Map of sexually transmitted disease care in Spanish emergency departments

Objective. To determine the approaches used in Spanish emergency departments (EDs) in patients suspected of having sexually transmitted diseases (STD) analysed according to the size of the hospital, ED census and autonomous community. Material and methods. Questionnaire to the heads of 282 public EDs (7/24) related to emergency routines for patients with suspected STD. Results compared using odds-ratio (OR) and 95% confidence interval (95%CI) according to hospital size (large vs medium-small: ≥500 vs. <500 beds) and ED census (high vs. medium-low: ≥200 vs. <200 patients/day), by autonomous community. Results. A total of 250 EDs responded (89%). With protocol for STD 36% of EDs [>60% Catalonia, Vasque Country, more in large hospitals (LH), (OR=2.65, 95%CI=1.46-4.82) and high census (HCEN) EDs, (OR=3.49, 95%CI=2.03-5.98)]. 70% obtained exudate sampling (>80% Catalonia, Madrid, Castilla-La Mancha, Aragón, Navarra, Vasque Country), 44% STD serology (>60% Madrid) and 35% HIV serology [(>60% Navarra, Baleares; more in LH (OR=2.43, 95%CI=1.34-4.42) and HCEN EDs (OR=1.94, 95%CI=1.15-3.29)]. At discharge, follow-up in hospital outpatients clinics 53% of EDs [>60% Catalonia, Comunidad Valenciana, Murcia, Castilla-La Mancha, Vasque Country, Asturias; more in LH (OR=2.45, 95%CI=1.31-4.57) and HCEN EDs (OR=2.25, 95%CI=1.35-3.76)] and by primary care 28% (>80% Cantabria). In 55% of EDs, patients are discharged with a scheduled follow-up (>80% Extremadura, La Rioja, Navarra) and 32% visit next workday [>60% Vasque Country; more in LH (OR=3.43, 95%CI=1.87-6.30) and HCEN EDs (OR=3.63, 95%CI=2.08-6.37)]. Conclusion. The care of patients with suspected STD is not homogeneous in Spanish EDs. Areas of improvement were detected, especially the need for specific diagnostic and follow-up protocols.

Nursing consultation practice for psychosocial problems on heart failure patiens in hospital-based outpatient clinic

Funding Acknowledgements Type of funding sources: None. Background The client"s condition for heart failure requires environmental support to be able to be confident and able to carry out activities according to the directions given while the patient is undergoing treatment in the hospital, but sometimes in the client"s time period at home there will be situations where patients may experience complaints or changes in conditions that can affect his cardiovascular status. Purpose this study is conducted to identify psychological and social problems and needs of heart failure clients with a qualitative approach of observation, invite individuals or families to participate, motivate individuals to develop the potential to maintain optimal health. In addition, this study was conducted to assess the need and effectiveness of the practice of consulting for heart failure nursing in hospital outpatients Method qualitative observation approach in nursing consulting practice using steps of the nursing process consisting of an assessment of physical, psychological and social conditions and client needs, formulating problems, making plans and taking care of actions in accordance with the problems that exist by nurses in the outpatient clinic at home sick. Results Clients who came to the outpatient clinic had various psychological and social problems. From the observations and interviews it was found that psychological and social problems were the most common causes. Psychosocial problems arise due to the client himself, life companion (husband or wife) and family members who live together. So that the family system to support clients with heart failure is not awakened. Health education and promotion to clients, life companions, and family members of heart failure clients who live at home are needed when the client controls health to maintain the client"s health support system while at home. All clients and families in this study stated that the practice of nursing consultations in hospital outpatients is very helpful for clients and families to improve the situation they face. Conclusion the practice of nursing consultations can identify the problems and needs of clients and families. Strengthening the client support system for heart failure at home is needed so that psychological and social problems can be reduced when the client is in the family environment. Nursing consultation practices at outpatient hospitals are needed to help motivate clients and families in maintaining and increasing care and support for clients who suffer from heart failure while at home. Psychosocial problems The client felt anxious, lack of attention, complained sleeping difficulty, often forgot taking medicine, and forgot managing fluid intakeThe client,while at home, was fastidious and wanted to many, was difficult to be told or managed, was always suspicious with their spouse"s activity easily got angry or temperamental, the client"s child felt annoyed because the client acted annoying, the client"s spouse felt annoyed because the client was impatient and temperamentalPsychological, and social problems in heart failure patients

90 Demographics and Characteristics of Patients with Recurrent Falls Attending Tertiary Hospital Outpatients Department

Background Falls are a common cause of morbidity and mortality in older adults, with most being caused by identifiable risk factors. This study aimed to assess demographics and clinical characteristics of patients who had recurrent falls attending the medicine for the older person (MFTOP) outpatient department at a tertiary centre. Methods Retrospective analysis of patients seen at MFTOP OPD between January 2018 and December 2018. Data were obtained from clinical notes. Age, gender, blood pressure, cognitive tests, blood tests, diagnoses and medications that could contribute to falls were recorded. Results 100 patients were reviewed. 60% were female (60). Mean and median ages were 83. Causes of falls included; gait/balance disorders or weakness 36.0%, environment-related/'accident' 19.0%, alcohol 5.0%, dizziness/vertigo 5.0%, visual disorder 4.0%, confusion 4.0%, others 3.0%, drop attack 1.0%, unknown 5.0%. 18.4% (18/98) had orthostatic hypotension (OH), of which 44.4% (8/18) had low standing systolic BP <120 P=0.0205 compared to the non-OH group. Median HbA1c was 39 (30 - 83) for 80 patients 95% CI 39.5-43.4. 11.9% (11/92) had low serum sodium (<135) (95% CI 137.7-139.3). 29.0% (29/100) had impaired cognition of which 13.4% (4/29) were at risk of vitamin D deficiency P=0.5767. Other medical conditions potentially contributing to falls included; arthritis 16.0%, Parkinson’s disease 7% and incontinence 3.0%. Medications that can contribute to falls included; antihypertensive agents 67 (66.3%), tricyclic antidepressants 19 (18.8%), antianxiety agents 15 (14.9%), opiates 12 (11.9%), hypnotics/ tranquilizers 27(26.7%) and diuretics 28 (27.7%). Conclusion There is a high prevalence of co-morbidities and polypharmacy in patients with recurrent falls. Identifying modifiable causes may reduce the risk of falls in the future. Tighter glycaemic control was observed and relaxed glucose control in high-risk older adults are recommended.