Antibiotic Associated Diarrhea in Hospitalized Adult Patients

Background: Antibiotic associated diarrhea (AAD) occurs from the first initiation until 2 months of the end of antibiotic treatment. The aims of this study were to know the incidence of AAD, Clostridium difficile infection and other gastrointestinal symptoms in hospitalized adult patients.Method: The study is a cross sectional study. We studied the antibiotic associated diarrhea (AAD), Clostridium difficile infection and other gastrointestinal symptoms in patients who were admited in Cipto Mangunkusumo Hospital. Inclusion were male or female, age 18-75 years old, Patients started receiving antibiotics maximal 2 x 24 hours prior to hospitalization, gave written informed consent.Results: The incidence of AAD was 11.5%. The incidence of Clostridium difficile infection was 15.4%. The Upper gastrointestinal symptom was present on 20 (38.5%) patients. Lower abdominal symptom was present on 10 (19.2%) patients.Conclusion: The Incidence of AAD and Clostridium difficile infection were 11.5% and 15.4% respectively. The clinical manifestations of AAD were diarrhea, other upper and lower abdominal symptoms

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Relationship between Knowledge, Attitude, Behavior, and Needle Stick Injury among Nurses at Cilegon Public Hospital, Banten

Background: Needle stick injury is one of the greatest risks faced by nurses. Deadly blood borne pathogens contaminating needle stick injuries may lead to a serious or fa­tal in­fection. This study aimed to examine the relationship between knowledge, at­ti­tude, behavior, and needle stick injury among nurse at Cilegon Regional Public Hos­pital. Subject and Method: This was cross sectional study conducted at Cilegon Regional Pub­­lic Hospital, Banten, from January to July 2018. Total of 51 nurses at emergency de­partment and central surgical installation were selected for this study by total sam­pling. The dependent variable was needle stick injury. The independent variables were know­ledge, attitude, and behavior. Data was collected by a set of questionnaire and bivariate analysis was performed by chi-square. Results: Poor knowledge (OR= 20.00; 95% CI= 2.07 to 193.17; p=0.004), poor attitude (OR= 4.28; 95% CI= 1.13 to 16.23; p=0.038), and reckless behavior (OR= 20.40; 95% CI= 4.08 to 101.94; p<0.001) were associated with increased risk of needle stick injury. Conclusion: Knowledge, attitude, and behavior are associated with needle stick in­jury. Keywords: knowledge, attitude, behavior, needle stick injury

Laporan Praktik Kerja Lapangan (PKL) di dusun Semutan dan dusun Ngrandu Desa Pomahan Kecamatan Baureno Kabupaten Bojonegoro

Desa Pomahan adalah salah satu desa di Kecamatan Baureno, Kabupaten Bojonegoro yang memiliki total wilayah seluas 327 hektar dengan jumlah penduduk sebanyak 3286 jiwa. Mayoritas penduduk Desa Pomahan berprofesi sebagai petani dan berpendidikan akhir sekolah dasar (SD).Desa Pomahan terdiri dari Dusun Nunuk, Dusun Ngrandu, Dusun Semutan, Dusun Pomahan, dan Dusun Godang. Berdasarkan analisis data, diperoleh tujuh daftar masalah di Dusun Ngrandu dan Semutan yaitu masalah pengelolaan sampah, banyaknya perokok aktif di dalam rumah, kurangnya pengetahuan terkait Antenatal Care (ANC), kurangnya pengetahuan terkait ASI Ekslusif, kurangnya kesadaran dalam pemakaian Alat Pelindung Diri (APD) ketika bekerja, kurangnya informasi dan ketidakmerataan kepemilikan JKN, serta tingginya angka kejadian ISPA. Prioritas masalah yang diperoleh dengan metode USG bersama perangkat dusun dan kader kesehatan di Dusun Semutan dan Ngrandu adalah tingginya perokok aktif di dalam rumah. Alternatif solusi dilakukan dengan metode NGT bersama perwakilan masyarakat Dusun Semutan dan Ngrandu yang hasilnya adalah adanya pemberian tulisan larangan merokok di depan pintu, penyediaan tempat rokok di luar rumah, menyediakan permen pada setiap kegiatan perkumpulan warga sebagai pengganti rokok, penyediaan asbak diluar rumah, menyediakan ruangan khusus rokok, menyuguhkan teh ketika ada tamu, dan menasehati anggota keluarga yang merokok. Selanjutnya, diperoleh prioritas solusi menggunakan metode MEER yaitu menyediakan asbak di luar rumah. Berdasarkan hal tersebut, kemudian disusun program GEMAS TANPA ROKOK yakni Gerakan Rumah Sehat tanpa Rokok. Adapun program GEMAS tanpa Rokok terdiri dari beberapa kegiatan yakni kegiatan konsolidasi bersama karang taruna Dusun Semutan dan Ngrandu untuk menggalang dukungan terhadap program GEMAS tanpa Rokok, kegiatan sosialisasi program GEMAS tanpa Rokok kepada masyarakat, kegiatan penyuluhan program GEMAS tanpa Rokok “Bahaya Rokok bagi Perokok Aktif dan Pasif”, kegiatan Door to Door untuk sosialisasi secara personal, penempelan media promosi di pintu masuk rumah warga, penempelan poster pada tempat-tempat strategis Dusun Semutan dan Ngrandu, dan pemberian pojok rokok (asbak berupa gelas) di luar rumah masyarakat yang dikunjungi, serta terakhir kegiatan deklarasi sebagai tindak lanjut atas serangakaian kegiatan dari program GEMAS tanpa Rokok

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures