Expected Practice as a Novel Antibiotic Stewardship Intervention.

"Expected practice" is a recently described method to alter clinical behavior. We implemented an expected practice around short-course antibiotic therapy, which was associated with decreased antibiotic utilization for multiple bacterial infections. Thus, we describe this expected practice as a novel, simple, and inexpensive tool to enhance antibiotic stewardship

Patient-driven resource planning of a health care facility evacuation

Introduction: The evacuation of a health care facility is a complex undertaking, especially if done in an immediate fashion, ie, within minutes. Patient factors, such as continuous medical care needs, mobility, and comprehension, will affect the efficiency of the evacuation and translate into evacuation resource needs. Prior evacuation resource estimates are 30 years old. Methods: Utilizing a cross-sectional survey of charge nurses of the clinical units in an urban, academic, adult trauma health care facility (HCF), the evacuation needs of hospitalized patients were assessed periodically over a two-year period. Results: Survey data were collected on 2,050 patients. Units with patients having low continuous medical care needs during an emergency evacuation were the postpartum, psychiatry, rehabilitation medicine, surgical, and preoperative anesthesia care units, the Emergency Department, and Labor and Delivery Department (with the exception of patients in Stage II labor). Units with patients having high continuous medical care needs during an evacuation included the neonatal and adult intensive care units, special procedures unit, and operating and post-anesthesia care units. With the exception of the neonate group, 908 (47%) of the patients would be able to walk out of the facility, 492 (25.5%) would require a wheelchair, and 530 (27.5%) would require a stretcher to exit the HCF. A total of 1,639 patients (84.9%) were deemed able to comprehend the need to evacuate and to follow directions; the remainder were sedated, blind, or deaf. The charge nurses also determined that 17 (6.9%) of the 248 adult intensive care unit patients were too ill to survive an evacuation, and that in 10 (16.4%) of the 61 ongoing surgery cases, stopping the case was not considered to be safe. Conclusion: Heath care facilities can utilize the results of this study to model their anticipated resource requirements for an emergency evacuation. This will permit the Incident Management Team to mobilize the necessary resources both within the facility and the community to provide for the safest evacuation of patients

Demographic Insights Into College-Going Students in India: A Morphological Analysis

Introduction: In the context of India's diverse culture and changing education system, it is crucial to understand the morphological characteristics of college students, especially with the government actively supporting sports through initiatives like the "Khelo India" program to aid young athletes.  The purpose of the study was to investigate the morphological characteristics of college-level athletes and non-athletes in India. Methods: 287 college students have been randomly selected to acquire a comprehensive set of demographic and anthropometric data. Results: The study revealed significant differences in body mass index (p=0.004), endomorphy (p=0.001), ectomorphy (p=0.02), and body fat percentage (p=0.001). However, no significant difference in mesomorphy (p=0.09) was identified, and only minimal differences in fat-free mass (p=0.57) were observed. College-level athletes exhibit an ectomorphic-mesomorphic physique (2.9-3.9-3.0), characterized by a distinct blend of muscularity and leanness. Non-athletes are mesomorphic-endomorphs (5.0-4.3-2.4), exhibiting higher body fat content and muscularity. Athletes had a significantly lower body fat percentage, highlighting the positive influence of sports training and regular physical exercise on reducing adiposity. The analysis of percentile rankings provides comprehensive insights into the distribution of anthropometric metrics among athletes and non-athletes, assisting in customizing training regimens, identifying areas for potential improvement, and enhancing a comprehensive assessment of individuals' physical characteristics. Conclusion: The study sheds light on the crucial role of morphological traits in discerning differences between college-level athletes and non-athletes within the broader context of the "Fit India Movement." The study will help design an effective training module to improve the overall health of college students.Introducción: En el contexto de la cultura diversa de la India y el cambiante sistema educativo, es crucial comprender las características morfológicas de los estudiantes universitarios, especialmente ahora que el gobierno apoya activamente los deportes a través de iniciativas como el programa "Khelo India" para ayudar a los atletas jóvenes. El propósito del estudio fue investigar las características morfológicas de los atletas y no atletas de nivel universitario en la India. Métodos: Se seleccionaron aleatoriamente 287 estudiantes universitarios para adquirir un conjunto completo de datos demográficos y antropométricos. Resultados: El estudio reveló diferencias significativas en el índice de masa corporal (p=0,004), endomorfia (p=0,001), ectomorfia (p=0,02) y porcentaje de grasa corporal (p=0,001). Sin embargo, no se identificaron diferencias significativas en la mesomorfia (p=0,09) y sólo se observaron diferencias mínimas en la masa magra (p=0,57). Los atletas de nivel universitario exhiben un físico ectomórfico-mesomórfico (2,9-3,9-3,0), caracterizado por una combinación distintiva de musculatura y delgadez. Los no deportistas son endomorfos mesomórficos (5,0-4,3-2,4) y exhiben mayor contenido de grasa corporal y musculatura. Los deportistas presentaban un porcentaje de grasa corporal significativamente menor, destacando la influencia positiva del entrenamiento deportivo y el ejercicio físico regular en la reducción de la adiposidad. El análisis de las clasificaciones percentiles proporciona información integral sobre la distribución de métricas antropométricas entre atletas y no atletas, lo que ayuda a personalizar los regímenes de entrenamiento, identificar áreas de posible mejora y mejorar una evaluación integral de las características físicas de los individuos. Conclusión: El estudio arroja luz sobre el papel crucial de los rasgos morfológicos a la hora de discernir las diferencias entre los atletas de nivel universitario y los no atletas dentro del contexto más amplio del "Movimiento Fit India". El estudio ayudará a diseñar un módulo de formación eficaz para mejorar la salud general de los estudiantes universitarios

Telehealth Solutions for In-hospital Communication with Patients Under Isolation During COVID-19

The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis that has quickly overwhelmed our healthcare system. It has led to significant shortages in personal protective equipment (PPE), ventilators, and intensive care unit beds across the nation. As the initial entry point for patients with suspected COVID illness, emergency departments (ED) have had to adapt quickly to prioritize the safety of patients and providers while still delivering optimal, timely patient care. COVID-19 has presented many challenges for the ED that also extend to all inpatient services. Some of these key challenges are the fundamental tasks of communicating with patients in respiratory isolation while minimizing PPE usage and enabling all patients who have been affected by hospitals’ visitor restrictions to connect with their families. We discuss the design principles behind implementing a robust in-hospital telehealth system for patient-provider and patient-family communication, provide a review of the strengths and weaknesses of potential videoconferencing options, and deliver concise, step-by-step guides for setting up a secure, low-cost, user-friendly solution that can be rapidly deployed

Ultrasound-guided introital drainage of pyometrocolpos

Pyometrocolpos can be caused by congenital malformations such as distal vaginal atresia and imperforate hymen. Patients usually present with obstructive urinary tract infections, acute kidney injury, or sepsis. Percutaneous drainage of the infected fluid can help treat the patient; however, recurrence is of concern. In this case report, we present a case of a child with recurrent pyometrocolpos due to distal vaginal atresia despite initial percutaneous drainage. To our knowledge, this is the first report of ultrasound-guided introital drainage of pyometrocolpos with relief of symptoms obviating the need for repeat drainage or immediate surgery. © 201

Bedside teaching on time to disposition improves length of stay for critically-ill emergency departments patients

Introduction: We tested the effect of a brief disposition process intervention on residents’ time to disposition and emergency department (ED) length of stay (LOS) in high acuity ED patients. Methods: This was a quasi-experimental study design in a single teaching hospital where ED residents are responsible for administrative bed requests for patients. Enrollment was performed for intervention and control groups on an even-odd day schedule. Inclusion criteria were ED patients triaged as Emergency Severity Index (ESI) 1 and 2. In the intervention group, the attending physician prompted the resident to make the disposition immediately after the evaluation of resuscitation patients. In the control group, the attending physicians did not intervene in the disposition process unless more than 2 hours passed without a disposition. Main outcomes were time to disposition and total ED LOS. Results: A total of 104 patients were enrolled; 53 (51%) in the intervention group and 51 (49%) in the control group. After controlling for ESI and resident training year, mean disposition time was significantly shorter in the intervention group by 41.4 minutes (95% CI: 32.6-50.1). LOS was also shorter in the intervention group by 93.3 minutes (95% CI: 41.9-144.6)

Urinary tract infections and antibiotic susceptibility among the patients attending B & D hospital of Lalitpur, Nepal

Background: Urinary tract infection is the most common bacterial infections in humans and serious health problem in many parts of the world. It has become more complicated in treatment due to different pathogens and increasing resistant to antimicrobial agents. This study aims to investigate the prevalence of urinary tract infection and antibiotic susceptibility patterns of pathogens among the patients attending in B & B hospital Nepal. Materials and Methods: A hospital based cross sectional study was conducted in between April 2010 to March 2011. Urine samples were collected from clinically suspected patients and tested bacteriologically using standard procedures. Antimicrobial susceptibility test was performed for isolated pathogen using the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute guidelines. Results: Out of 1260 examined specimens 25.24 % were positive and majority 61.64% were females. The most common pathogens isolated were Escherichia coli (66.67%), Enterococcus (7.55%) and Staphylococcus (6.60 %). The drug resistant among the positive cases were reported. The highest resistant of positive cases was found with Cefexime (87.88%) and Enterococcus with Ampicillin (66.67%) and Staphyllococcus with Cloxacillin (66.67%). The highest susceptibility was for Vancomycin and Ampicillin i.e. 33.33% in each. Conclusion: The findings showed that E. coli isolates were the predominant pathogen and the presence of bacterial isolates with very high resistance to the commonly prescribed drugs. As drug resistance among bacterial pathogens is an evolving process and serious issue. Therefore, routine surveillance and monitoring studies should be conducted to provide physicians knowledge on the updated and most effective empirical treatment of UTIs

Seis islas temporales en Still — The Economy of Waiting

This article focuses on the analysis of the performative installation Still — The Economy of Waiting, work by German artist Julian Hetzel. This project addresses specific issues related to the mechanisms in labour productivity and work ethics. Taking as a starting point post-Fordist production models, Hetzel observes the current transformation of the idea of "work" into the notion of "occupation". While "labour and work" concepts have been oriented towards a productive model that pursues specific results and objectives, the concept "occupation" focuses on activity as a process, that is, its purpose is none other than to remain busy, thereby raising a temporary counter-model with which to generate a gap in the flow of capitalist circulation.El artículo se centra en el análisis de la instalación performática Still — The Economy of Waiting, obra del artista alemán Julian Hetzel. En dicho proyecto se abordan ciertas problemáticas asociadas a los mecanismos en la producción laboral y las éticas del trabajo. Tomando como punto de partida modelos de producción posfordistas, Hetzel observa la actual transformación de la idea de "trabajo" en la idea de "ocupación". Mientras que la idea de "labor y trabajo" han estado orientadas hacia un modelo productivo que persigue resultados y objetivos específicos, la idea de "ocupación" se centra en la actividad como proceso, es decir, su finalidad no es otra que la de permanecer ocupado, planteando con ello un contra-modelo temporal con el que generar una brecha en el flujo de la circulación capitalista