Audit of Transient Ischaemic Attack (TIA) inpatient management: a retrospective assessment

@#The aim of this retrospective study was to audit the management of transient ischaemic attack (TIA) patients admitted in 2012 compared to a previous audit (2009 to mid-2010). Data were obtained by reviewing the electronic clinical records of patients. Data on patient demographics, patient assessment and management according to TIA guidelines were collected. A total of 61 patients were admitted to hospital with primary diagnosis of TIA. One in four patients had an alternative diagnosis. TIA severity (ABCD2 score) was not calculated in 13% of the patients. Most patients had computed tomography (CT) brain imaging performed. Antiplatelet therapy was not adjusted in 10% of patients. Carotid doppler ultrasound was not considered in 20% of the patients. Most of the carotid dopplers were done within one week. Only 6.6% of the patients were referred for carotid endarterectomy. Blood pressure medications were not optimised in 57.4% of the patients. Only 27.9% were prescribed statin therapy. Not all patients had documented ECG findings or discussion regarding anticoagulation. There was a 32.8% 3-month readmission rate. In 2012 several aspects of TIA guideline management were not done appropriately compared to the previous audit. The areas of improvement identified in this assessment include optimising antiplatelet therapy and blood pressure management, as well as timely carotid ultrasound for anterior circulation TIA. Further education and reiteration of guideline-based TIA management is recommended. A follow-up audit of the service is warranted

Clinical Characteristics of Children Needing Inpatient Treatment after Failed Outpatient Treatment for Fecal Impaction / 대한소아소화기영양학회지

PURPOSE: Treatment of chronic constipation and fecal impaction is usually outpatient and requires high or frequent doses of laxatives. However, there are children who fail outpatient treatments, sometimes repeatedly, and are ultimately hospitalized. We sought to compare the characteristics of the children who failed outpatient treatment and needed inpatient treatment vs those who achieved success with outpatient treatment, in an effort to identify attributes that might be associated with a higher likelihood towards hospitalization. METHODS: In this retrospective cohort study, we reviewed the medical records of all patients aged 0 to 21 years, with chronic functional constipation and fecal impaction seen in the pediatric gastroenterology clinic over a period of 2 years. RESULTS: Total of 188 patients met inclusion criteria. While 69.2% were successfully treated outpatient (referred to as the outpatient group), 30.9% failed outpatient treatment and were hospitalized (referred to as the inpatient group). The characteristics of the inpatient group including age at onset of 3.6±3.6 years (p=0.02); black ethnicity (odds ratio [OR] 4.31, 95% confidence interval [95% CI] 2.04–9.09); p < 0.001); prematurity (OR 2.39, 95% CI 1.09–5.26; p=0.02]; developmental delay (OR 2.20, 95% CI 1.12–4.33; p=0.02); overflow incontinence (OR 2.26, 95% CI 1.12–4.53, p=0.02); picky eating habits (OR 2.02, 95% CI 1.00–4.08; p=0.04); number of ROME III criteria met: median 4, interquartile range 3–5 (p=0.04) and 13±13.7 constipation related prior encounters (p=0.001), were significantly different from the outpatient group. CONCLUSION: Identification of these characteristics may be helpful in anticipating challenges and potential barriers to effective outpatient treatment.

Pattern of drug use in psoriasis inpatients in the department of dermatology at a tertiary care teaching hospital.

Background: The pattern of drug use in people hospitalized with a primary diagnosis of psoriasis has never been studied previously in India. The aim of the study was to characterize the prescription pattern of people admitted to hospital with psoriasis so that rational prescribing could be promoted among dermatologists. Methods: Case files belonging to 32 patients, admitted in the Department of Dermatology with psoriasis, of a tertiary care teaching hospital in Kerala, over a period of 1-year were retrieved with the assistance of the medical records department. The data thus obtained was analyzed using descriptive statistics. Results: The average age of patients who were admitted with psoriasis was 49.9 years, and their average duration of hospital stay was 7.96 days. A total of 296 formulations were prescribed to 32 patients. Out of 296 formulations, only 10 (3.37%) were generic and rest 286 (96.62%) branded. Fixed dose combinations consisted of 32.43% (96/296) of the prescribed formulations. Psoriasis vulgaris (56.25%) was the most common cause for admission. Of all the prescribed medications, 4 (1.35%) did not contain clear instructions for the route of administration. Strength was clearly mentioned in only 89 (30%) of the preparations. In 98% of the prescriptions, the exact dose was missing. Conclusions: The study reveals various deficiencies which exist in the prescribing pattern of drugs for management of psoriasis. Educational interventions among the doctors as well as students should be carried out to promote rational drug use.