycin. Acinetobacter was 100% sensitive to penicillin, cefuroxime, colistin, piperacillin+tazobactum combination, tigecycline, chloramphenicol and 100% resistant to cefixime, nalidixic acid. Citrobacter freundii was 100% sensitive to ceftazidime, ceftriaxone, cotrimoxazole, amikacin, gentamicin, ciprofloxacin, levofloxacin, imipenem, meropenem, netilmicin, nalidixic acid and 100% resistant to ampicillin, cefixime, nitrofurantoin. Conclusion: More and more antibiotics are becoming ineffective due to emergence of resistance. Serious actions should be taken. Awareness should be raised from the policy maker level to the physicians and patients. [ABSTRACT FROM AUTHOR]

This was a descriptive cross-sectional study conducted with an aim to assess the level of knowledge and preventive practice regarding hepatitis B among the nurses in Dhaka Medical College Hospital. The study was conducted from January 2015 to June 2015. Total sample was 207 and purposive sampling technique was followed for data collection, which was done by face to face interview. The data were collected on a structured questionnaire and analyzed by SPSS. Out of 207 respondents, majority (54.1%) were found in the age group of 18 to 30 years, where mean age was 33 + 0.2 years. Among them female (83.5%) outnumbered the male (16.4%). Most of them (81.2%) were Muslim. Majority (49.8%) were educated up to HSC level and half of them (51.7%) were married. Majority(45.4%) had family income > 20,000 taka. Most of them (91.8%) had good knowledge that virus was the causative agent of hepatitis B and 84.5% understood 'infected blood transfusion' as common means of disease transmission. About 83.1% had the knowledge about other routes of transmission. Nearly half (51.7%) were not aware of being at risk of infected by HBV but more than half (56.5%) received vaccination for HBV. Most of them (85%) stated that hepatitis B had complications. Mean knowledge score was 8.28 + 2.9, while 80.7% had good level of knowledge, only 19.3% had poor knowledge. Again, mean preventive practice score was 4.78 + 1.3, while 87.4% had good level of preventive practice and 12.6% had poor preventive practice. Here mean practice of prevention was significantly associated with level of knowledge of respondents (P<0.001). In the study overall knowledge and practice was found to be satisfactory. Most of the nursing staffs were at risk of hepatitis B. So appropriate educational and health promotion programs can increase these knowledge & practice further. [ABSTRACT FROM AUTHOR]

The article presents news briefs related to medical sector. One of the complications of pancreatic cancer is pancreatic exocrine insufficiency. A delay before the surgery is optimal after a short radiotherapy 4 to 12 weeks after completion of short-term radiotherapy (RT). The addition of external radiotherapy (RTE) pelvic adjuvant chemotherapy allows to obtain a modest survival benefit from patients with endometrial cancer stages III-IVA.

Introduction: Premature rupture of membrane or PROM means when membrane ruptures before the onset of labour at a gestational age less than 37 completed weeks. In Bangladesh, every year, around 28,000 women die due to complications of pregnancy and childbirth. Nonscientific intervention in PROM made at various levels intensify the pregnancy complications several times, thereby leading many more deaths of foetus and newborn. Aetiology of PROM is largely unknown. The possible causes are either reduction of membrane strength or an increase in intrauterine pressure or both. Proper diagnostic facilities, proper monitoring and standard protocol in the management can improve the maternal and fetal outcome. Aim and objective: The aim of the study was to observe the incidence, type and maternal and fetal outcome of PROM. Materials and Method: A prospective case control analytical study was carried out at Dhaka Medical College Hospital, Dhaka from May '2000 to December'2000. Total 120 patients were selected for this study among them 60 patients as case (Group A) and 60 patients were taken as control (Group B). Both primi and multigravida with Pregnancy more than 28 weeks with intact membrane as control and spontaneous rupture of membrane taken as case. High- risk patients such as hypertensive disorder of pregnancy, APH, cardiac disease, previous H/O caesarean section were excluded from the study. After taking proper history, speculum examination, some diagnostic investigations were carried out. Findings were recorded in predesigned questionnaire and statistical analysis were done using computerized software SPSS for Windows. A P value < 0.05 was taken as significant. Results: In our study maternal complications were significantly higher in Group A patients (Chi-square test: X2 = 6.263, df= 1, P< 0.05). Number of premature babies in PROM patients (25%) was significantly higher than control group. Perinatal morbidity was found higher in PROM (36.66%) compared to control group (31.66%). Most common morbidity was neonatal jaundice in PROM patients (13.33%) compared to babies of control group (8.33%). Conclusion: This study focused on certain risk factors in relation to PROM which can be preventable and reduce incidence and improvement of maternal and fetal outcome. [ABSTRACT FROM AUTHOR]

Background Under-reporting of type II (patient/visitor-on-worker) violence by workers has been attributed to a lack of essential event details needed to inform prevention strategies. Methods Mixed methods including surveys and focus groups were used to examine patterns of reporting type II violent events among ∼11,000 workers at six U.S. hospitals. Results Of the 2,098 workers who experienced a type II violent event, 75% indicated they reported. Reporting patterns were disparate including reports to managers, co-workers, security, and patients' medical records-with only 9% reporting into occupational injury/safety reporting systems. Workers were unclear about when and where to report, and relied on their own 'threshold' of when to report based on event circumstances. Conclusions Our findings contradict prior findings that workers significantly under-report violent events. Coordinated surveillance efforts across departments are needed to capture workers' reports, including the use of a designated violence reporting system that is supported by reporting policies. Am. J. Ind. Med. 59:853-865, 2016. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: Mental health service users have high rates of medical co-morbidity but frequently experience problems accessing and transitioning between tertiary medical and primary care services. The aim of this study was to identify ways to improve service users' with medical co-morbidity care and experience during their transition between tertiary medical hospitals and primary care services.Method: Experience-based co-design (EBCD) qualitative study incorporating a focus group discussion. The study took place in a large tertiary medical service, incorporating three medical hospitals, and primary care services, in Melbourne, Australia. A purposive sample of service users and their caregivers and tertiary medical and primary care clinicians participated in the focus group discussion, in August 2014. A semi-structured interview guide was used to inform data collection. A thematic analysis of the data was undertaken.Results: Thirteen participants took part in the focus group interview, comprising 5 service users, 2 caregivers and 6 clinicians. Five themes were abstracted from the data, illustrating participants' perspectives about factors that facilitated (clinicians' expertise, engagement and accessibility enhancing transition) and presented as barriers (improving access pathways; enhancing communication and continuity of care; improving clinicians' attitudes; and increasing caregiver participation) to service users' progress through tertiary medical and primary care services. A sixth theme, enhancing service users' transition, incorporated three strategies to enhance their transition through tertiary medical and primary care services.Conclusion: EBCD is a useful approach to collaboratively develop strategies to improve service users' with medical co-morbidity and their caregivers' transition between tertiary medical and primary care services. A whole-of-service approach, incorporating policy development and implementation, change of practice philosophy, professional development education and support for clinicians, and acceptance of the need for caregiver participation, is required to improve service users' transition. [ABSTRACT FROM AUTHOR]

Objective: To study hyperglycaemia in acute medical admissions to Irish regional hospital.Research Design and Methods: From 2005 to 2007, 2061 white Caucasians, aged >18 years, were admitted by 1/7 physicians. Those with diabetes symptoms/complications but no previous record of hyperglycaemia (n=390), underwent OGTT with concurrent HbA1c in representative subgroup (n=148). Comparable data were obtained for 108 primary care patients at risk of diabetes.Results: Diabetes was diagnosed immediately by routine practice in 1% (22/2061) [aged 36 (26-61) years (median IQ range)/55% (12/22) male] with pre-existing diabetes/dysglycaemia present in 19% (390/2061) [69 (58-80) years/60% (235/390) male]. Possible diabetes symptoms/complications were identified in 19% [70 (59-79) years/57% (223/390) male] with their HbA1c similar to primary care patients [54 (46-61) years], 5.7 (5.3-6.0)%/39 (34-42)mmol/mol (n=148) vs 5.7 (5.4-6.1)%/39 (36-43)mmol/mol, p=0.35, but lower than those diagnosed on admission, 10.2 (7.4-13.3)%/88 (57-122)mmol/mol, p<0.001. Their fasting plasma glucose (FPG) was similar to primary care patients, 5.2 (4.8-5.7) vs 5.2 (4.8-5.9) mmol/L, p=0.65, but 2hPG higher, 9.0 (7.3-11.4) vs 5.5 (4.4-7.5), p<0.001. HbA1c identified diabetes in 10% (15/148) with 14 confirmed on OGTT but overall 32% (48/148) were in diabetic range on OGTT. The specificity of HbA1c in 2061 admissions was similar to primary care, 99% vs 96%, p=0.20, but sensitivity lower, 38% vs 93%, p<0.001 (63% on FPG/23% on 2hPG, p=0.037, in those with possible symptoms/complications).Conclusion: HbA1c can play a diagnostic role in acute medicine as it diagnosed another 2% of admissions with diabetes but the discrepancy in sensitivity shows that it does not reflect transient/acute hyperglycaemia resulting from the acute medical event. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the reliability and validity of the Chinese version of the Patient Health Questionnaire (PHQ-15) in a tertiary hospital. Methods: Using a cross-sectional study design, the Chinese version of the PHQ-15 was administered to a total of 1329 inpatients. To examine the discriminant validity of this questionnaire, we investigated the correlation of the PHQ-15 score with sociodemographic data and the PHQ-9 and GAD-7 scale scores. Exploratory factor analysis was performed to assess the internal consistency of the PHQ-15. To evaluate the consistency of this questionnaire with item response theory (IRT), IRT analysis was performed. Methods: Using a cross-sectional study design, the Chinese version of the PHQ-15 was administered to a total of 1329 inpatients. To examine the discriminant validity of this questionnaire, we investigated the correlation of the PHQ-15 score with sociodemographic data and the PHQ-9 and GAD-7 scale scores. Exploratory factor analysis was performed to assess the internal consistency of the PHQ-15. To evaluate the consistency of this questionnaire with item response theory (IRT), IRT analysis was performed. Conclusions: The PHQ-15 scale had good reliability and high validity to detect patients with high somatic symptom severity in a Chinese tertiary hospital. Several of the current findings were consistent with previous research on the PHQ-15 in Western countries and in China. To improve the diagnostic quality of this questionnaire, items 4, 8 and 11 can be omitted. [ABSTRACT FROM AUTHOR]

Background: The objective of our study was the development of a semi-quantitative real-time PCR to detect uropathogens. Two multiplex PCR reactions were designed to detect Escherichia coli, Klebsiella spp., Enterobacter spp., Citrobacter spp., Proteus mirabilis, Enterococcus faecalis, and Pseudomonas aeruginosa. 16S based PCR was performed in parallel to detect Gram-positive and Gram-negative bacteria. Firstly to identify non-targeted agents of infection in the same urine specimen, and secondly to quantify background flora. The method was evaluated in comparison with standard bacterial culture, and a commercial PCR kit for detection of uropathogens. Findings: Analysis with a known panel of 116 clinical isolates yielded a PCR specificity of 100%. Analysis of urine specimens from 211 patients revealed a high correlation of PCR Cq values with both culture positivity and quantity. Concordance between PCR and culture was 98% when both methods yielded results. PCR was found to be more sensitive than culture. With a cut-off Cq value of 33, the negative predictive value of PCR was 94%. The 16S PCR confirmed most results. One specimen was positive by 16S PCR suggesting another cause of infection not detected by the specific PCR assays. Conclusion: We conclude that it is feasible to detect and identify uropathogens by multiplex real-time PCR assay. [ABSTRACT FROM AUTHOR]

Background: Developing countries are now experiencing the epidemiologic transition, whereby the burden of chronic diseases, like metabolic syndrome, is increasing. However, no study had previously been conducted to show the status of metabolic syndrome among outpatients of Jimma University Teaching Hospital. Therefore, this study was designed to determine the prevalence of metabolic syndrome and associated factors among adult ($20 years) patients. Methods: A cross-sectional hospital-based study was conducted in July 2014 among adult ($20 years) patients attending Jimma University Teaching Hospital, outpatient department. All patients attending the outpatient department and were willing to participate in the study were included. Anthropometric and biochemical measurements were undertaken for all the study subjects to know the status of metabolic syndrome. Metabolic syndrome was identified using the National Cholesterol Education Program's Adult Treatment Panel III criteria. Results: A total of 225 participants were included in the study, of whom 106 (47.1%) were males and 119 (52.9%) were females. A total of 59 (26%) adults were found to have metabolic syndrome, which was seen more than twice as much in females, 42 (35%), as compared with males, 17 (16%), (P<0.01). The most frequent metabolic syndrome parameters were hypertension (45%), hyperglycemia (39%), decreased high-density lipoprotein (HDL) (31%), central obesity (26%), and elevated triglycerides (18%). Elevated blood pressure is more common in females (44.5%) than in males (34.9%). Decreased HDL-cholesterol was observed among 37% of females versus 24% males (P<0.001) and 6% of males versus 45% females had central obesity (P<0.001). Hypertension and body mass index were significantly lower among males (35% and 14%) than females (45% and 41%) (P<0.01 and P<0.001), respectively. Conclusion: It is demonstrated that metabolic syndrome is prevalent in adult outpatients in Jimma and increases as age increases; it is more common among females than males. Among the five diagnostic criteria for metabolic syndrome, hypertension, hyperglycemia, and low HDL-cholesterol were the most prevalent. As metabolic syndrome is rising at an alarming rate, we recommend that relevant prevention, diagnostics, and therapy in adult outpatients are undertaken. [ABSTRACT FROM AUTHOR]

Objective: To describe the real-world use of adalimumab for maintenance treatment of ulcerative colitis (UC) and associated healthcare costs in English hospitals. Design: Retrospective cohort study. Setting: Analysis of NHS Hospital Episode Statistics linked with pharmacy dispensing data in English hospitals. Patients: Adult UC patients receiving ≥240mg during adalimumab treatment induction, subsequently maintained on adalimumab. Outcomes: Frequency and pattern of adalimumab use and dose escalation during maintenance treatment and associated healthcare costs (prescriptions and hospital visits). Results: 191 UC patients completed adalimumab treatment induction. 83 (43.46%) dose escalated during maintenance treatment by ≥100% (equivalent to weekly dosing) (median time to dose escalation: 139 days). 56 patients (67.47%) subsequently de-escalated by ≥50% (median time to dose de-escalation: 21 days). Mean all-cause healthcare costs for all patients ≤12 months of index were £13,892. Dose escalators incurred greater mean healthcare costs than non-escalators ≤12 months of index (£14,596 vs. £13,351). Prescriptions accounted for 96.49% of UC-related healthcare costs (£11,090 of £11,494 in all patients). Conclusions: Within the cohort, 43.46% of UC patients escalated their adalimumab dose by ≥100% and incurred greater costs than non-escalators. The apparent underestimation of adalimumab dose escalation in previous studies may have resulted in underestimated costs in healthcare systems. [ABSTRACT FROM AUTHOR]

Background: In-hospital cardiac arrest (IHCA) has a poor prognosis and clinicians often write "Do-Not-Attempt-Resuscitation" (DNAR) orders based on co-morbidities.Aim: To assess the impact of the Age-combined Charlson Co-morbidity Index (ACCI) on 30-days survival after IHCA.Material and Methods: All patients suffering IHCA at Karolinska University Hospital between 1st January and 31st December 2014 were included. Data regarding patient characteristics, co-morbidities and survival were drawn from the electronic patient records. Co-morbidities were assessed prior to the IHCA as ICD-10 codes according to the ACCI. Differences in survival were assessed with adjusted logistic regression models and presented as Odds Ratios with 95% Confidence Intervals (OR, 95% CI) between patients with an ACCI of 0-4 points versus those with 5-7 points, as well as those with ≥8 points. Adjustments included hospital site, heart rhythm, ECG surveillance, witnessed status and place of IHCA.Results: In all, 174 patients suffered IHCA, of whom 41 (24%) survived at least 30 days. Patients with an ACCI of 5-7 points had a minor chance and those with an ACCI of ≥8 points had a minimal chance of surviving IHCA compared to those with an ACCI of 0-4 points (adjusted OR 0.10, 95% CI 0.04-0.26 and OR 0.04, 95% CI 0.03-0.42, respectively).Conclusion: Patients with a moderate or severe burden of ACCI have a minor chance of surviving an IHCA. This information could be used as part of the decision tools during ongoing CPR, and could be an aid for clinicians in planning care and discussing DNAR orders. [ABSTRACT FROM AUTHOR]

Introduction: In arthritic condition like osteoarthritis or rheumatoidarthritis, the hip joint becomes very much painful. Patient can hardly walk or even stand up in advance condition. But total hip replacement can give them new hope to live(1). Medication can relieve the symptom variably but THR can be the ultimate solution for these type of patients. Materials & Methods: We have operated total sevenpatients in the year, 2017 at DMCH. All have painful hip with advance stages of arthritis. Both cemented and non-cemented THR done for them according to their clinical condition. Early mobilization with the help of walker started for them as soon as the pain permits. Results: Results were evaluated by Harris Hip Score. All the patients were found clinically improved. Outcome measured with Harris Hip Score was excellent in 4 cases, good in 2 cases and fair in 1 case. Conclusion: THR is now a days a gold standard of practice throughout the world with published journal. We have started this practice in Bangladesh too and this time at DMCH in a large scale. Results are yet to be decided as at least 1 year follow up is required to find out how they do in our local community. [ABSTRACT FROM AUTHOR]

Background and Objective: Both Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are rapidly spreading in the developing countries. Both of them are blood borne and are transmitted through unscreened blood transfusion, inadequately sterilized needles and equipment. According to WHO's criteria of endemicity, Pakistan has high disease burden of Hepatitis B and C. The present study was planned to determine the frequency and to identify the risk factors of hepatitis B and C virus in the general community of Farash town. Methods: This descriptive study was carried out in Al Nafees Medical Hospital Lab, from January 2013 to December 2013. Both the genders and all age groups were included in the study. All the patients who fulfilled the inclusion criteria had given a written consent. Data was collected through questionnaire and was analyzed on Statistical Package for Social Sciences (SPSS) version 21. Results: Three-hundred and forty five patients were studied. Among these 92 (27%) were males and 253(73%) were female, 33% of them had hepatitis C, 9% had hepatitis B. History of injections was reported in all of the patients. Visit to community barbers was present in 58.6% and 41% cases of hepatitis B and C. History of dental procedures was obtained in 7(24%) and 15(13%) patients of hepatitis B and C. Conclusion: Major contributors for Hepatitis B and C in Farash town are use of unsterilized therapeutic injections and visit to community barbers. Education of the barbers regarding sterilization may help in reducing the burden of infection in this community. [ABSTRACT FROM AUTHOR]

Background: In spite of experiencing a large decline in the spread and burden of infectious diseases, the Global Burden of Disease Project suggests that about 30% of the disease burden in India is attributable to infections. The hospital data constitute a basic and primary source of information for continuous follow up of this changing pattern of morbidity and mortality. Aim: To identify the pattern and trend of different infectious diseases among admissions in the Infectious Disease ward of North Bengal Medical College and Hospital. Materials and Methods: Retrospective analysis of inpatient hospital database over 5 years period (January 2008 - December 2012) of Infectious Disease ward of North Bengal Medical College & Hospital. Results: Among 3277 admissions in the Infectious Disease ward during 2008-12, diarrhoeal diseases (84.3%) were most common. The highest mortality was recorded for rabies cases (83.9%), followed by tetanus (32.6%) and diphtheria (27.3%). The majority cases of diphtheria (78.9%) and measles (53.1%) belonged to below 9 years age. Except the year 2010, there was a gradual rise in admissions from 2008 to 2012. Conclusion: Review of hospital records provided information regarding the pattern of diseases but no definite trend among admissions in the infectious diseases ward. [ABSTRACT FROM AUTHOR]

This study characterized particulate matter 2.5 microns in the naturally ventilated Pediatric and Medicine wards and mechanically ventilated Central and Neonatal Intensive Care Units (CENICU and NICU) of an urban tertiary care hospital in the Philippines in terms of concentration, elemental composition, indoor/outdoor (I/O) ratios and enrichment factors. The samples were collected from October to December 2013 and from March to April 2014. Results showed that the average of PM 2.5 in the Pediatric (32.8 μgm -3 in October to December 2013 and 28.4 μgm -3 in March to April 2014) and Medicine Wards (30.0 μgm -3 in October to December 2013) exceeded the WHO guideline value of 25 μgm -3 . The I/O ratios suggest that outdoor air is the major source of PM 2.5 in all sites. Comparison of pollutant levels showed differences between the PM 2.5 concentrations in Pediatrics and NICU (p < 0.0001 in October to December 2013 and p = 0.003 in March to April 2014) and in Medicine and CENICU (p = 0.002 in October to December 2013 and p = 0.037 in March to April 2014). Moreover, outdoor PM 2.5 concentrations were higher than the measurements in NICU and CENICU (p < 0.0001). X-ray fluorescence analysis measured 15 elements, including manganese, iron, vanadium, lead and mercury, which are highly hazardous to health. Enrichment factor analysis showed that mercury, sulfur and bromine were highly enriched indicating significant contamination from anthropogenic sources. The researchers recommend the determination of these elements in soil within the area and other compartments and undertake a source apportionment study to ascertain the sources of these elements. [ABSTRACT FROM AUTHOR]

Background: Evidence from developed countries showed that medication errors are common and harmful. Little is known about medication errors in resource-restricted settings, including Vietnam. Objectives: To determine the prevalence and potential clinical outcome of medication preparation and administration errors, and to identify factors associated with errors. Methods: This was a prospective study conducted on six wards in two urban public hospitals in Vietnam. Data of preparation and administration errors of oral and intravenous medications was collected by direct observation, 12 hours per day on 7 consecutive days, on each ward. Multivariable logistic regression was applied to identify factors contributing to errors. Results: In total, 2060 out of 5271 doses had at least one error. The error rate was 39.1% (95% confidence interval 37.8%- 40.4%). Experts judged potential clinical outcomes as minor, moderate, and severe in 72 (1.4%), 1806 (34.2%) and 182 (3.5%) doses. Factors associated with errors were drug characteristics (administration route, complexity of preparation, drug class; all p values < 0.001), and administration time (drug round, p = 0.023; day of the week, p = 0.024). Several interactions between these factors were also significant. Nurse experience was not significant. Higher error rates were observed for intravenous medications involving complex preparation procedures and for anti-infective drugs. Slightly lower medication error rates were observed during afternoon rounds compared to other rounds. Conclusions: Potentially clinically relevant errors occurred in more than a third of all medications in this large study conducted in a resource-restricted setting. Educational interventions, focusing on intravenous medications with complex preparation procedure, particularly antibiotics, are likely to improve patient safety. [ABSTRACT FROM AUTHOR]

For the prevention of falls, individual fall risk assessment is the necessary first step. Thus, we attempted to identify independent risk factors for falls and develop a prediction model using a scoring system for patients with neurological disorders in acute hospital settings. This study was a secondary analysis of a previous study performed to compare the reliability and validity of three well-known fall assessment tools in patients with neurological disorders. We considered comorbid diseases and potential medications in addition to variables included in the three tools. Multiple logistic regression analysis was used to develop a prediction model for falls. Predictive scores were calculated using the proportional odds ratio (OR) of each predictor. The discriminative power of this model was evaluated by receiver-operating characteristic (ROC) area under the curve (AUC) analysis. A total of 32 falls were noted among 1018 patients. History of falls (OR, 4.01; 95% CI, 1.61–9.98; p = .003), cerebrovascular disease (CVD) (OR, 2.61; 95% CI, 1.11–6.14; p = .028), severe impaired gait (OR, 7.28; 95% CI, 2.45–21.65; p < .001), and overestimate of one's own gait ability (OR, 9.14; 95% CI, 3.89–21.45; p < .001) were identified as meaningful predictors for falling after adjusting for age, diabetes, confusion or disorientation, up-and-go test, altered elimination, and antipsychotics by univariate analysis. The discriminative power of fall risk score calculated by the prediction model was 0.904 of AUC (p < .001). Our results suggest that in addition to fall history and the presence of CVD, neurological assessment for gait and insight into gait ability are imperative to predict falls in patients with neurological disorders. [ABSTRACT FROM AUTHOR]

Background: Skin diseases affect 21-87 % of children in developing countries in Africa. However, the spectrum of the skin diseases varies from region to region due to several factors such as genetics, socioeconomic and environmental. The aim of this study was to determine the spectrum of childhood skin diseases in Tanzania.Methods: We conducted a prospective hospital- based cross-sectional study between September 2012 and August 2013 at a tertiary referral dermatology clinic. Children younger than 14 years presenting with new skin conditions were recruited. Diagnosis was mainly done clinically, but if the diagnosis was not clinically clear, further investigations were undertaken accordingly.Results: A total of 340 patients were recruited of which 56 (16.5 %) had more than one skin condition. Both genders were equally affected. Infections and infestations accounted for the majority (43.5 %, n = 177) of the skin conditions followed by eczematous dermatitis (28.5 %, n = 116) and pigmentary disorders (7.4 %, n = 30). Among the 152 infectious skin diseases, fungal infections predominated (50.7 %, n = 77) in the infectious group followed by bacterial (29.6 %, n = 45), and viral (19.7 %, n = 30).Conclusions: Skin infections are still the main cause of dermatological consultations in children although with a reduced prevalence. Inflammatory skin conditions are increasing and can be attributed to improved socioeconomic status and HIV pandemic. [ABSTRACT FROM AUTHOR]

Background: The Norwegian Knowledge Centre for the Health Services (NOKC) reports 30-day survival as a quality indicator for Norwegian hospitals. The indicators have been published annually since 2011 on the website of the Norwegian Directorate of Health (), as part of the Norwegian Quality Indicator System authorized by the Ministry of Health. Openness regarding calculation of quality indicators is important, as it provides the opportunity to critically review and discuss the method. The purpose of this article is to describe the data collection, data pre-processing, and data analyses, as carried out by NOKC, for the calculation of 30-day risk-adjusted survival probability as a quality indicator. Methods and Findings: Three diagnosis-specific 30-day survival indicators (first time acute myocardial infarction (AMI), stroke and hip fracture) are estimated based on all-cause deaths, occurring in-hospital or out-of-hospital, within 30 days counting from the first day of hospitalization. Furthermore, a hospital-wide (i.e. overall) 30-day survival indicator is calculated. Patient administrative data from all Norwegian hospitals and information from the Norwegian Population Register are retrieved annually, and linked to datasets for previous years. The outcome (alive/death within 30 days) is attributed to every hospital by the fraction of time spent in each hospital. A logistic regression followed by a hierarchical Bayesian analysis is used for the estimation of risk-adjusted survival probabilities. A multiple testing procedure with a false discovery rate of 5% is used to identify hospitals, hospital trusts and regional health authorities with significantly higher/lower survival than the reference. In addition, estimated risk-adjusted survival probabilities are published per hospital, hospital trust and regional health authority. The variation in risk-adjusted survival probabilities across hospitals for AMI shows a decreasing trend over time: estimated survival probabilities for AMI in 2011 varied from 80.6% (in the hospital with lowest estimated survival) to 91.7% (in the hospital with highest estimated survival), whereas it ranged from 83.8% to 91.2% in 2013. Conclusions: Since 2011, several hospitals and hospital trusts have initiated quality improvement projects, and some of the hospitals have improved the survival over these years. Public reporting of survival/mortality indicators are increasingly being used as quality measures of health care systems. Openness regarding the methods used to calculate the indicators are important, as it provides the opportunity of critically reviewing and discussing the methods in the literature. In this way, the methods employed for establishing the indicators may be improved. [ABSTRACT FROM AUTHOR]

Objective: To know the prevalence and etiology of oral and maxillofacial trauma in elders. Methods: Analytical quantitative cross-sectional study conducted at a public trauma hospital located in Fortaleza-Ceará, Brazil. The study population comprised patients with trauma who were hospitalized from April to August 2014. Of these patients, patients with oral and maxillofacial trauma were chosen to be included in the research. A questionnaire was administered in order to obtain information on socio-demographics, systemic comorbidities, use of medication, deleterious habits (smoking and alcohol consumption), etiology of oral and maxillofacial trauma and type of pre-hospital care. Results: Of the 280 elderly hospitalized with trauma, 47 had oral and maxillofacial trauma, with a prevalence of 16.8%. In this group, the age ranged from 60 to 88 years, with a mean age of 72.4 years (SD± 8.38). The elderly were mostly women (55.3%), self-declared pardos (53.2%), who presented with cardiovascular disorders (48.9%), and who received formal pre-hospital care (70.2%). Elderly who were in the 60–69 years age group, spent 6–9 years at school and drank alcohol were 2.64, 3.75, and 1.97, respectively, more likely to suffer oral and maxillofacial trauma. The main causes of trauma were physical aggression, traffic accidents, falls and domestic accidents. All of the physical aggressions resulted in oral and maxillofacial traumas, and the elderly who suffered traffic accidents were four times more likely to have oral and maxillofacial trauma. Conclusion: The prevalence of 16.8% and the lack of research on oral and maxillofacial traumas in the elderly is worrisome and should be included in the oral health indicators for the elderly population to support the importance of oral health. [ABSTRACT FROM AUTHOR]

Background: HIV/AIDS and Diabetes Mellitus are the diseases’ known to supress cell mediated immunity and predispose patients for opportunistic infections. Hence, we conducted a study to compare the common opportunistic infections (OIs) between People Living with HIV with DM (PLHIV-DM) and PLHIV without DM (PLHIV). Methodology: PLHIV with DM and without DM (1:1) were prospectively included in the study from January 2011 to January 2012 at a tertiary care hospital in Mangalore city. Patients were classified as Diabetic if their fasting plasma glucose was ≥ 7.0mmol/l (126mg/dl) or 2–h plasma glucose was ≥11.1mmol/l (200mg/dl). Standard procedures and techniques were followed for diagnosis of OIs as per WHO guidelines. The data was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 11.5. Findings: The study included 37 PLHIV with DM and 37 PLHIV without DM and both groups were treated with Anti-Retroviral Therapy (ART). The median age was 47 years (IQR: 41-55years) for PLHIV-DM as compared to 40 years (IQR: 35–45.5 years) for PLHIV (p<0.0001). PLHIV-DM had median CD4 counts of 245 (IQR: 148–348) cells/μl compared to 150(IQR: 70–278) cells/μl for PLHIV (p = 0.02). Common OIs included oral candidiasis (49% of PLHIV-DM and 35% of PLHIV); Cryptococcal meningitis (19% of PLHIV-DM and 16% of PLHIV); Pneumocystis jiroveci pneumonia (5% of PLHIV-DM and 18% of PLHIV); extra pulmonary tuberculosis (22% of PLHIV-DM and 34.5% of PLHIV); and Cerebral toxoplasmosis (11% of PLHIV–DM and 13.5% of PLHIV). Microbiological testing of samples from PLHIV- DM, C krusei was the most common Candida species isolated from 9 out of 18 samples. Out of six pulmonary TB samples cultured, four grew Non-tuberculosis mycobacteria (NTM) and two Mycobacterium tuberculosis complexes. Conclusions: Study did not identify any significant difference in profile of opportunistic infections (OIs) between PLHIV with and without Diabetes. [ABSTRACT FROM AUTHOR]

Objectives: Staphylococcus lugdunensis can cause community- and healthcare-associated infections. This study investigated the molecular characteristics of S. lugdunensis isolates collected at our hospital and compared the characteristics of the infectious and commensal isolates. Methods: We collected the S. lugdunensis isolates between 2003 and 2013. The antimicrobial resistance test, SCCmec typing, accessory gene regulator (agr) typing, pulsed-field gel electrophoresis (PFGE), and δ-like hemolysin activity were performed. Results: In total, 118 S. lugdunensis isolates were collected, of which 67 (56.8%) were classified into the infection group and 51 (43.2%) into the commensal group. The oxacillin resistance rate was 36.4%. The most common SCCmec types were SCCmec types V (51.4%) and II (32.6%). In total, 34 pulsotypes were identified. The PFGE typing revealed five clones (pulsotypes A, J, M, N, and P) at our hospital. Pulsotypes A and N caused the spread of high oxacillin resistance. In total, 10.2% (12 of 118) of the isolates lacked δ-like hemolysin activity. Compared with the infection group, the commensal group showed a higher percentage of multiple drug resistance and carried a higher percentage of SCCmec type II (11 of 22, 50% and 3 of 21, 14.3%) and a lower percentage of SCCmec type V (8 of 22, 36.4% and 14 of 21, 66.7%). The commensal group (27 PFGE types) showed higher genetic diversity than did the infection group (20 PFGE types). No difference was observed in the distribution of the five main pulsotypes, agr typing, and the presence of δ-like hemolysin activity between the two groups. Conclusions: Five main clones were identified at our hospital. The commensal group showed higher genetic diversity, had a higher percentage of multidrug resistance, and carried a higher percentage of SCCmec type II and a lower percentage of SCCmec type V than did the infection group. [ABSTRACT FROM AUTHOR]

Introduction: Professor Konstantinos Logothetopoulos is considered one of the founders of modern Gynaecology in Greece. Material and methods: The establishment of new hospitals and medical institutes in Greece, the invention of the Logo-pack and organization of the first radiotherapy centre in Greece confirm his title as a distinguished medical doctor. However, he collaborated with the Nazi occupiers during the Second World War and for this reason he is considered a traitor as his decision to become Prime Minister overshadows the image of the distinguished professor and cancels all his contribution to Greek gynaecology. Conclusion: The aim of this article is to illustrate truths and facts of the life of a prominent doctor and to prove how his political decisions damaged irreversibly his career. [ABSTRACT FROM AUTHOR]

Background and Objectives: Salmonella is an important food-borne pathogen in humans. Strains of Salmonella spp. that producing extended-spectrum β-Lactamases have become a concern in medicine regarding both antimicrobial treatment and infection control program. The objective of this study was to describe the antibiotic susceptibility, ESBL production and determining the prevalence of the blaCTX-M-1 group among clinical isolates of Salmonella spp. Materials and Methods: A total of 110 Salmonella isolates collected from four Tehran hospitals during May 2012 and April 2013. The specific monovalan Salmonella antisera were used for serogrouping of Salmonella isolates. Antibacterial susceptibility was determined by disk diffusion and ESBL phenotype was confirmed by combination disk method. The blaCTX-M-1 group was identified by PCR with specific primers. The transferability of the blaCTX-1 group was tested by conjugation with broth matting method. Results: The prevalence of Salmonella serogroups consist of 56.4% serogroup D, 13.6 % serogroup C, 10 % serogroup B, and 1.8 % serogroup A and 18.2% other serogroups. Maximal resistance in Salmonella isolates was noticed against trimethoprim- sulfamethoxazole (63.6%) and nalidixic-acid (47/3%). All isolates were susceptible to imipenem and ciprofloxacin. Four isolates (3.6%) showed ESBLs phenotype. All Salmonella spp. that produce ESBls have blaCTX-1 genes group. A conjugative plasmid containing blaCTX-1 group was found in one Salmonella isolate. Conclusion: This study demonstrates the predominant presence of the gene encoding CTX-M-1 group among ESBLs producing of Salmonella spp. They can transmit to bacteria of this genus or even other genera of enteric bacteria. [ABSTRACT FROM AUTHOR]

Introduction: Staphylococcus aureus is one of the most common pyogenic bacteria. They are notorious for developing prompt resistance to newer antimicrobials. With increasing incidence of methicillin-resistant S. aureus (MRSA) isolates, the treatment options are also becoming limited. Clindamycin is an excellent drug for skin and soft tissue infections, but resistance mediated by the inducible phenotype (iMLSB) leads to in vivo therapeutic failure even though there may be in vitro susceptibility. The double disk approximation test (D-test) can reliably detect the presence of such isolates. This study was aimed to detect and report the prevalence of the iMLSB phenotype in NEIGRIHMS, a tertiary care center in Northeast India. Methodology: A total of 243 consecutive isolates were subjected to routine identification tests followed by antimicrobial sensitivity testing. Erythromycin-resistant isolates were tested for inducible resistance phenotype by the D-test. Results: Among strains tested, 95 (39%) were erythromycin resistant. Twenty-six (10.7%) isolates were D-test positive (iMLSB phenotype), 41 (16.88%) were constitutively resistant (cMLSB phenotype), and 28 isolates (11.52%) were found to be negative by D-test. The incidence of both inducible and constitutive phenotypes was higher in MRSA isolates compared to methicillin-sensitive S. aureus (MSSA) isolates. Conclusions: This study revealed a moderate prevalence of the inducible clindamycin phenotype in the staphylococcal isolates tested. Clinical microbiology laboratories in areas of high MRSA prevalence should consider performing the D-test routinely. This will help prevent prescription of drug(s) whose therapeutic efficacy is doubtful. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine socio-demographic profile among the OPD patients and the overall satisfaction level of the patients utilizing the OPD. STUDY DESIGN: A descriptive cross sectional study. PLACE AND DURATION: Conducted in OPD of Al-Nafees Hospital Islamabad from 12th January -12th March 2015. METHODOLOGY: Through convenient sampling a closed ended structured questionnaire was employed to collect the quantitative data. OPD patients aged 18-64 who showed willingness to participate were included in the study. Indoor patients, patients below 18 and above 64 and those who were not willing were excluded. RESULTS: The study was conducted on 209 patients. Overall satisfaction level of patients with the OPD health services was 86.2%. Satisfaction level was found to be more in females than males. 42.6% had a family income of >15000 Rupees but satisfaction level with OPD services was same among respondents falling in different categories of family income. Patients with primary level of education were more satisfied. 41.1% waited 15-30 minutes for the examination by the doctor. 89% of the patients were satisfied from the registration staff. 73.3% were satisfied with doctor's service. The satisfaction level from the nurses was 64.6%. 63.3% were satisfied from the services provided by the pharmacy. 63.2% said that the medical expenses were affordable. 88% of the patients agreed upon the cleanliness of the building of the hospital and 77% stated that that signs and boards were easy to follow. CONCLUSION: In the current study it was found that majority of respondents were highly satisfied with the OPD services offered at Al- Nafees Hospital. Patients were satisfied with the behavior of registration staff, Physicians' communication skills, waiting time for examination, nursing care, pharmacy services and logistic arrangements. [ABSTRACT FROM AUTHOR]

Background: The most important duty of a doctor is to save the life of patient; however, after providing first aid & resuscitative measures, the Casualty Medical Officer has to carry out exhaustive documentation of medico legal cases especially while examining the victims of physical trauma, domestic violence, a◻ empts of suicide, sexual assault, etc. The present study is carried out with a view to understand the pa◻ ern and magnitude of Medico legal cases (MLC's) in this region so as to identify methods to Prevent and reduce incidences, if any. Materials & method: This was a retrospective study; all the records of MLC's which came to the casualty department of the hospital between Jan 2013 to December 2013 were studied. Results: The males were maximally involved (66.3%). Among the age group 21-30 years (35%) were more. Among the MLC's cases, RTA constituted 31.77% followed by assault cases (26.71%). [ABSTRACT FROM AUTHOR]