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2.
Minerva Pediatr (Torino) ; 76(3): 372-380, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38842381

RESUMO

BACKGROUND: Nowadays children live in a digital world, exposed to relevant risks for their health and safety. The aim of this study is to investigate the use of multimedia devices in a sample of children and adolescents. METHODS: The study was performed between November 2018 and June 2019 in a third-level University Hospital, recruiting children and adolescents during general or specialistic follow-up visits. Anonymous, age-specific, questionnaires were distributed to 500 children and adolescents and 370 parents. RESULTS: Among children, 25 (17.1%) had their own mobile device, of which 84% Italian. The 54.1% of them uses multimedia devices half an hour/an hour per day and many of them (37.5% of Italian and 40% of foreign) use it without their parents' control. Most of adolescents had a mobile phone since the age of 10-12 years old. WhatsApp (Meta Inc., Cambridge, MA, USA) is the most used social network, followed by Instagram and Facebook. The use of multimedia devices was widespread between teenagers during classroom hours, meals and before sleeping and they are an important mean for cyberbullying. In addition, in the 29.9% of cases there is no correspondence between information given by parents and respective sons/daughters. CONCLUSIONS: This study shows more risks than advantages derived from the use of multimedia devices in children and adolescents. Therefore, it is essential to educate them about their correct and responsible use.


Assuntos
Multimídia , Humanos , Criança , Adolescente , Itália , Feminino , Masculino , Inquéritos e Questionários , Telefone Celular/estatística & dados numéricos , Pais/educação , Cyberbullying/estatística & dados numéricos , Mídias Sociais , Hospitais Universitários
3.
BMC Womens Health ; 24(1): 322, 2024 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-38834999

RESUMO

BACKGROUND: Cervical cancer is one of the leading causes of death in women worldwide. The majority of the cases are found in developing countries. The increasing risk of cervical cancer prevalence and growing danger of death from cervical cancer and the high occurrence of human papillomavirus (HPV) infection in women who are HIV positive give us the ground to study the prevalence and associated risk factors. OBJECTIVE: The study aims to assess the prevalence of cervical cancer screening and associated risk factors among HIV-positive women attending the Adult ART clinic at the University of Gondar Hospital. METHODS: An institution-based cross-sectional study was conducted from March to August 2021, on adult HIV-positive women attending the Adult ART clinic at Gondar University Referral Hospital by phone calling patients per week for six months to complete a total of 2744 HIV-positive patients who were not screened for cervical cancer before. The data were collected using an interviewer-administered questionnaire. Bivariate and multivariable logistic regression analyses were used to determine the presence and the degree of association between dependent and independent variables. In the multivariable logistic analysis, a P-value of < 0.05 and odds ratio with a 95% confidence interval were considered to determine independent predictors for the prevalence of premalignant or malignant cervical lesions among HIV-positive patients. RESULT: This study assessed 915 HIV Positive women who were screened for cervical cancer via visual inspection with acetic acid (VIA) as the primary screening tool and found that 24.48% had positive VIA results. Those with VIA-positive cases pathology examination showed 72.4% had abnormal pathology reports (CIN 1/2/3-51.25%, 17.23% cancer & 3.9% CIS), strengthening the finding in many studies that suggest HIV-positive women have a high rate of premalignant lesions.


Assuntos
Infecções por HIV , Lesões Pré-Cancerosas , Neoplasias do Colo do Útero , Humanos , Feminino , Etiópia/epidemiologia , Estudos Transversais , Adulto , Neoplasias do Colo do Útero/epidemiologia , Prevalência , Infecções por HIV/epidemiologia , Infecções por HIV/complicações , Fatores de Risco , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/epidemiologia , Detecção Precoce de Câncer , Adulto Jovem , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/complicações , Hospitais Universitários , Encaminhamento e Consulta/estatística & dados numéricos
4.
BMC Med Educ ; 24(1): 613, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38831265

RESUMO

BACKGROUND: Healthcare professionals constitute a critical component of clinical care services. To provide the expected service, they must continuously develop their profession through continuous learning. This kind of learning is recognized as continuing professional development (CPD). Traditionally, CPD is offered onsite. Onsite training is associated with some barriers that prevent healthcare professionals from attending such educational activities, including financial difficulties and long distance. This is why online learning is proposed to overcome these barriers. OBJECTIVE: The main purpose was to evaluate usability, knowledge and challenges of e-learning platforms for CPD of healthcare professionals at University Teaching Hospital of Kigali (CHUK). METHODS: The cross-sectional quantitative study approach was utilized; the data was collected at the workplace of nurses, midwives, and allied health professionals by using a pre-designed questionnaire. The data were analyzed using Statistical Package for the Social Sciences (SPSS) version 25 and presented as frequencies. RESULTS: A significant majority was aware of CPD e-learning platforms. For example, 95.7% of the participants were familiar with these platforms, indicating that they had some degree of knowledge about their existence and purpose. Regarding the mode of accessing CPD courses, 82.1% of participants preferred online platforms, demonstrating a strong will to use e-learning platforms. CONCLUSION: This study highlighted a high level of awareness and utilization of CPD e-learning platforms among healthcare professionals at CHUK, additionally, participants expressed confidence in using the platforms but emphasized the need for further support and training.


Assuntos
Educação a Distância , Humanos , Estudos Transversais , Feminino , Adulto , Masculino , Hospitais de Ensino , Instrução por Computador/métodos , Inquéritos e Questionários , Hospitais Universitários , Educação Continuada/métodos , Pessoal de Saúde/educação , Pessoa de Meia-Idade , Internet , Conhecimentos, Atitudes e Prática em Saúde
5.
Tunis Med ; 102(6): 354-359, 2024 Jun 05.
Artigo em Francês | MEDLINE | ID: mdl-38864199

RESUMO

INTRODUCTION: The increase in hip arthroplasties predicts a rise in periprosthetic fractures in Morocco, posing challenges for orthopedic surgeons. Therapeutic strategies vary considerably, highlighting the absence of a universally accepted treatment protocol. AIM: To analyze the management of per-prosthetic hip fractures, while addressing the challenges associated with them. METHODS: This was a retrospective study, conducted in the trauma-orthopedics department between December 2015 and November 2022. Nineteen patients who presented to the hospital with fractures around a hip prosthesis were included. RESULT: Nineteen periprosthetic fractures were observed. The majority of patients (68%) were women, with an average age of 68. The Vancouver classification showed that 52.6% of the fractures were type B1, and 21.1% type C, while the other fracture types were distributed differently. These fractures were mainly associated with diagnoses such as femoral neck fracture (63.2%) and coxarthrosis (31.6%). We observed variations in treatment recommendations and results between the different series analyzed. We noted discrepancies with certain series concerning fracture types and therapeutic choices. However, in our series, we achieved satisfactory results, with successful consolidation and the absence of complications in all patients. CONCLUSION: These results underline the importance of an individualized approach to fracture management, taking into account the specificities of each case.


Assuntos
Artroplastia de Quadril , Fraturas do Quadril , Hospitais Universitários , Fraturas Periprotéticas , Humanos , Feminino , Estudos Retrospectivos , Fraturas Periprotéticas/epidemiologia , Fraturas Periprotéticas/terapia , Fraturas Periprotéticas/cirurgia , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/diagnóstico , Masculino , Marrocos/epidemiologia , Idoso , Pessoa de Meia-Idade , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia de Quadril/métodos , Hospitais Universitários/estatística & dados numéricos , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Fraturas do Quadril/terapia , Idoso de 80 Anos ou mais , Traumatologia/normas , Traumatologia/métodos , Ortopedia/estatística & dados numéricos , Prótese de Quadril/estatística & dados numéricos , Adulto
6.
Sultan Qaboos Univ Med J ; 24(2): 216-220, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38828249

RESUMO

Objectives: This study aimed to report any suspected adverse drug reactions (ADRs) experienced by all vaccinated staff and students in a tertiary teaching hospital following COVID-19 vaccination. Methods: This retrospective study was conducted during the COVID-19 vaccination campaign at Sultan Qaboos University and Hospital in Muscat, Oman, from August to September 2021. An online survey was generated and sent to all staff and students via email and text messages. An announcement was made on the hospital website with a link to the survey. Results: A total of 8,421 individuals reported being vaccinated at least once with a total of 11,468 doses administered from January to July 2021; 8,014 staff and students received the Pfizer-Biotech vaccine while 3,454 staff and students received the Oxford-AstraZeneca vaccine. The survey received a total of 3,275 responses (response rate = 38.8%). Of these, 741 individuals (22.6%) experienced an ADR after vaccination and 67.2% (n = 498) were females (P <0.001). The majority of the ADRs reported were fever and chills (19.7%) followed by localised pain and swelling at the injection site (18.8%). Other ADRs such as hair loss (0.5%) were reported, and one staff/student reported a clot in the right leg. Among the responders, 27.0% considered their ADRs as mild while 25.0% considered them as severe. Conclusions: In the study cohort, mild symptoms of COVID-19 vaccines were reported. Females experienced more ADRs compared to males. Long-term observation of ADRs to the vaccines and follow-up monitoring should be done on subjects to preclude any unwanted effects.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Vacinas contra COVID-19/efeitos adversos , Vacinas contra COVID-19/administração & dosagem , Hospitais Universitários/estatística & dados numéricos , Omã/epidemiologia , Estudos Retrospectivos , Inquéritos e Questionários
7.
BMC Pregnancy Childbirth ; 24(1): 411, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38849723

RESUMO

BACKGROUND: Thrombocytopenia in pregnancy is a common multifactorial abnormality of the hematological system, next to anemia. It leads to more increased risk of bleeding during delivery, labour, or the postpartum period. Despite being a significant public health concern, there are limited studies done concerning thrombocytopenia during pregnancy. OBJECTIVE: To assess the magnitude and associated factors of thrombocytopenia among pregnant women at Mizan Tepi University Teaching Hospital from September 2023 to November 2023. METHODS: An institutional-based cross-sectional study was carried out on 230 systematic randomly selected pregnant women who attended antenatal visits from September 2023 to November 2023 G.C using data collection tools. The pretested structured questionnaires were employed to obtain clinical, nutritional, and sociodemographic information. Additionally, three millilitres of venous blood were collected from each participant and analyzed using a Sysmex hematology analyzer. The data was entered into Epidata version 4.6 and analyzed using STATA version 14. Descriptive statistics were computed, and logistic regression was used to identify predictors with a significance level of less than 0.05. RESULTS: Two hundred thirty pregnant women participated in the study. Among study participants, the magnitude of thrombocytopenia was 55(24.35%) with 32 (57.14%) mild, 19 (33.93%) moderate, and 5 (8.93%) severe thrombocytopenia. The determinant factors which shown significant association were Malaria parasite infection (AOR 9.27 at 95% CI 7.42, 10.87), one-year Inter-birth interval (AOR 1.7 at 95% CI 1.24, 2.14), History of abortion (AOR 3.94 95% CI 3.13, 4.86), History of hypertension (AOR 3.12 95% CI 1.56, 4.12), HIV infection (AOR 1.81 95% CI 1.32.2.52) and HBV infection (AOR 3.0 95% CI 2.82, 3.34). CONCLUSION: Thrombocytopenia is a public health problem and mild type of thrombocytopenia was the most predominant. The determinant factors that showed significant association with thrombocytopenia were Malaria Parasitic infection, one-year Inter-birth interval, History of abortion, History of hypertension, HIV infection, and HBV infection. Therefore, pregnant women should be continuously screened for thrombocytopenia to avoid excessive bleeding. Increasing Inter-birth interval, preventing abortion as well as timely diagnosis and treatment of underlying causes such as malaria infection, hypertension, HBV, and HIV is important to reduce the burden of thrombocytopenia.


Assuntos
Hospitais de Ensino , Complicações Hematológicas na Gravidez , Trombocitopenia , Humanos , Feminino , Gravidez , Trombocitopenia/epidemiologia , Estudos Transversais , Etiópia/epidemiologia , Adulto , Complicações Hematológicas na Gravidez/epidemiologia , Fatores de Risco , Adulto Jovem , Hospitais Universitários
8.
BMC Health Serv Res ; 24(1): 704, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38840130

RESUMO

BACKGROUND: In recent years, patient safety has begun to receive particular attention and has become a priority all over the world. Patient Safety Culture (PSC) is widely recognized as a key tenet that must be improved in order to enhance patient safety and prevent adverse events. However, in gynecology and obstetrics, despite the criticality of the environment, few studies have focused on improving PSC in these units. This study aimed at assessing the effectiveness of an educational program to improve PSC among health professionals working in the obstetric unit of a Tunisian university hospital. METHODS: We conducted a quasi-experimental study in the obstetric unit of a university hospital in Sousse (Tunisia). All the obstetric unit's professionals were invited to take part in the study (n = 95). The intervention consisted of an educational intervention with workshops and self-learning documents on patient safety and quality of care. The study instrument was the French validated version of the Hospital Survey on Patient Safety Culture. Normality of the data was checked using Kolmogorov-Smirnov test. The comparison of dimensions' scores before and after the intervention was carried out by the chi2 test. The significance level was set at 0.05. RESULTS: In total, 73 participants gave survey feedback in pre-test and 68 in post-test (response rates of 76.8% and 71.6, respectively). Eight dimensions improved significantly between pre- and post-tests. These dimensions were D2 "Frequency of adverse events reported" (from 30.1 to 65.6%, p < 0.001), D3 "Supervisor/Manager expectations and actions promoting patient safety" (from 38.0 to 76.8%, p < 0.001), D4 "Continuous improvement and organizational learning" (from 37.5 to 41.0%, p < 0.01), D5 "Teamwork within units" (from 58.2 to 79.7%, p < 0.01), D6 "Communication openness" (from 40.6 to 70.6%, p < 0.001), and D7 "Non-punitive response to error" (from 21.1 to 42.7%, p < 0.01), D9 "Management support for patient safety" (from 26.4 to 72.8%, p < 0.001), and D10 "Teamwork across units" (from 31.4 to 76.2%, p < 0.001). CONCLUSIONS: Educational intervention, including workshops and self-learning as pedagogical tools can improve PSC. The sustainability of the improvements made depends on the collaboration of all personnel to create and promote a culture of safety. Staff commitment at all levels remains the cornerstone of any continuous improvement in the area of patient safety.


Assuntos
Segurança do Paciente , Humanos , Segurança do Paciente/normas , Tunísia , Feminino , Adulto , Cultura Organizacional , Masculino , Obstetrícia/educação , Hospitais Universitários , Ginecologia/educação , Gestão da Segurança , Inquéritos e Questionários , Pessoal de Saúde/educação , Unidade Hospitalar de Ginecologia e Obstetrícia , Atitude do Pessoal de Saúde
9.
BMC Health Serv Res ; 24(1): 708, 2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38840245

RESUMO

BACKGROUND: Intensive Care Unit (ICU) capacity management is essential to provide high-quality healthcare for critically ill patients. Yet, consensus on the most favorable ICU design is lacking, especially whether ICUs should deliver dedicated or non-dedicated care. The decision for dedicated or non-dedicated ICU design considers a trade-off in the degree of specialization for individual patient care and efficient use of resources for society. We aim to share insights of a model simulating capacity effects for different ICU designs. Upon request, this simulation model is available for other ICUs. METHODS: A discrete event simulation model was developed and used, to study the hypothetical performance of a large University Hospital ICU on occupancy, rejection, and rescheduling rates for a dedicated and non-dedicated ICU design in four different scenarios. These scenarios either simulate the base-case situation of the local ICU, varying bed capacity levels, potential effects of reduced length of stay for a dedicated design and unexpected increased inflow of unplanned patients. RESULTS: The simulation model provided insights to foresee effects of capacity choices that should be made. The non-dedicated ICU design outperformed the dedicated ICU design in terms of efficient use of scarce resources. CONCLUSIONS: The choice to use dedicated ICUs does not only affect the clinical outcome, but also rejection- rescheduling and occupancy rates. Our analysis of a large university hospital demonstrates how such a model can support decision making on ICU design, in conjunction with other operation characteristics such as staffing and quality management.


Assuntos
Unidades de Terapia Intensiva , Melhoria de Qualidade , Unidades de Terapia Intensiva/organização & administração , Humanos , Simulação por Computador , Hospitais Universitários , Tempo de Internação/estatística & dados numéricos , Tomada de Decisões , Tomada de Decisões Gerenciais
10.
Med Mycol J ; 65(2): 33-38, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38825528

RESUMO

Antifungal stewardship (AFS), compared with antimicrobial stewardship (AS), requires more advanced knowledge, skills, and multidisciplinary collaboration in its implementation. Therefore, fewer facilities are performing AFS compared with AS. At our hospital, we started AS and AFS in 2014. Our AFS programs include the following: i) interventions for patients with yeast-positive blood cultures, ii) introduction of a conditional antifungal notification system, and iii) commencement of AS team rounds. AFS for filamentous fungi includes bronchoscopy and microbial identification, including genetic and drug susceptibility testing. These AFS activities have improved several processes and outcome measures. However, our AFS team has faced several problems owing to the impact of COVID-19. This review introduces the practice of AFS, which we initiated at our hospital in 2014, and presents the current problems.


Assuntos
Antifúngicos , Gestão de Antimicrobianos , Hospitais Universitários , Humanos , Antifúngicos/uso terapêutico , Antifúngicos/farmacologia , Gestão de Antimicrobianos/métodos , Japão , COVID-19 , SARS-CoV-2/efeitos dos fármacos , Micoses/tratamento farmacológico
11.
Sante Publique ; 36(2): 109-118, 2024.
Artigo em Francês | MEDLINE | ID: mdl-38834517

RESUMO

INTRODUCTION: Assessing patient turnaround times is essential for improving the quality of care in emergency service departments. PURPOSE OF THE RESEARCH: This study looked at waiting and treatment times, and their associated factors, in the surgical emergency service department at the Souro Sanou National Teaching Hospital (SSNTH) in Bobo-Dioulasso, Burkina Faso. RESULTS: This study was carried out on 380 patients with a median age of thirty-eight. The sex ratio was 0.54. In 63.7 percent of cases, the participants lived in urban areas. Most of the patients surveyed were farmers (34.7 percent). The median waiting time for patients was eleven minutes. The nature of the trauma sustained was associated with the waiting time. The median time taken to administer first aid was sixty-three minutes, with the unavailability of medication at the hospital pharmacy cited as a factor contributing to this delay. The median time taken to obtain paraclinical results was 134 minutes and 102 minutes for laboratory tests and scans, respectively. The factor associated with delays in obtaining scan results was the need for surgical intervention. The median waiting time for surgery was 24.3 hours. CONCLUSIONS: The turnaround times in the SSNTH surgical emergency department are long. For the improvement of patient turnaround times to be possible, an overhaul of the department is in order. In particular, a rapid consultation team needs to be established, and essential drugs for emergency care need to be made readily available.


Assuntos
Serviço Hospitalar de Emergência , Hospitais Universitários , Tempo para o Tratamento , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Burkina Faso , Adulto Jovem , Adolescente , Idoso , Criança , Emergências , Pré-Escolar , Fatores de Tempo , Estudos Transversais
12.
Support Care Cancer ; 32(7): 433, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38874658

RESUMO

PURPOSE: Readmission indicators are used around the world to assess the quality of hospital care. We aimed to assess the relevance of this type of indicator in oncology, especially for socially deprived patients. Our objectives were (1) to assess the proportion of unplanned hospitalizations (UHs) in cancer patients, (2) to assess the proportion of UHs that were avoidable, i.e., related to poor care quality, and (3) to analyze cancer patients the effect of patients' deprivation level on the type of UH (avoidable UHs vs. unavoidable UHs). METHODS: In a French university hospital, we selected all hospitalizations over a year for a random sample of cancer patients. Based on medical records, we identified those among UHs due to avoidable health problems. We assessed the association between social deprivation, home-to-hospital distance, or home-to-general practitioner with the type of UH (avoidable vs. unavoidable) via a multivariate binary logit estimation. RESULTS: Among 2349 hospitalizations (355 patients), there were 383 UHs (16 %), among which 38% were avoidable. Among UHs, the European Deprivation Index was significantly associated with the risk of avoidable UHs, with a lower risk of avoidable UH for patients with medium or high social deprivation. CONCLUSION: Our results suggest that the use of UHs rate as a quality indicator is questionable in oncology. Indeed, the majority of UHs were not avoidable. Furthermore, within UHs, those involving patients with medium or high social deprivation are more often unavoidable in comparison with other patients.


Assuntos
Hospitalização , Neoplasias , Indicadores de Qualidade em Assistência à Saúde , Humanos , Masculino , França , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Hospitalização/estatística & dados numéricos , Privação Social , Adulto , Estudos de Coortes , Idoso de 80 Anos ou mais , Hospitais Universitários , Qualidade da Assistência à Saúde , Readmissão do Paciente/estatística & dados numéricos
13.
J Infect Dev Ctries ; 18(5): 787-793, 2024 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-38865407

RESUMO

INTRODUCTION: Hepatitis B virus infection is a global public health concern and has a high degree of associated morbidity and mortality. In Ethiopia, Hepatitis B virus infection has a variable seroprevalence among different regions with an estimated overall prevalence of around 6%. However, there is a scarcity of data specific to cancer patients. METHODOLOGY: A hospital-based cross-sectional study was conducted among 384 cancer patients who came for follow-up at the oncology unit of Hawassa University Comprehensive Specialized Hospital from January 1/2020 to October 11/2021. A systematic sampling technique was employed to select the participants. Data was collected using structured and interviewer-administered questionnaires and blood samples were drawn from the patients to test hepatitis B virus sero-status. Data was entered to Epi- Data version 4.6 then exported and analysis was done using SPSS version 25. Descriptive statistics were used to describe the study participants. Finally, bivariable and multivariable binary logistic regression was used to identify significantly associated factors. RESULTS: The seroprevalence of hepatitis B virus infection among cancer patients was 7.6% [95% CI: (4.54 - 9.79)]. Having multiple sexual partners (AOR = 6.24, 95% CI (3.35-16.80)), a history of dental procedures (AOR = 3.34; 95% CI (1.007­7.66)), and being a hepatocellular carcinoma patient (AOR = 6.13; 95% CI (3.66-18.77)) were factors associated with seropositive status for Hepatitis B virus. CONCLUSIONS: The seroprevalence of Hepatitis B virus infection among cancer patients was high. It is better to consider HBV screening in cancer patients and doing cancer surveillance in HBV-infected patients.


Assuntos
Hepatite B , Neoplasias , Humanos , Etiópia/epidemiologia , Estudos Soroepidemiológicos , Masculino , Feminino , Estudos Transversais , Adulto , Pessoa de Meia-Idade , Hepatite B/epidemiologia , Neoplasias/epidemiologia , Adulto Jovem , Fatores de Risco , Hospitais Universitários , Idoso , Adolescente , Vírus da Hepatite B/imunologia , Prevalência , Hospitais Especializados/estatística & dados numéricos
14.
Nan Fang Yi Ke Da Xue Xue Bao ; 44(5): 998-1003, 2024 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-38862459

RESUMO

OBJECTIVE: To investigate the characteristics of Clostridioides difficile infection (CDI) in patients hospitalized for diarrhea and analyze the risk factors for CDI. METHODS: Stool samples were collected from 306 patients with diarrhea hospitalized in 3 university hospitals in a mid-south city of China from October to December, 2020. C. difficile was isolated by anaerobic culture, and qRT-PCR was used to detect the expressions of toxin A (tcdA) and B (tcdB) genes and the binary toxin genes (cdtA and cdtB). Multilocus sequence typing (MLST) was performed for the isolated strains without contaminating strains as confirmed by 16S rDNA sequencing. Etest strips were used to determine the drug resistance profiles of the isolated strains, and the risk factors of CDI in the patients were analyzed. RESULTS: CDI was detected in 25 (8.17%) out of the 306 patients. All the patients tested positive for tcdA and tcdB but negative for the binary toxin genes. Seven noncontaminated C. difficile strains with 5 ST types were isolated, including 3 ST54 strains and one strain of ST129, ST98, ST53, and ST631 types each, all belonging to clade 1 and sensitive to metronidazole and vancomycin. Hospitalization within the past 6 months (OR= 3.675; 95% CI: 1.405-9.612), use of PPIs (OR=7.107; 95% CI: 2.575-19.613), antibiotics for ≥1 week (OR=7.306; 95% CI: 2.274-23.472), non-steroidal anti-inflammatory drugs (OR=4.754; 95% CI: 1.504-15.031) in the past month, and gastrointestinal disorders (OR=5.050; 95% CI: 1.826-13.968) were all risk factors for CDI in the patients hospitalized for diarrhea. CONCLUSION: The CDI rate remains low in the hospitalized patients with diarrhea in the investigated hospitals, but early precaution measures are recommended when exposure to the risk factors is reported to reduce the risk of CDI in the hospitalized patients.


Assuntos
Clostridioides difficile , Infecções por Clostridium , Diarreia , Hospitais Universitários , Tipagem de Sequências Multilocus , Humanos , Diarreia/microbiologia , Diarreia/epidemiologia , Clostridioides difficile/genética , Clostridioides difficile/isolamento & purificação , Fatores de Risco , Infecções por Clostridium/microbiologia , Infecções por Clostridium/epidemiologia , China/epidemiologia , Toxinas Bacterianas/genética , Fezes/microbiologia , Antibacterianos/farmacologia , Hospitalização , Proteínas de Bactérias/genética , Enterotoxinas/genética , Masculino , Feminino , Pessoa de Meia-Idade
15.
Ger Med Sci ; 22: Doc06, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38883338

RESUMO

In addition to patient care, physiotherapy is increasingly important in research at university hospitals. Genuine physiotherapy research plays a decisive role in this. This position statement describes the opportunities, benefits, framework conditions, challenges, and research priorities of genuine physiotherapy research at German university hospitals.


Assuntos
Hospitais Universitários , Alemanha , Hospitais Universitários/normas , Humanos , Modalidades de Fisioterapia/normas , Pesquisa Biomédica/normas , Especialidade de Fisioterapia/normas
16.
Eur Rev Med Pharmacol Sci ; 28(11): 3796-3804, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38884515

RESUMO

OBJECTIVE: Intravenous (IV) fluid therapy is a known source of iatrogenic complications. Guideline implementation can be used to educate and guide physicians on adequate fluid management. In the emergency department (ED), a complex and interruption-driven environment, workload is high and active documentation is required to facilitate audits of fluid management quality. PATIENTS AND METHODS: Fluid management was evaluated in the ED records of adult non-critically ill patients admitted to a tertiary care center before (PRE: 1/12/2016-31/3/2017) and after (POST: 1/12/2018-31/3/2019) implementation of an educational intervention aiming to optimize IV fluid therapy in November 2018. First, the appropriateness of the 24-hour IV maintenance fluid prescription was evaluated, as prescribed by the emergency physician. Second, factors associated with appropriate prescribing were assessed, as well as the quality of fluid management documentation practice. Prescription appropriateness and documentation quality were evaluated retrospectively using a structured audit instrument and additional review by experts. RESULTS: A total of 237 patients (2.3%) were included in the PRE-intervention group and 253 patients (2.4%) in the POST-intervention group. The expert panel evaluated 214 prescriptions in 82.3% of patients (PRE: 99, POST: 115), and appropriateness increased significantly (19.2% vs. 61.2%, p=0.002). A higher odds of an appropriate IV maintenance fluid prescription was determined, attributed to the intervention (adjOR=2.580; 95% CI 1.363-4.884) and in patients having a prehospital intervention (adjOR=1.914, 95% CI 1.022-3.586). Appropriateness of fluid management documentation did not significantly improve after the implementation of the intervention (15.6% vs. 16.2%, p=0.858). CONCLUSIONS: The IV fluid prescriptions' appropriateness was significantly higher after guideline implementation. However, documentation quality of fluid management was poor in the studied ED records. Active stewardship programs are warranted to further monitor fluid management quality in the ED.


Assuntos
Serviço Hospitalar de Emergência , Hidratação , Hospitais Universitários , Humanos , Hidratação/normas , Serviço Hospitalar de Emergência/normas , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Infusões Intravenosas/normas , Adulto , Administração Intravenosa
17.
Clin Appl Thromb Hemost ; 30: 10760296241260736, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38863211

RESUMO

Anticoagulation management using warfarin is challenging in clinical practice. This study aimed to evaluate the knowledge, adherence, and satisfaction with warfarin therapy and associated factors among outpatients at the Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. An interview-based cross-sectional study was conducted among 350 patients receiving warfarin therapy at cardiac and hematology clinics of TASH. Anticoagulation knowledge assessment (AKA) questionnaires assessed the patients' warfarin knowledge. Adherence to warfarin was evaluated using the Morisky Green Levine Scale (MGLS), and patient satisfaction with warfarin therapy was assessed using the 17-item anticlot treatment scale (ACTS). Binary logistic regression was used to determine factors associated with the outcome variables, and p < .05 was used as the cut-off point to declare a significant association. The mean AKA score was 59.35 ± 13.04% (10.68 ± 2.34 correct answers), and 82 (23.4%) of participants achieved a passing score. Based on the MGLS, 192 (54.9%) study participants adhered well to warfarin. The mean level of satisfaction was 53.67 ± 8.56, with mean scores of 41.93 ± 7.80 and 11.74 ± 2.43 in the ACTS burden and benefit subscales, respectively. One hundred eighty-four (52.6%) patients were satisfied with warfarin therapy. The absence of hyperthyroidism was significantly associated with poor knowledge of warfarin therapy (adjusted odds ratio [AOR] = 4.28, 95% confidence interval [CI]: 1.01-18.22). Those living with family had a 56% lower chance of poor warfarin adherence (AOR: 0.44; 95% CI: 0.21-0.93) than those living alone. This study shows room for improvement in patient knowledge, adherence, and satisfaction with warfarin therapy.


Assuntos
Pacientes Ambulatoriais , Satisfação do Paciente , Varfarina , Humanos , Varfarina/uso terapêutico , Etiópia , Feminino , Masculino , Pessoa de Meia-Idade , Estudos Transversais , Adulto , Anticoagulantes/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Idoso , Hospitais de Ensino , Hospitais Universitários , Inquéritos e Questionários
18.
Med Trop Sante Int ; 4(1)2024 03 31.
Artigo em Francês | MEDLINE | ID: mdl-38846118

RESUMO

Sarcoidosis is a multisystem inflammatory disease of unknown etiology. The isolated extrapulmonary form is rare. We report the case of hepatosplenic sarcoidosis in a 29-year-old female patient.It is a patient with no notable medical history, who was seen in consultation for repeated epistaxis. Clinical examination noted nodular hepatomegaly associated with signs of portal hypertension and splenomegaly. Sedimentation rate, alkaline phosphatase, serum angiotensin converting enzyme, aminotransferases were high. Histological examination of the spleen and liver biopsy noted granulomatous inflammatory infiltration without cancerous lesion or tonsil stones.This picture is comparable with sarcoidosis, despite the absence of PET scans. The main challenge remains the differential diagnosis with other granulomatoses. Corticosteroid therapy is the first-line treatment, and after splenectomy the patient has achieved clinical and biological stability.


Assuntos
Hepatopatias , Sarcoidose , Esplenopatias , Humanos , Sarcoidose/patologia , Sarcoidose/diagnóstico , Feminino , Adulto , Esplenopatias/patologia , Esplenopatias/cirurgia , Esplenopatias/diagnóstico , Congo , Hepatopatias/patologia , Hepatopatias/diagnóstico , Hospitais Universitários
19.
Med Trop Sante Int ; 4(1)2024 03 31.
Artigo em Francês | MEDLINE | ID: mdl-38846126

RESUMO

Justification: This study describes the socio-demographic characteristics, clinical, therapeutic, and evolutionary aspects of ocular burns to contribute to the improvement of their management. Method: A retrospective study was conducted in the Ophthalmology Department of the Cocody University Hospital (CHU) in Abidjan, Côte d'Ivoire, from January 1, 2020, to January 31, 2021. It focused on 49 patient records with ocular trauma, including 12 bilateral cases, totaling 61 eyes. For each patient, socio-demographic data, the nature of the traumatic agent, burn etiologies, ocular burn stage, initial and final uncorrected visual acuity of the affected eye, and treatment were collected. Results: The proportion of ocular burns was 11% out of 436 cases of ocular trauma that consulted in the department. The average age of patients was 27.9 years ± 14.2, ranging from 3 to 60 years, with a male predominance (70%). Students were the most frequent socio-professional category (39%). Work-related accidents were the predominant circumstances, in a third of cases. Chemical agents were the main traumatic agents, in 54% of cases. The average consultation time was 3.5 days ± 7.9, ranging from 1 to 60 days. Stage 1 of the Roper-Hall classification was the most observed stage (51% of cases). Initial visual acuity of the affected eye was less than 1/20 in 28% of cases. Treatment was mainly medical, and a third of treated eyes had a final acuity less than 1/20. Conclusion: Visual prognosis is influenced by burn stages, etiologies, and consultation time, varying according to social and geographical origins.


Assuntos
Queimaduras Oculares , Hospitais Universitários , Humanos , Côte d'Ivoire/epidemiologia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Adolescente , Criança , Adulto Jovem , Pré-Escolar , Queimaduras Oculares/epidemiologia , Queimaduras Oculares/terapia , Acuidade Visual/fisiologia
20.
BMC Ophthalmol ; 24(1): 243, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38858622

RESUMO

BACKGROUND: Due to the asymptomatic nature of the disease and lack of awareness, most glaucoma patients present for eye examination late, after significant damage of optic nerve occur. Being aware of glaucoma is important for timely diagnosis of the disease and preventing blindness from it. OBJECTIVE: The aim of this study was to assess glaucoma awareness and associated factors among adult patients aged 35 and over attending the eye outpatient department. METHODS: Hospital based cross-sectional study was conducted on 284 adult patients aged 35 and over attending ophthalmic outpatient department from July to August 2022 using systematic random sampling. An interviewer-administered questionnaire was used to collect data. The data were checked for completeness, and then entered to SPSS version 22 software. Descriptive and binary logistic regression analyses were performed. Independent variables with p-value ≤ 0.05 in multivariate logistic regression were considered as statistically significant. RESULTS: About 284 study participants, of whom 57.75% were male, participated in this study with a response rate of 94.1%. The mean age of the study participants was 53.58 years. Only 39.09%(95% CI: 36.53-41.65) were aware of glaucoma. Age groups 46-50 [AOR; 1.83: 1.18, 2.56] and 51-64 [AOR; 3.21: 2.03, 4.39], having college education or above [AOR; 3.1: 2.20, 6.64], family member with glaucoma [AOR; 5.86:3.25, 8.0], income 6500 ETB [AOR; 2.9: 1.97, 5.00] and previous eye examination [AOR; 2.15: 1.46, 4.05] were factors significantly associated with awareness of glaucoma. The main sources of information were news media, family members with glaucoma and health workers. CONCLUSION: More than half (60.91%) of adult ophthalmic patients attending HUCSH were unaware of glaucoma and need eye health education concerning glaucoma.


Assuntos
Glaucoma , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Etiópia/epidemiologia , Estudos Transversais , Glaucoma/epidemiologia , Adulto , Idoso , Inquéritos e Questionários , Hospitais Especializados/estatística & dados numéricos , Oftalmologia , Hospitais Universitários
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