Hospital Practices and Research
Volume:4 Issue: 3, Summer 2019

Physicians working in hospitals face challenges when it comes to understanding and meeting the medical, legal, and ethical subjects outlined in the hospital bylaws. Hospital staff physicians and the hospital administration both aspire for high quality medical care and the assurance of patient safety. Unfortunately, when quality concerns surface, there can be reasonable differences of opinion as to whether a physician’s practice pattern met the accepted threshold of the standard of care. Such differences of opinion can lead to conflict that fuels a physician review. One complication for physicians is that many of the issues that surface at peer reviews are veiled in legal concepts and underpinnings for which physicians lack education, training, and familiarity. It would be prudent for all physicians working in hospitals to become familiar with the hospital bylaws and regulations. Physicians must take a leadership role in assuring fair and equitable peer review.

Common cancers such as colon, breast, and lung cancer are increasing in developing countries.

This study was conducted to determine 10-year trends and changes in common cancers in patients from a referral hospital in Tehran, Iran.

This cross-sectional study investigated a study population comprising colon, stomach, lung, prostate, and breast cancer patients registered at the cancer center of a referral hospital in Tehran, Iran from April 1, 2007 to the end of March, 2016 (n=4472). Inclusion criteria were a definitive diagnosis of cancer and an age between 15 and 75 years. Data was entered into SPSS (version 18) software and analyzed using the Time Series analysis and Scatter IO graph.

Significant correlations (P value <0.001) were seen between age increases in patients and the increasing number of patients in any type of cancer. With almost all of the five studied cancers, incidence increased with aging (P value <0.001). The incremental linear trend in the age of patients with lung (P value = 0.008) and colon (P value = 0.004) cancers and the decreasing trend in the age of prostate cancer patients (P value = 0.001) were statistically significant.

The incidence of cancer has increased over the past 10 years in both genders and ages. It is suggested that future studies should address the causes and factors behind the increasing incidence of common cancers.

As suggested by the Minorities’ Diminished Returns (MDRs) theory, educational attainment shows a weaker protective effect for racial and ethnic minority groups compared to non-Hispanic Whites. This pattern, however, is never shown for hospitalization risk. This cross-sectional study explored racial and ethnic variations in the association between educational attainment and hospitalization in the United States. Data came from the National Health Interview Survey (NHIS 2015). The total sample was 28,959 American adults. Independent variables was educational attainment. The main outcome was hospitalization during the last 12 months. Age, gender, employment, marital status, region, obesity, and number of cardiovascular conditions were covariates. Race and ethnicity were the effect modifiers. Logistic regression models were utilized to analyze the data. From all participants, 16.2% were Black and 11.6% were Hispanic with a mean age of 51 years. Overall, higher education levels were associated with lower odds of hospitalization, independent of all confounders. Educational attainment showed significant interactions with race (odds ratio [OR] =1.04, 95% CI = 1.01-1.08) and ethnicity (OR = 1.04, 95% CI =1.01-1.07) on hospitalization, indicating smaller protective effects of educational attainment on hospitalization of Hispanics and Blacks than non-Hispanic Whites. The protective effects of educational attainment on population health are smaller for Blacks and Hispanics compared to non-Hispanic Whites. To prevent health disparities, the diminished returns of educational attainment should be minimized for racial and ethnic minorities. To do so, there is a need for innovative and bold economic, public, and social policies that do not limit themselves to equalizing socioeconomic status, but also help minorities leverage their available resources and gain tangible outcomes.

From Gaya and adjoining regions, the trend in patients admitted with acute neurological illness was investigated. Illnesses were identified as sudden outbreaks of Japanese virus encephalitis (JE), Herpes simplex virus encephalitis (HSV-1&2), and other acute encephalitis syndrome (AES). In the current study, an investigation was carried out to assess potential infectious pathogens in patients aged 16 years or younger who were admitted to Anugrah Narayan Magadh Memorial Medical College Hospital, Gaya, with encephalitis-like symptoms. Cross-epidemiological, serological, and molecular biological studies were performed on samples collected from 71 patients below 16 years of age. Patients’ clinical histories, i.e. fever, socio-demographic characteristics, and other clinical data, were extracted from patient files. The results showed confirmed AES cases, including 49.30% JE and 7.04% HSV positive patients. A higher case-fatality rate of 40% in JE and 40% HSV cases below 7 years of age were observed during treatment would become an unavoidable concern. The epidemical sex ratio was observed to be higher in girls than in boys (1.26:1). The results suggested that JE virus was found to be a main causative risk factor responsible for disease transmission in the outbreak area.

A professional is an individual who prefers a profession, is specially qualified in its technical aspects, and makes a living with the profession. This research was conducted to determine the professional values of nurses and the factors affecting them. This descriptive research evaluated a sample of 97 nurses working in a private hospital in Ankara, Turkey. Data was collected using the demographic form and professional values scale (PVS). Among the nurses in the study sample, 43% had a graduate degree, 84.5% were staff nurses, and 37.2% were surgery, obstetrics, and cardiovascular surgery nurses. The mean score of professional values of nurses in this study was determined to be 4.20 ± 0.55. It was determined that professional values of nurses in the 34-year and older group, including male nurses, those usually working the day shift, those who chose the profession, those with memberships in associations, and those who participated in scientific meetings/seminars, had higher scores for professional values, but this finding was statistically insignificant (P > 0.05). The professional values of nurses was found to be above the middle level. In this light, it can be recommended, especially to managers, that training on professional values should be planned for nurses. It is also recommended that nurses receive undergraduate education and other comprehensive studies. In order to achieved a desired position in nursing, nurses must update regularly their scientific knowledge, participate in scientific meetings/seminars, and become members of professional associations.

Hand hygiene plays a key role in the prevention of healthcare-associated infection in critical patients.

The current study aimed to evaluate compliance with hand hygiene practices.

An observational and descriptive study was carried out in a 35-bed medical-surgical critical care unit in La Habana (Cuba) from January 2017 to December 2018. The observational method recommended by the World Health Organization (WHO) was used.

Overall compliance was 34.2% (5516/16 125), with better compliance among physicians (39%) compared with nurses (31.4%) and ancillary staff (19.5%). Better compliance was observed after patient contact (65.7%) and after contact with patients’ surroundings (42.0%) in comparison with greater focus on patient safety as before patient contact (23.3%) and before an aseptic task (11.4%). Hand washing was performed more frequently than hand rubs.

Compliance with hand hygiene practices is low and no improvement in compliance was observed during the study period. This practice is related to the high risk of transmission of healthcare-related infections in critical patients and requires quality improvement interventions.

Total hip arthroplasty (THA) after proximal femoral fixation is a challenging procedure due to possible hardware-related complications.

A 78-year-old female with hip osteoarthritis had a proximal femoral osteotomy fixed using a blade plate in the same femur 41 years ago. A two-step approach was planned. After a challenging hardware removal, an iatrogenic subtrochanteric fracture below the degenerated hip occurred after three months. THA with a tapered long stem was successfully performed with no need for additional osteosynthesis, and good results were seen two years later.

THAs in subtrochanteric fractures are technically demanding but feasible in selected cases. Hardware removal before THA implantation may carry important risks, and the surgical team should be prepared to perform arthroplasty in case of complications.

THA in a subtrochanteric fracture below hip osteoarthritis is a feasible option in selected cases.