Impact of the day of the week on the discontinuation of broad-spectrum antibiotic prescriptions; a multi-centered observational study

To encourage and guide antimicrobial stewardship team (AST) activity and promote appropriate antibiotic use, we studied the impact of day of the week on the initiation and discontinuation of antibiotic administration. This was a multicenter observational study conducted at 8 Japanese hospitals from April 1 to September 30, 2019, targeting patients who underwent treatment with broad-spectrum antibiotics, such as anti-methicillin-resistant Staphylococcus aureus agents and anti-pseudomonal agents. We compared the weekly numbers of initiations and discontinuations of antibiotic prescription on each day of the week or on the days after a holiday. There was no statistical difference in the number of antibiotic initiations on both weekdays and the day after a holiday. However, antibiotic discontinuation was significantly higher from Tuesday onward than Monday and from the second day than the first day after a holiday. Similar trends were observed regardless of the categories of antibiotics, hospital and admission ward, and AST activity. This study suggests that broad-spectrum antibiotics tend to be continued during weekends and holidays and are most likely to be discontinued on Tuesday or the second day after a holiday. This was probably due to behavioral factors beyond medical indications, requiring further antimicrobial stewardship efforts in the future.

11 A Sequential Simulation Experience for Interim Foundation Doctors and Analysis of Preparedness to Practice Early

Introduction Covid-19 necessitated the early graduation of medical students to join the healthcare workforce as Foundation Interim Year 1 (FiY1) doctors. A sequential simulation session was implemented to improve and assess FiY1 preparedness towards approaching deteriorating patients. Method 12 FiY1 doctors participated in the session containing three sequential major stations: complex new admission, ward-based management, and acute deterioration. Participants interpreted investigations, performed examinations, created management plans, and escalated using a pager. Results There was a significant improvement in preparedness for giving treatment (median(IQR): pre-simulation 3(3-4) vs. post-simulation 4(4-4.75); p = 0.04) and paperwork (2(2-3.75) vs. 4(3.25-4.75); p = 0.03). Following four weeks of FiY1 participants demonstrated significant improvement in preparedness for giving treatment (median(IQR): pre-simulation 3(3-4) vs. post-FiY1 4.5(4-5); p = 0.01), communication and teamworking (4(3.25-4.75) vs. 5(5-5.75); p = 0.01), and paperwork (2(2-3.75) vs. 5(5-5); p = 0.01). The FiY1 programme improved integration within teams and facilitated training whilst medical school placements left participants feeling apprehensive and unprepared to practice. Conclusions This session provided an engaging method of increasing preparedness towards common challenges new physicians face. This study suggests future senior medical student apprenticeships should give the same investment, opportunities, and responsibilities as that of the FiY1 programme.

Satisfaction and associated factors towards inpatient health care services among adult patients at Pawie General Hospital, West Ethiopia

Introduction Improving the quality of services is the primary goal of the Ethiopia reform program to satisfy patients. Patient satisfaction is an attitude resulting from a person’s general orientation towards a total experience of health care. According to world health organization consumer satisfaction is playing an increasingly important role in the quality of care reforms and health-care delivery more generally. Objective To assess patient’s satisfaction and associated factors with health care services among admitted patients in Pawie General Hospital, Benishangul Gumuze Region, West Ethiopia, 2020 Methods Institution based cross-sectional study was conducted among adult patients admitted to Pawie General Hospital. A systematic random sampling technique was employed to recruit 334 participants and a structured interviewer-administered questionnaire was used to collect data. Data were entered into Epi Data version 3.1, analyzed using SPSS version 23, and presented in tables and graphs. Bivariable and multivariable logistic regressions were computed to identify factors associated with patient satisfaction. P-values < 0.05 and adjusted odds ratios were used to declare the significance and strength of the association. Result The overall patient’s satisfaction towards inpatient health care services at Pawie General Hospital was 60.8% with 95% CI (55.4, 65.9). Factors like admission ward [AOR = 2.60; 95% CI (1.34, 5.03)] and privacy [AOR = 12.5; 95% C I (2.89, 54.1)] were significantly associated with patient’s satisfaction. Conclusion The satisfaction level of patients admitted to Pawie General Hospitals was low. Admission ward and perceived privacy assured were factors significantly associated with patient satisfaction among patients admitted to Pawie General Hospital. The hospital administration system is better to work together to fill the gaps identified and improve the level of patient satisfaction.

Measles outbreaks among health workers in a university hospital admission ward in Northeastern Thailand in 2019: reflections on the occupational health management system

Objectives This study examined a measles outbreak among health workers in a university hospital admission ward and details of the existing occupational health management system. Methods Secondary data was obtained from two sources: 1) from the Occupational Health and Safety Office outbreak investigation report a post-exposure immunity evaluation which is completed after a measles, mumps, or rubella outbreak and 2) from the medical records of the individual cases. In addition, the Occupational Health and Safety Office guidelines were reviewed and a descriptive epidemiological investigation was conducted. Results A total of 75 health workers in the university hospital admissions ward who were potentially exposed were included in the study, of whom three were diagnosable as measles based on a positive immunoglobulin M (IgM) test. The three health workers who were identified as confirmed cases were nursing assistants; two worked in the admissions ward 4A, and one worked in the cardiac care unit. We found evidence that a propagated source caused the outbreak. The occupational health management system in the hospital at that time had only exposure and post-exposure protocols, but no pre-exposure protocol. Conclusion None of the health workers who were diagnosable as measles had been examined for measles immunity during their pre-placement health examination. The occupational health management system should revise the policy for ensuring the immunity to measles of health workers before allowing them to begin work and conducting a respirator fit test before using an N95 respirator.

Prediction of COVID-19 mortality among hospitalized patients in Sudan

BackgroundCOVID-19 was primarily reported in China. The mortality rate across countries had ranged from 1% up to more than 10% and it is underestimated in some countries. Advanced age is the most frequently reported factor associated to mortality. Other factors were the presence of comorbidities such as diabetes mellitus, hypertension and obesity. Several models for mortality prediction had been developed to assist in improving the prognosis. The aim of our study was to assess the factors related to mortality among COVID-19 patients and develop a prediction model based on these factors.MethodsA retrospective cohort study assessed the factors related to the mortality among COVID-19 patients who attended Imperial Hospital isolation centre on November-December, 2020, Khartoum, Sudan. Statistical tests performed were chi-square test, odds ratio and regression to develop the prediction model. Tests were considered statistically significant when p < 0.05.Results105 patients were studied. 29% of the patients were deceased, while, 71% were discharged alive. A statistically significant association was found between the age and severity with regards to mortality rate (p=0.034, 0.018 respectively). The model equation for mortality prediction: Mortality = −14.724+ (1.387* Age) + (−0.323* Gender) + (1.814* Admission) + (0.193* Ischemic Heart Disease) + (−0.369* Fever) + (1.595* Cough) + (1.953* Complications) + (0.149* Duration of hospitalization) + (0.999* Enoxaparin dose).ConclusionsAge, admission ward, cough and enoxaparin dose were statistically significant predictors for COVID-19 mortality (p= 0.014, 0.011, 0.015, 0.006 respectively).

The differences between referred and non-referred patients to a psychiatric consultation-liaison service in a general hospital

Objective The primary aim of this study was to investigate whether there are clinical differences between patients who are referred or not referred for psychiatric consultation and liaison service. The secondary aim was to compare the perspectives of doctors, nurses and patients. Methods This naturalistic, prospective and comparative study (N = 294) utilised a control sample of non-referrals (n = 177, consenting 81) and referrals (n = 177, consenting 49). The normality of the data was examined with the Shapiro-Wilk test; bivariate group comparisons were made using Mann-Whitney, Wilcoxon tests and bivariate regression analyses. Statistically adjusted group comparisons were performed with multivariate median regressions. Results The sample presented limited representativeness. Referred patients were predominantly women, mostly living alone and not working. Compared to the non-referred patients, their disease episode and length of hospital stay were significantly longer, self-efficacy and quality of life lower and psychological stress was higher. For referred patients, there were no differences between the estimations of mental burden and the need for care among doctors, nurses and patients. Self-efficacy and appraisal of one's own burden were the best predictors of the extent of mental symptoms. Discussion Patients in an admission ward for internal medicine referred to a psychiatric consultation-liaison service displayed a more adverse psychosocial profile and were more psychologically burdened than non-referred patients, but they are also relevantly subsyndromal burdened. Identifying and supporting burdened patients is an endeavour that requires collaborative care, especially in the transition to specialised mental health and to primary care.

The Status of Ageism in Caring for Elderly Patients From Nurses’ Perspective

Background: As the number of elderly people referred to hospitals increases, so does the number of discrimination reports in the care of the elderly, compared with younger people. This study aimed to investigate the status of ageism in caring for elderly patients from nurses’ perspective. Methods: It was a descriptive cross-sectional study that was conducted in three selected hospitals of Ardabil province, Iran, in 2019. A total of 482 nurses were recruited by convenience sampling. The data were collected using a demographics questionnaire and the Ageism Scale in Hospital Care and analyzed using descriptive (frequency, percentage, mean, and standard deviation) and inferential statistics (the Pearson correlation coefficient, independent t-test, one-way ANOVA, and Scheffe post hoc test) in SPSS V. 20. Results: The mean age of the participants was 33 years. Most nurses showed moderate ageism when providing care to older adults. The level of ageism was significantly associated with age (P=0.002), gender (P=0.001), work experience (P=0.032), and the ward in which the nurses worked (P=0.001) Conclusion: The findings revealed that the study hospitals suffered ageism. Also, the level of ageism was associated with the age, gender, admission ward, and work experience of the nurses. Thus, it is suggested to consider appropriate interventions to prevent ageism, when designing and planning care for older adults.

Accuracy and Completeness of Medication Histories in Patients in Medical Admission Ward at the University Teaching Hospital

Background: Quality documentation of medication histories at the time of hospitaladmission with regard to accuracy and completeness is not documented at the University Teaching Hospital (UTH), in Zambia. The aim of our study was to assess the accuracy and completeness of medication histories obtained in patients upon hospital admission. Materials and Methods: We conducted a prospective cross-sectional study at the medical admission ward, University Teaching Hospital, over a period of 3months. Our study enrolled 322 patients admitted to this ward who were above 18 years of age and were able to communicate verbally, if not, were accompanied by a caregiver. Clinical records of these patients were screened to review allmedications the patient was taking and patients/caregivers were interviewed to obtain acomplete medication history. All information obtained from patients through interviews was compared with medications recorded in the patient’s clinical records at the time of admission to the hospital. The Statistical Package for Social Sciences(SPSS) version 22 was used for all statistical calculations. Results: Of 287 clinical records, 175 (61%) incidents of inaccurate medication histories at the time of admission were identified and that medication histories in clinical records of patients were incomplete or poorly documented. Conclusion: Our study shows that 61% of medication histories in patients at the time of admission to hospitals are inaccurate. Quality documentation of medication histories in clinical records at the time of hospital admission is poor.

Using a hepatitis B surveillance system evaluation in Fujian, Hainan, and Gansu provinces to improve data quality and assess program effectiveness, China, 2015

Background Monitoring hepatitis B surveillance data is important for evaluating progress towards global hepatitis B elimination goals. Accurate classification of acute and chronic hepatitis infections is essential for assessing program effectiveness. Methods We evaluated hepatitis B case-reporting at six hospitals in Fujian, Hainan and Gansu provinces in 2015 to assess the accuracy of case classification. We linked National Notifiable Disease Reporting System (NNDRS) HBV case-reports with hospital information systems and extracted information on age, gender, admission ward and viral hepatitis diagnosis from medical records. To assess accuracy, we compared NNDRS reported case-classifications with the national HBV case definitions. Multivariable logistic regression was used to identify factors associated with misclassification. Results Of the 1420 HBV cases reported to NNDRS, 23 (6.5%) of the 352 acute reports and 648 (60.7%) of the 1068 chronic reports were correctly classified. Of the remaining, 318 (22.4%) were misclassified and 431 (30.4%) could not be classified due to the lack of supporting information. Based on the multivariable analysis, HBV cases reported from Hainan (aOR = 1.8; 95% CI: 1.3–2.4) and Gansu (aOR = 12.7; 95% CI: 7.7–20.1) along with reports from grade 2 hospitals (aOR = 1.6; 95% CI:1.2–2.2) and those from non-HBV related departments (aOR = 5.3; 95% CI: 4.1–7.0) were independently associated with being ‘misclassified’ in NNDRS. Conclusions We identified discrepancies in the accuracy of HBV case-reporting in the project hospitals. Onsite training on the use of anti-HBc IgM testing as well as on HBV case definitions and reporting procedures are needed to accurately assess program effectiveness and ensure case-patients are referred to appropriate treatment and care. Routine surveillance evaluations such as this can be useful for improving data quality and monitoring program effectiveness.