Anti-microbial resistant in Gram-negative bacteria bacillus: Enterobacteriaceae and non-fermenting bacilli isolated at Sominé DOLO Hospital of Mopti, Mali

Background: β-lactams and carbapenems. are the major antibiotics used to treat gram-negative bacteria and non-fermenting bacilli. However, the increasing production of β-lactamase and carbapenemase limits the therapeutic options. Our study aims to determine the resistant phenotypes of these bacteria while describing their epidemiological aspect. Material and Methods: This was a cross-sectional study by consecutive enrollment from January 2018 to December 2019 at Sominé DOLO Hospital of Mopti, Mali. We performed manual method for bacteria culture, identification and antibiotics sensitivity testing. The antibiotics sensitivity testing was accessed by the diffusion method according to CA-SFM/EUCAST (“Comité de l’Antibiogramme de la Société Française de Microbiologie” / European Committee on Antimicrobial Susceptibility Testing) recommendations V1.0 february 2018 and V2.0 may 2019 2019 V.2.0. May recommendation released in 2019. Data were analyzed by software R 4.0.3 GUI 1.73 Catalina build (7892). Results: At all 904 samples were included in this study. Out of the 904 cultures, 297 sample (32.85%) were positive. The rates of enzymes production were as follow: Extended-spectrum ß-lactamase (ESBL) 56.42% (101/179), cepholosporinase hyperproduction (HCASE) 15.64% (28/179), cephalosporinase production (CASE) 6.14% (11/179), penicillinase hyperproduction (HP) 5.58% (10/179), carbapenemase production (CP) 6.14% (11/179) and savage strains 10.05% (18/179). Conclusion: Our data showed a high prevalence of resistance to β-lactamins ß-talactamins and carbapenemes in gram-negative bacteria and non-fermenting bacillus bacilli. The A high level of β-lactamase and carbapenemase production by gram negative bacillus were also reported by others authors calls for the rational use of antibiotic in hospital setting.

Anti-microbial resistant in Gram-negative bacteria bacillus: Enterobacteriaceae and non-fermenting bacilli isolated at Sominé DOLO Hospital of Mopti, Mali

Background: β-lactams and carbapenems. are the major antibiotics used to treat gram-negative bacteria and non-fermenting bacilli. However, the increasing production of β-lactamase and carbapenemase limits the therapeutic options. Our study aims to determine the resistant phenotypes of these bacteria while describing their epidemiological aspect. Material and Methods: This was a cross-sectional study by consecutive enrollment from January 2018 to December 2019 at Sominé DOLO Hospital of Mopti, Mali. We performed manual method for bacteria culture, identification and antibiotics sensitivity testing. The antibiotics sensitivity testing was accessed by the diffusion method according to CA-SFM/EUCAST (“Comité de l’Antibiogramme de la Société Française de Microbiologie” / European Committee on Antimicrobial Susceptibility Testing) recommendations V1.0 february 2018 and V2.0 may 2019 2019 V.2.0. May recommendation released in 2019. Data were analyzed by software R 4.0.3 GUI 1.73 Catalina build (7892). Results: At all 904 samples were included in this study. Out of the 904 cultures, 297 sample (32.85%) were positive. The rates of enzymes production were as follow: Extended-spectrum ß-lactamase (ESBL) 56.42% (101/179), cepholosporinase hyperproduction (HCASE) 15.64% (28/179), cephalosporinase production (CASE) 6.14% (11/179), penicillinase hyperproduction (HP) 5.58% (10/179), carbapenemase production (CP) 6.14% (11/179) and savage strains 10.05% (18/179). Conclusion: Our data showed a high prevalence of resistance to β-lactamins ß-talactamins and carbapenemes in gram-negative bacteria and non-fermenting bacillus bacilli. The A high level of β-lactamase and carbapenemase production by gram negative bacillus were also reported by others authors calls for the rational use of antibiotic in hospital setting.

Understanding psychosis: treatment and rehabilitation (updates for clinicians)

Psychosis is a group of psychotic disorders. Its manifestation depends on the specific type of functional violation. However, this is characterized by a gradual increase in clinical signs and a change in behavior. Symptoms of psychosis can be recognized by the following manifestations: hallucinations, delusional ideas, movement disorders, mood disorders including manic and depressive disorders and changes in emotional sphere. Psychosis occurs due to problems in the functioning of neurons. Due to the violation of bonds in the molecules, they do not receive nutrition and they are deficient in oxygen. This leads to the fact that neurons cannot transmit nerve impulses; multiple dysfunctions occur in the central nervous system. The type of psychosis depends on a part of the brain suffered from the hunger strike. The causes of this disorder are of 3 types: endogenous, associated with internal processes, exogenous or external and organic, when the causes of psychosis are changes in the brain such as tumors, trauma or hemorrhage. Psychosis is usually treated in a hospital setting. Such patients require urgent admission as they cannot control their actions, they can harm themselves and others. Psychosis is a relapse-prone disease. With timely and comprehensive treatment, the prognosis will be favorable. This review article is a good educational material for medical and psychological practitioners whose goal is to improve knowledge of treatment and rehabilitation processes of psychosis and its related disorders.

Risk factors for clinically relevant deviations in patients’ medication lists reported by patients in personal health records: a prospective cohort study in a hospital setting

Background Personal health records have the potential to identify medication discrepancies. Although they facilitate patient empowerment and broad implementation of medication reconciliation, more medication discrepancies are identified through medication reconciliation performed by healthcare professionals. Aim We aimed to identify the factors associated with the occurrence of a clinically relevant deviation in a patient’s medication list based on a personal health record (used by patients) compared to medication reconciliation performed by a healthcare professional. Method Three- to 14 days prior to a planned admission to the Cardiology-, Internal Medicine- or Neurology Departments, at Amphia Hospital, Breda, the Netherlands, patients were invited to update their medication file in their personal health records. At admission, medication reconciliation was performed by a pharmacy technician. Deviations were determined as differences between these medication lists. Associations between patient-, setting-, and medication-related factors, and the occurrence of a clinically relevant deviation (National Coordinating Council for Medication Error Reporting and Prevention class $$\ge$$ ≥ E) were analysed. Results Of the 488 patients approached, 155 patients were included. Twenty-four clinically relevant deviations were observed. Younger patients (adjusted odds ratio (aOR) 0.94; 95%CI:0.91–0.98), patients who used individual multi-dose packaging (aOR 14.87; 95%CI:2.02–110), and patients who used $$\ge$$ ≥ 8 different medications, were at highest risk for the occurrence of a clinically relevant deviation (sensitivity 0.71; specificity 0.62; area under the curve 0.64 95%CI:0.52–0.76). Conclusion Medication reconciliation is the preferred method to identify medication discrepancies for patients with individual multi-dose packaging, and patients who used eight or more different medications.

Role of pediatric nurse in management of child with special needs

Children facing life with chronic illness and disability are increasing in number. There are multiple factors which are responsible for that. Most of the children survive well into adulthood with early intervention, treatment and care. Pediatric nurses may create excellent professional roles caring for children with special health care needs and their families. The main responsibility will be to provide the children medical care and developmental training so that they can handle basic daily functions and lead happy, healthy lives. The role of a pediatric nurse in this field is not fixed. They may have to carry out different kinds of responsibilities based on the type and extent of special need. Pediatric nurses are responsible for helping children adapt to a hospital setting and prepare them for medical treatment and procedures. These nurses have special training to provide expert care to the child with special needs while working with the family to address their concerns, problems and help them to understand different treatment options and services available for the child with special needs. Pediatric nurses not only focus on the child with special needs but involve themselves in the wellbeing of other family members. They have special training in caring of children, good interacting skills, good empathy, immense love for children, flexibility, having control over their own emotions and stress management skills.

Medication Errors in Pediatrics: Proposals to Improve the Quality and Safety of Care Through Clinical Risk Management

Medication errors represent one of the most common causes of adverse events in pediatrics and are widely reported in the literature. Despite the awareness that children are at increased risk for medication errors, little is known about the real incidence of the phenomenon. Most studies have focused on prescription, although medication errors also include transcription, dispensing, dosage, administration, and certification errors. Known risk factors for therapeutic errors include parenteral infusions, oral fluid administration, and tablet splitting, as well as the off-label use of drugs with dosages taken from adult literature. Emergency Departments and Intensive Care Units constitute the care areas mainly affected by the phenomenon in the hospital setting. The present paper aims to identify the risk profiles in pediatric therapy to outline adequate preventive strategies. Precisely, through the analysis of the available evidence, solutions such as standardization of recommended doses for children, electronic prescribing, targeted training of healthcare professionals, and implementation of reporting systems will be indicated for the prevention of medication errors.

Merger and post-merger integration at Oxford University Hospitals: mixed-methods evaluation and lessons learned

Purpose Hospital mergers are common in the United Kingdom and internationally. However, mergers rarely achieve their intended benefits and are often damaging. This study builds on existing literature by presenting a case study evaluating a merger of two hospitals in Oxford, United Kingdom with three distinct characteristics: merger between two university hospitals, merger between a generalist and specialist hospital and merger between two hospitals of differing size. In doing so, the study draws practical lessons for other healthcare organisations.Design/methodology/approach Mixed-methods single-case evaluation. Qualitative data from 19 individual interviews and three focus groups were analysed thematically, using constant comparison to synthesise and interpret findings. Qualitative data were triangulated with quantitative clinical and financial data. To maximise research value, the study was co-created with practitioners.Findings The merger was a relative success with mixed improvement in clinical performance and strong improvement in financial and organisational performance. The merged organisation received an improved inspection rating, became debt-free and achieved Foundation Trust status. The study draws six lessons relating to the contingencies that can make mergers a success: (1) Develop a strong clinical rationale, (2) Communicate the change strategy widely and early, (3) Increase engagement and collaboration at all levels, (4) Be transparent and realistic about the costs and benefits, (5) Be sensitive to the feelings of the other organisation and (6) Integrate different organizational cultures effectively.Originality/value This case study provides empirical evidence on the outcome of merger in a university hospital setting. Despite the relatively positive outcome, there is no strong evidence that the benefits could not have been achieved without merger. Given that mergers remain prevalent worldwide, the practical lessons might be useful for other healthcare organisations considering merger.

Primary Central Nervous System Lymphoma: A Real-World Comparison of Therapy Access and Outcomes by Hospital Setting

Background This study analyzes sociodemographic barriers for primary CNS lymphoma (PCNSL) treatment and outcomes at a public safety-net hospital versus a private tertiary academic institution. We hypothesized that these barriers would lead to access disparities and poorer outcomes in the safety-net population. Methods We reviewed records of PCNSL patients from 2007-2020 (n = 95) at a public safety-net hospital (n = 33) and a private academic center (n = 62) staffed by the same university. Demographics, treatment patterns, and outcomes were analyzed. Results Patients at the safety-net hospital were significantly younger, more commonly Black or Hispanic, and had a higher prevalence of HIV/AIDS. They were significantly less likely to receive induction chemotherapy (67% vs 86%, p = 0.003) or consolidation autologous stem cell transplantation (0% vs. 44%, p = 0.001), but received more whole-brain radiation therapy (35% vs 15%, p = 0.001). Younger age and receiving any consolidation therapy were associated with improved progression-free (PFS, p = 0.001) and overall survival (OS, p = 0.001). Hospital location had no statistical impact on PFS (p = 0.725) or OS (p = 0.226) on an age-adjusted analysis. Conclusions Our study shows significant differences in treatment patterns for PCNSL between a public safety-net hospital and an academic cancer center. A significant survival difference was not demonstrated, which is likely multifactorial, but likely was positively impacted by the shared multidisciplinary care delivery between the institutions. As personalized therapies for PCNSL are being developed, equitable access including clinical trials should be advocated for resource-limited settings.

Silica nanoparticles with encapsulated DNA (SPED) to trace the spread of pathogens in healthcare

Background To establish effective infection control protocols, understanding pathogen transmission pathways is essential. Non-infectious surrogate tracers may safely explore these pathways and challenge pre-existing assumptions. We used silica nanoparticles with encapsulated DNA (SPED) for the first time in a real-life hospital setting to investigate potential transmission routes of vancomycin-resistant enterococci in the context of a prolonged outbreak. Methods The two study experiments took place in the 900-bed University Hospital Zurich, Switzerland. A three-run ‘Patient experiment’ investigated pathogen transmission via toilet seats in a two-patient room with shared bathroom. First, various predetermined body and fomite sites in a two-bed patient room were probed at baseline. Then, after the first patient was contaminated with SPED at the subgluteal region, both patients sequentially performed a toilet routine. All sites were consequently swabbed again for SPED contamination. Eight hours later, further spread was tested at predefined sites in the patient room and throughout the ward. A two-run ‘Mobile device experiment’ explored the potential transmission by mobile phones and stethoscopes in a quasi-realistic setting. All SPED contamination statuses and levels were determined by real-time qPCR. Results Over all three runs, the ‘Patient experiment’ yielded SPED in 59 of 73 (80.8%) predefined body and environmental sites. Specifically, positivity rates were 100% on subgluteal skin, toilet seats, tap handles, and entertainment devices, the initially contaminated patients’ hands; 83.3% on patient phones and bed controls; 80% on intravenous pumps; 75% on toilet flush plates and door handles, and 0% on the initially not contaminated patients’ hands. SPED spread as far as doctor’s keyboards (66.6%), staff mobile phones (33.3%) and nurses’ keyboards (33.3%) after eight hours. The ‘Mobile device experiment’ resulted in 16 of 22 (72.7%) positive follow-up samples, and transmission to the second patient occurred in one of the two runs. Conclusions For the first time SPED were used to investigate potential transmission pathways in a real hospital setting. The results suggest that, in the absence of targeted cleaning, toilet seats and mobile devices may result in widespread transmission of pathogens departing from one contaminated patient skin region.

Comparison of accidental pediatric scald burns in a tertiary care center: hot cauldron burns versus accidental spill burns

Background: Scald burns result from exposure to high-temperature fluids and are more common in the pediatric age group. They occur mainly by two mechanisms: (i) spill and (ii) immersion (hot cauldron) burns. These two patterns differ in clinical characteristics and outcomes. Scalds cause significant morbidity and mortality in children. The objective of this study was to compare accidental spill burns and hot cauldron burns in a hospital setting. Methods: An analytical cross-sectional study was conducted by reviewing the secondary data of scald cases admitted during the years 2019 and 2020 in a burn-dedicated tertiary care center. Total population sampling was adopted. Data analysis was done partly using SPSS, version-23, and Stata-15. Mann Whitney U-test and Chi-square/Fisher's exact test were done appropriately to find associations between different variables. Binary regression analysis was performed taking mortality events as the outcome of interest. Results: Out of 108 scald cases, 43 (39.8%) had hot cauldron burns and 65 (60.2%) had accidental spill burns. Overall mortality was 16 (14.8%), out of which hot cauldron burns and accidental spill burns comprised 12 (75.0%) and 4 (25.0%), respectively. Binary logistic regression analysis showed the type of scald, age, and Baux score found to be associated with mortality. Every one-year increment in age had a 29% lower odds of occurrence of mortality event (adjusted odds ratio [OR], 0.71; 95% confidence interval [CI], 0.50-0.99, p=0.042). Likewise, every one-point increment in Baux score was associated with 19% higher odds of mortality (adjusted OR, 1.190; 95% CI, 1.08-1.32; p<0.001). Conclusions: Accidental spill burn was more common but mortality was significantly higher for hot cauldron burns. The risk of mortality was significantly higher in burn events occurring outside the house, and burns involving back, buttocks, perineum, and lower extremities.