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Informal caregiver burden and burnout can cause worsened outcomes of care for both the recipient of care and the caregiver’s overall health. Experiencing increased levels of distress by the caregiver may be the deciding factor for the elder remaining in the home or being placed in a long-term facility for care. Thus, healthcare professionals must be diligent in assessment for presence of a caregiver on admission, as well as identifying needs and providing education of resources within the community upon discharge. The purpose of this project is to implement admission screening for caregiver presence during the inpatient stay, with the goal of early communication to the interdisciplinary team. The project aims are as follows: a) to integrate the “Preparing for Caring” screening tool into the electronic health record, b) for nursing to provide education to the caregiver and assist with identification of needs during the inpatient stay, c) for nursing and the interdisciplinary team to collaborate with the caregiver during the inpatient stay to prepare for discharge, d) to provide education of resources available within the community upon discharge, and e) to include discussion of caregiver presence during the daily interdisciplinary team meeting. Program outcome measures will include use of aggregate data reports to determine the percentage of compliance for screening conduction, case review of identified caregivers, discharge education, and provision of a resource list upon discharge. Specified outcomes are being measured weekly during the implementation phase. As a result of the above, it will be determined if identification and subsequent intervention for informal family caregivers reduces readmission rate to an inpatient facility and the caregiver’s overall sense of burden in providing care upon discharge. Expected outcomes will be reduction in 30-day readmission to the inpatient geropsychiatry unit due to caregiver distress.

Background: Knowledge of the incidence of tuberculosis (TB) and hospitalization postpartum could reduce maternal morbidity and mortality. TB infections are prevalent in pregnant women living with Human immunodeficiency virus (HIV) compared to women not living with HIV in South Africa. Adherence to Antiretroviral Therapy (ART) is poor among pregnant and postpartum women living with HIV (WLHIV), thus making WLHIV at a higher risk of hospitalization postpartum, due to the increased risk of Cesarean delivery (CD) and obstetric conditions as a result of HIV. The prevalence of TB among pregnant and postpartum women is poorly defined including in high prevalence TB and HIV locations, indicating limited evidence. The aim is to explore the incidence of TB and hospitalization within four years postpartum among WLHIV, including associated risk factors. Methodology: The study population is from phase 2 of the Maternal and Child HealthAntiretroviral Therapy (MCH-ART) study. It is a single-arm observational cohort study of 628 WLHIV who attended antenatal care (ANC). Enrolment into phase 1 began in March 2013, the final deliveries from phase 2 were in December 2014, and the final follow-up visits were completed in 2016. MCH-ART is an ongoing study with global approval examining strategies for providing HIV care and treatment to HIV-infected women who initiate ART during pregnancy and their HIV-exposed infants. This study took place at the Midwife-Obstetric Unit (MOU) at Gugulethu Community Health Centre, Western Cape South Africa. It consists of three connected study designs and three phases through the antenatal and postnatal periods. Phase 1 is a cross-sectional study, phase 2 is a cohort study and phase 3 is a randomized trial. Kaplan-Meier survival analysis was used to assess the incidence of TB and hospitalization over time among ix WLHIV up to four years postpartum and Cox regression was used to measure the effect of risk factors on the incidence of TB and hospitalization. Results: Thirty-five (35) WLHIV developed TB postpartum at a total person-time of 2365.1 woman-years. The incidence rate (IR) of developing TB among WLHIV postpartum was 1.48 (95% CI=1.03-2.06) cases per 100 woman-years from 2013 to 2018. Twenty-three (23) WLHIV was hospitalized postpartum and a total person-time of 552.8 woman-years was spent. The IR of hospitalization among WLHIV postpartum was 4.16 (95% CI=2.64-6.24) cases per 100 womanyears from 2013 to 2018. The IR of TB and hospitalization among WLHIV postpartum is statistically significant. Adjusting, for other risk factors, the history of diabetes at ANC, the history of TB at ANC and CD4 count (200 - <500) cells/mm3 at ANC also significantly increases the incidence of TB postpartum, whereas, obstetric reasons is associated with the hospitalization of WLHIV.

INTRODUCTION: Acute severe ulcerative colitis (ASUC) is a severe complication of ulcerative colitis (UC) that is associated with significant morbidity, treatment refractoriness and need for colectomy. Patients who do not adequately respond to the initial intravenous steroid therapy receive medical rescue therapy with infliximab or cyclosporine or undergo surgery for their refractory disease. However, there is limited guidance on management of steroid responders in this setting. While it is well established that Crohn’s disease (CD) is progressive and benefits from early institution of immunosuppressive therapy, such a paradigm is less well established in UC and thresholds for therapy escalation remain poorly defined. In immunosuppression-naïve patients, whether a single hospitalization for ASUC is a sufficient threshold to escalate to immunomodulator or biologic therapy is unknown. METHODS: From a single tertiary referral center, we identified all patients with ASUC hospitalized for intravenous steroids who were immunosuppression naïve (new UC diagnosis, no therapy, or 5-aminosalicylate (5-ASA) therapy) at their index hospitalization. We excluded patients who were refractory to steroids and initiated medical rescue therapy or required surgery during the index hospitalization. Our primary exposure of interest was initiation of biologic therapy within 1 month of hospital discharge or immunomodulator therapy (thiopurine, methotrexate) within 3 months. Our primary outcomes were need for colectomy within 12 months following hospitalization. Secondary outcomes include re-hospitalization rate within 12 months and late colectomy ( between 91-365 days). RESULTS: Our study included a total of 133 immunosuppressive-naïve ASUC patients among whom 56 (42%) escalated therapy to thiopurine (93%) or biologic (7%) post-hospitalization. The median age of the cohort was 29 years (range 16 – 88 years) and 46% were male. 82 patients (62%) had pancolitis on disease distribution. 38% and 58% were noted to have moderate to severe disease on sigmoidoscopic evaluation. Thirteen patients (10%) underwent surgery by 1 year. At 12 months, there was no difference in the rate of colectomy among those with therapy escalation (13%) compared to those who did not undergo such escalation (8%, unadjusted OR= 1.69 p=0.53). This lack of difference remained robust on multivariable regression analysis and propensity score adjusted models (OR 0.90, 95% confidence interval (CI) 0.18 – 4.45). There was no difference in the rates of hospitalization within 1 year (OR 2.24 95% CI 0.16 – 4.22) or in the time to colectomy between the two groups (log-rank p=0.27). CONCLUSION: Immunosuppression-naïve ASUC patients who respond to intravenous steroids remain at high risk for colectomy with 10% (13/133) receiving such surgery within 1 year. Therapy escalation was not associated with a reduction in this risk. There is an important need for larger prospective studies defining the benefit of early therapy escalation in UC, and appropriate thresholds for the same.

Background: Groote Schuur Hospital (GSH) Division of Dermatology receives many referrals from local clinics and hospitals. Some of these patients are admitted to the dermatology wards for diagnosis and/or management. It is important to look at the spectrum and outcome of these patients who are admitted to dermatology wards at the hospital, to inform policy. Objectives: To characterise the spectrum of dermatological conditions requiring admission, to determine the outcome and to describe the factors that may influence the outcome of dermatological conditions in patients admitted to the dermatology wards at Groote Schuur Hospital in South Africa. Methods: This research employed descriptive retrospective analysis to describe the dermatology inpatients who were admitted to dermatology wards at Groote Schuur Hospital over the period January 2017 to December 2017. Results: There were a total of 120 admissions to Groote Schuur Hospital Dermatology wards in 2017. Of these, 89 (74.1%) were new admissions and 31 (25.8%) re-admissions. The most frequent diagnosis was drug reaction (27.5%), followed by psoriasis (23.3%), eczema (17.5%), and bullous disease (10%). Less common indications for admission were infections, lupus erythematosus, scabies, ulcers, pyoderma gangrenosum and cutaneous small-vessel vasculitis. The outcome of the admission was usually favorable. Conclusions: The most common diagnoses on admission were drug reactions, psoriasis, eczema, and bullous diseases. The generally favorable outcomes would support the future use of inpatient care for people with severe skin disorders.

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SAMMANFATTNING Bakgrund: Varje år insjuknar omkring 350 barn i cancer i Sverige. Cancer hos barn brukar ofta vara mer aggressiv och snabbväxande än hos vuxna. Antal cancerdiagnoser hos barn har ökat, men dödligheten i sjukdomen har minskat. Med diagnosen kommer behandlingar som innebär mycket tid på sjukhus. Vilken behandling man får skiljer sig beroende på vilken diagnos man får, men den anpassas även för barnet i fråga. Anpassad vård minskar risken för både psykologiska och fysiologiska biverkningar. Syfte: Syftet var att beskriva hur barn med cancer upplever att vårdas på sjukhus. Metod: Litteraturöversikt med deskriptiv design. 10 artiklar med kvalitativa studier valdes ut från databasen PubMed. Artiklarna granskades och fem kategorier utformades utifrån deras resultat.  Resultat: Många av barnen kände sig isolerade av att vara inlagda på sjukhus. Stöd från familj och vänner kunde hjälpa dem att känna sig mindre isolerade. Aktiviteter på sjukhuset kunde fungera som en distraktion från sjukdomen. Det kunde vara värdefullt att prata med andra i samma situation, men det kunde vara svårt att få närstående att förstå hur de kände. Medicinska ingrepp, speciellt de som involverade nålar, bidrog till en känsla av stress och lidande. Barnen kunde ta kontroll över sin situation på många sätt. En del letade information, medan andra kämpade emot vid ingrepp.  Slutsats: När barns upplevelser uppmärksammas kan vårdpersonal bättre jobba för att förbättra deras sjukhusvistelse. Sjukhusvistelsen kommer förmodligen aldrig att kunna bli helt positiv, men det finns mycket som kan bidra till att den åtminstone blir bättre. Nyckelord: Cancer, upplevelser, barn, hospitalisering / ABSTRACT Background: Each year around 350 children get diagnosed with cancer in Sweden. Cancer in children is often more aggressive and fast growing than cancer in adults. The number of cancer diagnoses in children has increased, but the mortality rate has decreased. Along with the diagnoses comes treatments that require a lot of time spent in hospitals. The treatment you get depends on the diagnoses, but also on the child in question. Personalized treatment decreases the risk of both psychological and physical side effects. Purpose: The purpose was to describe how children with cancer experience hospitalization.  Method: A literature review with descriptive design. 10 articles with qualitative studies were chosen from the database PubMed. The articles were reviewed and five categories were formed from their results.  Result: A lot of the children felt isolated whilst being hospitalized. Activities in the hospital helped serve as a distraction from their illness. Talking to others in the same situation as them could help, but it could be hard to get family to understand. Medical interventions, especially those involving needles, contributed to a feeling of stress and suffering. The children had many ways of managing these feelings. Some searched for information, others fought back during the medical interventions. Conclusion: Nursing staff have a better ability to improve the hospital stay if children's experiences are acknowledged. The hospital stay will probably never be fully positive, but there is a lot that can be done to improve it. Keywords: Cancer, experience, child, hospitalization

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