Factors Affecting Cotrimoxazole Prophylactic Therapy Compliance in HIV Patients Attending a Care and Treatment Clinic at Bugando Medical Centre in Mwanza, Tanzania

Introduction: Cotrimoxazole Prophylactic Therapy (CPT) compliance lowers the risk of opportunistic infections and other Acquired Immune Deficiency Syndrome (AIDS)-related diseases. The aim of this study was to examine factors that influence compliance with CPT among HIV patients in the Care and Treatment Clinic (CTC) at Bugando Medical Centre (BMC) in Mwanza, Tanzania. Methods: A descriptive cross-sectional study was conducted at the BMC between April 1, 2021, and June 30, 2021. Data were collected using face-to-face interviews and a semi-structured questionnaire. Data are presented in frequency, percentages, and cross-tabulation tables. A P-value of less than 0.05 was considered statistically significant. Results: The prevalence of compliance with CPT by self-reported measurement was 158 (63.7%). Most CPT-compliant participants were more likely to have a spouse who is familiar with CPT, have a family member who is aware of their HIV status, and be aware of the benefits of CPT. The majority of participants who complied with CPT were more likely to have experienced counseling during refill, felt that the length of time spent seeing doctors for treatment was reasonable, and received accurate information from them. Conclusion: Most adult HIV patients attending CTC at BMC were reported to be in compliance with CPT. These findings suggest that improving social support and patient-provider communication may be effective strategies for improving compliance with CPT among HIV patients.

Functional Confirmation Using a Medical X-Ray System of a Semiconductor Survey Meter

In recent years, semiconductor survey meters have been developed and are in increasing demand worldwide. This study determined if it is possible to use the X-ray system installed in each medical facility to calculate the time constant of a semiconductor survey meter and confirm the meter’s function. An additional filter was attached to the medical X-ray system to satisfy the standards of N-60 to N-120, more copper plates were added as needed, and the first and second half-value layers were calculated to enable comparisons of the facility’s X-ray system quality with the N-60 to N-120 quality values. Next, we used a medical X-ray system to measure the leakage dose and calculate the time constant of the survey meter. The functionality of the meter was then checked and compared with the energy characteristics of the meter. The experimental results showed that it was possible to use a medical X-ray system to reproduce the N-60 to N-120 radiation quality values and to calculate the time constant from the measured results, assuming actual leakage dosimetry for that radiation quality. We also found that the calibration factor was equivalent to that of the energy characteristics of the survey meter.

Risk Factors of Neonatal Medical Adhesive-Related Skin Injury and Management of High-Risk Nodes

Objective:To analyze the risk factors of neonatal medical adhesive-related skin injury and put forward targeted preventive measures,so as to provide reference for the care and prevention of neonatal medical adhesive-related skin injuries.Methods:Using the convenience sampling method,262 neonates admitted to the neonatal intensive care unit(NICU)of a tertiary general hospital in Wenzhou from April 2021 to May 2022 were selected as the study subjects.The incidence of medical adhesive-related skin injuries in these neonates was retrospectively analyzed.Results:Among the 262 children,43 cases had skin injuries,with an incidence rate of 16.4%.Single factor analysis showed that the occurrence of medical adhesive-related skin injury was related to gestational age,weight,electrocardiogram(ECG)monitoring,venous access,ambient temperature,and mechanical ventilation(P<0.05).Multivariate logistic regression showed that gestational age,ECG monitoring,and ambient temperature were independent risk factors of medical adhesive-related skin injury(OR values were 0.700,0.431,and 6.365,respectively).Conclusion:The high incidence of neonatal medical adhesive-related skin injury may be caused by one or more factors.Clinical measures should be taken,such as selecting the appropriate type of adhesive according to gestational age and using skin-protecting membrane,minimizing ECG monitoring,etc.,to prevent the occurrence of neonatal medical adhesive-related skin injury.

Factors Influencing Patients to Decide to Discharge Themselves against Medical Advice at Tertiary Hospitals: A Cross-Sectional Study

Background: Discharged against medical advice (DAMA) is defined as any instance when a patient wants to leave the hospital against the managing physician’s decision. This study aimed to identify factors that influence patients to decide to be DAMA. Methods: A descriptive, cross-sectional study. The study was conducted in the emergency department (ED) of King Fahad Medical City (KFMC)-Saudi Arabia-Riyadh city. A questionnaire in both Arabic and English was distributed to all participants to fill in either English or Arabic. Results: Between 1 March and 30 April 2021, 510 responses were collected. Most of the study participants (31.4%) were over the age of 54. Our findings showed that 12.5% of our participants had taken discharge against medical advice in the past. Results Regarding Factors That Influence Patients to Decide on DAMA Showed: Regarding Inappropriate behavior and disrespect of the physician or staff to the patient and his relatives, 262 (51.4%) participants, 85 (16.7%) participants, and 163 (32%) participants agreed, neutral, and disagreed, respectively. Regarding the Lack of physicians’ and nurses’ attention to the patient and his relatives (emotionally), our result showed that 278 (54.5%) participants, 95 (18.6%) participants, and 137 (26.9%) participants agreed, neutral, and disagree, respectively. Regarding failure to inform the patient or his relatives of his condition, it showed that 257 (50.4%) participants, 95 (18.6%) participants, and 158 (31%) participants agreed, neutral, and disagreed, respectively. Regarding feeling better from DAMA, our result showed 226 (44.3%) participants, 119 (23.3%) participants, and 165 (32.4%) participants agreed, neutral, and disagreed, respectively. Regarding patients’ or their relative’s tiredness of hospital stay, the result showed that 166 (32.5%) participants, 104 (20.4%) participants, and 240 (47.1%) participants agreed, neutral, and disagreed, respectively. Conclusion: The long wait time to be seen by a physician was the major factor that forced patients to leave the emergency department against medical advice.

Writing strategies for improving the access of medical literature

When conducting a literature review,medical authors typically search for relevant keywords in bibliographic databases or on search engines like Google.After selecting the most pertinent article based on the title’s relevance and the abstract’s content,they download or purchase the article and cite it in their manuscript.Three major elements influence whether an article will be cited in future manuscripts:the keywords,the title,and the abstract.This indicates that these elements are the“key dissemination tools”for research papers.If these three elements are not determined judiciously by authors,it may adversely affect the manuscript’s retrievability,readability,and citation index,which can negatively impact both the author and the journal.In this article,we share our informed perspective on writing strategies to enhance the searchability and citation of medical articles.These strategies are adopted from the principles of search engine optimization,but they do not aim to cheat or manipulate the search engine.Instead,they adopt a reader-centric content writing methodology that targets well-researched keywords to the readers who are searching for them.Reputable journals,such as Nature and the British Medical Journal,emphasize“online searchability”in their author guidelines.We hope that this article will encourage medical authors to approach manuscript drafting from the perspective of“looking inside-out.”In other words,they should not only draft manuscripts around what they want to convey to fellow researchers but also integrate what the readers want to discover.It is a call-to-action to better understand and engage search engine algorithms,so they yield information in a desired and self-learning manner because the“Cloud”is the new stakeholder.

Factors Influencing the Emergency Medical Service Response Time for Cardiovascular Disease in Guangzhou, China

While emergency medical service (EMS) response time (ERT) is a major factor associated with the survival of patients with cardiovascular disease (CVD), relatively few studies have explored the factors associated with ERT. This study aimed to assess the current status of ERT and to identify the factors affecting ERT in patients with CVD in China. Between January 1, 2011 and December 31, 2015, EMS responses to CVD incidents in Guangzhou, China, were examined. The primary outcome was ERT, defined as the time from receipt of an emergency call to the arrival of paramedics on the scene. Factors associated with ERT were evaluated by multivariable logistic regression. A total of 44 383 CVD incidents were analysed. The median ERT was 12.58 min (interquartile range=9.98-15.67). Among the risk factors, distance (OR=13.73, 95% CI=11.76- 16.04), level of hospital (OR=1.57, 95% CI=1.40-1.75), and site of the incident (OR=1.53, 95% CI=1.38-1.69) were the top three significant factors affecting the ERT. Our results suggest that greater attention should be given to factors affecting the ERT. It is essential to make continuous efforts to promote the development of effective interventions to reduce the response time.

An Analysis of the Medical Costs of and Factors Affecting Diabetes Using the Medical Checkup and Payment Dataset in Japan: Can We Reduce the Prevalence of Diabetes?

Background: The cost and economic burden of diabetes are a serious worldwide issue. In this study, we evaluated medical payments for persons diagnosed with diabetes and the factors that led to a person having diabetes to reduce its prevalence. Methods: A dataset containing 113,979 medical checkups and 3,671,783 monthly medical, dental, care-giving and pharmacy payment records of one health insurance society was used. The dataset contains information of normal and healthy persons. The sample period ran from April, 2013 to March, 2016. The medical payments for persons diagnosed with diabetes were calculated. The regression analysis was used to remove the effects of age and gender. The probit analysis was used to analyze the factors that led to a person having diabetes. Results: In 2.9% of cases, the person undergoing the checkup was diagnosed with diabetes, and the medical payments for these patients were 2.7 times as much as the average medical payment per person. This result did not change significantly even if age and gender were considered. The results of the probit analysis suggested that body mass index, high systolic blood pressure, low diastolic blood pressure, eating habits, physical activities, smoking, drinking alcohol and sleeping were important factors for diabetes. Conclusion: The diabetes might be a costlier disease than previously thought in Japan. By the estimation, 8% of all medical payments were made for these persons with diabetes, which is much higher than the result shown by national survey data. However, overall prevalence could be recused by efforts such as prevention of overweight and obesity.

Evaluation of Medical Costs of Kidney Diseases and Risk Factors in Japan

Background: Kidney (renal) diseases and dialysis are among the most costly disorders and represent a worldwide burden. In this study, we evaluate the medical costs for individuals with kidney diseases and risk factors for the diseases in Japan. Data and Methods: The dataset used contained 113,979 medical checkups and 3,172,066 medical cost records obtained from 48,022 individuals in one health insurance society. The sample period was April 2013 to March 2016. We evaluated the distribution of all medical costs, and those of kidney diseases specifically. Then the power transformation Tobit model was used to remove the effects of other variables. Finally, a probit analysis was used to analyze the risk factors. Results: In 0.25% of all cases, individuals were diagnosed with kidney diseases. An individual with kidney disease cost 14.5 times more than those without kidney disease. If the diseases progressed into chronic kidney disease (CKD), the medical costs increased substantially. Even disregarding various characteristics of individuals, this conclusion did not vary. We found important risk factors included diabetes and blood pressure problems. In particular, an individual with both factors had a high probability of developing kidney disease. Conclusion: Kidney diseases are much costlier than other diseases. Screening high-risk individuals, educating patients, and ensuring that treatment begins at an early stage are critically important to controlling medical costs. Limitations: The dataset was observatory, and the sample period was only 3 years.

Determinants of internet addiction among medical students in Casablanca: a cross-sectional study

Objective:This study aimed to estimate the prevalence and determinants of Internet addiction among medical students at the Faculty of Medicine and Pharmacy of Casablanca,Morocco.Methods:This was a cross-sectional study conducted among students at the Faculty of Medicine and Pharmacy in Casablanca between October and March 2020.An online questionnaire was administered to students to collect data and internet addiction was assessed by the Young questionnaire.A score threshold≥50 was adopted to define addiction.Univariate and multivariate logistic regression analyses were used to identify factors associated with internet addiction.Results:Out of a total of 4093 FMPC students enrolled in the 2020-2021 academic year,506 agreed to participate in this study,including 303 females and 203 males.The mean addiction score assessed on the Young scale was(49.08±16.11).The prevalence of Internet addiction was 44.5%(225/506,95% CI:40% to 49%).Multiple regression analysis showed that being older than 20 years(OR=0.17,95% CI:0.40 to 0.64),being female(OR=1.70,95% CI:1.04 to 2.78),being in the dissertation year(6th year)(OR=5.17,95% CI:2.23 to 11.44),having a history of psychiatric consultation(OR=2.64,95% CI:1.34 to 5.21),having divorced parents(OR=2.64,95% CI:1.05 to 5.87),use of sleeping medication(OR=2.9,95% CI:1.05 to 3.70),sleep disorders(OR=2.06,95% CI:1.25 to 3.79),sleep deprivation(OR=2.26,95% CI:1.39 to 3.65),excessive daytime sleepiness(OR=5.39,95% CI:2.19 to 13.24),anxiety disorders(OR=1.47,95% CI:1.18 to 2.30),duration of internet connection(>4 h)(OR=11.43,95% CI:4.85 to 27.66),and having frequent conflicts with parents(OR=2.37,95% CI:1.49 to 3.79)and friends(OR=0.26,95% CI:0.11 to 0.65)were independently associated with internet addiction.Conclusion:The prevalence of Internet addiction among medical students in Casablanca remains high.Targeted action on the determinants would be of great value in prevention.

Study on learning intention and influencing factors of rural demand - oriented junior medical students in Yunnan province

[目的] 探讨农村订单定向专科医学生的学习意愿及影响因素,为改善该群体的学习意愿提供依据. [方法]采取分层整群抽样方法抽取就读于云南省3所高职（ 专） 医学院校的413名农村订单定向专科医学生 为调查对象,采用调查问卷进行现场调查,调查内容包括基本情况、学习意愿、学习动力、报考原因等. [结果] 52. 96%的农村订单定向专科医学生学习意愿弱;学习动力来源主要是适应以后工作、获取知识技能、 报答父母辛勤付出;二分类Logistic回归结果显示,农村订单定向专科医学的学习意愿受到多种因素影响. [结论]农村订单定向专科医学生的学习意愿不强,需通过营造学习氛围、严格教学管理、专业思想教育、完 善招考政策进行引导和改善.

Patients Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya

Antihypertensive medication is one way to manage hypertension but many hypertensive patients do not optimize drug therapy to achieve blood pressure control. Hypertensive medication non-adherence continues to become a contributing factor to hypertensive complications like heart attacks, heart failure, stroke, kidney disease. Prevalence of non-adherence to antihypertensive treatment is not known but it’s thought to be increasing. Associated factors of non-adherence are complex, are both internal and external to the patient but are difficult to extrapolate. This can partly be because the determinants of non-adherence to hypertensive may have a locality effect due to many factors such as culture and health system in a given locality. Hence, studies from one region may not have a cross-application. Therefore, there is the need to study the factors associated with non-adherence at a local scale. Descriptive study design was adopted to guide the implementation of the study. The population comprised of 575 people among doctors, pharmacists, nurses, record officers and hypertension patients. The respondents were identified through simple random sampling and a sample size of 81 patients was achieved and 10 health care providers including doctors, pharmacists, record officers and nurses were also interviewed through census method. Data was collected between the month of April and May 2019. Questionnaires were used as data collection tools for the patients while the interview schedule was conducted to health care providers through an interview guide. Descriptive and inferential statistics were used for data analysis, aided by SPSS. The study revealed a significant negative correlation (rpb = &minus;0.227, p 0.05) between age and non-adherent, insignificant relationship with marital status (rpb = &minus;0.129), insignificant (rpb = &minus;0.064) correlation with patients’ level of education and a positive correlation with monthly income (rpb = 0.24). A majority of patients stated that (64%) of the hypertensive patients had missed medication. Patient-related factors: cost of medication, religious beliefs, age of the patient, their education level, preference to traditional medicine, and sociocultural factors together were found to be significant predictors of non-adherence to hypertension medication, χ2= 17.14, df = 1, N = 81, p 0.05. However, it’s only age (p = 0.01), religious beliefs (p = 0.04), and cost of medication (p 0.05) that were individually, significant predictors to non-adherence. Non-adherence to hypertension medication is a major problem at Chuka Level Five Hospital. This was due to lack of funds, time, forgetfulness and patient thinking that they had healed thus continuous follow-ups to improve adherence, positive reinforcement to increase motivation in order to address forgetfulness, and supply of constant and subsidized hypertensive drugs to the hospital are necessary to prevent patients from missing the drugs. There is need to reduce out of pocket payment through establishment and strengthening of the community health insurance scheme. The study recommends that the hospital should set aside some resources for making patients’ follow-ups especially those were treated and left to go home;discussions be made with patients on severity of non-adherence and importance of adherence;use of positive reinforcement to increase motivation and mechanism to be put in place to subsidize the cost of medication.

Risk factors for cost-related medication non-adherence among older patients with diabetes

AIM: To assess the risk factors for cost-related medication non-adherence(CRN) among older patients with diabetes in the United States. METHODS: We used data from the 2010 Health and Retirement Study to assess risk factors for CRN including age, drug insurance coverage, nursing home residence, functional limitations, and frequency of hospitalization. CRN was self-reported. We conducted multivariate regression analysis to assess the effect of each risk factor. RESULTS: Eight hundred and seventy-five(18%) of 4880 diabetes patients reported CRN. Age less than 65 years, lack of drug insurance coverage, and frequent hospitalization significantly increased risk for CRN. Limitation in both activities of daily living and instrumental activities of daily living were also generally associated with increased risk of CRN. Residence in a nursing home and Medicaid coverage significantly reduced risk.CONCLUSION: These results suggest that expandingprescription coverage to uninsured, sicker, and community-dwelling individuals is likely to produce the largest decreases in CRN.

Patient and Health System Related Factors Associated with Non-Adherence to Antihypertensive Medication among Patients at Chuka Referral Hospital, Kenya

Background: Non-adherence to hypertensive medication continues to become a contributing factor to hypertensive complications like stroke, heart attacks, kidney disease heart failure. Associated factors to non-adherence are complex, are both internal and external to the patient and are difficult to extrapolate. Reports from Chuka referral hospital records showed that in 2016 there were 140 patients with hypertensive complications from 560 patients who attended the medical clinic that year. Objective: This study sought to explore the patient’s related factors that are associated with non-adherence to hypertension medication. Methods: This is a descriptive study design of (N = 575) people among them doctors, pharmacists, nurses, record officers and hypertension patients. Simple random sampling for patients (n = 81) and census sampling for health care workers was done and data collected using questionnaires and interview schedules between April 4th-May 30th 2019. Inferential and descriptive statistics were used for data analysis, aided by SPSS version 25. Results: 64% of the patients stated that they had missed medication. A significant negative correlation (rpb = -0.23, p < 0.05) between age and non-adherence, significant positive correlation with monthly income (rpb = 0.24, p < 0.04), non-significant relationship between non-adherence and marital status (rpb = -0.13, p = 0.25) and patients’ level of education (rpb = -0.06, p = 0.57). The overall model of health system related factors were found to be significant (p < 0.05) and this included;quality of health service, physician patient relationship, stock out, health education, and availability of medicine (p = 0.012). Conclusion: Lacks of funds, unavailability of drugs are the leading factors to regimen completion. This could be easily be addressed by the government.

New Onset of Atrial Fibrillation in a Medical ICU: Prevalence and Risk Factors

Objectives: To evaluate the prevalence and the risk factors of new onset atrial fibrillation (AF) in a single medical ICU. Methods: A prospective observational study was conducted in a 10 bed single medical ICU over a period of 18 months. All patients with sinus rhythm admitted in the medical ICU were included. Those presenting with any arrhythmia on admission, having a PACEMAKER or having undergone a recent cardiothoracic surgery were excluded. Results: Of the 377 patients included on the study, atrial fibrillation occurred in 26 patients (7%). Patients who developed AF were older, had higher severity scores on admission, and required significantly more fluids, catecholamine, and mechanical ventilation. They had a longer ICU and hospital LOS. ICU mortality was significantly higher in AF patients. Five inde- pendent risk factors of AF were identified by multivariate analysis: advanced age, the presence of COPD, sepsis, car- diogenic shock, and hypoxemia. Conclusion: AF occurs in approximately 7% of medical critically ill patients and is associated with age, a history of COPD, the presence of sepsis, cardiogenic shock and hypoxemia. AF occurs in more critically ill patients and is associated with increased morbidity and mortality.

Identification of Factors Influencing Out-of-county Hospitalizations in the New Cooperative Medical Scheme

Summary:Throughout the duration of the New Cooperative Medical Scheme(NCMS),it was found that an increasing number of rural patients were seeking out-of^county medical treatment,which posed a great burden on the NCMS fund.Our study was conducted to examine the prevalence of out-of^county hospitalizations and its related factors,and to provide a scientific basis for follow?up health insurance policies.A total of 215 counties in central and western China from 2008 to 2016 were selected.The total out-of-county hospitalization rate in nine years was 16.95%,which increased from 12.37%in 2008 to 19.21%in 2016 with an average annual growth rate of 5.66%.Its related expenses and compensations were shown to increase each year,with those in the central region being higher than those in the western region.Stepwise logistic regression reveals that the increase in out-of-county hospitalization rate was associated with region(XI),rural population(X2),per capita per year net income(X3),per capita gross domestic product(GDP)(X4),per capita funding amount of NCMS(X5),compensation ratio of out-of^county hospitalization cost(X6),per time average in-county(X7)and out-of-county hospitalization cost(X8).According to Bayesian network(BN),the marginal probability of high out-of^county hospitalization rate was as high as 81.7%.Out-of^county hospitalizations were directly related to X8,X3,X4 and X6.The probability of high out-of-county hospitalization obtained based on hospitalization expenses factors,economy factors,regional characteristics and NCMS policy factors was 95.7%,91.1%,93.0% and 88.8%,respectively.And how these factors affect out-of-county hospitalization and their interrelationships were found out.Our findings suggest that more attention should be paid to the influence mechanism of these factors on out-of-county hospitalizations,and the increase of hospitalizations outside the county should be reasonably supervised and controlled and our results will be used to help guide the formulation of proper intervention policies.

Analysis on Occupational Well-being Status and Influencing Factors of Medical Staff in Tuberculosis Departments

Objective:To investigate the status of occupational well-being of medical staff in tuberculosis department and analyze its influencing factors,so as to provide a basis for improving the occupational well-being of medical staff in tuberculosis department.Methods:In May 2020,we adopted the method of cluster sampling to select staff members from the tuberculosis departments of the Affiliated Hospital of Hebei University and infectious disease hospital.A total of 139 medical staff were recruited as the research subjects,and were investigated using medical staff occupational well-being scale.Results:The total score of occupational well-being was 76.4697 points,There were statistically significant differences(P<0.05)in occupational well-being score among tuberculosis medical staff with different age,years of work,job title,night shift,marital status,and occupational type.The influencing factors of occupational well-being were the night shift,years of work,occupational type,and marital status(P<0.05).Conclusion:The overall level of occupational well-being of tuberculosis medical staffs is moderate,and occupational well-being is affected by night shift,years of work,occupational type and marital status.It is recommended that managers take targeted measures to improve the occupational well-being of tuberculosis medical staff.

Restraining Factors and Improving Paths for the Operation Mechanism of New Rural Cooperative Medical System in China

The new rural cooperative medical system has achieved periodical achievements since its establishment.Nevertheless,there are many factors hampering the development of the new system,such as the high cost,the difficulties in fund procurement,the lack of management,the narrow coverage of benefit,the ineffective constraint to the designated medical institutions,the high fund balance rate,and the poor medical facilities and services in rural areas.Countermeasures are put forward to solve these problems,including improving the system design,expanding the coverage of the system,expanding the fund sources,reducing the financing costs,strengthening the fund supervision,enhancing the supervision of designated medical institutions,and improving the capacity of health services in rural areas.

Dynamics and data fitting of a time-delayed SIRS hepatitis B model with psychological inhibition factor and limited medical resources

Hepatitis B is an infectious disease worthy of attention.Considering the incubation period,psychological inhibition factor,vaccine,limited medical resources and horizontal transmission,an SIRS model is proposed to describe hepatitis B transmission dynamics.In order to describe the behavior changes caused by people's psychological changes,the non-monotonic incidence rate is adopted in the model.We use the saturated treatment rate to describe the limited medical resources.Mathematical analysis shows the existence conditions of the equilibria,forward or backward bifurcation,Hopf bifurcation and the Bogdanov-Takens bifurcation.During the observation of the case data of hepatitis B in China,it is found that there are mainly three features,periodic outbreaks,aperiodic outbreaks,and periodic outbreaks turns to aperiodic outbreaks.According to the above features,we select three different representative regions,Jiangxi,Zhejiang province and Beijing,and then use our model to fit the actual monthly hepatitis B case data.The basic reproduction numbers that we estimated are 1.7712,1.4805 and 1.4132,respectively.The results of data fitting are consistent with those of theoretical analysis.According to the sensitivity analysis of Ro,we conclude that reducing contact,increasing treatment rate,strengthening vaccination and revaccinating can effectively prevent and control the prevalence of hepatitis B.

Predicting factors for the need of extracorporeal membrane oxygenation for suicide attempts by cardiac medication:a single-center cohort study

BACKGROUND:Severe poisoning due to the overdosing of cardiac drugs can lead to cardiovascular failure.In order to decrease the mortality rate,the most severe patients should be transferred as quickly as possible to an extracorporeal membrane oxygenation(ECMO)center.However,the predictive factors showing the need for venous-arterial ECMO(VA-ECMO)had never been evaluated.METHODS:A retrospective,descriptive,and single-center cohort study.All consecutive patients admitted in the largest ICU of Reunion Island(Indian Ocean)between January 2013 and September 2018 for beta-blockers(BB),calcium channel blockers(CCB),renin-angiotensin-aldosterone system blockers,digoxin or anti-arrythmic intentional poisonings were included.ECMO implementation was the primary outcome.RESULTS:A total of 49 consecutive admissions were included.Ten patients had ECMO,39 patients did not have ECMO.Three patients in ECMO group died,while no patients in the conventional group died.The most relevant ECMO-associated factors were pulse pressure and heart rate at first medical contact and pulse pressure,heart rate,arterial lactate concentration,liver enzymes and left ventricular ejection fraction(LVEF)at ICU-admission.Only pulse pressure at first medical contact and LVEF were significant after logistic regression.CONCLUSION:A transfer to an ECMO center should be considered for a pulse pressure<35 mmHg at first medical contact or LVEF<20%on admission to ICU.

Effect of Electronic Medical Record Utilization on Depression, Anxiety and Stress among Doctors and Nurses in Johor, Malaysia

Background： The usage of modem technology in healthcare record system is now a must throughout the world. However, many doctors and nurses has been reporting facing numerous challenges and obstacles in the implementation. The aim of the present study is to determine the prevalence of depression, anxiety and stress among doctors and nurses who utilize EMR （electronic medical record） and its associated factor. Methods： A comparative cross-sectional study was conducted ~om January till April 2012 among doctors and nurses in two public tertiary hospitals in Johor in which one of them uses EMR and the other one still using the MMR （manual medical record） system. Data was collected using self-administered validated Malay version of DASS-21 （Depression, Anxiety, and Stress Scales-21） items questionnaire. It comprises of socio-demographic and occupational characteristics. Findings： There were 130 respondents with a response rate of 91% for EMR and 123 respondents with a response rate of 86% for MMR. The mean （SD） age of respondents in EMR and MMR groups were 34.7 （9.42） and 29.7 （6.15） respectively. The mean （SD） duration of respondents using EMR was 46.1 （35.83） months. The prevalence of depression, anxiety and stress among respondents using EMR were 6.9%, 25.4% and 12.3%. There were no significant difference between the study groups related to the depression, anxiety and stress scores. In multivariable analysis, the significant factors associated with depression among respondents using EMR was age （OR 1.10, 95% CI 1.02, 1.19）. The significant factors associated with stress among respondents using EMR was marital status （OR 3.33, 95% CI 1.10, 10.09） and borderline significant was computer skill course （OR 2.94, 95% CI 0.98, 8.78）. Conclusion： The prevalence of depression, anxiety and stress of those who uses EMR were within acceptable range. Age, marital status and computer skill are the identified factor associated with the depression and stress level which need to be considered in its implementation.