BACKGROUND With an increase in the elderly population,the frequency of hospitalizations in recent years has also risen at a rapid pace.This,in turn,has resulted in poor outcomes and costly treatments.Hospitalization r...BACKGROUND With an increase in the elderly population,the frequency of hospitalizations in recent years has also risen at a rapid pace.This,in turn,has resulted in poor outcomes and costly treatments.Hospitalization rates increase in elderly patients due to a decline in glomerular filtration rate(GFR).AIM To investigate the connection between GFR and comorbidity and reasons for hospitalization in elderly patients.METHODS We analyzed patients aged 75 years and over who were admitted to the internal medicine clinic of a tertiary hospital in Eskisehir.At admission,we calculated GFR values using the Modification of Diet in Renal Disease study formula and classified them into six categories:G1,G2,G3a,G3b,G4,and G5.We analyzed associations with hospitalization diagnoses and comorbidity factors.RESULTS The average age of the patients was 80.8 years(±4.5 years).GFR was 57.287±29.5 mL/kg/1.73 m2 in women and 61.3±31.5 mL/kg/1.73 m2 in men(P=0.106).Most patients were admitted to the hospital at G2 stage(32.8%).The main reasons for hospitalization were anemia(34.4%and 28.6%)and malnutrition(20.9%and 20.8%)in women and men,respectively(P=0.078).The most frequent comor-bidity leading to hospitalization was arterial hypertension(n=168,28%),fo-llowed by diabetes(n=166,27.7%)(P=0.001).CONCLUSION When evaluating geriatric patients,low GFR alone does not provide sufficient information.Patients’comorbid factors should also be taken into account.There is no association between low GFR during hospitalization and hospitalization-Hamarat H.Aging and GFR related diagnoses.Knowing the GFR value before hospitalization will be more informative in such studies.展开更多
Background: Obesity is a chronic complex disease defined by excessive fat deposits that can impair health. Obesity occurs as a result of an imbalance in diet (energy intake) and physical activity (energy expended), mu...Background: Obesity is a chronic complex disease defined by excessive fat deposits that can impair health. Obesity occurs as a result of an imbalance in diet (energy intake) and physical activity (energy expended), multifactorial diseases due to obesogenic environment (availability of convenience food, media influence, etc.), psycho-social factors (social support systems, cultural/environmental influence, etc.) and genetic variants. Other causes are a subgroup of etiological factors (medications, diseases, immobilization, iatrogenic procedures, monogenic disease/genetic syndrome). Obesity is measured clinically by several common tools apart from body mass index (BMI), such as waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio, and neck circumference. WC and WHR are common tools for measuring central obesity while BMI measures generalized obesity. Aims: The goal of this study is to assess the prevalence of obesity amongst health workers of David Umahi Federal University Teaching Hospital, Uburu, Ebonyi state, Southeast Nigeria and to note the prevailing factors. A reliable estimate of the prevalence of obesity among health workers will contribute to the statistics needed to sway policymakers in the country to take urgent and substantial action on the increasing prevalence of obesity, especially in the healthcare industry. Methodology: The study was carried out between May 2024 and June 2024 at the David Umahi Federal University Teaching Hospital situated in Uburu, Ohaozara Local government area of Ebonyi state, Southeast Nigeria. The questionnaire was designed using the Finnish diabetic risk score (FINDRISC). It contained basic comprehending questions on age, gender, exposure to high blood pressure medication, and anthropometric measurement amongst others. Weight was taken with a portable weighing scale and height, with a stadiometer. Both were taken with shoes and headgear removed. The BMI was calculated using the weight (kg) divided by the square of the height (m2). Result: Generally, the prevalence of obesity (>30 kg/m2) in this study was low 17.6% (38), Overweight (BMI 25 - 30), 38.9%, (84) healthy Weight, (BMI 18.5 - 24.9), 43.5% (94). The study revealed that a family history of diabetes was significantly related to higher BMI, with participants more likely to be overweight or obese (p = 0.00030). Similarly, participants with a personal history of diabetes were predominantly in the obese category (p = 0.00038). Waist circumference also showed a strong association with BMI, as larger waist measurements were more common among obese individuals (p = 9.2 × 10−8). In contrast, the analysis found no significant relationships between BMI and age, gender, high blood pressure, or exercise habits. Conclusion: The socio-demographic determinants of obesity in this study were gender, age < 45 years and exposure to exercise. These determinants should form the areas of focus for interventions such as health education and the design of work environments as environments designed to promote physical activities while working will reduce the prevalence of obesity in tertiary institutions.展开更多
BACKGROUND Necrotizing fasciitis(NF)is a potentially fatal bacterial infection of the soft tissues.Liver cirrhosis appears to be a contributing factor to higher morbidity and mor-tality in patients with NF.This resear...BACKGROUND Necrotizing fasciitis(NF)is a potentially fatal bacterial infection of the soft tissues.Liver cirrhosis appears to be a contributing factor to higher morbidity and mor-tality in patients with NF.This research article explores the relationship between these two conditions.AIM To evaluate whether liver cirrhosis increases morbidity and mortality in patients with NF,focusing on inpatient mortality,septic shock,length of stay,and hospital costs.METHODS This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2019 National Inpatient Sample.Cases were identified as pa-tients with both NF and cirrhosis,while controls were non-cirrhotic.The study focused on inpatient mortality as the primary outcome,with secondary outcomes including surgical limb amputation,mechanical ventilation rates,septic shock,length of stay,and hospital costs.RESULTS A total of 14920 patients were admitted to the hospital for management of NF,of which 2.11%had liver cirrhosis.Inpatient mortality was higher in cirrhotic patients(9.5%vs 3%;adjusted odds ratio=3.78;P value=0.02).Cirrhotic patients also had higher rates of septic shock(10.5%vs 4.9%,P value<0.01).Length of hospital stay,total charges,and rates of mechanical ventilation were not statistically different between groups.CONCLUSION Liver cirrhosis is an independent risk factor of in-hospital mortality and morbidity in patients with NF.Clinicians should be aware of this association to ensure better clinical outcomes and spare healthcare expenditure.展开更多
Abortion is one of the leading causes of maternal death in Cameroon, despite numerous policies and strategies put in place to reduce it by 2030.This study aims to describe the epidemiologic aspects of abortions within...Abortion is one of the leading causes of maternal death in Cameroon, despite numerous policies and strategies put in place to reduce it by 2030.This study aims to describe the epidemiologic aspects of abortions within hospitals in the city of Yaoundé in 2023. Methods: This was a descriptive cross-sectional study with prospective data collection in the maternity wards of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, and the Yaoundé Central Hospital for 7 months, from the 1st of November 2022 to the 31st of May 2023. The variables studied were demographic and clinical characteristics, means of recourse and post-abortion contraception. The frequency of abortions was calculated as the ratio of the number of abortions to the number of deliveries. The calculation of numbers and frequencies was used to describe the study population, and to highlight the sociodemographic and clinical characteristics of the patients recruited. Quantitative variables were expressed as mean ± standard deviation. Data were collected numerically and classified according to type, then analyzed using Epi-info version 7.2 software. Microsoft Office Excel 2013 was used to produce figures and tables. Results: During the study period, 169 patients were selected out of 1882 patients who had consulted for gynaecological emergencies;but only 164 of them accepted to participate. The frequency of abortions was 9.6% (169/1882). The age group of 25 to 29 years was the most represented, with 29.3% (48/164). They were mainly single 76.2% (125/164), and housewives 33.5% (55/164). The notion of previous abortion was found in 30.5% (50/164) of them. Approximately 19.5% of patients (32/164) reported to have conceived while using contraception, 56.2% of whom (18/32) used male condoms. At the time of admission to the emergency unit, the predominant symptom was bleeding in 70.7% of cases. The abortions were mainly spontaneous, in 75% of cases (123/164). In cases of induced abortions, 24.4% (10/41) of them took place after 14 weeks. Unexpected pregnancy was the main reason for termination in 46.3% of cases (19/41). Regarding induced abortion, 58.54% (24/41) of them resorted to voluntary medical termination. The mortality rate was 1.2%. The acceptability rate of a modern contraceptive method before discharge was 31.7%. Conclusion: Although frequent in our environment, data relating to abortion remain under-evaluated. Abortions occur mainly among young, single women, with a still very high proportion of induced abortions. The acceptability of post-abortion contraception remains poor. Prevention of unwanted pregnancies and risk factors is necessary to reduce the burden of abortions in low-income countries.展开更多
Porters play a crucial role in hospitals because they ensure the efficient transportation of patients,medical equipment,and vital documents.Despite its importance,there is a lack of research addressing the prediction ...Porters play a crucial role in hospitals because they ensure the efficient transportation of patients,medical equipment,and vital documents.Despite its importance,there is a lack of research addressing the prediction of completion times for porter tasks.To address this gap,we utilized real-world porter delivery data from Taiwan University Hospital,China,Yunlin Branch,Taiwan Region of China.We first identified key features that can influence the duration of porter tasks.We then employed three widely-used machine learning algorithms:decision tree,random forest,and gradient boosting.To leverage the strengths of each algorithm,we finally adopted an ensemble modeling approach that aggregates their individual predictions.Our experimental results show that the proposed ensemble model can achieve a mean absolute error of 3 min in predicting task response time and 4.42 min in task completion time.The prediction error is around 50%lower compared to using only the historical average.These results demonstrate that our method significantly improves the accuracy of porter task time prediction,supporting better resource planning and patient care.It helps ward staff streamline workflows by reducing delays,enables porter managers to allocate resources more effectively,and shortens patient waiting times,contributing to a better care experience.展开更多
Air quality is a critical factor in maintaining health and well-being, influencing both current conditions and future outcomes. Hospitals are one of the sensitive areas of our society, for they are built as sanctuarie...Air quality is a critical factor in maintaining health and well-being, influencing both current conditions and future outcomes. Hospitals are one of the sensitive areas of our society, for they are built as sanctuaries for treatment and recovery, making the quality of paramount importance. This study investigates the impact of traffic-related emissions on indoor air quality within a Level 5 Hospital outpatient ward. Measurements were taken over five consecutive days, revealing that while CO2 levels generally remained within safe limits, there were instances where concentrations exceeded 3000 ppm, categorizing them as “Hazardous.” Notably, particulate matter (PM2.5 and PM10) levels fluctuated significantly, with peak concentrations observed during working hours correlating with increased vehicle activity. The data indicated that PM2.5 levels reached as high as 75 µg/m3, with 91.68% of recorded values exceeding the World Health Organization’s (WHO) and Environmental Protection Agency 24-hour mean threshold of 25 µg/m3. Similarly, PM10 concentrations peaked at 120 µg/m3, with 61.19% of values surpassing the WHO threshold of 50 µg/m3, both of which pose serious health risks, particularly to vulnerable populations such as pregnant women, infants, and the elderly. Additionally, the study highlighted the critical role of wind direction in pollutant dispersion, with specific patterns contributing to elevated indoor concentrations. These findings underscore the urgent need for targeted interventions and proactive air quality management strategies in healthcare facilities, including the strategic design of hospital wards away from primary emission sources and the promotion of electric vehicle use to mitigate traffic-related emissions.展开更多
Fangcang shelter hospitals are modular,rapidly deployable facilities that play a vital role in pandemic response by providing centralized isolation and basic medical care for large patient populations.Artificial intel...Fangcang shelter hospitals are modular,rapidly deployable facilities that play a vital role in pandemic response by providing centralized isolation and basic medical care for large patient populations.Artificial intelligence(AI)has the potential to transform Fangcang shelter hospitals into intelligent,responsive systems that are capable of significantly improving emergency preparedness,operational efficiency,and patient outcomes.Key application areas include site selection and design optimization,clinical decision support,AI-assisted clinical documentation and patient engagement,intelligent robotics,and operational management.However,realizing AI's full potential requires overcoming several challenges,including limited data accessibility,privacy and governance concerns,inadequate algorithmic adaptability in dynamic emergency settings,insufficient transparency and accountability in AI-driven decisions,fragmented system architectures due to proprietary formats,high costs disproportionate to the temporary nature of Fangcang shelter hospitals,and hardware reliability in austere environments.Addressing these challenges demands standardized data-sharing frameworks,development of explainable and robust AI algorithms,clear ethical and legal oversight,interoperable modular system designs,and active collaboration among multidisciplinary stakeholders.展开更多
Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for m...Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for multiple complications. The objective of this study was to characterize clinically and biologically type 2 diabetic patients followed at the National Center for Diabetology and Arterial Hypertension of the Central Hospital of Yaoundé. Method: This prospective, cross-sectional, and analytical study took place from April 5 to July 31, 2023 (4 months) on 100 diabetic patients of both sexes (61 women and 39 men), aged from 31 to 88 years. Body Mass Index, systolic and diastolic blood pressure, and cardiac frequency were measured on each of the patients. Subsequently, blood was collected from the patients for the determination of the complete blood count, HBA1c, lipid profile, serum albumin, TNF-α, and IL-6 levels. The data were analyzed using SPSS 17.0 software. Results: The age average of our population was 56.99 ± 11.51 years, the population was primarily female (61%) and primarily between the ages of 55 and 88. 67% of respondents were married. 59% went to secondary school. 73% of them lived in urban areas. 30% were obese and 40% were overweight, with an average BMI of 28.75 kg/m2. 76% of patients took oral antidiabetic medications. HbA1c level average was 8.65%, with 60% having readings above 6.5%. Low hemoglobin and hypochromia were among the abnormalities of red blood cells observed. Lipid profiles revealed low HDL-cholesterol and high triglycerides and cholesterol. Elevated levels of TNF-α and IL-6 indicated inflammation and cardiovascular risk. Conclusion: These results indicate the necessity of focused diabetic care and management on diabetic patients attending the central hospital of Yaoundé, Cameroon.展开更多
Background:Whether lactated Ringer's solution is clinically superior to normal saline for routine intravenous administration of fluids is uncertain.Methods:In an open-label,two-period,two-sequence,cross-sectional,...Background:Whether lactated Ringer's solution is clinically superior to normal saline for routine intravenous administration of fluids is uncertain.Methods:In an open-label,two-period,two-sequence,cross-sectional,cluster-randomized,crossover trial,we assigned hospitals in Ontario,Canada,to use either lactated Ringer's solution or normal saline hospital-wide for a period of 12 weeks.展开更多
Introduction: Respiratory distress is a clinical condition accompanied by an increase in work of breathing, with the respiratory accessory muscles brought into play to ensure normal arterial oxygenation. It is a major...Introduction: Respiratory distress is a clinical condition accompanied by an increase in work of breathing, with the respiratory accessory muscles brought into play to ensure normal arterial oxygenation. It is a major cause of morbidity and mortality in pediatrics. The aim of our study was to investigate the epidemiological, clinical and therapeutic aspects of respiratory distress in children aged between 1 month and 15 years seen in the emergency department of the Bangui paediatric university hospital. Methodology: This was a 3-month descriptive cross-sectional study, from January 1 to March 31, 2023. All children aged 1 month to less than 15 years presenting with respiratory distress were included. Results: A total of 3021 children were admitted to the emergency medical services of Bangui’s pediatric university hospital. Of these, 164 were included in the study. The predominance was male, with a sex ratio of 1.09. The 0 - 2 age group was the most represented, with 67 patients (42.85%). The majority of patients came from Bangui, accounting for 146 (89.02%) of cases. Respiratory difficulty (59.15%), characterized by dyspnea and cough, associated with fever, vomiting, physical asthenia and diarrhea, were the main reasons for consultation. The main pathologies noted were respiratory 92 (56.10%), followed by cardiac pathologies 21 (12.8%). Antibiotic administration (76.82%) was the most common therapeutic procedure used in the management of respiratory distress. Conclusion: Respiratory distress remains an important cause of infant mortality in our context, with major management problems.展开更多
BACKGROUND Atrial fibrillation(AF)remains the most common cardiac arrhythmia.The safety of endoscopic retrograde cholangiopancreatography(ERCP)in patients with AF remains largely unknown.AIM To analyze the effect of A...BACKGROUND Atrial fibrillation(AF)remains the most common cardiac arrhythmia.The safety of endoscopic retrograde cholangiopancreatography(ERCP)in patients with AF remains largely unknown.AIM To analyze the effect of AF on hospital outcomes in patients undergoing ERCP.METHODS We performed a retrospective cohort study using the Nationwide Inpatient Sample database.Adult patients with AF who underwent an inpatient ERCP were identified,then stratified by timing of ERCP,via international classification of diseases-10 codes.The primary outcome was all-cause in-hospital mortality.Secondary outcomes,including resource utilization,were assessed.Statistical analysis was performed using STATA software.RESULTS Of the 433245 patients that underwent an ERCP,49615 had a diagnosis of AF.Patients with AF had a significantly higher in-hospital mortality compared to those without AF[3.82%vs 1.13%,odds ratio(OR)=1.93,P<0.01].AF was significantly associated with increased hospital stay(+1.71 days),hospital charges($21210),shock(OR=2.17),sepsis(OR=1.34),intensive care unit admission(OR=2.41),acute kidney injury(OR=1.51),as well as a decreased likelihood of discharge to home(OR=0.59),(all with P<0.01).These results were consistent after propensity score matching.Upon subgroup analysis,patients with AF,whom underwent ERCP>72 hours,had worse outcomes including higher inhospital mortality(adjusted OR=1.47,P<0.01).CONCLUSION By way of this large,national analysis it appears AF is associated with significantly worse hospitalization outcomes,inducing increased mortality,in those undergoing ERCP.Further prospective investigation is warranted to potentially guide clinical recommendations for patients with AF undergoing ERCP in this setting.展开更多
The propagation characteristics of wireless body area network(WBAN)under the hospital environments at 10GHz are studied for exploring the feasibility of indoor high frequency communication.Based on the extensive measu...The propagation characteristics of wireless body area network(WBAN)under the hospital environments at 10GHz are studied for exploring the feasibility of indoor high frequency communication.Based on the extensive measured data in the hospital room and corridor scenarios,a new path loss(PL)model with the antenna angle factor(called as AAF)is proposed,where AAF is used to characterize the influence of angle change of a wearable or handheld device of the human body on the PL.Moreover,the expression of AAF is presented,which is a trigonometric functional of the angle of receiving antenna.In addition,the statistical characteristics of the time-domain root-mean-square delay spread(RMS-DS)are given under the two hospital scenarios,and a novel RMSDS model is also presented.In the proposed model,the RMS-DS is expressed as a linear function of PL,and a normal random variable is employed to describe the deviation between the measured RMS-DS and the linear function.The validity of the proposed models is verified in the different hospital environments,and the simulation results show that the proposed models have higher accuracy and better adaptability than the existing models.展开更多
The centralized procurement of drugs in the medical system is a key link,which not only affects the economic effect of institutions,but also relates to the medical quality and patient safety.In the current era,central...The centralized procurement of drugs in the medical system is a key link,which not only affects the economic effect of institutions,but also relates to the medical quality and patient safety.In the current era,centralized drug procurement in hospitals can meet the needs of most patients;however,the specific steps of the work still need to be optimized.Starting from the level of hospital drug centralized procurement work,this paper discusses the policy background,analyzes the practice of drug centralized procurement in tertiary hospitals,and provides specific work management suggestions,aiming to improve work efficiency and serve as a reference for optimizing subsequent hospital drug centralized procurement work.展开更多
Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,m...Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,management and outcomes of these patients and to describe predictors of length of hospital stay(LoS)in this context.Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge(January 2018-December 2022).A TAVI program was implemented in may 2021.Baseline clinical characteristics,management and in-hospital complications were registered.Predictors of long hospital stay(>7 day)were assessed by binary logistic regression.Results We included 614 patients,with mean age 80.5 years.Most patients(438/614,71.2%)presented conditions that precluded an early discharge.Mean hospital stay was 7.6 days.Patients admitted after the implementation of the program had a significantly lower burden of comorbidities.The rate of conduction disturbances after TAVI remained stable around 60%.However,permanent pacemaker requirement declined from 30.3%to 22.5%(P=0.028).LoS was reduced after the implementation of the program both in patients suitable for an early discharge(from 6.5 day to 4 day,P<0.001)and unsuitable patients(from 9.4 day to 7.7 day,P=0.014).The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases,day of the week,emergent procedures,and conduction disturbances and other complications as independent predictors of long stay after TAVI.Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge.The implementation of a TAVI program improved selection of patients,with a lower burden of comorbidities,a lower rate of complications and a marked reduction of hospital stay.展开更多
BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care....BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.展开更多
Background: Chronic low back pain is a leading cause of morbidity and disability globally. Low and Middle-Income Countries (LMICs) tend to be more affected, with chronic low back pain (CLBP) being among the leading pr...Background: Chronic low back pain is a leading cause of morbidity and disability globally. Low and Middle-Income Countries (LMICs) tend to be more affected, with chronic low back pain (CLBP) being among the leading presenting complaints at specialist consultation. The exact burden of this disease is sparingly known in our setting. Objective: To evaluate the burden of chronic low back pain at the Yaounde Central Hospital. Methods: This was a descriptive cross-sectional study for a period of 3 months, from March 2022 to May 2022. After obtaining ethical clearance and research authorisations, data was collected using structured questionnaires from patients with chronic low back pain presenting at the Yaounde Central Hospital during the aforementioned time frame. This data was then tabulated with the Statistical Package for Social Sciences (SPSS 23.0), and disability was assessed using the modified Roland Morris Disability Questionnaire and the Oswestry Disability Index. Data analysis was done using the International Business Machines Statistical Package for Social Sciences (IBM-SPSS) VERSION 23.0. Results: 115 cases of CLBP were included. The mean age was 52.62 years, and the sex ratio was 0.3. The average monthly income was less than 50,000 frs CFA, in 37.4% of cases. In 57.9%, patients had a job that involved physical labour. The patients had a secondary level of education in 40.9%, and alcohol consumption was observed in 36%. The average number of days of a work stoppage due to LBP was 12.75 days (±12SD), and the median duration of CLBP was 7.15 (7.5SD) years. The median pain intensity was 7 (±2SD), with leg pain and sensory neuropathy observed in 67.8% and 63.5% respectively. Lumbar X-ray was done in 45.2% and revealed lumbar osteoarthrosis in 62.4%. Hypertension as a comorbidity was observed in 26.1%. Medical treatment was used at least once in 98.3% of cases. The average cost of management per month was assessed, and the median was 52,000 FCFA (±20,876 SD). Using the Oswestry Disability Questionnaire, 46 patients, that is 40% of the study population, were classified as severely disabled with a median ODI score of 40%. The factors which were independently associated with disability were level of education, alcohol consumption, treatment modality, pain intensity, body mass index (BMI), psychological wellbeing and number of sick leave days. Conclusion: Chronic low back pain is common in our setting. There is a female predominance with the mean age of the study population situated in the 5th decade. Low-income earners and patients with a job involving physical labour were the most affected. Medical treatment was the main therapeutic modality, with the average cost of management per month being above the average monthly income of the greater majority of the patients. Several factors influenced disability, some of which were independently associated with it, such as level of education, alcohol consumption and treatment modality.展开更多
Alcohol use has contributed to large disease burdens,and alcohol-related problems are prevalent among patients in general hospitals and primary care settings.This review aims to deepen the understanding of screening,i...Alcohol use has contributed to large disease burdens,and alcohol-related problems are prevalent among patients in general hospitals and primary care settings.This review aims to deepen the understanding of screening,intervention,and treatment referral for alcohol-related problems in these settings.We searched the literature published in English from PubMed,ScienceDirect,and the World Health Organization website.We found that while a series of screening tools can be used,screening rates were low.The awareness of screening should be strengthened.Brief interventions and pharmacotherapy are the two main methods used in general hospitals and primary care settings,with complementary and alternative medicine considered under the framework of integrative medicine.Individuals with severe alcohol-related problems or alcohol use disorders should be referred to specialty treatment for alcohol abuse,but referral is sometimes ignored.A gap exists between general hospitals/primary care facilities and specialized alcohol-related treatment providers.In conclusion,screening,intervention,and referral to treatment comprise a continuum for patients with alcohol-related problems.Opportunities to prevent and manage these problems in general hospitals and primary care settings are abundant,and taking action will promote the addressing of this public health issue.展开更多
Still common in developing countries, acute rheumatic fever (ARF) is not only a disease of children and adolescents, but can also occur in adults. At this age, the diagnosis of rheumatic flare-ups can be difficult due...Still common in developing countries, acute rheumatic fever (ARF) is not only a disease of children and adolescents, but can also occur in adults. At this age, the diagnosis of rheumatic flare-ups can be difficult due to the frequency of other types of joint diseases and the existence of degenerative and dystrophic valve disease. In adults, the initial rheumatic attack is marked by the predominance of joint damage over cardiac damage. However, it is often at this age that rheumatic valve disease is discovered. The revised Jones criteria also find their place in the diagnosis of AAR in adults. Objective: To study the demographic, clinical, and biological characteristics of acute rheumatic fever (ARF) in the General Medicine Department of the Siguiri Prefectural Hospital. Materials and Methods: This descriptive observational study examined the demographic, clinical and biological characteristics of acute rheumatic fever (ARF) at the Siguiri Prefectural Hospital, Guinea, between April 1 and September 31, 2021 according to Jones criteria. The data were collected on a form containing sociodemographic variables (age, sex, profession), rheumatological, cardiac, pulmonary and neurological clinical signs, biological variables and treatment. Results: Figure 1 shows the flow of the hospital frequency of the RAA in the General Medicine Department of the Prefectural Hospital of Siguiri. During the study period, 420 patients were hospitalized, of whom 161 patients had AAR, a frequency of 38.33%. Table 1 shows the distribution of patients diagnosed with ARB, by sociodemographic characteristics. The average age was 44.7 ± 19.78 years and the extremes of 14 and 90 years, the female sex dominated with a ratio of 0.75. The informal sector was in the majority in 45.34% of cases and most were illiterate, i.e. 53.42%. In our study, the incidence was lower during the dry season than during the rainy season, a hot season with high rainfall and humidity, the rainy period was a provider with a peak in August and September. The lifestyle was characterized by overcrowding in 87.58% of patients. The main complaint was fever, i.e. 88.82%. Rheumatological manifestations such as arthritis were 98.14%, chest pain was 37.89% (61 cases). The diagnosis was confirmed by ASLO titration in 85.71% of patients and 98.55% (136 cases) had a titration greater than 400 U/ml. Conclusion: The results obtained from our study show a high prevalence of acute rheumatic fever, which makes it a worrying health problem in the Siguiri health district. Young female adult patients, married with an informal profession and not in school residing in Siguiri were the most encountered in our study. The main functional signs mentioned by the patients were fever, cough and abdominal pain;osteoarticular pain and chest pain dominated the clinical picture. Almost all of our patients had an ASLO titer greater than 400 U/ml and a positive C-reactive protein. Our results show a high risk of spread of acute rheumatic fever within the population of Siguiri. Due to the serious complications caused by acute rheumatic fever, particular attention must be paid to it by carrying out other, much larger studies in order to identify the problem of RAA.展开更多
Objective:To explore the target management model for clinical pharmacists in primary hospitals facing current shortages of clinical pharmacists,in order to improve the work efficiency and service quality of clinical p...Objective:To explore the target management model for clinical pharmacists in primary hospitals facing current shortages of clinical pharmacists,in order to improve the work efficiency and service quality of clinical pharmacy,and promote the high-quality development of clinical pharmacy in primary hospitals.Methods:Developing a target management model,adopting a wide coverage work model of“1+1+N”(that is,1 clinical pharmacist,1 resident clinical department,and N contracted clinical departments).According to the SMART principle,various work assessment indicators were quantified.This involved setting clear work goals,diversifying work methods,personalizing work methods,standardizing workflows,and using numerical assessment indicators.Regular supervision,inspection,feedback,and improvement mechanisms were implemented.Results:The implementation of the target management model has made the work effectiveness of clinical pharmacists visualized.There were more than 200 annual consultations and multidisciplinary team(MDT)cases,with an opinion adoption rate of 90.2%and a patient improvement rate of 80.6%.More than 1500 rational drug use interventions were conducted,with a suggestion adoption rate of 83.5%.In terms of pharmaceutical indicators control.The intensity of antibacterial drug use in 2024(without CMI adjustment)was 30.07 DDDs,significantly lower than the 2023 value of 33.54 DDDs,and also significantly lower than the provincial average(32.87 DDDs)and the average for hospitals of the same level(32.49 DDDs).The daily usage of intravenous infusion per bed for hospitalized patients was 2.09,a decrease from 2.15 in 2023,significantly lower than the provincial average of 2.71 and the average of 2.56 in hospitals of the same level.The amount of the second batch of national key monitoring drugs accounts for the value was 6.48%,significantly lower than the provincial average of 8.27%and the same level hospital average of 8.82%.In terms of chronic disease pharmaceutical management,taking the pharmaceutical management of patients with chronic heart failure as an example,the usage rates of renin-aldosterone-angiotensin-system inhibitors(RAAS inhibitors)and beta-blockers for heart failure in the management group were 87.88%and 80.81%,respectively,significantly higher-1 than those in the control group(62.22%and 65.56%).Heart rate in the management group(69.54±10.68 times·min-1)was significantly lower than in the control group(80.04±17.68 times·min)(P<0.001).The low-density lipoprotein cholesterol(1.69±0.57 mmol·L-1)was significantly lower than the control group(1.95±0.77 mmol·L-1)(P<0.001),and the 1-year readmission rate was 47.47%,significantly lower than the control group 56.67%.The Minnesota Living with Heart Failure Questionnaire(MLHFQ)Score was(44.20±10.78),significantly lower than the control group(55.89±11.48)(P<0.001),indicating a significant improvement in the patient’s quality of life.Conclusions:The targeted management model for clinical pharmacists can effectively enhance communication and collaboration between clinical pharmacists and clinicians,improve the work efficiency and service quality of clinical pharmacists in primary hospitals,promote the work of clinical pharmacy towards standardization and scientificization,boost the high-quality development of pharmacy in primary hospitals,and also provide new ideas and methods for the management of clinical pharmacists in other primary hospitals.展开更多
This paper examines the travel behaviors of hand-foot-and-mouth disease(HFMD)patients in Nanchang City in central China.Based on the HFMD patients’hospital visitation data from the Center of Disease Control(CDC)of Na...This paper examines the travel behaviors of hand-foot-and-mouth disease(HFMD)patients in Nanchang City in central China.Based on the HFMD patients’hospital visitation data from the Center of Disease Control(CDC)of Nanchang in 2018,a spatial network of patient-to-hospital trip flows is constructed.A Geographic Information Systems(GIS)automated network community detec-tion method,termed‘ScLeiden’,is utilized to delineate the study area into six hospital service areas(HSAs)to represent distinctive health care markets.Patients’travel patterns across these HSAs are compared to highlight the geographic disparity.In two HSAs anchored by major hospitals in the regions,the volume of patients increased up to a travel range and then declined,and thus formed a single peak in the trip volume distribution curve across travel time.Each of the remaining four HSAs exhibited two or more peaks in their trip volume distribution curves.The patterns reflected the split choices of patients for the largest Children Hospital in the region,the second-tier county hospital,or others,which were likely to be stratified by their economic affordability,transportation means,and possible health literacy.The study provides valuable insights into the delineation of HSAs and the unique patients’travel behaviors in China.展开更多
文摘BACKGROUND With an increase in the elderly population,the frequency of hospitalizations in recent years has also risen at a rapid pace.This,in turn,has resulted in poor outcomes and costly treatments.Hospitalization rates increase in elderly patients due to a decline in glomerular filtration rate(GFR).AIM To investigate the connection between GFR and comorbidity and reasons for hospitalization in elderly patients.METHODS We analyzed patients aged 75 years and over who were admitted to the internal medicine clinic of a tertiary hospital in Eskisehir.At admission,we calculated GFR values using the Modification of Diet in Renal Disease study formula and classified them into six categories:G1,G2,G3a,G3b,G4,and G5.We analyzed associations with hospitalization diagnoses and comorbidity factors.RESULTS The average age of the patients was 80.8 years(±4.5 years).GFR was 57.287±29.5 mL/kg/1.73 m2 in women and 61.3±31.5 mL/kg/1.73 m2 in men(P=0.106).Most patients were admitted to the hospital at G2 stage(32.8%).The main reasons for hospitalization were anemia(34.4%and 28.6%)and malnutrition(20.9%and 20.8%)in women and men,respectively(P=0.078).The most frequent comor-bidity leading to hospitalization was arterial hypertension(n=168,28%),fo-llowed by diabetes(n=166,27.7%)(P=0.001).CONCLUSION When evaluating geriatric patients,low GFR alone does not provide sufficient information.Patients’comorbid factors should also be taken into account.There is no association between low GFR during hospitalization and hospitalization-Hamarat H.Aging and GFR related diagnoses.Knowing the GFR value before hospitalization will be more informative in such studies.
文摘Background: Obesity is a chronic complex disease defined by excessive fat deposits that can impair health. Obesity occurs as a result of an imbalance in diet (energy intake) and physical activity (energy expended), multifactorial diseases due to obesogenic environment (availability of convenience food, media influence, etc.), psycho-social factors (social support systems, cultural/environmental influence, etc.) and genetic variants. Other causes are a subgroup of etiological factors (medications, diseases, immobilization, iatrogenic procedures, monogenic disease/genetic syndrome). Obesity is measured clinically by several common tools apart from body mass index (BMI), such as waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio, and neck circumference. WC and WHR are common tools for measuring central obesity while BMI measures generalized obesity. Aims: The goal of this study is to assess the prevalence of obesity amongst health workers of David Umahi Federal University Teaching Hospital, Uburu, Ebonyi state, Southeast Nigeria and to note the prevailing factors. A reliable estimate of the prevalence of obesity among health workers will contribute to the statistics needed to sway policymakers in the country to take urgent and substantial action on the increasing prevalence of obesity, especially in the healthcare industry. Methodology: The study was carried out between May 2024 and June 2024 at the David Umahi Federal University Teaching Hospital situated in Uburu, Ohaozara Local government area of Ebonyi state, Southeast Nigeria. The questionnaire was designed using the Finnish diabetic risk score (FINDRISC). It contained basic comprehending questions on age, gender, exposure to high blood pressure medication, and anthropometric measurement amongst others. Weight was taken with a portable weighing scale and height, with a stadiometer. Both were taken with shoes and headgear removed. The BMI was calculated using the weight (kg) divided by the square of the height (m2). Result: Generally, the prevalence of obesity (>30 kg/m2) in this study was low 17.6% (38), Overweight (BMI 25 - 30), 38.9%, (84) healthy Weight, (BMI 18.5 - 24.9), 43.5% (94). The study revealed that a family history of diabetes was significantly related to higher BMI, with participants more likely to be overweight or obese (p = 0.00030). Similarly, participants with a personal history of diabetes were predominantly in the obese category (p = 0.00038). Waist circumference also showed a strong association with BMI, as larger waist measurements were more common among obese individuals (p = 9.2 × 10−8). In contrast, the analysis found no significant relationships between BMI and age, gender, high blood pressure, or exercise habits. Conclusion: The socio-demographic determinants of obesity in this study were gender, age < 45 years and exposure to exercise. These determinants should form the areas of focus for interventions such as health education and the design of work environments as environments designed to promote physical activities while working will reduce the prevalence of obesity in tertiary institutions.
文摘BACKGROUND Necrotizing fasciitis(NF)is a potentially fatal bacterial infection of the soft tissues.Liver cirrhosis appears to be a contributing factor to higher morbidity and mor-tality in patients with NF.This research article explores the relationship between these two conditions.AIM To evaluate whether liver cirrhosis increases morbidity and mortality in patients with NF,focusing on inpatient mortality,septic shock,length of stay,and hospital costs.METHODS This retrospective cohort study utilized data from the Healthcare Cost and Utilization Project 2019 National Inpatient Sample.Cases were identified as pa-tients with both NF and cirrhosis,while controls were non-cirrhotic.The study focused on inpatient mortality as the primary outcome,with secondary outcomes including surgical limb amputation,mechanical ventilation rates,septic shock,length of stay,and hospital costs.RESULTS A total of 14920 patients were admitted to the hospital for management of NF,of which 2.11%had liver cirrhosis.Inpatient mortality was higher in cirrhotic patients(9.5%vs 3%;adjusted odds ratio=3.78;P value=0.02).Cirrhotic patients also had higher rates of septic shock(10.5%vs 4.9%,P value<0.01).Length of hospital stay,total charges,and rates of mechanical ventilation were not statistically different between groups.CONCLUSION Liver cirrhosis is an independent risk factor of in-hospital mortality and morbidity in patients with NF.Clinicians should be aware of this association to ensure better clinical outcomes and spare healthcare expenditure.
文摘Abortion is one of the leading causes of maternal death in Cameroon, despite numerous policies and strategies put in place to reduce it by 2030.This study aims to describe the epidemiologic aspects of abortions within hospitals in the city of Yaoundé in 2023. Methods: This was a descriptive cross-sectional study with prospective data collection in the maternity wards of the Yaoundé Gynaeco-Obstetric and Paediatric Hospital, and the Yaoundé Central Hospital for 7 months, from the 1st of November 2022 to the 31st of May 2023. The variables studied were demographic and clinical characteristics, means of recourse and post-abortion contraception. The frequency of abortions was calculated as the ratio of the number of abortions to the number of deliveries. The calculation of numbers and frequencies was used to describe the study population, and to highlight the sociodemographic and clinical characteristics of the patients recruited. Quantitative variables were expressed as mean ± standard deviation. Data were collected numerically and classified according to type, then analyzed using Epi-info version 7.2 software. Microsoft Office Excel 2013 was used to produce figures and tables. Results: During the study period, 169 patients were selected out of 1882 patients who had consulted for gynaecological emergencies;but only 164 of them accepted to participate. The frequency of abortions was 9.6% (169/1882). The age group of 25 to 29 years was the most represented, with 29.3% (48/164). They were mainly single 76.2% (125/164), and housewives 33.5% (55/164). The notion of previous abortion was found in 30.5% (50/164) of them. Approximately 19.5% of patients (32/164) reported to have conceived while using contraception, 56.2% of whom (18/32) used male condoms. At the time of admission to the emergency unit, the predominant symptom was bleeding in 70.7% of cases. The abortions were mainly spontaneous, in 75% of cases (123/164). In cases of induced abortions, 24.4% (10/41) of them took place after 14 weeks. Unexpected pregnancy was the main reason for termination in 46.3% of cases (19/41). Regarding induced abortion, 58.54% (24/41) of them resorted to voluntary medical termination. The mortality rate was 1.2%. The acceptability rate of a modern contraceptive method before discharge was 31.7%. Conclusion: Although frequent in our environment, data relating to abortion remain under-evaluated. Abortions occur mainly among young, single women, with a still very high proportion of induced abortions. The acceptability of post-abortion contraception remains poor. Prevention of unwanted pregnancies and risk factors is necessary to reduce the burden of abortions in low-income countries.
基金supported by National Taiwan University Hospital Yunlin Branch Project NTUHYL 110.C018National Science and Technology Council,Taiwan.
文摘Porters play a crucial role in hospitals because they ensure the efficient transportation of patients,medical equipment,and vital documents.Despite its importance,there is a lack of research addressing the prediction of completion times for porter tasks.To address this gap,we utilized real-world porter delivery data from Taiwan University Hospital,China,Yunlin Branch,Taiwan Region of China.We first identified key features that can influence the duration of porter tasks.We then employed three widely-used machine learning algorithms:decision tree,random forest,and gradient boosting.To leverage the strengths of each algorithm,we finally adopted an ensemble modeling approach that aggregates their individual predictions.Our experimental results show that the proposed ensemble model can achieve a mean absolute error of 3 min in predicting task response time and 4.42 min in task completion time.The prediction error is around 50%lower compared to using only the historical average.These results demonstrate that our method significantly improves the accuracy of porter task time prediction,supporting better resource planning and patient care.It helps ward staff streamline workflows by reducing delays,enables porter managers to allocate resources more effectively,and shortens patient waiting times,contributing to a better care experience.
文摘Air quality is a critical factor in maintaining health and well-being, influencing both current conditions and future outcomes. Hospitals are one of the sensitive areas of our society, for they are built as sanctuaries for treatment and recovery, making the quality of paramount importance. This study investigates the impact of traffic-related emissions on indoor air quality within a Level 5 Hospital outpatient ward. Measurements were taken over five consecutive days, revealing that while CO2 levels generally remained within safe limits, there were instances where concentrations exceeded 3000 ppm, categorizing them as “Hazardous.” Notably, particulate matter (PM2.5 and PM10) levels fluctuated significantly, with peak concentrations observed during working hours correlating with increased vehicle activity. The data indicated that PM2.5 levels reached as high as 75 µg/m3, with 91.68% of recorded values exceeding the World Health Organization’s (WHO) and Environmental Protection Agency 24-hour mean threshold of 25 µg/m3. Similarly, PM10 concentrations peaked at 120 µg/m3, with 61.19% of values surpassing the WHO threshold of 50 µg/m3, both of which pose serious health risks, particularly to vulnerable populations such as pregnant women, infants, and the elderly. Additionally, the study highlighted the critical role of wind direction in pollutant dispersion, with specific patterns contributing to elevated indoor concentrations. These findings underscore the urgent need for targeted interventions and proactive air quality management strategies in healthcare facilities, including the strategic design of hospital wards away from primary emission sources and the promotion of electric vehicle use to mitigate traffic-related emissions.
文摘Fangcang shelter hospitals are modular,rapidly deployable facilities that play a vital role in pandemic response by providing centralized isolation and basic medical care for large patient populations.Artificial intelligence(AI)has the potential to transform Fangcang shelter hospitals into intelligent,responsive systems that are capable of significantly improving emergency preparedness,operational efficiency,and patient outcomes.Key application areas include site selection and design optimization,clinical decision support,AI-assisted clinical documentation and patient engagement,intelligent robotics,and operational management.However,realizing AI's full potential requires overcoming several challenges,including limited data accessibility,privacy and governance concerns,inadequate algorithmic adaptability in dynamic emergency settings,insufficient transparency and accountability in AI-driven decisions,fragmented system architectures due to proprietary formats,high costs disproportionate to the temporary nature of Fangcang shelter hospitals,and hardware reliability in austere environments.Addressing these challenges demands standardized data-sharing frameworks,development of explainable and robust AI algorithms,clear ethical and legal oversight,interoperable modular system designs,and active collaboration among multidisciplinary stakeholders.
文摘Introduction: Diabetes remains a real public health problem today, due to its associated morbidity and mortality. It induces numerous metabolic, biochemical, hematological, and immunological changes, responsible for multiple complications. The objective of this study was to characterize clinically and biologically type 2 diabetic patients followed at the National Center for Diabetology and Arterial Hypertension of the Central Hospital of Yaoundé. Method: This prospective, cross-sectional, and analytical study took place from April 5 to July 31, 2023 (4 months) on 100 diabetic patients of both sexes (61 women and 39 men), aged from 31 to 88 years. Body Mass Index, systolic and diastolic blood pressure, and cardiac frequency were measured on each of the patients. Subsequently, blood was collected from the patients for the determination of the complete blood count, HBA1c, lipid profile, serum albumin, TNF-α, and IL-6 levels. The data were analyzed using SPSS 17.0 software. Results: The age average of our population was 56.99 ± 11.51 years, the population was primarily female (61%) and primarily between the ages of 55 and 88. 67% of respondents were married. 59% went to secondary school. 73% of them lived in urban areas. 30% were obese and 40% were overweight, with an average BMI of 28.75 kg/m2. 76% of patients took oral antidiabetic medications. HbA1c level average was 8.65%, with 60% having readings above 6.5%. Low hemoglobin and hypochromia were among the abnormalities of red blood cells observed. Lipid profiles revealed low HDL-cholesterol and high triglycerides and cholesterol. Elevated levels of TNF-α and IL-6 indicated inflammation and cardiovascular risk. Conclusion: These results indicate the necessity of focused diabetic care and management on diabetic patients attending the central hospital of Yaoundé, Cameroon.
文摘Background:Whether lactated Ringer's solution is clinically superior to normal saline for routine intravenous administration of fluids is uncertain.Methods:In an open-label,two-period,two-sequence,cross-sectional,cluster-randomized,crossover trial,we assigned hospitals in Ontario,Canada,to use either lactated Ringer's solution or normal saline hospital-wide for a period of 12 weeks.
文摘Introduction: Respiratory distress is a clinical condition accompanied by an increase in work of breathing, with the respiratory accessory muscles brought into play to ensure normal arterial oxygenation. It is a major cause of morbidity and mortality in pediatrics. The aim of our study was to investigate the epidemiological, clinical and therapeutic aspects of respiratory distress in children aged between 1 month and 15 years seen in the emergency department of the Bangui paediatric university hospital. Methodology: This was a 3-month descriptive cross-sectional study, from January 1 to March 31, 2023. All children aged 1 month to less than 15 years presenting with respiratory distress were included. Results: A total of 3021 children were admitted to the emergency medical services of Bangui’s pediatric university hospital. Of these, 164 were included in the study. The predominance was male, with a sex ratio of 1.09. The 0 - 2 age group was the most represented, with 67 patients (42.85%). The majority of patients came from Bangui, accounting for 146 (89.02%) of cases. Respiratory difficulty (59.15%), characterized by dyspnea and cough, associated with fever, vomiting, physical asthenia and diarrhea, were the main reasons for consultation. The main pathologies noted were respiratory 92 (56.10%), followed by cardiac pathologies 21 (12.8%). Antibiotic administration (76.82%) was the most common therapeutic procedure used in the management of respiratory distress. Conclusion: Respiratory distress remains an important cause of infant mortality in our context, with major management problems.
文摘BACKGROUND Atrial fibrillation(AF)remains the most common cardiac arrhythmia.The safety of endoscopic retrograde cholangiopancreatography(ERCP)in patients with AF remains largely unknown.AIM To analyze the effect of AF on hospital outcomes in patients undergoing ERCP.METHODS We performed a retrospective cohort study using the Nationwide Inpatient Sample database.Adult patients with AF who underwent an inpatient ERCP were identified,then stratified by timing of ERCP,via international classification of diseases-10 codes.The primary outcome was all-cause in-hospital mortality.Secondary outcomes,including resource utilization,were assessed.Statistical analysis was performed using STATA software.RESULTS Of the 433245 patients that underwent an ERCP,49615 had a diagnosis of AF.Patients with AF had a significantly higher in-hospital mortality compared to those without AF[3.82%vs 1.13%,odds ratio(OR)=1.93,P<0.01].AF was significantly associated with increased hospital stay(+1.71 days),hospital charges($21210),shock(OR=2.17),sepsis(OR=1.34),intensive care unit admission(OR=2.41),acute kidney injury(OR=1.51),as well as a decreased likelihood of discharge to home(OR=0.59),(all with P<0.01).These results were consistent after propensity score matching.Upon subgroup analysis,patients with AF,whom underwent ERCP>72 hours,had worse outcomes including higher inhospital mortality(adjusted OR=1.47,P<0.01).CONCLUSION By way of this large,national analysis it appears AF is associated with significantly worse hospitalization outcomes,inducing increased mortality,in those undergoing ERCP.Further prospective investigation is warranted to potentially guide clinical recommendations for patients with AF undergoing ERCP in this setting.
基金supported in part by the Program of Jiangsu(Prospective and Key Technologies for Industry)under Grants BE2022067 and BE2022067-2,BE2022067-1.
文摘The propagation characteristics of wireless body area network(WBAN)under the hospital environments at 10GHz are studied for exploring the feasibility of indoor high frequency communication.Based on the extensive measured data in the hospital room and corridor scenarios,a new path loss(PL)model with the antenna angle factor(called as AAF)is proposed,where AAF is used to characterize the influence of angle change of a wearable or handheld device of the human body on the PL.Moreover,the expression of AAF is presented,which is a trigonometric functional of the angle of receiving antenna.In addition,the statistical characteristics of the time-domain root-mean-square delay spread(RMS-DS)are given under the two hospital scenarios,and a novel RMSDS model is also presented.In the proposed model,the RMS-DS is expressed as a linear function of PL,and a normal random variable is employed to describe the deviation between the measured RMS-DS and the linear function.The validity of the proposed models is verified in the different hospital environments,and the simulation results show that the proposed models have higher accuracy and better adaptability than the existing models.
文摘The centralized procurement of drugs in the medical system is a key link,which not only affects the economic effect of institutions,but also relates to the medical quality and patient safety.In the current era,centralized drug procurement in hospitals can meet the needs of most patients;however,the specific steps of the work still need to be optimized.Starting from the level of hospital drug centralized procurement work,this paper discusses the policy background,analyzes the practice of drug centralized procurement in tertiary hospitals,and provides specific work management suggestions,aiming to improve work efficiency and serve as a reference for optimizing subsequent hospital drug centralized procurement work.
文摘Background The number of transcatheter aortic valve implantation(TAVI)procedures in patients with severe aortic stenosis(AS)is increasing worldwide.We aimed to assess the impact of a TAVI program on clinical profile,management and outcomes of these patients and to describe predictors of length of hospital stay(LoS)in this context.Methods Retrospective single center study enrolling consecutive AS patients undergoing TAVI and surviving to discharge(January 2018-December 2022).A TAVI program was implemented in may 2021.Baseline clinical characteristics,management and in-hospital complications were registered.Predictors of long hospital stay(>7 day)were assessed by binary logistic regression.Results We included 614 patients,with mean age 80.5 years.Most patients(438/614,71.2%)presented conditions that precluded an early discharge.Mean hospital stay was 7.6 days.Patients admitted after the implementation of the program had a significantly lower burden of comorbidities.The rate of conduction disturbances after TAVI remained stable around 60%.However,permanent pacemaker requirement declined from 30.3%to 22.5%(P=0.028).LoS was reduced after the implementation of the program both in patients suitable for an early discharge(from 6.5 day to 4 day,P<0.001)and unsuitable patients(from 9.4 day to 7.7 day,P=0.014).The final predictive model for LoS included prior pacemaker and availability of TAVI program as protectors and other valvular diseases,day of the week,emergent procedures,and conduction disturbances and other complications as independent predictors of long stay after TAVI.Conclusions Most patients undergoing TAVI present conditions that preclude an early hospital discharge.The implementation of a TAVI program improved selection of patients,with a lower burden of comorbidities,a lower rate of complications and a marked reduction of hospital stay.
文摘BACKGROUND Obstructed defecation syndrome(ODS)is a subtype of constipation that is consi-dered one of the major pelvic floor dysfunctions affecting the aging population,particularly women over 50 seeking medical care.The condition is characterized by the urge to defecate but an impaired ability to expel the fecal bolus.ODS is associated with various anorectal abnormalities,which are not always apparent during a standard physical examination,requiring specialized imaging techniques for proper diagnosis.AIM To study the distribution of causes of ODS in patients with chronic constipation by magnetic resonance defecography(MRD).METHODS This observational study evaluated the causes of ODS in 57 patients with chronic constipation who presented to Bangabandhu Sheikh Mujib Medical University between July 2020 and June 2021.After obtaining institutional review board approval and informed consent,patients underwent history taking,physical exams,and relevant investigations.ODS was diagnosed using Rome III criteria,with colonoscopy ruling out organic causes.Standard MRD was performed in different phases,and images were analyzed by expert radiologists and reported in a stan-dardized format.RESULTS Pelvic floor descent and anorectal junction descent were the most frequent findings,each present in 94.7%of cases.Rectocele was observed in 78.9%of patients,while vaginal or uterine prolapse was seen in 59.4%of females.Less common abnormalities included paradoxical contraction(7%),and there were no cases of sigmoidocele.Functional measurements showed significant differences in pelvic floor dynamics between rest and defecation,particularly in the H-line,M-line,and descent of pelvic organs(P<0.05).CONCLUSION Pelvic floor descent and anorectal descent were the most common findings in patients suffering from ODS,fo-llowed by rectocele.Younger females(<30 years)were most affected.
文摘Background: Chronic low back pain is a leading cause of morbidity and disability globally. Low and Middle-Income Countries (LMICs) tend to be more affected, with chronic low back pain (CLBP) being among the leading presenting complaints at specialist consultation. The exact burden of this disease is sparingly known in our setting. Objective: To evaluate the burden of chronic low back pain at the Yaounde Central Hospital. Methods: This was a descriptive cross-sectional study for a period of 3 months, from March 2022 to May 2022. After obtaining ethical clearance and research authorisations, data was collected using structured questionnaires from patients with chronic low back pain presenting at the Yaounde Central Hospital during the aforementioned time frame. This data was then tabulated with the Statistical Package for Social Sciences (SPSS 23.0), and disability was assessed using the modified Roland Morris Disability Questionnaire and the Oswestry Disability Index. Data analysis was done using the International Business Machines Statistical Package for Social Sciences (IBM-SPSS) VERSION 23.0. Results: 115 cases of CLBP were included. The mean age was 52.62 years, and the sex ratio was 0.3. The average monthly income was less than 50,000 frs CFA, in 37.4% of cases. In 57.9%, patients had a job that involved physical labour. The patients had a secondary level of education in 40.9%, and alcohol consumption was observed in 36%. The average number of days of a work stoppage due to LBP was 12.75 days (±12SD), and the median duration of CLBP was 7.15 (7.5SD) years. The median pain intensity was 7 (±2SD), with leg pain and sensory neuropathy observed in 67.8% and 63.5% respectively. Lumbar X-ray was done in 45.2% and revealed lumbar osteoarthrosis in 62.4%. Hypertension as a comorbidity was observed in 26.1%. Medical treatment was used at least once in 98.3% of cases. The average cost of management per month was assessed, and the median was 52,000 FCFA (±20,876 SD). Using the Oswestry Disability Questionnaire, 46 patients, that is 40% of the study population, were classified as severely disabled with a median ODI score of 40%. The factors which were independently associated with disability were level of education, alcohol consumption, treatment modality, pain intensity, body mass index (BMI), psychological wellbeing and number of sick leave days. Conclusion: Chronic low back pain is common in our setting. There is a female predominance with the mean age of the study population situated in the 5th decade. Low-income earners and patients with a job involving physical labour were the most affected. Medical treatment was the main therapeutic modality, with the average cost of management per month being above the average monthly income of the greater majority of the patients. Several factors influenced disability, some of which were independently associated with it, such as level of education, alcohol consumption and treatment modality.
基金Supported by Shandong Province Medical and Health Technology Development Plan Project,No.202203090753.
文摘Alcohol use has contributed to large disease burdens,and alcohol-related problems are prevalent among patients in general hospitals and primary care settings.This review aims to deepen the understanding of screening,intervention,and treatment referral for alcohol-related problems in these settings.We searched the literature published in English from PubMed,ScienceDirect,and the World Health Organization website.We found that while a series of screening tools can be used,screening rates were low.The awareness of screening should be strengthened.Brief interventions and pharmacotherapy are the two main methods used in general hospitals and primary care settings,with complementary and alternative medicine considered under the framework of integrative medicine.Individuals with severe alcohol-related problems or alcohol use disorders should be referred to specialty treatment for alcohol abuse,but referral is sometimes ignored.A gap exists between general hospitals/primary care facilities and specialized alcohol-related treatment providers.In conclusion,screening,intervention,and referral to treatment comprise a continuum for patients with alcohol-related problems.Opportunities to prevent and manage these problems in general hospitals and primary care settings are abundant,and taking action will promote the addressing of this public health issue.
文摘Still common in developing countries, acute rheumatic fever (ARF) is not only a disease of children and adolescents, but can also occur in adults. At this age, the diagnosis of rheumatic flare-ups can be difficult due to the frequency of other types of joint diseases and the existence of degenerative and dystrophic valve disease. In adults, the initial rheumatic attack is marked by the predominance of joint damage over cardiac damage. However, it is often at this age that rheumatic valve disease is discovered. The revised Jones criteria also find their place in the diagnosis of AAR in adults. Objective: To study the demographic, clinical, and biological characteristics of acute rheumatic fever (ARF) in the General Medicine Department of the Siguiri Prefectural Hospital. Materials and Methods: This descriptive observational study examined the demographic, clinical and biological characteristics of acute rheumatic fever (ARF) at the Siguiri Prefectural Hospital, Guinea, between April 1 and September 31, 2021 according to Jones criteria. The data were collected on a form containing sociodemographic variables (age, sex, profession), rheumatological, cardiac, pulmonary and neurological clinical signs, biological variables and treatment. Results: Figure 1 shows the flow of the hospital frequency of the RAA in the General Medicine Department of the Prefectural Hospital of Siguiri. During the study period, 420 patients were hospitalized, of whom 161 patients had AAR, a frequency of 38.33%. Table 1 shows the distribution of patients diagnosed with ARB, by sociodemographic characteristics. The average age was 44.7 ± 19.78 years and the extremes of 14 and 90 years, the female sex dominated with a ratio of 0.75. The informal sector was in the majority in 45.34% of cases and most were illiterate, i.e. 53.42%. In our study, the incidence was lower during the dry season than during the rainy season, a hot season with high rainfall and humidity, the rainy period was a provider with a peak in August and September. The lifestyle was characterized by overcrowding in 87.58% of patients. The main complaint was fever, i.e. 88.82%. Rheumatological manifestations such as arthritis were 98.14%, chest pain was 37.89% (61 cases). The diagnosis was confirmed by ASLO titration in 85.71% of patients and 98.55% (136 cases) had a titration greater than 400 U/ml. Conclusion: The results obtained from our study show a high prevalence of acute rheumatic fever, which makes it a worrying health problem in the Siguiri health district. Young female adult patients, married with an informal profession and not in school residing in Siguiri were the most encountered in our study. The main functional signs mentioned by the patients were fever, cough and abdominal pain;osteoarticular pain and chest pain dominated the clinical picture. Almost all of our patients had an ASLO titer greater than 400 U/ml and a positive C-reactive protein. Our results show a high risk of spread of acute rheumatic fever within the population of Siguiri. Due to the serious complications caused by acute rheumatic fever, particular attention must be paid to it by carrying out other, much larger studies in order to identify the problem of RAA.
文摘Objective:To explore the target management model for clinical pharmacists in primary hospitals facing current shortages of clinical pharmacists,in order to improve the work efficiency and service quality of clinical pharmacy,and promote the high-quality development of clinical pharmacy in primary hospitals.Methods:Developing a target management model,adopting a wide coverage work model of“1+1+N”(that is,1 clinical pharmacist,1 resident clinical department,and N contracted clinical departments).According to the SMART principle,various work assessment indicators were quantified.This involved setting clear work goals,diversifying work methods,personalizing work methods,standardizing workflows,and using numerical assessment indicators.Regular supervision,inspection,feedback,and improvement mechanisms were implemented.Results:The implementation of the target management model has made the work effectiveness of clinical pharmacists visualized.There were more than 200 annual consultations and multidisciplinary team(MDT)cases,with an opinion adoption rate of 90.2%and a patient improvement rate of 80.6%.More than 1500 rational drug use interventions were conducted,with a suggestion adoption rate of 83.5%.In terms of pharmaceutical indicators control.The intensity of antibacterial drug use in 2024(without CMI adjustment)was 30.07 DDDs,significantly lower than the 2023 value of 33.54 DDDs,and also significantly lower than the provincial average(32.87 DDDs)and the average for hospitals of the same level(32.49 DDDs).The daily usage of intravenous infusion per bed for hospitalized patients was 2.09,a decrease from 2.15 in 2023,significantly lower than the provincial average of 2.71 and the average of 2.56 in hospitals of the same level.The amount of the second batch of national key monitoring drugs accounts for the value was 6.48%,significantly lower than the provincial average of 8.27%and the same level hospital average of 8.82%.In terms of chronic disease pharmaceutical management,taking the pharmaceutical management of patients with chronic heart failure as an example,the usage rates of renin-aldosterone-angiotensin-system inhibitors(RAAS inhibitors)and beta-blockers for heart failure in the management group were 87.88%and 80.81%,respectively,significantly higher-1 than those in the control group(62.22%and 65.56%).Heart rate in the management group(69.54±10.68 times·min-1)was significantly lower than in the control group(80.04±17.68 times·min)(P<0.001).The low-density lipoprotein cholesterol(1.69±0.57 mmol·L-1)was significantly lower than the control group(1.95±0.77 mmol·L-1)(P<0.001),and the 1-year readmission rate was 47.47%,significantly lower than the control group 56.67%.The Minnesota Living with Heart Failure Questionnaire(MLHFQ)Score was(44.20±10.78),significantly lower than the control group(55.89±11.48)(P<0.001),indicating a significant improvement in the patient’s quality of life.Conclusions:The targeted management model for clinical pharmacists can effectively enhance communication and collaboration between clinical pharmacists and clinicians,improve the work efficiency and service quality of clinical pharmacists in primary hospitals,promote the work of clinical pharmacy towards standardization and scientificization,boost the high-quality development of pharmacy in primary hospitals,and also provide new ideas and methods for the management of clinical pharmacists in other primary hospitals.
文摘This paper examines the travel behaviors of hand-foot-and-mouth disease(HFMD)patients in Nanchang City in central China.Based on the HFMD patients’hospital visitation data from the Center of Disease Control(CDC)of Nanchang in 2018,a spatial network of patient-to-hospital trip flows is constructed.A Geographic Information Systems(GIS)automated network community detec-tion method,termed‘ScLeiden’,is utilized to delineate the study area into six hospital service areas(HSAs)to represent distinctive health care markets.Patients’travel patterns across these HSAs are compared to highlight the geographic disparity.In two HSAs anchored by major hospitals in the regions,the volume of patients increased up to a travel range and then declined,and thus formed a single peak in the trip volume distribution curve across travel time.Each of the remaining four HSAs exhibited two or more peaks in their trip volume distribution curves.The patterns reflected the split choices of patients for the largest Children Hospital in the region,the second-tier county hospital,or others,which were likely to be stratified by their economic affordability,transportation means,and possible health literacy.The study provides valuable insights into the delineation of HSAs and the unique patients’travel behaviors in China.
