ABSTRACT Introduction The Wells score, which is a 9-item clinical rule, is used to assess the diagnostic probability of deep vein thrombosis (DVT) in suspected patients. However, the accuracy of the Wells rule has not been investigated in Ghanaians. Methods In a cross-sectional design, 138 suspected DVT patients underwent pretest probability of DVT using the Wells rule. Thereafter, a compressive duplex ultrasound study (CDUS) was performed on both legs to confirm the presence of DVT. Using the CDUS as the gold standard, the accuracy and reliability of the Wells rule were assessed as sensitivity, specificity, predictive values and accuracy diagnostic odds. Youden’s index was used to determine the optimal cutoff of Wells score to predict DVT. Results The prevalence of DVT was 38.8% and it was associated with localized tenderness [OR (95% CI) = 3.4 (1.49 – 7.76), p = 0.003], calf swelling [3.72 (1.7 – 8.12), p = 0.001] and previous DVT [4.69 (1.74 – 12.61), p = 0.001]. The sensitivity, specificity, and accuracy diagnostic odds ratio for the 2-level Wells score were 38.3%, 93.3%, 73.9% and 8.44 respectively. From the receiver operator characteristic analysis, the area under curve for the 2-level Wells score was 0.76 and the optimal Wells score cut-point for diagnosing DVT based on Youden’s index was >1, with sensitivity, specificity, positive and negative predictive values of 69.4%, 72.1%, 58.6% and 80.5% respectively. Conclusion The prevalence of DVT in suspected patients in our study population was 38.8% and associated with localized tenderness, calf swelling and previous DVT. Reducing the cut-point of the Wells score to 1 increased the sensitivity and accuracy of the Wells rule in our study population.

ABSTRACT Objectives Clinical handover is a major part of everyday work in healthcare settings. Clinical handover plays a great role between emergency medical services (EMS) and emergency nurses in providing safe and quality EMS. This study aims to assess the communication and handover mechanism between EMS and the emergency departments (ED) in Palestinian hospitals, to identify opportunities for improvement, and to make recommendations to improve the handover. Methods A descriptive, quantitative cross-sectional approach was used in this study. A sample of 220 emergency nurses working in governmental hospital and 130 paramedics working in the Palestine Red Crescent Society were conveniently selected from the West Bank, including Jerusalem. Results Our study showed that effective EMS-ED communication was perceived to have a high-degree impact on patient outcomes and patient waiting time in EDs, and a medium-degree impact on the readiness of healthcare providers. One-sample t-tests confirmed that perceived patient outcomes, readiness of healthcare providers, and patient waiting time in EDs were all perceived to be significantly influenced by EMS-ED communication. Conclusion Our findings demonstrate that effective EMS-ED communication, as perceived by healthcare providers, significantly influences patient outcomes, healthcare provider readiness, and patient waiting times. The availability of communication tools and the accuracy/adequacy of information are also perceived to significantly impact patient handover effectiveness and patient health/medical procedures, collectively enhancing the perceived quality and efficiency of emergency healthcare services.

ABSTRACT Introduction Interprofessional collaboration (IPC), involving multidisciplinary teams of physicians, nurses, pharmacists, and other allied healthcare professionals, has been recognized as a strategy to streamline patient management and reduce systemic inefficiencies. IPC may help reduce hospital wait times (HWT), patients’ length of stay (LOS) while enhancing overall quality of care. Objective This study explores how IPC, patient demographics, and admission characteristics influence HWT and LOS. Methods Data were drawn from the 2022 National Hospital Ambulatory Medical Care Survey (NHAMCS), n = 2,121 admitted patients in the United States. Multiple linear regression models were used to analyze the associations between IPC, patient demographics, urgency of admission, admission characteristics, and hospital wait times and length of stay. Results Increased IPC was significantly associated with shorter HWT (p < 0.05) but a marginal increase in LOS (p < 0.05). High-urgency admission was associated with reduced HWT (p < 0.05). Older patients experienced modestly shorter waits (p < 0.001) but longer stays (p < 0.001). Admission to a stepdown unit correlated with longer wait times (p < 0.05). Conclusions Strengthening IPC and effectively managing high-urgency admissions may help reduce HWT. Further research is needed to explore why IPC is linked to longer hospital stays and how to optimize resource allocation in stepdown units. These insights hold prospects to guide strategies for improving hospital efficiency and patient experiences.

ABSTRACT Study objectives Reversal of warfarin-induced anticoagulation using prothrombin complex concentrate (PCC4) is more rapidly achieved than with traditional methods, such as fresh frozen plasma (FFP). In many rural facilities, the availability of both FFP and PCC4 has been limited. A tertiary hospital instituted a program to provide PCC4 to rural sites using an air transport team and pharmacy exchange. We hypothesized that increasing accessibility of PCC4 would shorten time to INR reversal. Methods This was a retrospective study with the primary outcome being time to INR reversal (INR ≤ 1.6) and time to PCC4 administration from outside hospital admission. Active warfarin prescription, transfer to a tertiary facility, and administration of anticoagulation reversal between January 2013 and December 2020 were required for inclusion. Patients were grouped by dates before and after implementation of the program in August 2016. Linear regressions were performed to determine the effect of the variable and INR reversal methods on the time to INR reversal as well as the time to PCC4 administration. Time-to-event analysis was used to analyze the primary outcome between comparison groups. p values of less than 0.05 were considered significant. Results Chart review identified 189 patients: 56 within the pre-implementation group and 133 within the post-implementation group. Statistics were compared between these two groups. The post-implementation group had a shorter time to INR reversal (median 9.97 h) compared with the pre-implementation group (median 14.58 h, p = 0.00004). Time to PCC4 administration was also significantly decreased (p = 0.023). No statistically significant differences were found for hospital survival or 30-day mortality. Conclusion In rural hospitals, increasing availability of PCC4 using air medical transport along with a medication exchange program significantly reduces time to PCC4 administration in warfarin anticoagulated patients.

ABSTRACT Introduction Liver cirrhosis, a complex and progressive disease, imposes a significant global health burden, characterized by irreversible liver tissue scarring and various life-threatening complications. Traditionally linked to factors like chronic alcohol consumption and viral hepatitis infections, the rising prevalence of obesity introduces a new dimension to its etiology. As obesity rates continue to climb worldwide, the confluence of liver cirrhosis and bariatric surgery has become an increasingly pertinent and clinically relevant topic of inquiry. Methods In this study, we aimed to investigate the impact of liver cirrhosis on patients who underwent bariatric surgery, using data from the 2020 National Inpatient Sample (NIS) database. We compared the outcomes of 82,414 patients who had bariatric surgery, stratifying them based on the presence or absence of liver cirrhosis. We assessed baseline demographic characteristics and comorbidities, in-hospital outcomes, and complications related to the surgery. Results Patients with liver cirrhosis who underwent bariatric surgery demonstrated several distinct trends. On average, they were older (mean age 63 years) and predominantly female (52%) compared to those without cirrhosis (mean age 52, 71% female). Furthermore, comorbidities such as hypertension, diabetes with chronic complications, and alcohol abuse were more prevalent in the cirrhosis group. In terms of outcomes, patients with liver cirrhosis faced significantly higher inpatient mortality rates (4%) compared to those without cirrhosis (1%) with p < 0.001. They also experienced a notably longer average length of hospital stay (2.35 days longer, 95% CI: −3.46 --1.25, p < 0.001) and incurred higher hospitalization costs (add AOR and p value here). Additionally, patients with cirrhosis had increased odds of experiencing acute heart failure (adjusted odds ratio: 1.87, 95% CI: 1.14–2.57, p = 0.01) and requiring blood transfusions (adjusted odds ratio: 1.71,95% CI: 1.13–3.09, p = 0.009). Although the adjusted odds ratio for inpatient mortality was higher in cirrhosis patients (1.58, 95% CI: 0.76–3.30, p = 0.21), it did not reach statistical significance. Conclusion This study highlights the substantial impact of liver cirrhosis on post-bariatric surgery outcomes. Patients with cirrhosis who undergo bariatric surgery face higher inpatient mortality rates and a greater risk of complications, particularly acute heart failure and the need for blood transfusions. The longer hospital stays and increased costs further emphasize the challenges in managing this unique patient population. These findings emphasize the need for careful patient selection, risk assessment, and a multidisciplinary approach when considering bariatric surgery for individuals with both liver cirrhosis and obesity.

ABSTRACT It is well known that rheumatic diseases are characterized by an increased infection risk, due to several factors, such as an intrinsically dysfunctional immune system, disease activity, and the use of immunosuppressive drugs. Glucocorticoids are widely used therapeutic agents for treating several chronic inflammatory and immune diseases, due to their anti-inflammatory and immunosuppressive effects. Their use is burdened by well-known side effects in dose- and duration of use-dependent manner. Physicians need to be aware of the mechanism of action of glucocorticoids, their side effects, particularly infectious side effects, and the significance of cumulative dose and duration of glucocorticoid treatment. Additionally, physicians shoultdleveld have knowledge of each patient and their comorbidities. They could use appropriate tools for assessing glucocorticoid-related toxicity and morbidity, particularly in the context of chronic glucocorticoid administration. This comprehensive understanding is crucial for ensuring the proper and safe use of these drugs, particularly in terms of minimizing infectious risks. The aim of this review is to focus on available data concerning the infectious risk associated to glucocorticoid treatment in rheumatic diseases, highlighting the role of the correct drug management in clinical practice and the role of the disease itself in the occurrence of this worthy side effect. We conducted a review of randomized controlled trials and observational studies about glucocorticoid use in autoimmune/rheumatic diseases, analyzing the infectious risk during glucocorticoid therapy, and its relationship with the used dose and duration of treatment.

ABSTRACT Objectives To determine if a multidisciplinary pathway focused on non-opioid pain management, delirium assessment, and resource utilization improved outcomes in geriatric hip fracture patients. The goal was to reduce opioid usage, consultation not congruent with guidelines, and increase use of regional anesthesia to reduce delirium and improve outcomes. Methods An observational study was performed on hip fracture patients before and after the intervention. Hospitalists were educated on indications for preoperative cardiac consultation and specialized preoperative cardiac testing according to evidence-based guidelines with the inpatient cardiology service. Additional education on multimodal analgesia, limiting opioids, and peripheral nerve blocks was provided by the acute pain service. Pre-intervention outcomes from 1 July 20171 July 2017 to 31 May 201831 May 2018 (N = 92) were compared to post-intervention outcomes from 1 July 20181 July 2018 to 31 May 201931 May 2019 (N = 98) and included delirium, length of stay, 30-day readmission rate, time from arrival to procedure start time, time to first physical therapy session, and completion of cardiology consult time. We examined adherence, use of nerve blocks, and pre- and post-operative pain scores and opioid use. Results Delirium was reduced from 50.0% (N = 46/92) to 28.6% (N = 28/98); p = 0.002. Postoperative opioid use (IV morphine milligram equivalents) decreased from an average of 57.2 mg (±67.7) to 42.6 mg (±58.2),P < .0001. There was a significant decrease in mean pre-operative (5.4 ± 4.14 to 5.05 ± 2.8, P < .0001) and post-operative pain scores (4.3 ± 5.2 to 3.2 ± 2.2, P < .0001). There was a significant reduction in time to cardiology consultation from 18 h] to 12 h ; p < .001). Conclusions A multidisciplinary collaboration between hospitalists, anesthesiologists, and cardiologists for hip fracture patients was associated with a reduction in pain and delirium and time to cardiologist evaluation. Prospective studies focusing on additional patient-centered outcomes are warranted.

ABSTRACT Objective There is a need to assess the quality of antimicrobial prescribing in hospitals as a first step toward improving future prescribing to reduce antimicrobial resistance (AMR). This is in line with Ghana's National Action Plan. Methods A point prevalence survey of antimicrobial use was undertaken at the adult medical, surgical, and pediatric wards of Tamale Teaching Hospital using the standardized Global Point Prevalence Survey (GPPS) tool. Key target areas include adherence to current guidelines, limiting the prescribing of ‘Watch’ antibiotics with their greater resistance potential, and limiting the prescribing of antibiotics post-operatively to prevent surgical site infections (SSIs). Results Out of 217 patients' medical records assessed, 155 (71.4%) patients were prescribed antimicrobials. The rates were similar among children (73.9%) and adults (70.3%). Most of the antibiotics prescribed were in the WHO ‘Watch’ group (71.0%) followed by those in the ‘Access’ group (29%). Out of the 23 cases indicated for surgical antimicrobial prophylaxis to prevent SSIs, the majority (69.6%) were given doses for more than 1 day, with none receiving a single dose. This needs addressing to reduce AMR and costs. Guideline compliance with the current Ghanaian Standard Treatment Guidelines (GSTG) for managing infections was also low (28.7%). The type of indication was the only independent predictor of guideline compliance (aOR = 0.013 CI 0.001–0.127, p-value = 0.001). Conclusion Given current concerns with antimicrobial prescribing in this hospital, deliberate efforts must be made to improve the appropriateness of prescribing to reduce AMR via targeted antimicrobial stewardship programs.

ABSTRACT Objectives Vietnam is one of the countries in highly endemic areas of hepatitis B virus (HBV) infection in the world. Our study aims to determine the prevalence of HBV infection among different age groups of workers who had been included for annual general health checkups Methods This cross-sectional study was conducted at the Health Screening Department, University Medical Center at Ho Chi Minh City, Vietnam, using anonymous data from employees who had health checkups from June 2017 to June 2018. Results A total of 5727 subjects were included, with an overall HBV prevalence of 9.0%. The prevalence of HBV infection was significantly higher in men and lowest in the age groups of 18–30. In multivariable analysis, the variables that were independently associated with HBV infection were male gender (Odd ratio (OR), 2.03; 95% confidence interval (CI), 1.58–2.60; p < 0.001), older than 30 years old (age group of 31–40: OR 1.7; 95% CI, 1.33–2.18; p < 0.001; of 41–50, OR 1.82; 95% CI, 1.37–2.43; p < 0.001); high total cholesterol (OR, 0.77; 95% CI, 0.64–0.94; p = 0.011), high triglyceride (OR, 0.53; 95% CI, 0.42–0.65; p < 0.001), and having significant fibrosis (OR, 2.7; 95% CI 1.85–3,95; p < 0.001). Conclusions The prevalence of HBV infection among employees on health assessments is still high (9%), even in the age group under 30 (7%). Male, age group older than 30, and significant liver fibrosis were the factors related to HBV infection. High cholesterol and level triglyceride were protective factors against HBV infection.