Palliative care out patient consultation service in a teaching hospital in Bangladesh

Palliative care is a newly emerging subspecialty in Bangladesh. The aims of this study were i) to determine the characteristics, types of referral, disease pattern and insight about the disease and ii) to estimate the prevalence of pain and other common symptoms in a population of patients with advanced incurable state of cancer and attending the newly established palliative care out patient clinic. The data were collected at the outpatient clinic during first consultation using a modified structured data collection sheet from the Institute of Palliative Medicine (IPM) in Calicut, Keralla, India. Two hundred and three patients with mean age 50 years, diagnosed as suffering from incurable cancer were seen during a period of 21 months from October 2007 to June 2009. Most of the patients were from less privileged socioeconomic group (86%), stays with family (99%), already know about their disease status and prognosis (62%). Referred from other disciplines formed the major group (72%) of this population. All of them had been under treatment for variable period ranging from one month to four years. The most common five symptoms noted by the service providers were pain (89%), loss of appetite (61%), sleeplessness (55%), lack of energy (47%) and constipation (44%). Population based studies are required to determine the actual magnitude of sufferers and suffering in spite of the availability of global knowledge and skill to reduce these sufferings of the incurably ill members of the society.     

An ethics consultation service in a teaching hospital. Utilization and evaluation

A newly established formal ethics consultation service in a university teaching hospital was prospectively evaluated. A physician-ethicist interviewed and examined patients, interviewed family and others as needed, and entered a formal consultation note in the medical record. The requesting physician and the consultant independently completed structured questionnaires. Fifty-one consultation requests were received from 45 physicians from seven departments between July 1, 1986, and June 30, 1987. Seventeen (33%) of 51 patients were in the intensive care unit, and 19 patients (37%) were fully oriented at the time of consultation. Overall, 61% of the patients survived to leave the hospital. The requesting physician sought assistance with withholding or withdrawing life-sustaining treatment in 49% of cases, with resuscitation issues in 37%, and with legal issues in 31%. Assistance with more than one issue was sought in 39 cases (76%). In 36 cases (71%), the requesting physician stated that the consultation was "very important" in patient management, in clarifying ethical issues, or in learning about medical ethics. We conclude that ethics consultation performed by physician-ethicists provides useful, clinically acceptable assistance in a teaching hospital.     

Lung cancer audit in an Irish teaching hospital

Background Lung cancer is the most common cause of cancer-related death in Ireland. There are few complete data sets available as to the stage and cell type of lung cancers at time of presentation in Ireland. Aim To audit the lung cancers presenting to a large Dublin teaching hospital over a 12-month period. Method Prospective evaluation of all lung tumours presenting to our institution over a consecutive 12-month period. Results One hundred and ninety-eight lung cancers presented over the study period. There were 34 cases of small cell carcinoma and 150 cases of non-small cell carcinoma (NSCC). Fourteen patients were too ill or compromised at time of presentation for tissue confirmation. The most common cell type was squamous carcinoma. Eighty-four per cent of the NSCCs were either stage 3 or 4 at presentation. Conclusion Most lung cancers present late in the time course of the disease. Distribution of cell type and location are similar in Ireland and other developed countries.     

Anti-social behaviour in a large Irish teaching hospital

Background

Anti-social behaviour affects staff physically and psychologically and has financial implications. More information on its occurrence is required for effective risk management.

Aims

We undertook to audit the complete dataset on anti-social behaviour in an urban Irish hospital.

Methods

Data, collected from computerised incident reports between January 2005 and December 2008, were analysed with respect to date, location, incident type, person affected, type and severity of injury.

Results

There were 3,727 incidents over 4?years, with numbers rising annually at the approximate rate of 20%. Most involved nursing staff. Incidents occurred primarily on medical and surgical wards and were usually classified as minor. Physical or verbal assaults were most frequently reported.

Conclusion

Anti-social behaviour appears to be increasing. Certain wards and categories of healthcare professionals are at particular risk. More research is required to explain factors leading to such behaviour and optimum strategies for its active management.     

Profiling harmful medication errors in an acute Irish teaching hospital

Background

Medication error reporting systems in hospitals are faced with the challenge of processing vast numbers of reports which identify a myriad of safety issues. With such large volumes of data and limited resources it makes sense to adopt a prioritisation approach. Several published studies have focused solely on the subset of errors which cause patient harm. The majority of such research has concerned the individual analysis of criteria associated with medication errors. However, the research described here used an alternative approach which involved linking the three criteria of medication class, patient outcome, and type of error, in order to describe the medication-related scenarios presenting greatest risk to the organisation.

Aims

To identify the highest-priority medication-related risks in an acute teaching hospital. To profile harmful medication errors submitted to a voluntary reporting system in a tertiary healthcare setting in Ireland.

Methods

A database of medication errors, reported via an internal voluntary reporting system over a 5-year period, was analysed. The criteria of medication class, patient outcome and type of error were analysed separately and then cross-tabulated.

Results

The medication classes, error types and adverse patient outcomes most frequently associated with harm were identified. The cross-tabulation highlighted ten priority risk areas which accounted for the majority of patient harm.

Conclusions

A cross-tabulation strategy for prioritising medication-associated risks was successfully applied to a hospital database comprising medication errors. The profile developed for harmful medication errors in this acute tertiary healthcare setting was broadly in line with that published for error reporting systems internationally.     

Cost of treating heart failure in an Irish teaching hospital

Background  

The prevalence of heart failure is 3 to 20 per 1,000 population, but may exceed 100 per 1,000 in the over 65 age group. Some 1–2% of the total healthcare budget is consumed in the management of heart failure.     

Transforming management of patients undergoing splenectomy in an Irish teaching hospital

Background

Post-splenectomy infection has a mortality rate of up to 70%. Previously we have published data confirming the poor adherence to best practice guidelines with relation to management of the asplenic patient. A defined protocol of care was established, staff education commenced and a ‘patient information leaflet’ made available.

Aim

To ascertain whether management of the asplenic patient has improved since the implementation of a structured programme of care.

Method

Retrospective chart review of all splenectomies performed in Beaumont Hospital between 2002 and 2008.

Results

Overall, 75.9% of patients were documented as having received the recommended vaccinations. Of these, 48.7% were not timed according to recommended guidelines. Prophylactic antibiotics were documented as prescribed in all but five patients discharged.

Conclusions

These results demonstrate an improvement in post-splenectomy care between 2002 and 2008. However, further improvements are necessary.     

Retroperitoneoscopic nephrectomy: the experience of an Irish teaching hospital

Background  

Since its introduction, laparoscopic nephrectomy is increasingly being used worldwide as a method of removing the kidney, both in benign disease and in small volume tumours. To our knowledge, we are the first surgeons in Ireland to perform this procedure with results that support its use in select cases.     

Patient and disease profile of emergency medical readmissions to an Irish teaching hospital

Objective: To determine whether there was a relationship between coded diseases at the time of hospital discharge, a pattern of ordering investigations, and hospital readmission in a major teaching hospital. Design: Systematic review of data relating to emergency medical patients admitted to St James'' Hospital Dublin between 1 January and 31 December 2002. Data sources and methods: Data on discharges from hospital recorded in the Hospital In-Patient Enquiry (HIPE) system. The value of HIPE data in describing the relationship between the pattern of resource utilisation, diagnostic related groups, and hospital readmission has not previously been examined. Results: Of 5038 episodes recorded among 4050 patients admitted, the number of readmissions was up to 15. Age and male gender were factors associated with readmission, and readmitted patients remained in hospital for longer. No particular test request predicted readmission, but computed tomography of the brain was associated with a reduced readmission rate. Discharge diagnostic related group coding at first discharge predicted readmission—codes related to heart failure, respiratory system, alcohol, malignancy, and anaemia. Conclusions: It was found that clinical coding using the HIPE database strongly predicted hospital readmission. It may be argued that early hospital readmission reflects unsatisfactory patient care, alternatively that many readmissions are not preventable, representing either new events in elderly patients with chronic illnesses and frequent co-morbidity or related to social factors. The utility of specific interventions, in patients at high risk for hospital readmission, could be explored.     

The incidence of acute stroke emergency admissions in an Irish teaching hospital

Background  

Approximately 2,500 people die from stroke each year yet there is a lack of Irish services provision.     

Effect of a geriatric consultation service on management of patients in an acute care hospital.

Elderly patients present particular management challenges. We conducted a randomized clinical trial of the effect of a geriatric consultation service on the management of elderly patients in an acute care hospital. A total of 113 patients aged 75 years or more who met certain criteria were assigned to either receive (57 patients) or not receive (56) care by the service. At the end of their hospital stay the patients were assessed with regard to predetermined outcomes. The patients were followed up for 1 year after discharge to determine death rates and direct health care expenditures. The intervention group showed significantly greater improvement in mental status (p less than 0.01), were receiving fewer medications at discharge (p less than 0.05) and had lower short-term death rates (p less than 0.05) than the control group. A geriatric consultation service can improve the hospital care and health of the elderly.     

Psychiatric comorbidities in cancer patients: acute interventions by the psychiatric consultation liaison service

Wiener Medizinische Wochenschrift - The aim of this study was to explore the psychiatric comorbidities in cancer patients examined by the psychiatric consultation liaison services (CLP) in...     

Management of patients undergoing splenectomy in an Irish teaching hospital: impact of guidelines

Introduction  

Overwhelming post-splenectomy infection (OPSI) has a 50–70% mortality rate and carries a lifetime risk for the asplenic patient. Specific British guidelines have been developed to reduce its incidence.