Control in the Hospital by Extensive Clinical rules for Unplanned hospitalizations in older Patients (CHECkUP); study design of a multicentre randomized study

Background Due to ageing of the population the incidence of multimorbidity and polypharmacy is rising. Polypharmacy is a risk factor for medication-related (re)admission and therefore places a significant burden on the healthcare system. The reported incidence of medication-related (re)admissions varies widely due to the lack of a clear definition. Some medications are known to increase the risk for medication-related admission and are therefore published in the triggerlist of the Dutch guideline for Polypharmacy in older patients. Different interventions to support medication optimization have been studied to reduce medication-related (re)admissions. However, the optimal template of medication optimization is still unknown, which contributes to the large heterogeneity of their effect on hospital readmissions. Therefore, we implemented a clinical decision support system (CDSS) to optimize medication lists and investigate whether continuous use of a CDSS reduces the number of hospital readmissions in older patients, who previously have had an unplanned probably medication-related hospitalization. Methods The CHECkUP study is a multicentre randomized study in older (≥60 years) patients with an unplanned hospitalization, polypharmacy (≥5 medications) and using at least two medications from the triggerlist, from Zuyderland Medical Centre and Maastricht University Medical Centre+ in the Netherlands. Patients will be randomized. The intervention consists of continuous (weekly) use of a CDSS, which generates a Medication Optimization Profile, which will be sent to the patient’s general practitioner and pharmacist. The control group will receive standard care. The primary outcome is hospital readmission within 1 year after study inclusion. Secondary outcomes are one-year mortality, number of emergency department visits, nursing home admissions, time to hospital readmissions and we will evaluate the quality of life and socio-economic status. Discussion This study is expected to add evidence on the knowledge of medication optimization and whether use of a continuous CDSS ameliorates the risk of adverse outcomes in older patients, already at an increased risk of medication-related (re)admission. To our knowledge, this is the first large study, providing one-year follow-up data and reporting not only on quality of care indicators, but also on quality-of-life. Trial registration The trial was registered in the Netherlands Trial Register on October 14, 2018, identifier: NL7449 (NTR7691). https://www.trialregister.nl/trial/7449.

Comparative Study of Intestinal Parasitic Infection among Pregnant and Non-Pregnant Women in Owerri, Nigeria: A Case Study of the Federal Medical Centre, Owerri

A survey of intestinal parasites of pregnant and non-pregnant women attending the Federal Medical Centre, Owerri, Imo State, Nigeria was carried out between November 2010 and April 2011. A total of 300 samples (150 from pregnant women and 150 from non – pregnant women respectively) were randomly collected from these women who attended the hospital. The samples were examined using the direct wet preparation and formol ether concentration technique. A total of 41 (13.67%) women were infected. The infected stool samples contained eggs of Ascaris lumbricoides (48.78%), Hookworm (39.02%), and Cysts of Entamoeba histolytica (12.20%). Although, more pregnant women (16(39.02%)), the difference was not statistically significant. The highest prevalence of 20% was observed in the pregnant women within the age – group of 27-30 while the age group of 19-22 years. The difference between the prevalence of infection in the age group was significant. However personal hygiene improved health education programs and supervised public toilets together with food vendor's education have been recommended as measures to eradicate intestinal parasitic infections among pregnant and non-pregnant women. It has been recommended that stool analysis should be part of the antenatal screening tests particularly in subjects with a high level of parasitemia.

A Retrospective Study of Lacunar Stroke Cases in University Malaya Medical Centre (UMMC) According to Age and Gender

Worldwide, stroke was ranked as the second commonest cause of death and the third most common cause of disability-adjusted life-years. Lacunar stroke is one type of stroke. The aim of this study is to determine the dependability of gender differences in lacunar stroke epidemiology on patient age as the influence of gender on stroke risk and outcome changes across the lifespan. Thus, this study was to identify age, and gender differences among lacunar stroke patients at University Malaya Medical Centre (UMMC). This study was conducted retrospectively from January 2016 to December 2019 in UMMC. Patients were selected based on inclusion and exclusion criteria. The inclusion criteria include a clinical diagnosis of lacunar stroke, age categories of middle age (40 – 59 years old) and older age (60 years and above), as well as undergo CT examination. The exclusion criterion is other than lacunar stroke patients. Patient’s data on gender and age were retrieved from the database PACS of UMMC. The analyzation includes cross tabulation of categorical data and independent t-test. Among 94 cases, higher cases of lacunar stroke are found to occur in men (58.51%). Furthermore, both middle age (13.83%) and older age (44.68%) among male patient shows higher percentage of lacunar incidence compared to female patients. Moreover, old age patients (76.60%) for each gender shows higher percentage of lacunar incidence compared to middle-aged patients (23.30%). Meanwhile the independent t-test result demonstrated that the mean age of female patients (67.79) diagnosed with lacunar stroke is not statistically different from the mean age of male patients (68.47). The study indicated that lacunar stroke is most likely to occur in men either at age 40 or 60 and above. Higher cases were recorded in older category which is at age 60 and above for both genders.

Cervix-Online computer program: 27 years of hospital-based clinical registry for cervical cancer at the University Medical Centre Maribor

Background Clinical registries are designed to collect quality data about the care for cancer patients in order to improve it. They gather data that are generated during diagnosis and cancer treatment and also post-treatment follow-up. Analysis of collected data allows an improvement in the quality of patient care and a comparison with other health care providers. The aim of the present article is to describe the current version and practice of hospital-based cervical cancer registry in UKC Maribor. Materials and methods The first questionnaire for monitoring patients with cervical cancer was introduced at the Department of Gynecologic and Breast Oncology of the Maribor General Hospital in 1994. Since then, the principles for treating cervical cancer have been revised on several occasions. Therefore, based on our experience and new approaches to treatment, we have frequently amended the questionnaire content. It was redesigned into a form that is currently in use and transformed into a Cervix-Online computer program in 2014. Results Over the last 27 years, we have collected data on cervical cancer patients treated at the University Medical Centre Maribor and former Maribor General Hospital. The Cervix-Online computer program that was developed for this purpose enabled a rapid and reliable collection, processing and analysis of 116 different data of patients with cervical cancer, including general data, history, diagnostic procedures, histopathological examination results, treatment methods, and post-treatment follow-ups. Conclusions The hospital-based cervical cancer registry with Cervix-Online computer program enables the collection of data to enhance diagnosis and the treatment of cervical cancer patients, the organization of day-to-day service, as well as the comparison of our treatment results with national and international standards. Incomplete or incorrect data entry, however, might pose a limitation of the clinical registry, which depends on several healthcare professionals involved in the diagnostic procedures, treatment, and follow-up of cervical cancer patients.

Knowledge, Attitude and Practice of Dog Bite Patients and their Attendants Visiting Jinnah Post Graduate Medical Centre – A Tertiary Care Hospital in Karachi

Dog bite is a global issue and endemic to especially African and Asian countries, where due to lack of awareness dogs (both domestic and wild) are either un-vaccinated or unneutered. The higher authorities seems to be least bothered concerning the increasing number of stray dog in these countries. Although lot of planning is done, no proper execution of these strategies are observed. The other issue is the negligent attitude of people towards wound management. The objective of this study is to assess the knowledge, attitude and practice of dog bite patients and their attendants visiting Jinnah Post-graduate Medical Centre, a tertiary care hospital in Karachi. The structured questionnaires were got filled via interview from both the patient and their attendant at the time they visited the dog bite clinic in the hospital. The results of the study revealed in appropriate and irresponsible attitude on both the part of patients and the concerned authorities responsible for is management. This research work was an endeavor to do the gap analysis in order to ensure practical implementation to overcome the endemic of dog bite and rabies.

P-P07 The incidence of Malignancy in Patients with Suspected Periampullary Tumours Who Underwent Blind Whipple Resections: A Single Institution Cross Sectional Review at King Hussein Medical Centre, Amman, Jordan

Background In this study, we evaluated the incidence of malignant and benign histopathological findings in patients undergoing blind pancreaticoduedenectomy (PD) for presumed periampullary cancer based on clinical, radiological and endoscopic findings. Methods Medical records of 29 patients who underwent pancreaticoduedenectomy at King Hussein Medical Centre were reviewed. Demographics, clinical presentation, preoperative imaging and postoperative histopathological results were analysed Results The percentage of malignancy was 82.8% and that of a benign lesion was 17.2%.All patients with benign results on final histopathology had chronic pancreatitis (100%), and all of them (100%) had abdominal pain on initial presentation. Out of all patients with periampullary malignancy, 21 (87.5%) had jaundice on initial presentation. The most important radiological correlate of malignancy is dilatation of the common bile duct greater than 6mm. Conclusions The finding of chronic pancreatitis in pancreaticoduedenectomy specimens of patients with suspected periampullary malignancy is justifiable, because none of the differences in clinical presentation or available diagnostic modalities can be reliably used to distinguish between benign versus malignant disease. Moreover, Pancreaticoduedenectomy in these patients offers the best chance for long term survival with acceptable mortality and morbidity.

Bacteria Patterns on Tonsillar Surface and Tonsillar Core Tissue among Patients Scheduled for Tonsillectomy at Bugando Medical Centre, Mwanza, Tanzania

Background: Tonsillitis is an inflammation of the tonsils due to either viruses or bacteria. Here, we report the bacteria patterns on the tonsillar surface and tonsillar core tissue among patients scheduled for tonsillectomy at Bugando Medical Centre (BMC), Mwanza Tanzania. Methods: The study included 120 patients planned for tonsillectomy between April and July 2019. Swab samples from tonsillar surface pre-tonsillectomy and core post-tonsillectomy were collected. Culture was performed following the microbiology laboratory standard operating procedures. Data analysis was completed using STATA version 13, as per the study objectives. Results: The slight majority of participants were males (73; 60.83%) with median age of 6 years (interquartile range 4–11). The proportion of positive culture growth was higher on the surface than in core swab samples: 65 (54.2%) vs. 42 (35.0%), p = 0.003. The commonest bacterial pathogen detected from the surface and core were S. aureus in 29 (40.3%) and 22 (51.2%) participants, followed by S. pyogenes in 17 (23.6%) and 11 (25.6%), respectively. Methicillin-resistant Staphylococcus aureus (MRSA) was observed in 20/51 (39%) of isolates. Streptococcus pyogenes resistance to macrolides ranged from 8.3% for core isolates to 35.3% for surface isolates. Features suggestive of tonsillitis on histology were reported in 83 (73.5%) samples. Conclusion: More than two-thirds of patients undergoing tonsillectomy had a positive culture for possible bacterial pathogens. Staphylococcus aureus and Streptococcus pyogenes were the predominant bacteria detected with more than one third of Staphylococcus aureus being MRSA. More studies to investigate the treatment outcome of these patients are highly recommended.