Implementation of Triage System and Shortening Patient Journey Time to Prevent COVID-19 Transmission in a University Hospital during a Pandemic

To explore the characteristics of the patient under investigation (PUI), and the routes and the patient journey time in our outpatient service, we examined the demographic data, presenting symptoms, risks of contact with COVID-19 cases, and the results of real-time polymerase chain reaction (PCR) tests in PUI cases from March to May 2020. The contact time, transfer time and total journey time of patient journey routes in our hospital were also explored. The results were shown in numbers, percentages and medians (interquartile range, IQR). A total of 334 PUI cases were identified from our triage system. The median (IQR) age was 35 (27, 47) years. Cough was the most common presenting symptom (56.2%), while fever (≥37.5 °C) was found in only 19.8% of the cases. The median (IQR) time of onset of the presenting symptoms was 3 (1, 5) days. The most common risk of contact with COVID-19 cases found during the triage was living in or returning from an outbreak area. Fifteen (4.5%) of the PUI cases had positive real-time PCR tests. The contact time and transfer time were longest in the PUI ward and from the Emergency Department (ED) to the PUI ward, respectively. Plans and actions to shorten the transfer time between the ED and the PUI ward and the total journey time should be developed.

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Clinical profile and outcome of acute organophosphate poisoning in children of Upper Egypt: a cross-sectional study

BMC Pediatrics ◽

10.1186/s12887-021-02563-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Khaled A. Abdel Baseer ◽

Eman Fathala Gad ◽

Yaser F. Abdel Raheem

Keyword(s):

Cumulative Dose ◽

Demographic Data ◽

Cross Sectional Study ◽

University Hospital ◽

Arterial Oxygen ◽

Organophosphate Poisoning ◽

Time Interval ◽

Sectional Study ◽

Cross Sectional ◽

Presenting Symptoms

Abstract Background Organophosphates are one of the most common agents of poisoning in developing countries including Egypt. Due to lack of data about characteristics of organophosphates poisoning in our localities, we aimed to evaluate its clinical pattern and factors affecting outcome. Methods It was a cross-sectional study conducted in South valley University hospital between January 2019 and December 2019. It included all children ≤16 years of age presented with organophosphates poisoning. Diagnosis was performed from the history taken from the patient’s relatives and presenting symptoms. Demographic data, mode and route of poisoning, time from exposure to presentation, clinical symptomatology, grading and routine investigations were evaluated in addition to treatment taken and outcome. Results During the study period, 108 children; mean age was 7.95 ± 4.11 years (range 1. 5-16 years) presented with organophosphorous poisoning. Sixty five (60%) cases were females and 43 (40%) were males. Unintentional acts (87%) were detected more than suicidal (13%) and inhalation route (63.8%) more than ingestion (36. 2%). Miosis was the most frequent clinical sign (100%) followed by respiratory distress (77.7%). Regarding time of presentation to emergency department, 43 (40%) cases were presented within 6 h while others presented more than 6 h post-exposure. Mechanical ventilation (MV) was needed for 14 (13%) cases and 6 (5.5%) cases died due to respiratory failure. Duration of hospital stay, mean time interval from toxic exposure to hospital presentation, leucocytosis, need for MV and cumulative dose of pralidoxime were significantly higher in non survivors than survivors while Pao2 (partial arterial oxygen) and GCS (Glasgow coma scale) were significantly lower. Conclusion This study concluded that time consumed till presentation to hospital, low GCS, need for MV, leucocytosis, decreased PaO2 and increased cumulative dose of pralidoxime were independent risk factors of mortality.

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Health-related quality of life in different trimesters during pregnancy

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01811-y ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Huailiang Wu ◽

Weiwei Sun ◽

Hanqing Chen ◽

Yanxin Wu ◽

Wenjing Ding ◽

...

Keyword(s):

Quality Of Life ◽

Pregnant Women ◽

Demographic Data ◽

Cross Sectional Study ◽

University Hospital ◽

Health Related Quality ◽

Cross Sectional ◽

Related Quality ◽

Health Related

Abstract Background Pregnant women experience physical, physiological, and mental changes. Health-related quality of life (HRQoL) is a relevant indicator of psychological and physical behaviours, changing over the course of pregnancy. This study aims to assess HRQoL of pregnant women during different stages of pregnancy. Methods This cross-sectional study was performed using the The EuroQoL Group’s five-dimension five-level questionnaire (EQ-5D-5L) to assess the HRQoL of pregnant women, and demographic data were collected. This study was conducted in a regional university hospital in Guangzhou, China. Results A total of 908 pregnant women were included in this study. Pregnant women in the early 2nd trimester had the highest HRQoL. The HRQoL of pregnant women rose from the 1st trimester to the early 2nd trimester, and dropped to the bottom at the late 3rd trimester due to some physical and mental changes. Reports of pain/discomfort problem were the most common (46.0%) while self-care were the least concern. More than 10% of pregnant women in the 1st trimester had health-related problems in at least one dimension of whole five dimensions. In the whole sample, the EuroQoL Group’s visual analog scale (EQ-VAS) was 87.86 ± 9.16. Across the gestational stages, the HRQoL remained stable during the pregnancy but the highest value was observed in the 1st trimester (89.65 ± 10.13) while the lowest was in the late 3rd trimester (87.28 ± 9.13). Conclusions During pregnancy, HRQoL were associated with gestational trimesters in a certain degree. HRQoL was the highest in the early 2nd trimester and then decreased to the lowest in the late 3rd trimester due to a series of physical and psychological changes. Therefore, obstetric doctors and medical institutions should give more attention and care to pregnant women in the late 3rd trimester.

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Coassessment framework to identify person-centred unmet needs in stroke rehabilitation: a case report in Norway

BMJ Innovations ◽

10.1136/bmjinnov-2020-000432 ◽

2020 ◽

Vol 7 (1) ◽

pp. 148-156

Author(s):

Kari Jorunn Kværner ◽

Linn Nathalie Støme ◽

Jonathan Romm ◽

Karianne Rygh ◽

Frida Almquist ◽

...

Keyword(s):

Cognitive Impairment ◽

Stroke Rehabilitation ◽

Unmet Needs ◽

Health Workers ◽

University Hospital ◽

Health Staff ◽

Hospital Workers ◽

Next Of Kin ◽

Patient Journey ◽

Health Value

ObjectiveTo describe unmet needs and values in stroke rehabilitation using the Health Value Framework and the associated coassessment tool Health Value Spider, a framework designed to identify and prioritise unmet needs based on health technology assessment (HTA).SettingThe study took place at Oslo University Hospital, Norway, from February to April 2019. Participants in three consecutive workshops were recruited from Sunnaas Rehabilitation Hospital, Oslo Municipality, Hospital Procurement Trust and Oslo University Hospital. Twenty-four hospital workers (medical and allied health staff and administrative staff) participated in workshop 1 and 29 patients, user representatives and hospital workers in workshop 2. Twenty-one patients and hospital workers participated in workshop 3.InterventionsStakeholder analysis and scenario building was performed in a coassessment setting where unmet needs were identified applying the Health Value Framework. Two of the authors are also the developers of the Health Value Framework (KJK and LNS).ResultsIn the two first workshops where health workers, patients and next of kin perspectives were elicited, three needs were identified: patient insecurity in patient journey transitions, lack of stroke rehabilitation expertise in primary care and invisible patient problems, such as fatigue and cognitive impairment. In workshop 3, 12 opportunity areas were identified. Four opportunity areas were selected by the stakeholders based on a prioritisation process: early discovery of cognitive impairment, rehabilitation continuity, empowered patients and next of kin and remote monitoring and digital touchpoints.ConclusionHealth Value Spider successfully identified and prioritised unmet needs and described associated values.

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The epidemiology of Moebius syndrome in Italy

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01808-2 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Arturo Carta ◽

Stefania Favilla ◽

Giacomo Calzetti ◽

Maria Cristina Casalini ◽

Pier Francesco Ferrari ◽

...

Keyword(s):

Demographic Data ◽

Geographical Area ◽

National Level ◽

Age At Diagnosis ◽

University Hospital ◽

Italian Population ◽

Moebius Syndrome ◽

Cross Sectional ◽

Geographical Regions ◽

Chi Square Analysis

Abstract Background The epidemiology of Moebius syndrome (MBS) is difficult to assess. In the present study, we investigated the epidemiology of MBS in a well-defined population within a precise geographical area. Materials and methods Our university hospital is the only national referral center for the diagnosis and treatment of MBS. Participants in this cross-sectional study were patients affected by MBS who had been periodically followed by our medical staff since 1998. Most of the patients were referred to our hospital by the Italian Association of Moebius Syndrome (AISMO). Demographic data necessary for study purposes were made available in the AISMO database, updated to April 2018. Subjects were assigned to geographical macroareas that are conventionally used in surveys and epidemiological investigations by the Italian National Institute of Statistics. The rates and prevalence of MBS cases were calculated on the basis of the last available survey of the Italian population. Each study parameter was then calculated with reference to the whole country and macroarea partition. The sex rate and the corresponding prevalence were calculated with respect to the weighted whole population and to the respective sex population. Chi-square analysis was adopted to investigate possible differences among geographical regions and/or sexes. A p value < 0.05 was considered statistically significant. Results One hundred and sixty-four out of 212 MBS patients fulfilled our inclusion criteria. All cases occurred in Caucasian patients and were sporadic. The median age at diagnosis was 3.6 years, ranging from 0 to 55 years; this range was significantly reduced to 0–5 years (median age at diagnosis: 2.2 years) in patients included after 2007. The calculated prevalence at birth was 0.06 cases per 10,000 live births, with an overall prevalence of 0.27/100,000, without any sex or geographical predominance. Conclusions The prevalence of MBS observed herein, rounded for possible underestimation, was 0.3/100,000 people, without any regional difference in the distribution of cases. Our data confirm the rarity of the disease on a national level.

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3124 Early Electrographic Seizure Detection by Neuro ICU Nurses via Bedside Real-Time Quantitative EEG

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.93 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 38-38

Author(s):

Safa Kaleem ◽

Christa B. Swisher

Keyword(s):

Positive Predictive Value ◽

Real Time ◽

Predictive Value ◽

Quantitative Eeg ◽

University Hospital ◽

Duke University ◽

Study Population ◽

Time To Detection ◽

Sensitivity Specificity ◽

Improve Patient

OBJECTIVES/SPECIFIC AIMS: 1. Determine positive predictive value, negative predictive value, sensitivity, and specificity of Neuro ICU nurse interpretation of real-time bedside qEEG. 2. Determine difference in time to detection of first seizure between Neuro ICU nurse qEEG interpretation and EEG fellow reads of cEEG. 3. Determine what qualities of seizures make detection by neuro ICU nurses more or less likely – e.g. duration of seizures, type of seizures, spatial extent of seizures. METHODS/STUDY POPULATION: Recruit neuro ICU nurses taking care of 150 patients admitted to the Neuro ICU at Duke University Hospital who are initiated on cEEG monitoring. Nurses will be consented for their participation in the study. Neuro ICU nurses will evaluate the qEE RESULTS/ANTICIPATED RESULTS: From literature estimates of a 20% seizure prevalence in critical care settings, we hope to have 30 patients with seizures and 120 without. Based on prior study in the Duke Neuro ICU, we hypothesize that Neuro ICU nurses will have sensitivity and DISCUSSION/SIGNIFICANCE OF IMPACT: This is the first prospective study of neuro ICU nurse interpretation of real-time bedside qEEG in patients with unknown NCSE/NCS presence. If nurse sensitivity, specificity, and positive predictive value are clinically useful, which we deem would be so at a sensitivity of 70% or greater, with acceptable false alarm rate, nurse readings of qEEG could significantly decrease the time to treatment of seizures in the Neuro ICU patient population, and perhaps could improve patient outcomes.

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Clinical features of pharyngeal cancer: a retrospective study of 258 consecutive patients

The Journal of Laryngology & Otology ◽

10.1258/0022215011907703 ◽

2001 ◽

Vol 115 (2) ◽

pp. 112-118 ◽

Cited By ~ 18

Author(s):

A. Escribano Uzcudun ◽

P. Bravo Fernández ◽

J. J. Sánchez ◽

A. García Grande ◽

I. Rabanal Retolaza ◽

...

Keyword(s):

Retrospective Study ◽

Head And Neck ◽

Clinical Features ◽

Medical Records ◽

Performance Status ◽

Nasopharyngeal Cancer ◽

University Hospital ◽

Premalignant Lesions ◽

Pharyngeal Cancer ◽

Presenting Symptoms

Pharyngeal cancer still presents an unsatisfactory mortality (30-40 per cent in most series, with a slightly better prognosis for nasopharyngeal cancer relative to both oropharyngeal and hypophyarngeal cancers) despite advances in treatment. Therefore, it is critical to know the clinical features of pharyngeal cancer. The purpose of this study was to investigate the most relevant clinical features of pharyngeal cancer (oropharyngeal, hypopharyngeal, and nasopharyngeal) in order to improve knowledge of this malignancy with the aim of ameliorating diagnosis and treatment.The retrospective study was based on a review of medical records from 258 consecutive patients with pharyngeal cancer (oropharyngeal, hypopharyngeal and nasopharyngeal) diagnosed at La Paz University Hospital, Madrid, Spain, between January 1 1991 and and December 31 1995. Medical records were provided by the Departments of Otorhinolaryngology, Head and Neck Surgery, Radiation Oncology, and Medical Oncology.All medical records were analysed for the following clinical variables: 1) incidence, 2) sociodemographics, 3) sites (oropharynx, hypopharynx, nasopharynx) and subsites, 4) clinical and histological staging, 5) pathlogy, 6) presenting symptoms, 7) time to diagnosis, 8) patients’ general performance status at diagnosis, 9) personal cancer history and synchronous head and neck tumours, 10) premalignant lesions, and 11) paediatric cases.Our most outstanding finding was the excessively long time that elapsed between first clinical manifestation appearance and conclusive diagnosis of pharyngeal cancer (4.7 months for pharynx, 4.5 for oropharynx, 4.4 for hypopharynx and 6.5 for nasopharynx cancers). It was found that nasopharyngeal cancer was quite different from both oropharyngeal and hypopharyngeal cancers with respect to its potential aetiology, risk factors and clinical presentation. In addition it has a better prognosis.

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Low frequency of request for liaison psychiatry: A difficulty in the early detection of mental disorders by medical assistants?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.585 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S487-S487

Author(s):

M. Aguiar Machado ◽

J. Gonçalves Oliveira ◽

E. Oliveira Cunha ◽

E. Vieira de Melo ◽

E. Oliva-Costa

Keyword(s):

Depressive Symptoms ◽

Mental Disorders ◽

Early Detection ◽

Clinical Medicine ◽

Demographic Data ◽

Low Frequency ◽

Hospitalized Patients ◽

University Hospital ◽

Liaison Psychiatry ◽

Epidemiological Profile

IntroductionThe liaison psychiatry (LP) is a feature used by the psychiatrist in order to improve the management of patients with mental suffering and/or mental disorder admitted to general hospital.ObjectivesTo characterize the epidemiological profile of hospitalized patients at the university hospital of the federal university of Sergipe (HU-UFS) submitted to LP.Methodsretrospective and observational study, through analysis of medical records of patients admitted in the wards of clinical medicine and surgery from the HU-UFS, in the period from January to December 2015, submitted to LP. The information collected fed a specific questionnaire developed by the authors, intended for research of socio-demographic data and clinical profile.Resultsthe frequency of request for IP was of 3.5%, with the majority of applications was performed by clinical medicine (71.2%), while the surgical clinic was responsible for 28.8%. The main reason for the request of LP was the presence of depressive symptoms (49.1%). There was a predominance of females (52.5%) and the mean age was 45.9 ± 14.6 years.ConclusionsThe frequency of request for LP was very low, suggesting a difficulty in the early detection of mental disorders by physicians. This finding points to an underreporting of cases, since the prevalence of depressive symptoms in hospitalized patients is over 50% in this institution.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The Role of Dynamic Ultrasound in the Assessment of the Pathological Changes of Acromioclavicular and Sternoclavicular Joints

QJM ◽

10.1093/qjmed/hcab106.077 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Zeinab Yousif Ishag Abdelhafiz ◽

Khalid Ahmed Mohammed Ali ◽

Safaa Kamal Mohammed Badraldeen

Keyword(s):

Shoulder Pain ◽

Dynamic Assessment ◽

Cost Comparison ◽

University Hospital ◽

Patient Comfort ◽

Radiology Department ◽

Control Group ◽

Diagnostic Modality ◽

Presenting Symptoms ◽

Dynamic Ultrasound

Abstract Background Sonography is a useful imaging tool for the examination of musculoskeletal pathology. There are many advantages to this technique, including easy accessibility, low cost, comparison with the asymptomatic limb, and patient comfort. Unlike other available modalities, dynamic assessment is readily performed using sonography. Furthermore, the use of Doppler technique allows assessment of vascularity, inflammation, and anatomical relationships of the structure in question to adjacent vessels. Aim of Study This study investigates the value of dynamic ultrasound in the evaluation of AC and SC joints abnormality in comparison with the asymptomatic limb. Patients & Methods This prospective study included fifty cases, thirty patients were clinically positive for shoulder pain. Twenty healthy persons examined as control group. The patients were referred from Rheumatology and Immunology Department of Ain Shams University.US evaluation was performed at the Radiology Department of Ain –Shams University Hospital in period from January to June2018, to characterizing the AC and SC joints, their pathogenesis and sequelae. Dynamic US examination was also performed in all the cases. Results This study included 30 patients. The most common presenting symptoms in the primary care were shoulder pain which present in all 30 patients. Appropriate history and physical examination coupled with correct radiographs usually lead to an accurate diagnosis, we add that dynamic US which served a role in directing the management plan in 18 patients, this further confirmed with a positive clinical examination, in contrast to the other 12 patients for whom there was negative clinical findings. Conclusion High-resolution US technology, coupled with good anatomical knowledge and proper technique, has become valuable in the assessment of ACJ pathology as can be a useful initial diagnostic modality in SCJ osteoarthritis. Using US as a first line investigative tool can eliminate the need for further more expensive investigation like CT/ MRI and serve as a guide for further imaging and management.

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The feasibility and validity of using a real time location system (RTLS) to measure bedside contact time

Journal of Research in Nursing ◽

10.1177/17449871211016169 ◽

2021 ◽

pp. 174498712110161

Author(s):

Ann-Marie Cannaby ◽

Vanda Carter ◽

Thomas Hoe ◽

Stephenson Strobel ◽

Elena Ashtari Tafti ◽

...

Keyword(s):

Real Time ◽

Contact Time ◽

Measured Data ◽

Complete Agreement ◽

Observation Data ◽

The Real ◽

Measured Time ◽

The Difference ◽

Hospital Wards ◽

Location Systems

Background The association between the nurse-to-patient ratio and patient outcomes has been extensively investigated. Real time location systems have the potential capability of measuring the actual amount of bedside contact patients receive. Aims This study aimed to determine the feasibility and accuracy of real time location systems as a measure of the amount of contact time that nurses spent in the patients’ bed space. Methods An exploratory, observational, feasibility study was designed to compare the accuracy of data collection between manual observation performed by a researcher and real time location systems data capture capability. Four nurses participated in the study, which took place in 2019 on two hospital wards. They were observed by a researcher while carrying out their work activities for a total of 230 minutes. The amount of time the nurses spent in the patients’ bed space was recorded in 10-minute blocks of time and the real time location systems data were extracted for the same nurse at the time of observation. Data were then analysed for the level of agreement between the observed and the real time location systems measured data, descriptively and graphically using a kernel density and a scatter plot. Results The difference (in minutes) between researcher observed and real time location systems measured data for the 23, 10-minute observation blocks ranged from zero (complete agreement) to 5 minutes. The mean difference between the researcher observed and real time location systems time in the patients’ bed space was one minute (10% of the time). On average, real time location systems measured time in the bed space was longer than the researcher observed time. Conclusions There were good levels of agreement between researcher observation and real time location systems data of the time nurses spend at the bedside. This study confirms that it is feasible to use real time location systems as an accurate measure of the amount of time nurses spend at the patients’ bedside.

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Influence of patient age and colorectal polyp size on histopathology findings

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202014000200006 ◽

2014 ◽

Vol 27 (2) ◽

pp. 109-113 ◽

Cited By ~ 7

Author(s):

Silvana Marques e SILVA ◽

Viviane Fernandes ROSA ◽

Antônio Carlos Nóbrega dos SANTOS ◽

Romulo Medeiros de ALMEIDA ◽

Paulo Gonçalves de OLIVEIRA ◽

...

Keyword(s):

Demographic Data ◽

Colorectal Polyp ◽

Proximal Colon ◽

Colorectal Polyps ◽

University Hospital ◽

Consecutive Series ◽

Polyp Size ◽

Patient Age ◽

Cross Sectional ◽

Patient Âgé

BACKGROUND: Colorectal cancer is a major cause of morbidity and mortality and can arise through the adenoma-carcinoma sequence. Colonoscopy is considered the method of choice for population-wide cancer screening. AIM: To assess the characteristics of endoscopically resected polyps in a consecutive series of patients who underwent colonoscopy at a university hospital and compare histopathology findings according to patient age and polyp size. METHODS: Retrospective, cross-sectional of 1950 colonoscopy reports from consecutively examined patients. The sample was restricted to reports that mentioned colorectal polyps. A chart review was carried out for collection of demographic data and histopathology results. Data were compared for polyps sized ≤0.5 cm and ≥0.6 cm and then for polyps sized ≤1.0 cm and ≥1.1 cm. Finally, all polyps resected from patients aged 49 years or younger were compared with those resected from patients aged 50 years or older. RESULTS: A total of 272 colorectal polyps were resected in 224 of the 1950 colonoscopies included in the sample (11.5%). Polyps >1 cm tended to be pedunculated (p=0.000) and were more likely to exhibit an adenomatous component (p=0.001), a villous component (p=0.000), and dysplasia (p=0.003). These findings held true when the size cutoff was set at 0.5 cm. Patients aged 50 years or older were more likely to have sessile polyps (p=0.023) and polyps located in the proximal colon (p=0.009). There were no significant differences between groups in histopathology or presence of dysplasia. CONCLUSION: Polyp size is associated with presence of adenomas, a villous component, and dysplasia, whereas patient age is more frequently associated with sessile polyps in the proximal colon.

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