Clinical audit of medical referral notes at Bangladesh Medical University Hospital

A tertiary medical college hospital in Dhaka City Corporation area, Dhaka, Bangladesh. To identify factors associated with treatment delay among tuberculosis (TB) patients referred from a public diagnostic centre to various DOTS treatment centres in Dhaka City Corporation area, Bangladesh. A cross-sectional study was conducted among 123 patients referred from the Dhaka Medical College Hospital to different DOTS treatment centres during July-October 2012. Factors associated with treatment delay (>1 day between referral and initiation of DOTS treatment) were identified. Among the 123 patients referred from the hospital, treatment delay was found to range between 2 and 17 days (median 2). In bivariate analysis, treatment delay was found to be significantly associated with the patient's diagnostic category. In multivariate analysis, World Health Organization ( WHO) Category II patients were found to be four times more likely to have treatment delay than WHO Category I patients, and married patients were much more likely to have treatment delays than unmarried patients. The study findings suggest that the main factors contributing to treatment delay among TB patients were history of previous anti-tuberculosis treatment, marital status and age. Patients should be given extensive information about the dangers of treatment delay before referring them to DOTS treatment centres.

INTRODUCTIONTransfer of care from primary to specialist mental health services almost always requires a referral by hardcopy letter or sent via a structured electronic form. The quality and content of referrals can vary, leading to delays in treatment. AIMThe aim of the research was to explore the quality and content of referral letters received by two urban New Zealand community mental health teams. METHODSA retrospective audit of 4 months’ worth of referrals (n=92) from primary care to specialist mental health services was undertaken using an audit tool created from a review of literature. RESULTSThe audit identified gaps in the information provided by referrers, including a lack of evidence of treatment in primary care before referral, risk information, information relating to physical health concerns or co-existing problems, evidence of client consent to referral, and recording of ethnicity. Thirty-seven percent of referrals were considered to be of poor quality. Compared to hardcopy letters, referrals generated by an electronic referral system were of a better quality and contained more information. More than 40% of referrals were not accepted, although the reasons for this were not assessed as part of this audit. DISCUSSIONBetter integration of primary and secondary mental health care by using electronic referral templates may reduce the number of inappropriate or incomplete referrals. Referrals from primary care to specialist mental health services vary in content and quality, with many falling below a level that specialist services can accept. This impacts on the efficacy of services and ultimately on patients’ journeys between primary and secondary care. Development of a standard referral template for use by primary care services may improve the quality of referrals.

Objective The purpose of this cross-sectional study is to determine the reasons for the delay in orthodontic treatment from the patient’s point of view. Materials and methods Thirty patients undergoing fixed orthodontic treatment participated in this cross-sectional study. A pre-structured questionnaire was divided into two parts (Part A consists of demographic details while Part B consists of treatment-related questions) is sent through email and the patient was asked to fill out the form online. The final data were expressed in percentages. Result About half of the patients faced delays in treatment. From the patient’s point of view, 36.7% of patients responded that the doctors are the cause for delay in treatment whereas 40% of patients opposed the view. 53.3% of patients followed the appointment 46.7% were satisfied with their schedule 30% were not satisfied with the appointment dates and 26.7% didn’t follow the schedule More than 80% of patients are aware that not following the appointment dates will influence their treatment plan. The discomfort felt during or after treatment prevents 30% of the patient from continuing their treatment. Post procedural instructions are followed by most of the patients - 80.3%. Conclusion Many reasons contribute to the delay in orthodontic treatment, but it all plays a minor role. Patient’s responsibility for their treatment schedule and cooperation with the doctor plays a vital role. If the patient is convenient with the appointment schedule and satisfied with the treatment plan and procedure, it becomes easier to follow the plan and overcome the delay in treatment.

Introduction : One of the safety aspects in hospitals is patient safety. Studies show that 10% of patients in hospitals suffer from medical errors and it's harmful consequences while in some cases the errors can be prevented. Clinical audit ensures us with the standards and the proper treatment. According to the importance of patient safety and the need to calculate the norms and standards we decided to do a study with the aim of clinical audit for safe surgery in Shahroud medical university′s hospitals. Materials and methods: In this descriptive study, research environment was operating rooms of Shahroud medical university's hospitals between 2015-2016. The study surgical samples were selected randomly. Data was collected with WHO surgical safety checklist in the operating room. The checklist contained three parts. The first stage (Actions before anesthesia) contained 8 phrases, the second stage (pre-cut patient's skin actions) contained 10 phrases, and the third stage (actions before patient leaving) contained 5 phrases. Validity and reliability of study tool were determined by content and face validity and Inter- rater coefficient respectively. Data were analyzed by SPSS/16. Results: 54.26% of the safe surgical standards was observed in the operating rooms of Shahroud hospitals. 76.65% of surgical safety standards before anesthesia, 53.29% after unconsciousness and before the incision and 32.86% after the wound closure until the patient out of the operating room were respected. Conclusion : Since the criteria of safe surgery is below the standards suggested by the World Health Organization, hospital managers, supervisors and operation room heads should recognize the importance of patient safety as a serious issue and necessary arrangements must be taken for safety improvement. DOI: 10.18869/MPHBS.2016.07 Â

Incomplete Specialty Referral among Children in Community Health Centers

Background: Gender plays a significant role in health-care-seeking behavior for many diseases. Delays in seeking treatment, diagnosis, and treatment for pulmonary tuberculosis (pTB) may increase the risk of transmission in the community and lead to poorer treatment outcomes and mortality. This study explores the differences in factors associated with the total delay in treatment of male and female pTB patients in Selangor, Malaysia. Methods: A cross-sectional study was conducted from January 2017 to December 2017. Newly diagnosed pTB patients (≥18 years) were recruited from selected government health clinics and hospitals in Selangor during the specified study period. An interviewer-administered questionnaire was used to collect information on sociodemographic characteristics, lifestyle, knowledge about pTB, stigma, distance to the nearest health facility, and chronology of pTB symptom onset, diagnosis, and treatment. The total delay was measured as the length of time between the onset of pTB symptoms to treatment initiation. Factors significantly associated with a longer total delay among men and women were identified using binary logistic regression. Results: A total of 732 patients (61.5% men, 38.5% women) were enrolled in the study. The median total delay was 60 days. Men who have weight loss as a symptom (AOR: 1.63, 95%CI: 1.10–2.41) and are employed (1.89, 1.15–3.11) were more likely to have a longer total delay, while those who know others who have had pTB (0.64, 0.43–0.96) were less likely to have a longer total delay. On the other hand, among women, having a stigma towards TB (0.52, 0.32–0.84) and obtaining a pTB diagnosis at the first medical consultation (0.48, 0.29–0.79) were associated with a shorter total delay. Conclusion: Factors associated with the total delay in pTB treatment were different for male and female pTB patients. Increasing awareness of pTB symptoms and the importance of seeking early medical consultation and a prompt diagnosis among the general public may reduce total delay in pTB treatment.

Healthcare providers' attitudes towards delay in cancer treatment during COVID-19 pandemic

BackgroundCancer during pregnancy is relatively rare but may lead to maternal mortality. We aimed to assess the incidence of cancer related maternal mortality and the neonatal outcome in these patients. Also, doctor- and patient-related delay in cancer diagnosis and therapy among patients with cancer related maternal mortality is assessed.MethodsMaternal mortality was defined as death during pregnancy or within 1 year after delivery. Data of the Dutch Maternal Mortality Committee was used to calculate the cancer related maternal mortality rate and to assess neonatal outcome in the Netherlands. Delay was scored by ten medical specialist based on case descriptions.ResultsCancer related maternal mortality rate was 1.23 per 100,000 live births. Delay in either diagnosis or treatment occurred in 65%. Delay in diagnosis was more frequent then delay in treatment, and was mainly caused by health care providers. Only 77% of pregnancies were ongoing, and 65% ended preterm of which 85% was induced.ConclusionsAvoiding delay in diagnosis and therapy in case of pregnancy related cancer could potentially improve maternal and neonatal outcome. It is therefore essential to increase awareness among health care providers about the occurrence and recurrence of cancer in pregnancy and the possibilities of diagnostic and therapeutic interventions in these women.

Background: The purpose of this study was to compare patient delay, diagnosis delay and treatment delay in breast cancer patients of selected public and private health centers in Tehran, Iran.Methods: In this cross-sectional study, female patients with newly diagnosed breast cancer in a public medical complex and a private breast clinic within one year were included. Patient delay was considered positive, if the interval between the detection of the first symptom by the patient and the first visit to a health care provider took longer than one month. Delay in diagnosis was defined as the period of more than one week between the first medical visit for the symptoms and the diagnosis of breast cancer. Following the confirmed diagnosis of breast malignancy, if the medical treatment was initiated later than one week, treatment delay had occurred. The potential reasons for patient, diagnosis and treatment delay according to the patients’ reports were also recorded.Results: Overall, 385 patients were included of whom 52.7% were recruited from the public hospitals and 47.3% from a private clinic. The prevalence of patient delay, diagnosis delay and treatment delay were 31.7%, 17.9% and 28.3%, respectively. Patient delay was significantly more common among patients with lower socio-economic status and those recruited from the public hospitals. All the patients with diagnosis delay were in the group recruited from the public hospitals.Conclusions: Gaps between women of different socio-economic levels of the society need to be addressed in order to decrease patient, diagnosis and treatment delay.

Clinical audit as a systematic examination of medical procedures improves the quality and outcome of patient care. The purpose of a regulatory inspection is to check and verify that the operation and facilities are in full conformance with all legal requirements. To examine the content of the clinical audits and regulatory inspections of radiological procedures and whether these overlap, and to evaluate the costs to radiological units. Clinical audits were carried out at each imaging unit of Helsinki University Hospital (HUS) Medical Imaging Center in Finland in 2004 and 2005. The regulatory inspections were carried out after the clinical audits from 2005 to late 2007. The contents of the clinical audit and inspection reports were analyzed statistically and by content analysis. The results of the audits and the inspections were compared to analyze the overlaps, differences, and costs. The validity and conditions of the safety license, lines of authority, and responsibilities for the use of radiation and patient doses caused by different examinations were evaluated in both audits and inspections. The coverage and frequency of quality control procedures were monitored in every audit and inspection, but inspectors, in addition, checked radiation output. The costs of clinical audit and inspection were under 20 cents per radiological procedure. The auditors gave 98 recommendations, while inspectors gave 62 recommendations and 25 requirements. In clinical audits most of the recommendations concerned guidelines for examining a patient. In the inspections most recommendations were in the category of quality assurance activities. The clinical audits and regulatory inspections were cheap and had few overlapping topics, but several differences were apparent: in clinical audits, a broader and deeper view of the clinical procedures was taken by comparison with good practices, while regulatory inspections have mainly verified conformance to basic regulatory requirements.

Getting the Most Out of Your Telehealth Visits

Population-based data for neonatal herpes simplex virus (HSV) infection are needed to describe disease burden and to develop and evaluate prevention strategies. From April 2006 to September 2010, routine population-based surveillance was conducted using mandated provider and laboratory reports of neonatal HSV diagnoses and test results for New York City resident infants aged ≤60 days. Case investigations, including provider interviews and review of infant and maternal medical charts and vital records, were performed. Hospital discharge data were analyzed and compared with surveillance data findings. Between April 2006 and September 2010, New York City neonatal HSV surveillance detected 76 cases, for an average incidence of 13.3/100,000 (1/7519) live births. Median annual incidence of neonatal HSV estimated from administrative data for 1997 to 2008 was 11.8/100,000. Among surveillance cases, 90.8% (69/76) were laboratory confirmed. Among these, 40.6% (28/69) were HSV-1; 39.1% (27/69) were HSV-2; and 20.3% (14/69) were untyped. The overall case-fatality rate was 17.1% (13/76). Five cases were detected among infants aged >42 days. In all, 80% (20/25) of the case-infants delivered by cesarean section were known to have obstetric interventions that could have increased risk of neonatal HSV transmission to the infant before delivery. Over half (68%, or 52/76) of all cases lacked timely or ideal diagnostics or treatment. Administrative data may be an adequate and relatively inexpensive source for assessing neonatal HSV burden, although they lack the detail and timeliness of surveillance. Prevention strategies should address HSV-1. Incubation periods might be longer than expected for neonatal HSV. Cesarean delivery might not be protective if preceded by invasive procedures. Provider education is needed to raise awareness of neonatal HSV and to assure appropriate testing and treatment.

Results reporting for clinical trials led by medical universities and university hospitals in the nordic countries was often missing or delayed.

Analysis of clinical features of non-HIV Pneumocystis jirovecii pneumonia

Background: Pelvic organ prolapse (POP) is a major reproductive health problem that severely affects women’s quality of life in several ways. Women who suffer from POP silently wait to heal from their problem without seeking care until the disease progressively worsens. Objective: The aim of this study was to assess factors associated with delay in seeking treatment among women with POP at public hospitals in Bale Zone, Southeast Ethiopia. Design: Facility-based cross-sectional study. Methods: A total of 344 study participants were enrolled at public hospitals in Bale Zone, Southeast Ethiopia, from 20 February to 20 May 2023. A consecutive sampling method was used to select the respondents. Data were collected using a pretested interviewer-administered structured questionnaire. Both bivariable and multivariable logistic regressions were used to identify the predictors of the outcome variable. Both the crude odds ratio (COR) and adjusted odds ratio (AOR) along with a 95% confidence interval (CI) were used to estimate the strength of the association between predictors and the response variable. Results: This study revealed that out of 333 participants, 76.9% (95% CI: 72.1, 81.4) were delayed in the treatment of POP. The median time of delay for POP treatments was 36 [interquartile range (IQR): 24–96] months. Being a rural resident [adjusted odds ratio (AOR) = 2.02, 95% CI: 1.23, 4.00], autonomous decision-making (AOR = 5.46, 95% CI: 2.30, 10.85), lack of support (AOR = 3.94, 95% CI: 1.64, 9.48), an embarrassment to see male health care providers (AOR = 2.04, 95% CI: 1.09, 3.81), and a lack of knowledge about successful POP treatment (AOR = 2.29, 95% CI: 1.27, 4.14) were significantly associated with delay of treatment for POP. Conclusion: A large number of women with POP did not seek health care in this study: Being in rural, autonomous decision-making, a lack of support, an embarrassment to see male health care providers, and a lack of knowledge on successful treatment were associated with treatment delay. Educating women and the community to make them aware that it is a treatable condition and encourage women’s independence in decision-making on health care services in the family will improve their quality of life.