scholarly journals The Rise of EPR in The UK: A Cross-Sectional Study Examining The Effect of The Transition to EPR on Adherence to VTE Prophylaxis Guidelines in General Surgical Patients

2020 ◽  
Author(s):  
Ahmad Almohtadi ◽  
Malvika Subramaniam ◽  
Anja Mattson ◽  
Bihu Malhotra ◽  
Frida Margaretha Eriksson
Keyword(s):  
Risk Assessment ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Surgical Patients ◽  
Electronic Patient Records ◽  
Cross Sectional ◽  
Vte Prophylaxis ◽  
National Quality ◽  
Prescription Rates ◽  
The Impact

Abstract Background: Hospital-acquired venous thromboembolisms (VTEs) account for 50-60% of all VTEs observed. Surgical patients are particularly at risk, and preventative measures such as thromboembolism deterrent stockings (TEDs) and low molecular weight heparin (LMWH) proves to be beneficial. The National Quality Requirement in the NHS Standard Contract 2017/19 mandates that 95% of patients undergo VTE risk assessments. Due to nationwide transitions into electronic patient records (EPR), it is important to observe the impact on the completion of vital assessments such as VTE risk. The aim of this study is to observe the effect of implementing EPR in a tertiary hospital on VTE assessments and prophylaxis administration in admitted surgical patients.Methods: Using consecutive sampling method, all acute surgical admissions at the St. George’s Surgical Admissions Unit from 26th February to 18th March (n=154) pre-EPR and 31st October to 25th November (n=151) post-EPR implementation were observed for VTE risk assessment, 24-hour re-assessment, prophylaxis (LMWH, TED stockings) prescription, administration, and patient compliance. These two sets of data were compared using a two-tailed Z test to evaluate the effect of EPR on assessment completion, and to observe if national targets were met.Results: Pre-EPR, 96% of patients had a completed VTE assessment, which increased after EPR implementation to 97% (p=0.39). LWMH prescription rates decreased from 82% to 77%, following EPR (p=0.14). Moreover, TEDs prescriptions decreased from 84% to 64% post-EPR (p<0.01). Administration rates of prophylaxis led to a general improvement post-EPR. The 24-hour re-assessment decreased from 62% to 54% of patients (p=0.08).Conclusions: This study demonstrated that current practice met national requirements of VTE assessment. EPR implementation is associated with improved rates in administration of thromboprophylaxis. However, there is still much room for improvement in adherence to risk assessment completion. Data collection post-EPR began immediately after EPR implementation. Thus, lack of confidence and familiarity of the new system could have influenced assessment rates. A multifactorial approach is required when making large transitions, including enhancing staff attitude, increasing EPR training and assessments in individual Trust’s technological needs to achieve a standard use capability.

scholarly journals Pharmacotherapeutic follow-up in a respiratory intensive care unit: description and analysis of results

2018 ◽  
Vol 16 (2) ◽  
Author(s):  
Ana Carolina de Souza e Silva ◽  
Domingos Sávio de Carvalho Sousa ◽  
Eunice Bobô de Carvalho Perraud ◽  
Fátima Rosane de Almeida Oliveira ◽  
Bruna Cristina Cardoso Martins
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Pharmacist ◽  
Anatomical Therapeutic Chemical ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Respiratory Intensive Care Unit ◽  
The Impact

ABSTRACT Objective: To describe and evaluate the pharmacotherapeutic follow-up by a clinical pharmacist in an intensive care unit. Methods: A descriptive and cross-sectional study carried out from August to October 2016. The data were collected through a form, and pharmacotherapeutic follow-up conducted by a clinical pharmacist at the respiratory intensive care unit of a tertiary hospital. The problems recorded in the prescriptions were quantified, classified and evaluated according to severity; the recommendations made by the pharmacist were analyzed considering the impact on pharmacotherapy. The medications involved in the problems were classified according to the Anatomical Therapeutic Chemical Classification System. Results: Forty-six patients were followed up and 192 pharmacotherapy-related problems were registered. The most prevalent problems were missing information on the prescription (33.16%), and those with minor severity (37.5%). Of the recommendations made to optimize pharmacotherapy, 92.7% were accepted, particularly those on inclusion of infusion time (16.67%), and dose appropriateness (13.02%), with greater impact on toxicity (53.6%). Antimicrobials, in general, for systemic use were drug class most often related to problems in pharmacotherapy (53%). Conclusion: Pharmacotherapeutic follow-up conducted by a pharmacist in a respiratory intensive care unit was able to detect problems in drug therapy and to make clinically relevant recommendations.

scholarly journals Maternity handover in Kerala: a cross sectional study

2018 ◽  
Vol 5 (9) ◽  
pp. 3760 ◽  
Author(s):  
Aadil Sheikh ◽  
Jessica Dunphy ◽  
Claire Humphries ◽  
Christina MacArthur ◽  
Semira Manaseki-Holland
Keyword(s):  
Healthcare Provider ◽  
Tertiary Care ◽  
Obstetric Care ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Community Health Services ◽  
High Rate ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Impact

Background: The objective of the study was to explore the referral system from the community to hospital obstetric care in Kerala, India.Methods: Cross-sectional study. A total of 206 obstetric inpatients in 3 hospitals in Kerala, India completed an orally-administered questionnaire regarding referral and attitudes towards healthcare information.Results: Among 206 respondents, 19 (9%) had been referred from another healthcare provider.  In multivariate analysis, referral was independently associated with being in a tertiary hospital (p<0.001). At total of 17 referred women received a document containing hand-written notes from their previous healthcare provider. Just 3 of the documents available to view were formal referral documents; others were test results and/or hospital notes. A total of 170 (86%) of the 206 women thought that receiving documents such as referral letters was important; mostly because it helped them understand their condition and explain it to others (91%).Conclusions: A high rate of self-referral (91%) was reported by obstetric inpatients. It appears that some women who are referred do not receive a formal referral document. Participants thought that receiving referral documents was important. A strong health system requires transfer of information between primary and secondary/tertiary care services, which India is seeking to develop. Further research is needed into why women are not accessing community health services and the impact of the content of referral documents on patient care. 

Awareness of the use of hyponatraemia-inducing medications in older adults with hyponatraemia: a study of their prevalent use and association with recurrent symptomatic or severe hyponatraemia

2020 ◽  
Author(s):  
Kwanghee Jun ◽  
Yujin Kim ◽  
Young-Mi Ah ◽  
Ju-Yeun Lee
Keyword(s):  
Older Patients ◽  
Case Control Study ◽  
Cross Sectional Study ◽  
Case Control ◽  
Thiazide Diuretics ◽  
Cross Sectional ◽  
Severe Hyponatraemia ◽  
Prescription Rates ◽  
The Impact ◽  
Control Study

Abstract Background Cautious use or avoidance of hyponatraemia-inducing medications (HIMs) is recommended in older patients with hyponatraemia. Objective To evaluate the use of HIMs after treatment for symptomatic or severe hyponatraemia and to investigate the impact of HIMs on the recurrence of symptomatic or severe hyponatraemia in older patients. Design and settings A cross-sectional and nested case–control study using data obtained from national insurance claims databases. Methods The rate of prescribing HIMs during the 3 months before and after the established index date was analysed in a cross-sectional analysis. Multivariable logistic regression was performed to investigate the association between HIM use and recurrence of symptomatic or severe hyponatraemia after adjusting for covariates in a case–control study. Results The cross-sectional study included 1,072 patients treated for symptomatic or severe hyponatraemia. The proportion of patients prescribed any HIMs after hyponatraemia treatment decreased from 76.9 to 70.1%. The prescription rates significantly decreased for thiazide diuretics (from 41.9 to 20.8%) and desmopressin (from 8.6 to 4.0%), but the proportion of patients prescribed antipsychotics increased from 9.2 to 17.1%. Of 32,717 patients diagnosed with hyponatraemia, 913 (2.8%) showed recurrent hyponatraemia. After adjusting for comorbid conditions, the use of any HIMs including proton pump inhibitors [adjusted odds ratio (aOR) 1.34, 95% confidence interval (CI) 1.15–1.57] and two or more HIMs (aOR 1.48, 95% CI 1.22–1.78) especially in combination with thiazide diuretics increased the likelihood of severe hyponatraemia recurrence. Conclusions Prevalent use of HIMs after treatment for symptomatic or severe hyponatraemia and multiple HIM use increase the risk of recurrent hyponatraemia in geriatric patients.

Anxiety and depression during pregnancy in the era of COVID-19

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Rasha E. Khamees ◽  
Omima T. Taha ◽  
Tamer Yehia M. Ali
Keyword(s):  
Pregnant Women ◽  
Depression Scale ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Anxiety And Depression ◽  
P Value ◽  
Cross Sectional ◽  
Kuwait University ◽  
Multiparous Women ◽  
The Impact

Abstract Objectives This study aimed to evaluate anxiety and depression in pregnant women during this global disease. Methods This was a cross-sectional study recruiting 120 pregnant women. The study was conducted at the outpatient clinic of a tertiary hospital. We recruited women attending for antenatal care. Anxiety was evaluated using an Arabic validated Kuwait University Anxiety Scale (KUAS). Depression was evaluated using a validated Arabic form of the Edinburgh Postnatal Depression Scale (EPDS). Results The study included 48 (40%) nulliparous and 72 (60%) multiparous women. The mean KUAS scores for nulliparous and multiparous women were 45.27±10.78 and 47.28±10.62. Both nulliparous and multiparous women had a fairly high possibility of depression. Fifty-three (44.2%) of them reported scores ≥ of 14. Ninety-three (77.5%) women thought that COVID-19 pandemic would affect their pregnancies. There was a significant association between the number of women reporting fear related to the COVID-19 pandemic and their KUAS and EPDS scores (p-value <0.001 each). Conclusions COVID-19 affected the mental health of pregnant women to a great extent. Care should be directed to measures that would decrease the impact of this pandemic on vulnerable populations.

scholarly journals Malnutrition and nutrition impact symptoms (NIS) in surgical patients with cancer

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0241305
Author(s):  
Eduarda Cristina Rodrigues de Morais Viana ◽  
Isadora da Silva Oliveira ◽  
Ana Beatriz Rechinelli ◽  
Isabele Lessa Marques ◽  
Vanusa Felício de Souza ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Nutritional Intervention ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Surgical Patients ◽  
Cross Sectional ◽  
Patients With Cancer ◽  
Nutrition Impact Symptoms ◽  
Male Patients ◽  
Negative Impacts

Background and aim Nutrition impact symptoms (NIS) are common in cancer patients and the negative impacts on nutritional status indicate the need for research, diagnosis and nutritional intervention in order to reduce the risk of malnutrition. We aimed to verify the presence of malnutrition, the need for nutritional intervention, NIS and their influence on the nutritional status of surgical patients with cancer. Methods This cross-sectional study was carried out in a public tertiary hospital, from March 2017 to October 2019. Nutritional status, the need for nutritional intervention and NIS were assessed through the Patient-Generated Subjective Global Assessment (PG-SGA) in the first 48 hours of hospital admission. Results Among the 135 patients evaluated, 55.6% were elderly and 51.1% were male; patients had a median age of 62 years and a predominance of cancer located in the lower gastrointestinal tract (35.6%). Malnutrition and the need for nutritional intervention were identified in 60.0% and 90.4% of cases, respectively. The presence of three or more NIS was reported by 51.9% of patients. Significant differences in NIS were observed according to sex, PG-SGA classification and PG-SGA score. After logistic regression analysis, it was determined that the symptoms that increased the chances of malnutrition were anorexia, constipation, strange taste, mouth sores and others (depression, dental or financial problems). Conclusion Malnutrition, the need for nutritional intervention and the presence of three or more NIS were elevated in the patients evaluated. Malnutrition was associated with the presence of NIS, indicating the need for attention and care in antineoplastic treatment.

Practice of venous thromboembolism (VTE) prophylaxis in hospitalized cancer patients at a comprehensive cancer center.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 149-149
Author(s):  
M.Alma Rodriguez ◽  
Alma Yvette DeJesus ◽  
Lee Cheng ◽  
Michael Kroll
Keyword(s):  
Risk Assessment ◽  
Cancer Patients ◽  
Comprehensive Cancer Center ◽  
Categorical Variables ◽  
Cancer Center ◽  
Moderate Risk ◽  
Pharmacological Prophylaxis ◽  
Vte Prophylaxis ◽  
National Quality ◽  
The Impact

149 Background: VTE prophylaxis measures are endorsed by the National Quality Forum in alignment with quality indicators from the Centers for Medicare & Medicaid Services. Accordingly, documentation of VTE risk, prophylaxis measures, and contraindications are recommended for hospitalized patients. To standardize practice we embedded a VTE risk assessment and prophylaxis module into admission and post-surgical order sets (OS), starting August 15, 2011. Methods: A retrospective study of 9,065 cancer patients (≥18 years) admitted to The University of Texas MD Anderson Cancer Center between June 01, 2013 through September 30, 2013. Pharmacological prophylaxis was executed with low-molecular-weight heparin or unfractionated heparin. Mechanical prophylaxis was executed with graduated compression stockings and/or sequential compression devices. Chi-square testing was used to determine the association between categorical variables. All statistically significant levels were determined with P values < 0.05. Results: 7,366 (81%) of all hospital admissions had documented VTE risk assessment and prophylaxis through the standardized VTE module. Before implementation of the new OS, only 40% of eligible patients received an order for VTE prophylaxis. The majority of patients were designated high or moderate risk (91.1%). Patients with high risk were more likely to receive pharmacological prophylaxis than those with moderate risk (74.1% vs. 38.2%, P<0.01). The most frequent contraindications to pharmacological prophylaxis were major surgery with risk of bleeding and thrombocytopenia (Table). Conclusions: Most patients received VTE prophylaxis based on VTE risk levels presented in a standardized OS. There is is limited information in the clinical literature about the impact of VTE prophylaxis on outcomes among cancer patients, we plan to assess anticoagulation-related outcomes in this cohort of patients. [Table: see text]

Factors associated with perceived participation three months after being discharged from a tertiary hospital

2016 ◽  
Vol 31 (9) ◽  
pp. 1257-1266 ◽  
Author(s):  
Xuemei Chen ◽  
Yanan He ◽  
Xianmei Meng ◽  
Lanshu Zhou
Keyword(s):  
Social Relations ◽  
Rating Scale ◽  
Depression Scale ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Stroke Survivors ◽  
Family Role ◽  
Cross Sectional ◽  
Factors Associated ◽  
The Impact

Objectives: To describe how first-stroke survivors perceive their participation and the problems with such participation in life and to determine the factors associated with perceived participation at three months after hospital discharge. Design: A cross-sectional study. Setting: Patients were recruited from a tertiary hospital in Shanghai, China and they were followed up in their homes. Subjects: Two hundred and fifty-seven first-stroke survivors discharged for three months participated in this study. Measures: The Chinese version of the Impact on Participation and Autonomy questionnaire, Barthel Index, Chinese Stroke Scale, Hospital Anxiety and Depression Scale and Social Support Rating Scale. Results: One hundred thirty-four (52.1%) and 147 (57.2%) participants perceived their participation as poor to very poor in the domains of family role and autonomy outdoors, respectively. Conversely, 208 (80.9%) and 228 (88.7%) participants perceived their participation to be fair to good in the domains of social relations and autonomy indoors, respectively. The ability to perform activities of daily life was the strongest correlate of participation in the domains of autonomy indoors, family role, and autonomy outdoors, whereas anxiety was the strongest correlate of participation in the domain of social relations. Conclusions: Activities of daily living were significantly associated with perceived participation in almost all domains. In contrast, anxiety was an important factor in predicting participation in the domain of social relations. These findings suggest the need to explore different strategies of promoting participation for each domain.

scholarly journals Venous thromboembolism risk in psychiatric in-patients: a multicentre cross-sectional study

2019 ◽  
Vol 43 (6) ◽  
pp. 255-259
Author(s):  
Natalie Ellis ◽  
Carla-Marie Grubb ◽  
Sophie Mustoe ◽  
Eleanor Watkins ◽  
David Codling ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Assessment Tool ◽  
Psychiatric Patients ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
The Uk

Aims and methodWe assessed venous thromboembolism (VTE) risk, barriers to prescribing VTE prophylaxis and completion of VTE risk assessment in psychiatric in-patients. This was a cross-sectional study conducted across three centres. We used the UK Department of Health VTE risk assessment tool which had been adapted for psychiatric patients.ResultsOf the 470 patients assessed, 144 (30.6%) were at increased risk of VTE. Patients on old age wards were more likely to be at increased risk than those on general adult wards (odds ratio = 2.26, 95% CI 1.51–3.37). Of those at higher risk of VTE, auditors recorded concerns about prescribing prophylaxis in 70 patients (14.9%). Only 20 (4.3%) patients had a completed risk assessment.Clinical implicationsMental health in-patients are likely to be at increased risk of VTE. VTE risk assessment is not currently embedded in psychiatric in-patient care. There is a need for guidance specific to this population.

Patient deaths and medical residents: an Asian perspective

2020 ◽  
pp. bmjspcare-2020-002239
Author(s):  
Teresa Tan ◽  
Pei Lin Koh ◽  
Marcia Levetown ◽  
Lisa Wong ◽  
Joanne Lee ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Healthcare Providers ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Support Resources ◽  
Asian Context ◽  
The Impact ◽  
Dying Patient ◽  
Poor Concentration

ObjectivesDeath is a significant event that affects healthcare providers emotionally. We aimed to determine internal medicine (IM) and paediatric (PD) residents’ responses and the impact on the residents following patient deaths, and to compare any differences between IM and PD residents. We also aimed to determine whether sufficient resources and measures were in place to support residents through their grief process.MethodsThis is a single-centre, cross-sectional study involving residents from IM and PD programmes from an academic tertiary hospital in Singapore. The residents completed a questionnaire regarding their responses and emotions after experiencing patient deaths.ResultsA total of 122 residents (85 IM and 37 PD, equally distributed between year 1 to year 4 of residency training) participated, with 100% response rate. Only half (57%) felt they would be comfortable treating a dying patient and 66.4% reported feeling sad following their patient’s death. Most (79.5%) were not aware of support resources that were available and 82% agreed that formal bereavement training should be included in the residency curriculum. PD residents had more negative symptoms than IM residents, with poor concentration (PD 35.1% vs IM 16.5%, p=0.02) and lethargy (PD 35.1% vs IM 9.4%, p<0.01) being the most common.ConclusionIn our Asian context, residents are negatively affected by patient deaths, especially the PD residents. There is a need to incorporate relevant bereavement training for all residents.

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