Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,B...Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.展开更多
Background: research focusing on incidence of cancer amongst bipolar affective disorder (BAD) is sparse. Aim: to ex-amine the incidence of cancer in a cohort of BAD inpatients. Methods: the study sample was comprised ...Background: research focusing on incidence of cancer amongst bipolar affective disorder (BAD) is sparse. Aim: to ex-amine the incidence of cancer in a cohort of BAD inpatients. Methods: the study sample was comprised of BAD patients who had been admitted to a tertiary care mental health center during the period: 1990 to 2006. The data for the sample was cross-referenced with the National Cancer Registry. Analyses of Standardized Incidence Rates (SIR) for all organ systems malignancies were performed. Results: of 1,638 BAD patients included in the present study, 72 (0.04%) were diagnosed as suffering from co-morbid malignancy. This reflects a significantly reduced risk;SIR of 0.27 (95% CI 0.21-0.34). Reduced risk of cancer held true for both males and females (0.20 and 0.34, respectively). Nineteen women developed breast cancer;SIR = 0.42 (95% CI 0.25-0.66). Conclusions: the present study demonstrates reduced rates of cancer amongst patients suffering from BAD - with special reduction in breast cancer.展开更多
Objectives:Near misses happen more frequently than actual errors,and highlight system vulnerabilities without causing any harm,thus provide a safe space for organizational learning.Second-order problem solving behavio...Objectives:Near misses happen more frequently than actual errors,and highlight system vulnerabilities without causing any harm,thus provide a safe space for organizational learning.Second-order problem solving behavior offers a new perspective to better understand how nurses promote learning from near misses to improve organizational outcomes.This study aimed to explore frontline nurses’perspectives on using second-order problem solving behavior in learning from near misses to improve patient safety.Methods:A qualitative exploratory study design was employed.This study was conducted in three tertiary hospitals in east China from June to November 2015.Purposive sampling was used to recruit 19 frontline nurses.Semi-structured interviews and a qualitative directed content analysis was undertaken using Crossan’s 4I Framework of Organizational Learning as a coding framework.Results:Second-order problem solving behavior,based on the 4I Framework of Organizational Learning,was referred to as being a leader in exposing near misses,pushing forward the cause analysis within limited capacity,balancing the active and passive role during improvement project,and promoting the continuous improvement with passion while feeling low-powered.Conclusions:4I Framework of Organizational Learning can be an underlying guide to enrich frontline nurses’role in promoting organizations to learn from near misses.In this study,nurses displayed their pivotal role in organizational learning from near misses by using second-order problem solving.However,additional knowledge,skills,and support are needed to maximize the application of second-order problem solving behavior when near misses are recognized.展开更多
BACKGROUND Diabetes mellitus(DM)is a progressively increasing metabolic disorder and a significant public health burden that demands immediate global attention.However,there is a paucity of data about adherence to ant...BACKGROUND Diabetes mellitus(DM)is a progressively increasing metabolic disorder and a significant public health burden that demands immediate global attention.However,there is a paucity of data about adherence to antidiabetic drugs among patients with type-2(T2)DM in Uttarakhand,India.Outpatient research reported that more than 50%of patients do not adhere to the correct administration and appropriate medicine dosage.It has been reported that patients with chronic diseases who adhere to treatment may experience improvement in quality of life(QoL)and vice versa.AIM To assess the adherence to antidiabetic medication and QoL among patients with T2DM.METHODS This cross-sectional descriptive study was conducted at a tertiary care hospital in Uttarakhand,India.The Medication Adherence Rating Scale and World Health Organization QoL-BREF scale were used to assess medication adherence and QoL.RESULTS Two hundred seventy-seven patients suffering from T2DM participated in the study.Their mean age was 50.80(±10.6)years,155(56%)had a poor adherence level and 122(44%)had a good adherence level to antidiabetic medications.After adjusting for sociodemographic factors,multiple linear regression analysis found patients who were adherent to antidiabetic medications had significantly higher mean overall perception of QoL and overall perception of health,with beta scores of 0.36 and 0.34,respectively(both P=0.000)points compared with nonadherent patients.CONCLUSION There was an association between medication adherence and QoL in patients with T2DM.Hence,there is a need to plan awareness and counseling programs followed by regular follow-up to motivate patient adherence to recommended treatment and lifestyle regimens.展开更多
Purpose:To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department(TED)of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced b...Purpose:To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department(TED)of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster.Methods:A retrospective study was conducted in the TED in the affected zone.Data of all victims affected by the cyclone Fani on May 3,2019 were obtained from disaster records and medical case sheets.All patients except death on admission were included.Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score(RTS)and injury severity score(ISS).Trauma injury severity score(TRISS)was also calculated.Results:Of 75 patients,74 were included and the other one was brought dead and thus excluded.The age,median±interquartile range(IQ),was 41.0(27.7-53.0)years.The male to female ratio was 2:1.Most of the wounded were transported by the police control room vans on day 1:first 10 h,50.0%;10-24 h,20.3%.The median±IQ range of RTS,ISS and TRISS were 20(14-28),7.84(7.841-7.841),and 97.4(91.6-98.9),respectively.Simple external injury was the dominant injury type.Polytrauma(ISS>15)was seen in 67%cases and spine injury in 14%cases(7%cervical and 7%thoracolumbar).Injury causes included sharp flying objects(broken pieces of glasses and asbestos)in 31%cases,followed by fall of trees in 20.3%.Twenty-four patients were discharged after primary treatment,30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center.There was no in-house mortality.Challenges were related to electricity failure,mobile network breakdown,infrastructure collapse,and delay in expertise repair from outside due to airport/railway closure.Conclusion:In cyclonic storm like Fani,sharp flying objects,fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions.Polytrauma was seen in the majority of patients though external injury was the commonest.Th展开更多
Purpose: Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross dis...Purpose: Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross disparity between trauma services available in various parts of the country. Rural area in India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. The present study is to study the trends of occurrence of RTA cases by month, week and time of accident occurrence as well as to research the types of vehicle involved in accidents and other various risk factors related to them.Methods: During 1st January 2017 to 31st December 2017, a hospital-based and cross-sectional study of RTA victims was conducted. The patients were admitted in emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, when stabilized, they were shifted to the orthopaedics and surgery ward.Results: In the study, 654 road accident victims were included, of which the majority were males (77.5%) and the most of them belonged to rural (67%). RTA victims according to the month of occurrence majority were found in January (12.5%) and evening was time of a day with maximum accidents (32.1%). Mortality cases of RTA victims based on type of road user and it shows decreasing trend of mortality of motor-cyclists (54.2%) followed by pedestrian (25.1%).Conclusion: There should be control over people driving vehicles under the influence of alcohol and drivers over-speeding and rash driving on urban roads as well as rural village roads.展开更多
文摘Objective:To illustrate the clinical features and investigate the indicators associated with a fatal outcome in adult patients with severe Plasmodium falciparum malaria admitted to the Hospital for Tropical Diseases,Bangkok,Thailand.Methods:We studied 202 adult malaria patients admitted to the Intensive Care Unit.A total of 43 clinical variables were identified by univariate and logistic regression analyses,to eliminate confounding factors.Results:Regarding the statistical methods,only 6 variables-jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate,and white blood cell count-were significant indicators of death, with adjusted odds ratios(95%CI) of 15.2(2.1-32.3).4.3(2.3-12.6),3.3(2.3-5.7),2.4(1.9-3.5),2.2 (1.5-2.6),and 1.7(1.2-3.1),respectively.Conclusions:Our study found that jaundice,cerebral malaria,metabolic acidosis,body mass index,initial respiratory rate and white blood cell count were indicators of fatal outcome in severe Plasmodium falciparum malaria.Further studies on the fatal indicators in severe malaria need to be compared with data from different geographical areas,to construct practical measures to address potentially fatal indicators in different settings.
文摘Background: research focusing on incidence of cancer amongst bipolar affective disorder (BAD) is sparse. Aim: to ex-amine the incidence of cancer in a cohort of BAD inpatients. Methods: the study sample was comprised of BAD patients who had been admitted to a tertiary care mental health center during the period: 1990 to 2006. The data for the sample was cross-referenced with the National Cancer Registry. Analyses of Standardized Incidence Rates (SIR) for all organ systems malignancies were performed. Results: of 1,638 BAD patients included in the present study, 72 (0.04%) were diagnosed as suffering from co-morbid malignancy. This reflects a significantly reduced risk;SIR of 0.27 (95% CI 0.21-0.34). Reduced risk of cancer held true for both males and females (0.20 and 0.34, respectively). Nineteen women developed breast cancer;SIR = 0.42 (95% CI 0.25-0.66). Conclusions: the present study demonstrates reduced rates of cancer amongst patients suffering from BAD - with special reduction in breast cancer.
文摘Objectives:Near misses happen more frequently than actual errors,and highlight system vulnerabilities without causing any harm,thus provide a safe space for organizational learning.Second-order problem solving behavior offers a new perspective to better understand how nurses promote learning from near misses to improve organizational outcomes.This study aimed to explore frontline nurses’perspectives on using second-order problem solving behavior in learning from near misses to improve patient safety.Methods:A qualitative exploratory study design was employed.This study was conducted in three tertiary hospitals in east China from June to November 2015.Purposive sampling was used to recruit 19 frontline nurses.Semi-structured interviews and a qualitative directed content analysis was undertaken using Crossan’s 4I Framework of Organizational Learning as a coding framework.Results:Second-order problem solving behavior,based on the 4I Framework of Organizational Learning,was referred to as being a leader in exposing near misses,pushing forward the cause analysis within limited capacity,balancing the active and passive role during improvement project,and promoting the continuous improvement with passion while feeling low-powered.Conclusions:4I Framework of Organizational Learning can be an underlying guide to enrich frontline nurses’role in promoting organizations to learn from near misses.In this study,nurses displayed their pivotal role in organizational learning from near misses by using second-order problem solving.However,additional knowledge,skills,and support are needed to maximize the application of second-order problem solving behavior when near misses are recognized.
文摘BACKGROUND Diabetes mellitus(DM)is a progressively increasing metabolic disorder and a significant public health burden that demands immediate global attention.However,there is a paucity of data about adherence to antidiabetic drugs among patients with type-2(T2)DM in Uttarakhand,India.Outpatient research reported that more than 50%of patients do not adhere to the correct administration and appropriate medicine dosage.It has been reported that patients with chronic diseases who adhere to treatment may experience improvement in quality of life(QoL)and vice versa.AIM To assess the adherence to antidiabetic medication and QoL among patients with T2DM.METHODS This cross-sectional descriptive study was conducted at a tertiary care hospital in Uttarakhand,India.The Medication Adherence Rating Scale and World Health Organization QoL-BREF scale were used to assess medication adherence and QoL.RESULTS Two hundred seventy-seven patients suffering from T2DM participated in the study.Their mean age was 50.80(±10.6)years,155(56%)had a poor adherence level and 122(44%)had a good adherence level to antidiabetic medications.After adjusting for sociodemographic factors,multiple linear regression analysis found patients who were adherent to antidiabetic medications had significantly higher mean overall perception of QoL and overall perception of health,with beta scores of 0.36 and 0.34,respectively(both P=0.000)points compared with nonadherent patients.CONCLUSION There was an association between medication adherence and QoL in patients with T2DM.Hence,there is a need to plan awareness and counseling programs followed by regular follow-up to motivate patient adherence to recommended treatment and lifestyle regimens.
文摘Purpose:To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department(TED)of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster.Methods:A retrospective study was conducted in the TED in the affected zone.Data of all victims affected by the cyclone Fani on May 3,2019 were obtained from disaster records and medical case sheets.All patients except death on admission were included.Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score(RTS)and injury severity score(ISS).Trauma injury severity score(TRISS)was also calculated.Results:Of 75 patients,74 were included and the other one was brought dead and thus excluded.The age,median±interquartile range(IQ),was 41.0(27.7-53.0)years.The male to female ratio was 2:1.Most of the wounded were transported by the police control room vans on day 1:first 10 h,50.0%;10-24 h,20.3%.The median±IQ range of RTS,ISS and TRISS were 20(14-28),7.84(7.841-7.841),and 97.4(91.6-98.9),respectively.Simple external injury was the dominant injury type.Polytrauma(ISS>15)was seen in 67%cases and spine injury in 14%cases(7%cervical and 7%thoracolumbar).Injury causes included sharp flying objects(broken pieces of glasses and asbestos)in 31%cases,followed by fall of trees in 20.3%.Twenty-four patients were discharged after primary treatment,30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center.There was no in-house mortality.Challenges were related to electricity failure,mobile network breakdown,infrastructure collapse,and delay in expertise repair from outside due to airport/railway closure.Conclusion:In cyclonic storm like Fani,sharp flying objects,fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions.Polytrauma was seen in the majority of patients though external injury was the commonest.Th
文摘Purpose: Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross disparity between trauma services available in various parts of the country. Rural area in India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. The present study is to study the trends of occurrence of RTA cases by month, week and time of accident occurrence as well as to research the types of vehicle involved in accidents and other various risk factors related to them.Methods: During 1st January 2017 to 31st December 2017, a hospital-based and cross-sectional study of RTA victims was conducted. The patients were admitted in emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, when stabilized, they were shifted to the orthopaedics and surgery ward.Results: In the study, 654 road accident victims were included, of which the majority were males (77.5%) and the most of them belonged to rural (67%). RTA victims according to the month of occurrence majority were found in January (12.5%) and evening was time of a day with maximum accidents (32.1%). Mortality cases of RTA victims based on type of road user and it shows decreasing trend of mortality of motor-cyclists (54.2%) followed by pedestrian (25.1%).Conclusion: There should be control over people driving vehicles under the influence of alcohol and drivers over-speeding and rash driving on urban roads as well as rural village roads.
