Clinical Ward
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2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13598-e13598
Helen Winter ◽  
Joanna Willis ◽  
Stephen Lang ◽  
Kay Drury ◽  
Jonathan Heywood ◽  

e13598 Background: The impact on cancer outcomes from the Covid-19 pandemic has yet to be determined. Concerns persist on screening, delays in diagnosis, treatment interruptions and outcomes of infection in the immunosuppressed. The need for agile working has been exemplified by establishment of Nightingale Hospitals, staff redeployment and sudden integration of virtual consultations into clinical working. With most cancer clinical trials halted, recruitment into COVID-19 research became essential and embedded into the everyday. Here we present how rapid implementation of COVID-19 randomised clinical trials within an NHS organisation during the pandemic was achieved. Methods: A COVID-19 senior facilitation committee was set up to provide oversight, maximise staff capacity and resource and prioritise studies. Specific strategies to maximise access and clinical trials recruitment for patients including children and those with solid tumours were designed. These included presence of a research nurse at clinical ward rounds and team meetings, the promotion of protocol and informed consent training to all including doctors in the acute settings and weekly research meetings to share-best practice. Reflecting on learnings from this time provide an opportunity to consider how we adjust working for our patients in the future. Results: The integration of research into the everyday working of clinical teams looking after patients with COVID-19 has become the norm. The provision of protocol and informed consent training for all levels of staff and the consideration of all patients for trials during clinical ward rounds and multi-disciplinary meetings, have ensured access to trials has become embedded. The integration of research nurses working, upskilling and prompting clinical colleagues has ensured equity of access and provided a research presence and focus during the busy clinical day. The adoption of cross-disciplinary working, sharing best practice and a culture of commitment and support to the trials ensures no patient is denied the opportunity to participate. Three RTCs opened over 7 weeks. At one site 1904 patients were screened for one of the randomised-controlled trials and over 18% of these patients (351) were recruited and 175 patients declined. Conclusions: The pandemic has had a devastating impact across the UK. However, a coordinated and collaborative multi-disciplinary approach has supported high recruitment and equity of access for patients into COVID-19 trials. Learnings from this work may lead to embedding clinical trials and access to translational research for cancer patients in the future as we recover from the full impact of the pandemic. COVID-19 research has demonstrated how increased recruitment accelerates access and implementation of new innovations and novel drug combinations.The full impact of improved access to cancer research in the future during COVID recovery is worthy of more research.

2021 ◽  
Robbert G. Bentvelsen ◽  
Marguerite L. Bruijning ◽  
Niels H. Chavannes ◽  
Karin Ellen Veldkamp

BACKGROUND The risk of urinary tract infections is increased by the inappropriate placement and the unnecessary prolongation of use of indwelling urinary catheters. Sustained behaviour change in infection prevention could be promoted through patient empowerment trough a smartphone app. OBJECTIVE We aimed to assess the feasibility and efficacy of implementation actions on patients’ use of Participatient on a clinical ward, and to compare three survey methods for urinary catheter use. METHODS Participatient was introduced for all admitted patients at the surgical nursing ward in a university hospital in the Netherlands. In three months, the number of new app users, days of use, and sessions were recorded. In a comparison of before-and-after the app, three methods for point prevalence surveys of catheter use were tested. Surveys were conducted through manual parsing of the text in the electronic medical records, checkbox surveys, and nurse-notes surveys. RESULTS In all, 475 patients were admitted to the ward, 42(8.8%) installed the app, with 1-5 new users per week. The actions with most ensuing app use were the kick-off with clinical lesson and the recruiting of the intake nurse. Between the survey methods, there was considerable variation in catheter prevalence. Therefore, we used the standard method of manual parsing in further analyses. Catheter use prevalence decreased from 38% to 27% after app introduction. CONCLUSIONS Clinical application of Participatient, the infection prevention app for patients, could be feasible when implementation actions are combined. For surveying indwelling urinary catheter use prevalence, manual parsing is best applicable.

Zainul Ikhwan Ahmad Khusairi ◽  
Kartik K ◽  
Ahmad Bilal AN ◽  
Chung WM

Introduction: COVID-19 pandemic is an on-going devastating global event. It starts from December 2019 and is yet to resolve. To date, there are more than 25 million people diagnosed and 850 thousand deaths with COVID-19 (CDC, 2020). Healthcare services throughout the world are facing immense challenges. History taking has been inevitably the most emphasized tool in approaching all patients. However, the usefulness of medical history strongly depends on the patient’s story offered. Incorrect or hidden history may not only bring wrong diagnosis but endanger health care personnel.Objectives: This case series is aimed to describe the importance of clinical history-taking in assessing patients associated with COVID-19 symptoms or history.Methods: Assessment through interview method in taking patient history was used. The focus of history taking was related to health and COVID-19 history. The data collected is a type of secondary data from medical reports of patients who come to receive medical services at the Emergency and Trauma Department, General Public Hospital Taiping, Perak. A total of three cases are taken using the purposive sampling technique. Data is analysed and presented in the form of qualitative data.Results: This study found that the clinical history taking through interview method has successfully identified three patients with positive COVID-19 through assessment conducted.Conclusion: Therefore, the study proved that effective history taking implemented by paramedics was able to identify patients with positive COVID-19 and to plan an appropriate management and help them get discharged without complications. All physicians and other health care practitioners in the Emergency Department or in the clinical ward are also advised to be more competent by increasing their level of knowledge and skills related to assessing patients through effective clinical history taking.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S13

Sensors ◽  
2021 ◽  
Vol 21 (3) ◽  
pp. 887
Jesse F. Veenis ◽  
Sumant P. Radhoe ◽  
Petra Hooijmans ◽  
Jasper J. Brugts

Heart failure (HF) is a major health care issue, and the incidence of HF is only expected to grow further. Due to the frequent hospitalizations, HF places a major burden on the available hospital and healthcare resources. In the future, HF care should not only be organized solely at the clinical ward and outpatient clinics, but remote monitoring strategies are urgently needed to guide, monitor, and treat chronic HF patients remotely from their homes as well. The intuitiveness and relatively low costs of non-invasive remote monitoring tools make them an appealing and emerging concept for developing new medical apps and devices. The recent COVID-19 pandemic and the associated transition of patient care outside the hospital will boost the development of remote monitoring tools, and many strategies will be reinvented with modern tools. However, it is important to look carefully at the inconsistencies that have been reported in non-invasive remote monitoring effectiveness. With this review, we provide an up-to-date overview of the available evidence on non-invasive remote monitoring in chronic HF patients and provide future perspectives that may significantly benefit the broader group of HF patients.

2020 ◽  
Vol 2 (1) ◽  
pp. 37-43
Ana Teresa Sobreira Lima Verde ◽  
Ana Vitória Magalhães Chaves ◽  
Fernando Barroso Duarte ◽  
José Huygens Parente Garcia ◽  
Paula Frassinetti Castelo Branco Camurça Fernandes

Introduction: The COVID-19 infection is caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infection, which was first reported in Hubei, Wuhan province, China, in December 2019. There is a concern that immunocompromised patients are at greater risk of morbidity and mortality due to COVID-19 infection, although there is limited data on these patients. Here, we present an evolution of a series of cases of patients with COVID-19 in our service. Patients and methods: This is a retrospective cohort study conducted at the Hospital Universitário Walter Cantídio in Fortaleza-CE, Brazil. All patients hospitalized due to COVID-19 were screened for a history of organ or tissue transplantation, with a total number of 77 patients. Only patients confirmed for COVID-19 were included in the study. The inflammatory response and initial laboratory results, as well as the CALL score, were compared to a cohort of patients with COVID-19 not transplanted at the same time in our clinical ward or intensive care unit (ICU). The clinical course and clinical findings recorded during treatment were extracted from the electronic medical record. A bilateral P <0.05 (5%) was considered significant. Results: The total number of hospitalizations until July 24, 2020 for confirmed cases of COVID-19 was 77 patients. Of the total, 33 (42%) patients needed ICU. Most patients were male (61%). The median age was 62 [95% CI: 54-63] years, 31 (37%) had a previous diagnosis of hypertension, 24 (28%) of type 2 diabetes mellitus (DM-2). The total lethality of our service was 22%. The CALL score of patients admitted to the clinical ward and in the ICU was analyzed, with a higher average observed in the patients admitted in ICU, the average was 9.34 in the patients admitted in the clinical ward and 10.9 in the patients who required ICU. (p = 0.003) . The effect of neutrophil/lymphocyte ratio(NLR) at admission on the need of ICU care was analyzed by ROC curve and AUC and was found to be significant (AUC: 0.708, p = 0.002, 95% CI = 0.593 to 0.823). The number of transplant recipients in our service was 17 patients. The mean age was 56 years and the median was 55 years [95% CI: 45-65 years]. Of this subgroup, 6 patients (35%) required ICU, with no statistical difference when compared to non- transplanted patients (p = 0.443), and only 3 evolved to death (17%), also without statistical difference when compared to the subgroup of non-transplanted patients (p = 0.484). When compared to the sample of non-transplanted patients, lower values were found of the White Blood cells count, neutrophils and ferritin. However, despite lower values of fibrinogen, D-dimer, C-reactive protein (CRP) and lactate dehydrogenase (LDH), there was no statistical difference. Conclusion: It is a new disease, with few data, mainly in the studied population. Our sample was a reduced sample, however it was surprising to see a lower inflammatory tendency, although without statistical significance and with mortality similar to the general population. In addition, it is worth emphasizing the importance shown on the neutrophil / lymphocyte ratio of admission demonstrated by the ROC curve in patients who evolve in need of an ICU care.

2020 ◽  
Vol 2 (3) ◽  
Florence Stordeur ◽  
Katiuska Miliani ◽  
Ludivine Lacavé ◽  
Anne-Marie Rogues ◽  
Catherine Dumartin ◽  

Abstract Background Antibiotic use (ABU) surveillance in healthcare facilities (HCFs) is essential to guide stewardship. Two methods are recommended: antibiotic consumption (ABC), expressed as the number of DDD/1000 patient-days; and prevalence of antibiotic prescription (ABP) measured through point prevalence surveys. However, no evidence is provided about whether they lead to similar conclusions. Objectives To compare ABC and ABP regarding HCF ranking and their ability to identify outliers. Methods The comparison was made using 2012 national databases from the antibiotic surveillance network and prevalence study. HCF rankings according to each method were compared with Spearman’s correlation coefficient. Analyses included the ABU from entire HCFs as well as according to type, clinical ward and by antibiotic class and specific molecule. Results A total of 1076 HCFs were included. HCF rankings were strongly correlated in the whole cohort. The correlation was stronger for HCFs with a higher number of beds or with a low or moderate proportion of acute care beds. ABU correlation between ABC or ABP was globally moderate or weak in specific wards. Furthermore, the two methods did not identify the same outliers, whichever HCF characteristics were analysed. Correlation between HCF ranking varied according to the antibiotic class. Conclusions Both methods ranked HCFs similarly overall according to ABC or ABP; however, major differences were observed in ranking of clinical wards, antibiotic classes and detection of outliers. ABC and ABP are two markers of ABU that could be used as two complementary approaches to identify targets for improvement.

2020 ◽  
Takeshi Horii ◽  
Koichiro Atsuda

Abstract Objective Investigation of polypharmacy in patients with type 2 diabetes revealed that the medications being administered according to the patient’s symptoms and complaints strongly contributed to polypharmacy. We explored the effects of clinical ward pharmacy service, which evaluated the need for symptomatic treatment, therefore minimizing polypharmacy by reducing inappropriate medications. Results The number of drugs [hospitalization vs. discharge: 9 (1-17) vs. 7 (1-16), P < 0.001] and rate of PP (hospitalization vs. discharge: 75.4% vs. 61.1%, P < 0.001) were significantly lower at discharge. Since hospital admission, the number of drugs increased (n = 6, 11%), remained unchanged (n = 15,28%), decreased by 1 drug (n = 4,8%), decreased by 2 drugs (n = 3,6%), and decreased by more than 2 drugs (n = 25,5%). Daily drug costs were significantly reduced (hospitalization vs. discharge: $8.3 vs. $6.1, P < 0.001).

Michał Puliński ◽  
Wojciech Choiński ◽  
Marta Stęga

Introduction: The first thoracoscopic esophageal atresia (EA) surgery in Poland was performed by Professor Dariusz Patkowski in 2005 in Wrocław. In the Clinical Ward of Pediatric Surgery and Urology, Regional Specialistic Children’s Hospital in Olsztyn, thoracoscopic EA surgery was performed on 16 January 2009. Aim: Data presentation on thoracoscopic treatment of congenital EA. Material and methods: Between 2009 and 2018 in our Clinical Ward, 28 children (11 females and 17 males) diagnosed with EA underwent treatment. All patients presented with type III EA based on the Gross classification (lower tracheoesophageal fistula and atresia of the upper segment of the trachea) and 8 of them (29.6%) were diagnosed with coexisting diseases. Results and discussion: The duration of the surgery was 70–290 minutes with a mean time of 180 minutes. Conversion was performed in 6 (21.4%) cases. Leakage of the lymph occurred in 2 (7.1%) cases . In 3 (10.7%) cases, a radiographic image showed leakage of the anastomosis. Only 1 (3.6%) patient needed reoperation due to re-canalization of tracheoesophageal fistula. Pneumothorax occurred in 2 (7.1%) cases. In total, 4 (14.3%) patients died and 23 (82.1%) patients required additional esophageal dilatation due to its narrowing. Conclusions: The treatment results of thoracoscopic EA surgeries and undeniable advantages for the patient makes this technique a highly recommended method.

2020 ◽  
Vol 17 (2) ◽  
pp. 53-58
Slađana Milošević ◽  
Kristina Zarić ◽  
Sanja Mihajlović

Objective. The main objective of the research is to determine the characteristics and dynamics of the treatment of women addicted to alcohol, at the Clinic for Addiction Diseases of the Institute for Mental Health, Belgrade. Methods. The sample consists of 136 women addicted to alcohol who were treated at the Clinic for Addiction Diseases of the Institute for Mental Health at the time of the study, as well as patients who had been treated in two wards for the last five years: Clinical ward and Daily hospital. The survey was conducted at the end of 2017 and during 2018. Secondary data sources, ie documentation from the Institute of Mental Health, were used in the research These include patient medical histories and medical records. Analysis of characteristics of women alcoholics aged 18-68 years, treated during 2018, at the Clinic for Addiction Diseases within the Institute for Mental Health in Belgrade. For the research and based on the research variables, a separate matrix was created to analyze the content which was completed for each patient covered by the research sample. Results. The age of the respondents ranges from 18 to 68 years. The results of the analysis of substance abuse in the primary family show that in more than half of the cases (51.5%) there is a history of substance abuse in the family. The key findings of the study show that the largest role in the treatment of women addiction is played by family members who participated in the treatment, and the outcome of treatment was positive with that kind of women. Conclusion. Based on the results presented and conclusions drawn to the specificity of women's alcoholism, the implication is that there is a link between family situation and support and the development of alcoholism and treatment.

Carmine Zoccali ◽  
Peter J Blankestijn ◽  
Annette Bruchfeld ◽  
Giovambattista Capasso ◽  
Danilo Fliser ◽  

Abstract In January 2019, the ERA-EDTA surveyed nephrologists with questions on kidney care and kidney research designed to explore comprehension of the impact of alterations to organization of renal care and of advancements in technology and knowledge of kidney disease. Eight hundred and twenty-five ERA-EDTA members, ∼13% of the whole ERA-EDTA membership, replied to an ad hoc questionnaire. More than half of the respondents argued that kidney centres will be increasingly owned by large dialysis providers, nearly a quarter of respondents felt that many medical aspects of dialysis will be increasingly overseen by non-nephrologists and a quarter (24%) also believed that the care and long-term follow-up of kidney transplant patients will be increasingly under the responsibility of transplant physicians caring for patients with any organ transplant. Nearly half of the participants (45%, n = 367) use fully electronic clinical files integrating the clinical ward, the outpatient clinics, the haemodialysis and peritoneal dialysis units, as well as transplantation. Smartphone-based self-management programmes for the care of chronic kidney disease (CKD) patients are scarcely applied (only 11% of surveyed nephrologists), but a substantial proportion of respondents (74%) are eager to know more about the potential usefulness of these apps. Finally, European nephrologists expressed a cautious optimism about the application of omic sciences to nephrology and on wearable and implantable kidneys, but their expectations for the medium term are limited.

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