The effects of the coronavirus disease 2019 pandemic on neurospine surgery practice in the referral center hospital developing country

Background: The coronavirus disease 2019 (COVID-19) pandemic represents a once in a century challenge to human health care with over 4.5 million cases and over 300,000 deaths thus far. Surgical practice has been significantly impacted with all specialties writing guidelines for how to manage during this crisis. This study reported the effect of the COVID-19 pandemic on the neurosurgical practice, especially neurospine, in the outpatient visit, emergency department, and the surgical procedure. Methods: This study is the comparative retrospective about neurospine practice in the outpatient visit, emergency department, and the surgical procedure among before and during COVID-19 pandemic. We recorded data from January to December 2019 (before COVID-19 pandemic) and compared with the same period in the 2020 (during a COVID-19 pandemic). Results: A total of the outpatient visits, the average number per month was 28 ± 10.5 visits per month before the pandemic. The average number outpatient visit per month during the pandemic was 19 ± 11.1 visits per month, with the lowest in July 2020. The result of the average monthly neurospine surgical procedure before the pandemic was 5 ± 1.9 operations per month. Compared during the pandemic, there was decreased in the neurospine surgical procedure with the average number was 2 ± 2.7 operations per month. The decreased number significantly happens in the surgical procedure and emergency department patient (P < 0.05), while in the outpatient visit, the decreased statistically not significantly (P > 0.05). Conclusion: The COVID-19 pandemic changed all scopes of medical practice and training. Considering the limitation in the available resources, the number of educational cases may decrease in subspecialized disciplines such as neurospine neurosurgery. The COVID-19 pandemic affects in the neurospine and neurosurgery treatment policy in the referral tertiary hospital.

Evaluation of Seroprevalence of Hepatitis B Virus and Hepatitis C Virus in Reference Center Hospital in Turkey's Southeast Anatolia Among Patients Referred for Major or Minimally Invasive Surgery: Last Decade Experience in a Previously High Prevalence Area

Background: There is a high worldwide prevalence of chronic Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections, among the significant causes of liver-related morbidity and mortality. Objectives: We aimed to determine the prevalence of HBV and HCV in a referral center hospital in Southeast Anatolia among patients that applied for major or minimally invasive surgery. Methods: In a tertiary referral state hospital for general purposes, patients undergoing surgical procedures and serologic examinations for HBV and HCV were included in the study between January 2011 and September 2020. Results: In the general population, hepatitis B surface antigen (HBsAg) and anti-HBs were examined in 220,724 patients, and anti-HCV was examined in 186,017 patients. The mean age was 42.3 ± 20.2 years with a 51.8% male distribution. The frequency of positive HBsAg and anti-HCV in all patients was 9.4 and 0.9%, respectively. On the other hand, the frequency of positive HBsAg and anti-HCV was 4.2 and 0.7%, respectively, among patients admitted for a surgical procedure. The mean age was 46.1 ± 21.1 years with a slightly male predominance (54 vs. 46%). In this group, the frequency of positive HBsAg was higher in males (5.1%) while the lowest was in the 1 - 10 age range (0.4%) and the highest in the 41 - 50 age range (5.7%). Between 2011 and 2019, the prevalence of HBsAg positivity decreased from 6.4 to 4.0%, while anti-HCV positivity was similar in both genders, and its frequency increased with age. Conclusions: Between 2011 and 2020, the overall prevalence of HBV and HCV decreased in the Southeast Anatolia Region of Turkey.

PP140 Barriers And Prospects For The Development Of Hospital-Based Health Technology Assessment In Kazakhstan

IntroductionThe experience of implementing a hospital-based health technology assessment (HB-HTA) system in Kazakhstan is currently represented by only one organization, an independent HB-HTA unit established in 2015 in the Medical Center Hospital of the President's Affairs Administration (the Hospital). Despite the demonstrated positive experience of the Hospital, the widespread implementation of the HB-HTA system in Kazakhstan has experienced some barriers that must be considered before further development can occur.MethodsTo determine the barriers to developing and implementing HB-HTA in Kazakhstani hospitals, data from the Hospital's experience were obtained through a survey of Kazakhstan hospitals, conducted on behalf of the Ministry of Health Care. An official response was received from 29 hospitals. During the survey and discussions with hospital staff using the “brainstorming” method, several barriers to the development of HB-HTA in Kazakhstan were identified.ResultsBarriers at the system level included the lack of monitoring of the HB-HTA system at the national and regional levels and a lack of methodological support. Organizational barriers included a critically small number of HTA experts and the need for additional logistical support and funding from hospitals. The subjective factors we attributed to the rejection of the HB-HTA system by hospital management were the underestimation of lost profits and that HTA is a tool for promoting a transparent and open system for making managerial decisions.ConclusionsDespite some barriers, the development of HB-HTA in Kazakhstan is a promising area. The heads of key hospitals in Kazakhstan demonstrated a readiness and understanding of the need to use the principles of health technology assessment and clinical and economic analysis to promote the active transfer and implementation of innovative medical technologies.

Faktor – Faktor Yang Berhubungan Dengan Disiplin Kerja Karyawan Non Medis Di Rumah Sakit Pekanbaru Medical Center (PMC) Tahun 2020

ABSTRAK Keberhasilan suatu rumah sakit dipengaruhi oleh tenaga kesehatan atau sumber daya manusia yang disiplin, yang mencerminkan kesadaran dan kesediaan mentaati semua peraturan perusahaan dan norma-norma sosial yang berlaku. Faktor-faktor yang mempengaruhi disiplin kerja diantaranya ketepatan waktu, pemanfaatan sarana, balas jasa, tanggung jawab dan ketaatan terhadap aturan. Tujuan penelitian untuk mengetahui faktor-faktor yang berhubungan dengan disiplin kerja karyawan non medis di Rumah Sakit Pekanbaru Medical Center. Jenis penelitian kuantitatif dengan desain analitik Cross Sectional study.Populasi dalam penelitian ini adalah seluruh tenaga non medis di Rumah Sakit Pekanbaru Medical Center (PMC) yang berjumlah 70 orang . Teknik sampling yang digunakan adalah teknik total sampling. Analisis Univariat dilakukan untuk mendeskripsikan karakter masing-masing variabel yang diteliti, sedangkan analisis Bivariat dilakukan untuk mengetahui hubungan kedua variabel independen dan dependen. teladan pemipin P value 0.016, balas jasa P value 0.000, keadilan P value 0.000, pengawasan melekat P value 0.011, sanksi hukuman P value 0.008 dengan disiplin kerja. Ada hubungan antara teladan pemipin, balas jasa, keadilan, sanksi hukuman. Di sarankan agar Rumah Sakit Pekanbaru Medical Center (PMC) dapat meningkatkan penerapan prinsip keadilan dalam lingkungan kerjanya untuk dapat meningkatkan disiplin kerja karyawan ABSTRACT The success of a hospital is influenced by health workers or human resources who are disciplined, which reflects the awareness and willingness to obey all company regulations and applicable social norms. Factors affecting work discipline include timeliness, utilization of facilities, remuneration, responsibility and adherence to rules. The purpose of this study was to determine the factors related to the work discipline of non-medical employees at Pekanbaru Medical Center Hospital. This type of quantitative research is analytic cross sectional study design. The population in this study is all non-medical staff at Pekanbaru Medical Center Hospital, amounting to 70 people. The sampling technique used was total sampling technique. Univariate analysis was carried out to describe the character of each variable under study, while Bivariate analysis was carried out to see the relationship between the two independent and dependent variables. leadership models P value 0.016, reward P value 0.000, fairness P value 0.000, supervision attached P value 0,11, sanctions P value 0.008. There is a relationship between leadership models, reward, fairness, supervision attached, sanctions. it is recommended that Pekanbaru Medical Center Hospital to increase the implementation of fairness principle in the work environment in order to improve employee’s discipline Pekanbaru Medical Center Hospital

Case Report: Stemi With Covid-19

BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) causing coronavirus disease 2019 (COVID-19) has reached pandemic levels by March 2020. Patients with cardiovascular disease, particularly with cardiac injury represent a vulnerable population and increased risk of mortality and morbidity. There is still no guidelines for management of cardiovascular disease during the COVID-19 pandemic. CASE ILLUSTRATION An unconscious 52-year-old male brought to ER with complaints of abdominal discomfort and nausea. The patient had a cardiac arrest in ER and ROSC was obtained. The patient was intubated ECG showed anterior STEMI and primary PCI was performed. The endotracheal tube was changed due to blockage of excessive and thick slime. Tracheostomy was performed. Bronchoscopy was performed and found tracheal mucosal edema, hyperemic and easily bleed; mucous plug and blood clots in the tip of tracheostomy cannula. Thoracic CT-Scan showed ground-glass appearance and fibrosis of the 6th thoracic dextra segment. PCR SARS-CoV-2 showed reactive. The patient was discharged from our hospital after three weeks with clinically stable and referred to COVID-19 center hospital nearby his home for another two weeks. After PCR SARS CoV-2 was performed twice showed negative results, the patient was discharged. CONCLUSION SARS-CoV‑2 infection may lead to acute myocardial injury through viral systemic inflammation, although specific mechanism remained uncertain. A thick mucus plaque and stool cell may be a specific clinical features in COVID-19 patients. Tracheostomy has a continuing role in managing weaning from extended periods of mechanical ventilation during the COVID-19 pandemic.

A retrospective analysis of the impact of a hospital pharmacist-led procalcitonin protocol

Disclaimer In an effort to expedite the publication of articles , AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Procalcitonin is a precursor hormone to calcitonin that increases in response to systemic inflammation, especially of bacterial origin, and is otherwise undetectable in healthy states. Studies have shown that following effective antimicrobial treatment, procalcitonin levels steadily decline. To be utilized however, procalcitonin determinations must be ordered at specific times during a patient’s antimicrobial treatment. A retrospective medication-use evaluation of patients was performed at Medical Center Hospital and showed that in 70% of patients, initial procalcitonin levels were ordered inappropriately and procalcitonin levels were trended inconsistently during antibiotic treatment. Methods A pharmacist-led procalcitonin protocol was developed and presented to medical staff committees for approval. Data was collected from patients presenting with suspected or confirmed sepsis or lower respiratory tract infections for whom procalcitonin levels were utilized. Patient outcomes before and after protocol implementation were compared. Results A total of 400 patients were included in the study. The primary outcome of appropriate ordering of initial procalcitonin levels was improved in the postprotocol group relative to the preprotocol group (28% of patients [n = 56] vs 72% of patients [n = 144]; P &lt; 0.001). Patients in the postprotocol group had a procalcitonin level checked at discontinuation more frequently (8% [n = 16] vs 37% [n = 74], P &lt; 0.001) and had a higher rate of appropriate discontinuation of antibiotics (12% [n = 21] vs 46% [n = 77]; P &lt; 0.001). The postprotocol group also had fewer mean days of antibiotic therapy (9.17 vs 6.01; P &lt; 0.001). Conclusion Studies have shown the usefulness of procalcitonin levels for antimicrobial stewardship, but for procalcitonin testing to be properly utilized it must be ordered at the correct times during the patient’s therapy. The implementation of a hospital-wide pharmacist-led protocol resulted in an increase in appropriate ordering of baseline procalcitonin levels.

Prolonged Emergency Department Stay at Referring Facilities: A Poor Trauma Performance Improvement Tool

Background Delays in the transfers of injured patients are perceived to increase morbidity and mortality and drive initiatives to limit the emergency department length of stay (LOS) at referring facilities (RF). RF LOS >4 hours is used for performance improvement (PI) with a large review burden with few improvement opportunities. Methods A statewide trauma registry 2013-2018 was used. Descriptive and inferential statistics including logistic regression were used to evaluate nongeriatric adult patients with ED LOS <12 hours. Paired data analyses utilizing prehospital (PH) and RF variables, vital signs (VS), Glasgow Coma Score–Motor component (GCS-M), RF LOS, mortality, trauma center hospital LOS (HLOS), and intensive care unit (ICU) LOS were performed. Results 13,721 of 56,702 transfer patients were selected. Mortality fell over time in all abbreviated injury score groups. GCS-M and systolic blood pressure (SBP) were correlated with mortality in both prehospital and RF data and highest in patients with abnormal GCS-M or SBP in both settings (38.0%, 30.1%). Examination of mortality over time in the group with abnormal VS showed SBP as the only variable with increasing mortality related to RF LOS. Average HLOS and ICU LOS were longest in patients with abnormal PH and RF SBP and GCS-M. Discussion Support for PI evaluation of RF LOS >4 hours was not identified. Increased survival over time is explained by early transfers of high mortality patients. Our data support existing efficient statewide transfers and recommend PI review of transfer patients with abnormal GCS-M and SBP in a narrower timeframe.

Case series of gastrointestinal stromal tumors with lymph nodes metastasis: unusual presentations

Gastrointestinal stromal tumor (GIST) is a rare cancer of the gastrointestinal tract, it occurred about 0.1-3.0% of all gastrointestinal neoplasms. Accounted about 10% of small-bowel tumors, and 10-15% of all sarcomas. Liver is a common hematogenous spread in GIST. However, metastasis to lymph nodes is consider extremely rare and routine lymph node dissection for GIST tumor was not recommended. Hence, we reported a case series of GIST that metastasize to lymph node along our experience in our center, hospital Taiping, Malaysia from 2010 until 2020. Hereby we report total of 3 out of 18 GIST cases that we encountered confirmed through histopathology the existence of lymph node metastasis.