Irish journal of medical science
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Good clinical record-keeping is central in ensuring patient safety and effective communication between healthcare professionals. Poor communication is the root cause of many adverse events in medicine. ⋯ The use of the educational tool and a formal training session significantly improved the quality of notes written for surgical inpatients. Junior doctors do not feel adequately trained in this area. The authors recommend that formal training in record-keeping be included in all hospital induction programmes.
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Hip fracture is a growing healthcare challenge, with 6-8% 30-day mortality and 20-30% of patients incurring major morbidity, including impaired mobilisation and ability to live independently. While observational studies have shown no benefit of general versus spinal anaesthesia on 30-day mortality, intraoperative hypotension during hip fracture surgery is associated with increased 30-day mortality regardless of anaesthetic technique. Although a recent trial on younger patients demonstrated reduced postoperative complications by maintaining intraoperative arterial blood pressure close to preoperative baseline, there are no data correlating intraoperative hypotension during hip fracture surgery with postoperative morbidity. ⋯ In this exploratory retrospective analysis, the cumulative time of hypotension during hip fracture surgery correlated with extensive postoperative morbidity when adjusting to other known predictors. Intraoperative cumulative time of hypotension may be a good candidate for larger prediction studies as a predictor of postoperative complications. A randomised controlled trial evaluating the effect of actively minimising intraoperative hypotension on postoperative morbidity in hip fracture patients seems warranted.
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Potential drug-drug interactions (pDDIs) are especially frequent in patients with chronic obstructive pulmonary disease (COPD) who, if hospitalized, experience, on average 6.5 pDDIs on admission, and 7.2 on discharge. The aim of our study was to identify and analyze risk and/or protective factors for occurrence of pDDIs in hospitalized patients with COPD. ⋯ The COPD patients who were prescribed more drugs (especially antiarrhythmic and anticoagulants), by several independent prescribers, and having more comorbidities, were more prone to experience a pDDI; the only protective factor against pDDIs was age of the patients. In conclusion, COPD patients with the abovementioned risk factors should have their therapy more intensely monitored for pDDIs.
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Acute urinary retention (AUR) is a common urologic emergency. However, its management is not standardized due to lack of clinical guidelines. ⋯ Admission of patients with acute urinary retention leads to a definitive management decision and reduced prolonged catheterization.
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Modification of antibiotic prophylaxis prior to transrectal ultrasound-guided prostate biopsy (TRUSPB) based on pre-procedure rectal culture results is effective for prevention of infection from fluoroquinolone (FQ)-resistant and extended-spectrum beta-lactamase (ESBL) Escherichia coli strains. This has several implications for service delivery and cost. Our aim was to audit sepsis rates after introduction of ESBL screening and to identify risk factors for FQ resistance in ESBL strains and factors for sepsis risk. ⋯ In the face of rising TRUSPB sepsis and higher sepsis rates with ESBL carriers despite additional prophylaxis, introduction of a targeted antibiotic prophylaxis prior to TRUSPB sepsis prostate biopsies based on rectal swabs or urine cultures may reduce sepsis rates or clinicians may find themselves leaning towards increasingly performing transperineal biopsies with lower sepsis rates supporting the 'trexit' initiative.