COVID-19 Patients Symptoms: Gastrointestinal Presentations, Comorbidities and Outcome in a Canadian Hospital setting

Background: The Coronavirus disease 2019 (COVID-19) pandemic has had a significant global impact and Canada has seen significant morbidity and mortality nationwide. While public health interventions and provincially regulated health insurance coverage have been credited with minimizing transmission rates in Canada relative to neighboring countries, disease presentation has been presumed to be the same. Aim: We sought to determine factors associated with differences in gastrointestinal outcomes in COVID-19 patients at a Canadian hospital. Methods: We collected data from 192 hospital records of COVID-19 patients across seven Hamilton Health Sciences hospitals, a network of academic health centers located in Hamilton, Ontario serving one of the largest metropolitan areas in Canada. Statistical and correlative analysis of symptoms, comorbidities, and mortality were performed. Results: There were 192 patients. The mean age was 57.6 years (SD=21.0). For patients who died (n=27, 14%), mean age was 79.2 years old (SD=10.6) versus 54 years for survivors (SD=20.1). There was a higher mortality among patients with older age (p=0.000), long hospital stay (p=0.004), male patients (p=0.032), and patients in nursing homes (p=0.000). Patients with dyspnea (p=0.028) and hypertension (p=0.004) were more likely to have a poor outcome. Laboratory test values that were significant in determining outcomes were an elevated INR (p=0.007) and elevated creatinine (p=0.000). Cough and hypertension were the most common symptom and comorbidity, respectively. Diarrhea was the most prevalent (14.5%) gastrointestinal symptom. Impaired liver function was related to negative outcome (LR 5.6; p=0.018). Conclusion: In a Canadian cohort, elevated liver enzymes, prolonged INR and elevated creatinine were associated with poor prognosis. Hypertension was also linked to a higher likelihood of negative outcome.

Assessment of Canadian Hospital Pharmacists’ Job Satisfaction and Impact of Clinical Pharmacy Key Performance Indicators

Background: The clinical pharmacy key performance indicators (cpKPIs) are quantifiable measures of quality to advance clinical pharmacy practice and improve patient care. Although when delivered in combination they have been linked to important patient outcomes, no data are available relating to their impact on hospital pharmacists’ job satisfaction. Objectives: To determine the level of job satisfaction among Canadian hospital pharmacists and whether participation in cpKPI activities contributes to hospital pharmacists’ job satisfaction. Methods: A mixed-methods study was conducted. An electronic survey, consisting of 36 questions, was developed using a validated pharmacist job satisfaction tool and was then distributed nationally to hospital pharmacists between January 30 and March 14, 2019. Focus groups were conducted with pharmacists at Horizon Health Network in New Brunswick to further explore activities that contribute to their job satisfaction. Results: Overall, 284 pharmacists from 9 provinces completed the electronic survey. The mean job satisfaction score among hospital pharmacists was 3.93 (standard deviation 0.85) out of 5. Job satisfaction scores increased with increases in self-identified time spent performing cpKPI activities (r = 0.148, p = 0.014). Pharmacist satisfaction increased with time spent performing medication reconciliation on admission (β = 0.140, p = 0.032) and decreased with time spent identifying and resolving drug therapy problems (β = –0.153, p = 0.030). Three focus groups, comprising a total of 13 pharmacists, were conducted; during these sessions, some cpKPIs were highlighted favourably, although pharmacists described some ambivalence toward patient education. The importance of having an impact and receiving appreciation was highlighted. Conclusions: Canadian hospital pharmacists are generally satisfied with their jobs, and participation in cpKPI activities was found to be positively associated with hospital pharmacists’ job satisfaction. RÉSUMÉ Contexte : Les indicateurs clés de performance de la pharmacie clinique (ICPpc) sont des mesures quantifiables de la qualité qui permettent de faire avancer la pratique en pharmacie et d’améliorer les soins du patient. Bien qu’ils aient été associés à des résultats importants pour les patients lorsqu’ils sont utilisés conjointement, aucune donnée concernant leur impact sur la satisfaction professionnelle des pharmaciens d’hôpitaux n’est disponible. Objectifs : Déterminer le degré de satisfaction professionnelle des pharmaciens d’hôpitaux canadiens et noter si la participation aux activités liées aux ICPpc y contribue. Méthodes : Une étude à méthodologie mixte a été menée. À l’aide d’un outil validé mesurant la satisfaction professionnelle du pharmacien, les investigateurs ont préparé une enquête électronique comprenant 36 questions, qui a été distribuée à l’échelle nationale aux pharmaciens d’hôpitaux entre le 30 janvier et le 14 mars 2019. Des groupes de travail comprenant des pharmaciens au Réseau de santé Horizon au Nouveau-Brunswick ont exploré plus en profondeur les activités qui contribuaient à leur satisfaction professionnelle. Résultats : Globalement, 284 pharmaciens de neuf provinces ont répondu à l’enquête électronique. Le score moyen de satisfaction des pharmaciens d’hôpitaux était de 3,93 (écart type 0,85) sur 5. Les scores relatifs à la satisfaction professionnelle augmentaient lorsque le temps passé à faire des activités liées aux ICPpc augmentait (r = 0,148, p = 0,014). La satisfaction du pharmacien augmentait quand il passait du temps à faire le bilan comparatif des médicaments au moment de l’admission (β = 0,140, p = 0,032) et diminuait quand il devait déterminer et résoudre des problèmes de pharmacothérapie (β = –0,153, p = 0,030). Trois groupes de discussion comprenant 13 pharmaciens au total se sont penchés sur la question. Pendant leurs séances, ils ont mis en valeur certains ICPpc, bien que les pharmaciens aient décrit des ambivalences concernant les instructions données au patient. Ils ont aussi souligné l’importance d’avoir un effet positif et d’être apprécié. Conclusions : Les pharmaciens d’hôpitaux canadiens sont généralement satisfaits de leur travail et la participation à des activités liées aux ICPpc est associée à leur satisfaction professionnelle.

A methodology using UML & SADT to develop an effective business model in healthcare

A business process model is an abstraction of business funcionality in terms of modeling the goals, processes, objects and any other associated events of an enterprise. An effective business model can show how an enterprise and its subsets function today, and how one may plan for it to function in the future. Effective business modeling to gain insights towards improvements in hospital areas has been used infrequently by industrial engineers. This thesis presents a methodology using UML (Unified Modeling language) and SADT (Structured Analysis & Design Technique) that may be utilized to develop an effective business process model in the medical imaging area of a major Canadian hospital (St. Michael's Hospital). The effectiveness of this business model may clear the way towards a comprehensive analysis for improvements.

A methodology using UML & SADT to develop an effective business model in healthcare

A business process model is an abstraction of business funcionality in terms of modeling the goals, processes, objects and any other associated events of an enterprise. An effective business model can show how an enterprise and its subsets function today, and how one may plan for it to function in the future. Effective business modeling to gain insights towards improvements in hospital areas has been used infrequently by industrial engineers. This thesis presents a methodology using UML (Unified Modeling language) and SADT (Structured Analysis & Design Technique) that may be utilized to develop an effective business process model in the medical imaging area of a major Canadian hospital (St. Michael's Hospital). The effectiveness of this business model may clear the way towards a comprehensive analysis for improvements.

Neonatologie – Ausschließliche Ernährung mit humaner Milch: Rechnet sich das?

van Katwyk S et al. Economic Analysis of Exclusive Human Milk Diets for High-Risk Neonates, a Canadian Hospital Perspective. Breastfeed Med 2020; 15 (6): 377–386. DOI: 10.1089/bfm.2019.0273 Frühgeborene profitieren hinsichtlich einer Vielzahl potenzieller Komplikationen, beispielsweise der nekrotisierenden Enterokolitis, der Retinopathie, der Sepsis sowie der bronchopulmonalen Dysplasie, von einer ausschließlichen Ernährung mit humaner Milch, bei welcher die Milch der eigenen Mutter bzw. Donormilch mit aus pasteurisierter Spendermilch gewonnenem Fortifier angereichert wird. Ist dieses Vorgehen auch unter Kostenaspekten vertretbar?