Admissions in a medical ward and factors independently associated with mortality

Background: Diabetic Ketoacidosis (DKA) is the most common and yet potentially life-threatening acute complication of diabetes that progresses rapidly to death and requires immediate medical intervention. Objective: To assess the DKA management and treatment outcome/in-hospital mortality and its predictors among hospitalized patients with DKA at the Medical ward of Shashemene Referral Hospital (SRH). Method: A retrospective study was conducted at the Medical Ward of SRH from 01 February 2015 to 31 January 2017. A systematic random sampling technique was used to select study subjects based on the inclusion criteria. Thus, of 236 reviewed charts, only 225 patients with DKA fulfilled inclusion criteria. Treatment outcome was considered good for patients who have shown improvement at discharge, while poor for patients who left against medical advice or died in the hospital. Logistic regression analysis was done to determine independent predictors for treatment outcome/in-hospital mortality using SPSS version 20 with statistical significant at P ⩽ .05. Results: Of 225 patients with DKA, 124 (55.1%) were male. Regular insulin was prescribed to all patients and antibiotics were administered to 87 (38.7%). Potassium supplementation was given only for 28 (12.4%). Non-adherence to insulin treatment (n = 91; 40.4%) and infection (n = 66; 29.3%) were the principal DKA precipitating factors. Even though 73.8% of hospitalized patients with DKA have shown good treatment outcomes, DKA contributed 12% in-hospital mortality. The result of multivariate logistic regression analysis shown that hypoglycemia is the only independent predictor for in-hospital mortality[ P = .03]. Moreover, the independent predictors for poor DKA treatment outcome were found to be smoker [ P = .04], Urinary tract infection (UTI) relative to other co-morbid condition [ P < .001], severe hypokalemia which increase risk of poor treatment outcome by around 4 times [ P = .02], and use of Metronidazole as a concurrent medication relative to other concurrent medication [ P = .03]. Conclusion: There was a high in-hospital mortality rate due to correctable causes. This mortality is unacceptable as it was majorly related to the poor practice of potassium supplementation and hypoglycemia due to insulin. Thus, clinicians and stakeholders should have to focus on modifiable factors (hypokalemia, UTI, and hypoglycemia) to reduce poor treatment outcome/in-hospital mortality.

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Estimation of hand hygiene opportunities on an adult medical ward using 24-hour camera surveillance: Validation of the HOW2 Benchmark Study

American Journal of Infection Control ◽

10.1016/j.ajic.2014.02.020 ◽

2014 ◽

Vol 42 (6) ◽

pp. 602-607 ◽

Cited By ~ 31

Author(s):

Thomas Diller ◽

J. William Kelly ◽

Dawn Blackhurst ◽

Connie Steed ◽

Sue Boeker ◽

...

Keyword(s):

Hand Hygiene ◽

Medical Ward ◽

Benchmark Study ◽

Camera Surveillance

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In-hospital mortality rates and HIV: a medical ward review, Lilongwe, Malawi

International Journal of STD & AIDS ◽

10.1258/ijsa.2011.011021 ◽

2011 ◽

Vol 22 (8) ◽

pp. 465-470 ◽

Cited By ~ 17

Author(s):

A Akinkuotu ◽

E Roemer ◽

A Richardson ◽

D C Namarika ◽

C Munthali ◽

...

Keyword(s):

Hospital Mortality ◽

Mortality Rates ◽

Medical Ward

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Chronic subdural hematomas: a case series from the medical ward of a north Tanzanian referral hospital

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-019-0054-7 ◽

2019 ◽

Vol 34 (1) ◽

Author(s):

Sakina Mehboob Rashid ◽

Shahrzad Seyedeh Deliran ◽

Marieke Cornelia Johanna Dekker ◽

William Patrick Howlett

Keyword(s):

Mortality Rate ◽

Case Series ◽

Medical Ward ◽

Sub Saharan Africa ◽

Neurological Deficits ◽

Definitive Treatment ◽

Delayed Presentation ◽

General Medical Ward ◽

Subdural Hematomas ◽

History Of

Abstract Background Chronic subdural hematomas (CSDH) initially present as focal neurological deficits with or without signs of increased intracranial pressure, for which admission to the general medical ward may occur if they present with poorly understood neurological deficits and no evident history of trauma. The symptoms may be long standing and mimic stroke upon presentation. Their distribution and specific clinical features in sub-Saharan Africa are largely unknown. Methods We describe a series of subdural hematoma (SDH) inpatients from the medical ward of a tertiary referral center in Northern Tanzania, describing clinical and radiological characteristics and providing clinical outcome where possible. Results Our study population numbered 30, with a male majority (n = 19, 63.3%) and a mean age of 66.8 ± 14.5 years. Mean duration from symptom onset to admission in the medical ward was 20.0 ± 30.8 days. History of head injury was reported in only 43.3% of patients. Improvement in the neurological examination was noted in 68.1% of the 22 patients who underwent surgery. The mortality rate was 20.0%. Conclusion A majority of the patients were elderly males and presented late to the hospital. Delayed presentation and diagnosis due to, amongst other reasons, postponed imaging resulted in a prolonged time to definitive treatment and a high mortality rate compared to other regions of the world.

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THE IMPACT OF ANTIMICROBIAL STEWARDSHIP ON THE PATTERNS OF ANTIBIOTICS’ PRESCRIPTION AND CLINICAL OUTCOMES IN THE MEDICAL WARD OF A MALAYSIAN TERTIARY CARE HOSPITAL

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2021v13i3.40460 ◽

2021 ◽

pp. 20-25

Author(s):

OVAIS ULLAH SHIRAZI ◽

NORNY SYAFINAZ AB RAHMAN ◽

CHE SURAYA ZIN ◽

HANNAH MD MAHIR ◽

SYAMHANIN ADNAN

Keyword(s):

Length Of Stay ◽

Clinical Outcomes ◽

Antimicrobial Stewardship ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Medical Ward ◽

Prescribing Patterns ◽

Care Hospital ◽

Slope Change ◽

The Impact

Objective: To evaluate the impact of antimicrobial stewardship (AMS) on antibiotic prescribing patterns and certain clinical outcomes, the length of stay (LOS) and the re-admission rate (RR) of the patients treated within the medical ward of a tertiary care hospital in Malaysia. Methods: This quasi-experimental study was conducted retrospectively. The prescriptions of the AMS included alert antibiotics (AA) such as cefepime, ceftazidime, colistin (polymyxin E), imipenem-cilastatin, meropenem, piperacillin-tazobactam and vancomycin were reviewed for the period of 24 mo before (May, 2012–April, 2014) and after (May, 2014–April, 2016) the AMS implementation for the patients who were treated within the medical ward of a Malaysian tertiary care hospital. Patterns of antibiotics prescribed were determined descriptively. The impact of the AMS on the length of stay (LOS) and readmission rate (RR) was determined by the interrupted time series (ITS) comparative analysis of the pre-and post-AMS segments segregated by the point of onset (May, 2014) of the AMS program. Data analysis was performed through autoregressive integrated moving average (ARIMA) Winter Additive model and the Games-Howell non-parametric post hoc test by using IBM Statistical Package for Social Sciences version 25.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: A total of 1716 prescriptions of the AA included for the AMS program showed that cefepime (623, 36.3%) and piperacillin-tazobactam (424, 24.7%) were the most prescribed antibiotics from May 2012 to April 2016. A 23.6% drop in the number of the AA prescriptions was observed during the 24-month post-AMS period. The LOS of the patients using any of the AA showed a post-AMS decline by 3.5 d. The patients’ LOS showed an average reduction of 0.12 (95% CI, 0.05–0.19, P=0.001) with the level and slope change of 0.18 (95% CI, 0.04–0.32, P=0.02) and 0.074 (95% CI, 0.02–0.12, P=0.002), respectively. Similarly, the percent RR reduced from 20.0 to 9.85 during the 24-month post-AMS period. The observed post-AMS mean monthly reduction of the RR for the patients using any AA was 0.38 (95% CI, 0.23–0.53, P<0.001) with the level and slope change of 0.33 (95% CI, 0.14–0.51, P=0.02) and 0.37 (95% CI, 0.16–0.58, P=0.001), respectively. Conclusion: The AMS program of a Malaysian tertiary care hospital was a coordinated set of interventions implemented by the AMS team of the hospital that comprised of the infectious diseases (ID) physician, clinical pharmacists and microbiologist. The successful implementation of the AMS program from May, 2014 to April, 2016 within the medical ward resulted in the drop of the number of AA prescriptions that sequentially resulted in the significant (P<0.05) post-AMS reduction of the LOS and the RR.

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Important Aspects of Pharmacist‐led Medication Reviews in an Acute Medical Ward

Basic & Clinical Pharmacology & Toxicology ◽

10.1111/bcpt.12901 ◽

2017 ◽

Vol 122 (2) ◽

pp. 253-261 ◽

Cited By ~ 4

Author(s):

Cille Bülow ◽

Kirstine Ullitz Færch ◽

Helle Armandi ◽

Birgitte Nybo Jensen ◽

Jesper Sonne ◽

...

Keyword(s):

Medical Ward ◽

Medication Reviews

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Timing of Aspirin and Secondary Preventative Therapies in Acute Stroke: Support for Use of Stroke Units

Scottish Medical Journal ◽

10.1177/003693300505000209 ◽

2005 ◽

Vol 50 (2) ◽

pp. 69-72 ◽

Cited By ~ 1

Author(s):

J Reid ◽

M-J MacLeod ◽

D Williams

Keyword(s):

Acute Stroke ◽

Ct Scanning ◽

Medical Ward ◽

Stroke Patients ◽

Stroke Units ◽

General Medical Ward ◽

Brain Scans ◽

Angiotensin Ii Antagonist ◽

Acute Stroke Unit ◽

Ct Brain

Background: We aimed to study the timing of aspirin prescription in ischaemic stroke comparing patients admitted to an acute stroke unit (ASU) directly or via a general medical ward. We also analysed prescription of secondary preventive therapies in stroke patients in an ASU. Methods: Retrospective analysis was made of medical notes and prescription records of 69 patients admitted to an ASU over a three month period to establish timing of aspirin prescription with respect to onset of stroke symptoms, CT brain scan and route of admission to the ASU. Results: CT brain scans were obtained at a median of 2.1 days post stroke (IQ range 1.3–4.3). Patients directly admitted to the ASU received aspirin earlier post admission compared to those admitted via a medical ward (0.7 vs 2.2 days, p<0.01) and were also more likely to receive aspirin prior to CT scan being performed (57% vs 19%, p=0.02). 86% of stroke patients were discharged on an antiplatelet therapy, 79% on a statin, 37% on a thiazide diuretic and 32% on an ACE inhibitor or angiotensin II antagonist. Conclusion: Aspirin was given more promptly in acute stroke and more commonly prior to CT scanning in an ASU compared to a medical ward. Statin therapy is used extensively in stroke but there is a much lower rate of initiation of other secondary preventive therapies (e.g. anti-hypertensive therapy) in hospital. These findings demonstrate a hesitancy in early use of aspirin amongst general physicians and lends support for the use of stroke units.

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