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Background: Lateral neck radiographs are commonly used in the investigation and management of patients presenting with suspected fish bone impaction. The effectiveness of these is questioned, as many fish do not have radio-opaque bones. Objective: This study evaluated the utility of lateral neck radiographs in the management of patients presenting with fish bones retained in the upper aerodigestive tract, with the creation of a treatment algorithm to guide further management. Methods: An audit of practice was undertaken at the University Hospital of Southampton, identifying all patients admitted with potential fish bone impaction in the upper aerodigestive tract. Following analysis, a treatment algorithm was constructed for use by junior doctors. Results: In total, 34 per cent of patients with a normal radiograph were subsequently found to have a fish bone present under local or general anaesthetic assessment. The sensitivity of radiographs in the detection of fish bones was found to be 51.6 per cent. Conclusion: Lateral neck radiographs have limited value in the management of suspected fish bone impaction, and should only be used following detailed clinical examination of the upper aerodigestive tract. [ABSTRACT FROM AUTHOR]

This study proposes to measure frequency and to characterize the profile of potential drug interactions (pDDI) in a general medicine ward of a teaching hospital. Data about identification and clinical status of patients were extracted from medical records between March to August 2006. The occurrence of pDDI was analyzed using the database monographs Micromedex® DrugReax® System. From 5,336 prescriptions with two or more drugs, 3,097 (58.0%) contained pDDI. The frequency of major and well document pDDI was 26.5%. Among 647 patients, 432 (66.8%) were exposed to at least one pDDI and 283 (43.7%) to major pDDI. The multivariate analysis identified that factors related to higher rates of major pDDI were the same age (p< 0.0001), length of stay (p< 0.0001), prevalence of hypertension [OR=3.42 (p< 0.0001)] and diabetes mellitus [OR=2.1 (p< 0.0001)], cardiovascular diseases (p< 0.0001) and the number of prescribed drugs (Spearman's correlation=0.640622, p< 0.0001). Between major pDDI, the main risk was hemorrhage (50.3%), the most frequent major pDDI involved combination of anticoagulants and antiplatelet drugs. Among moderate pDDI, 3,866 (90.8%) involved medicines for the treatment of chronic non-communicable diseases, mainly hypertension. In HU-USP, the profile of pDDI was similar among adults and elderly (the most frequent pDDI and major pDDI were same), the difference was only the frequency in either group. The efforts of the clinical pharmacists should be directed to elderly patients with cardiovascular compromise, mainly in use of anticoagulants and antiplatelet drugs. Furthermore, hospital managers should increase the integration between levels of health care to promote safety patient after discharge. [ABSTRACT FROM AUTHOR]

Background Little is known about patterns of clinical skills acquisition among junior doctors undertaking clinical training in the early postgraduate period. A better understanding would assist in the design of effective educational interventions for this group. Methods We conducted a cross-sectional survey of the levels of confidence and experience with a broad raft of clinical skills among early PGY1 trainees (interns), PGY2s and PGY3s within a university teaching hospital network in Sydney at the beginning of the clinical year in 1999. The instrument was a new validated 69 item questionnaire. A total of 92 respondents took part, representing 100% of the PGY1 (n=36), PGY2 (n=31) and PGY3 (n=25) cohorts. Results Commencing interns reported high confidence levels with a small group of practical skills but less confidence with clinical management skills. Significant positive differences were found for confidence with all skill areas between early PGY1 and PGY3. We identified three patterns for skills acquisition. Pattern A was the most common, with a significant difference in levels of confidence and experience between PGY1 and PGY2 but not between PGY2 and PGY3 (e.g. suturing a simple laceration). In Pattern B, significant differences were found in levels of confidence and experience between PGY1 and PGY2 as well as between PGY2 and PGY3 (e.g. cardiopulmonary resuscitation). In Pattern C, significant differences were found in levels of experience between PGY2 and PGY3 but not between PGY1 and PGY2 (e.g. endotracheal intubation). There was a significant correlation between reported confidence and experience for all skill areas. Conclusions Early postgraduate medical trainees in a Sydney teaching hospital acquire high levels of confidence and experience in most skill areas after two years of training. The first postgraduate year is particularly significant for the development of clinical skills. [ABSTRACT FROM AUTHOR]

Examines the impact of medical round on the perceptions of patients and residents at a university hospital in Japan. Importance of ward rounds on clinical training; Advantages of bedside learning; Comparison between conference-room and bedside presentations

Background: We aimed to estimate the prevalence of faecal carriage of extended-spectrum cephalosporin (ESC) resistant E. coli and K. pneumoniae (ESCr-EK) and vancomycin resistant enterococci (VRE) in patients upon hospital admission and identify factors associated with carriage to better target interventions and to guide empirical antibiotic treatment. Methods: Between October 2014 and December 2016, we recruited patients admitted to a Norwegian university hospital. A rectal swab and questionnaire covering possible risk factors for colonisation were collected upon admission. Isolates were characterized by phenotypic methods. ESCr-EK isolates were subject to whole genome sequencing. We calculated prevalence and adjusted prevalence ratios (aPR) using binomial regression. Results: Of 747 patients, 45 (6.0%) were colonised with ESCr-EK, none with VRE. The ESCr-EK isolates in 41 patients were multidrug resistant; no isolates were non-suceptible to meropenem. Prevalence of ESCr-EK was higher among travellers to Asia (aPR = 6.6; 95%CI 3.6–12; p < 0.001). No statistical significant difference in carriage was observed between departments, age or any other factors in the univariable analyses. Conclusions: The observed prevalence of ESCr-EK colonisation upon admission was in the same range but lower than that reported in similar studies from Europe. Travel to Asia was a strong predictor for colonisation of ESCr-EK to be considered when administering empirical antimicrobial treatment. As less than one third of colonised patients had travelled to Asia, and no other factors investigated were found to be strongly associated with carriage, these findings underscore that healthcare personnel must apply standard infection control precautions for all patients. [ABSTRACT FROM AUTHOR]