Case Record Research Articles

Postoperative Outcome And Complications Among Peritoneal Carcinomatosis Patients

Introduction: Peritoneal carcinomatosis is a recurrence pattern in gastric cancer, commonly complicating the postoperative course, especially in high-risk individuals. These complications adversely affect quality of life, increase mortality, and have immediate postoperative clinical implications. Surgery is the best treatment for early-stage tumors, despite its associated risks, including mortality. Aim: To evaluate the impact of postoperative complications on the clinical outcomes of patients undergoing peritoneal cancer surgery. Methods: This cross-sectional observational study was conducted at the National Institute of Cancer Research and Hospital, Dhaka, Bangladesh, over twenty-one months from July 2017 to March 2019. Forty-two patients were selected based on inclusion and exclusion criteria and diagnosed clinically, radiologically, and histopathologically. Data were collected using a structured case record form and analyzed using SPSS-22. Results: The mean age of participants was 66.19 ± 10.38 years, with 33.3% aged 56-65 years. The cohort included 64.3% males and 35.7% females, with 52.4%, 40.5%, and 7.1% having a BMI of 18.5-24.9 kg/m², 25- 30 kg/m², and >30 kg/m², respectively. Smoking and betel leaf use were common (61.9% and 83.3%, respectively), with 69% from the middle class. Tumors primarily involved the proximal and distal stomach, with a mean size of 6.20 ± 1.86 cm, predominantly Type 3 and Type 4, and stages T4a and N2. No metastasis was observed. Total and lower radical gastrectomies were performed, with complications occurring in 9.5% (chest infection) and 14.3% (wound infection), while 76.2% had no complications. Conclusion: Complications can serve as indicators of postoperative clinical outcomes. The findings highlight the need for systemic changes in healthcare to reduce postoperative morbidity and mortality, thereby decreasing hospital stays.

Midwives' experiences regarding recordkeeping during intrapartum care in Limpopo Province healthcare facilities.

South Africa has experienced an increase in litigations because of poor recordkeeping. The quality of maternal healthcare necessitates quality recordkeeping. All midwives' interventions should be documented in the maternity case record as an instrument to highlight the quality of intrapartum care offered. The purpose of the study was to determine and describe the experiences of midwives regarding recordkeeping during intrapartum care in Limpopo province and to make recommendations to improve recordkeeping. A qualitative, explorative and descriptive design was adopted. Midwives were selected purposively to participate in focus group discussions. Data were thematically analysed with the help of the independent transcriptionist and coder. The findings revealed the themes: perceptions of midwives regarding recordkeeping and the challenges and enablers that influence recordkeeping during intrapartum care. Quality recordkeeping requires timely, detailed, comprehensive and accurate recording. The study recommended the availability of updated guidelines, in-service training, monitoring and evaluation of recordkeeping, peer review, record auditing, proper time management among midwives and appointment of staff in line with the staffing needs of the unit to enhance recordkeeping.Contribution:Quality recordkeeping has a positive impact on the provision of quality healthcare to mothers during intrapartum care and reduces litigations related to maternity cases.

The Catalog of Procedures as Part of Recordkeeping

The Regulation of the Government of the Republic of Serbia on recordkeeping of state administration bodies, which applies to other holders of public administration bodies from 2023, adapted recordkeeping to the needs of e-administration. The designed ePisarnica (Serbian erecords centre) as a unique software solution for recordkeeping and managing centralized registry of records, and a unique system for managing documents as a separate software solution, caused a number of changes in the way of managing registries on files in regard to the so far way of recordkeeping. The catalog of procedures is a new element in office business, it is a record of all administrative and non-administrative procedures of administration bodies and entities exercising public powers. The catalog also contains a codebook of records categories with retention periods. The paper will show the development and innovations in recordkeeping and the role of the catalog of proceedings in the central record of cases with special reference to the catalog of proceedings of provincial bodies.

Juridical Analysis of the Rechterlijk Pardon Concept Implementation in Ordinary Criminal Act Associated with the Non-Retroactive Principle in Indonesian Criminal Law

At first, the regulation of the concept of rechterlijk pardon in the provisions of Indonesian criminal law was inspired by a similar arrangement in the provisions of criminal law in the Netherlands. Where the purpose of the inclusion of the concept is to avoid the rigidity that has long occurred in the practice of administering criminal law there. Such reasons are also the reasons behind the inclusion of the concept of rechterlijk pardon in the provisions of Indonesian criminal law. Although it has been more than thirty years since the concept was first discussed, until now the concept of rechterlijk pardon has only been regulated in the provisions of article 54 paragraph (2) of the Draft Criminal Code and article 70 of the Juvenile Criminal Justice System Law. However, in the practice of examining ordinary criminal cases, it turns out that there have been several district court decisions that apply the concept of rechterlijk pardon in the consideration of their decisions, including the verdict of criminal case number 1038/Pid.B/LH/ 2019/PN Pbr, criminal case verdict number 52/Pid.B/2020/PN LBB, criminal case record number 1/Pid.C/2021/PN Ttn, and criminal case verdict number 8/Pid.B/2022/PN Rtg. Even though it is known that the criminal law Indonesia adheres to a non-retroactive principle that prohibits the enactment of a statutory provision before the provision is passed. Therefore, in this article, we will discuss further about the implementation of the concept of rechterlijk pardon in each criminal case decision, which is connected with the non-retroactive principle that applies in the provisions of Indonesian criminal law.

Intensive care unit admission rates and factors associated following Autologous stem cell transplantation-real-world experience from a tertiary center in rural India.

Infectious and other complications can necessitate admission to the intensive care unit (ICU) in autologous stem cell transplantation (ASCT). Data on need for ICU care, impact of various pre- and peri-transplant characteristics on requirement of ICU care and outcomes are scarce from the developing world. A retrospective case record review of ASCT cases was conducted. Pre- and peri-transplant characteristics like infection within 4weeks of transplant, mucositis, surveillance culture positivity, peri-transplant infections, comorbidity, and time to neutrophil and platelet engraftment were noted. A total of 109 patients underwent 109 ASCTs. Most common diagnosis was the plasma cell disorder in 75 (69%) patients. Forty-eight (45%) patients had peri-transplant infections. Fifteen (14%) patients had infections with multi-drug resistant (MDR) organisms. Fifteen (14%) patients required ICU care, the most common reason being hypotension in nine patients (8.3%). Four patients (3.7%) required non-invasive ventilation, and one (0.9%) required invasive ventilation. Mortality rate was 1.8% (two patients). Factors associated with the need for ICU care were time to platelet engraftment (median 15days among those required ICU care versus 13days who did not, p = 0.04) and presence of peri-transplant infection showed a trend toward ICU care need (19% among those required ICU care versus 7% in those who did not, p = 0.05). Delayed platelet engraftment was associated with the need for ICU care and peri-transplant infections were associated with a trend toward need for ICU care.

Imaging Features Differentiating Between Cardiac Sarcomas and Hematologic Neoplasms.

The aim of the study is to assess the efficacy of computed tomography (CT) and positron emission tomography (PET)/CT findings in differentiating between cardiac sarcoma and cardiac hematologic neoplasms, which are rare but potentially lethal primary cardiac malignancies. We searched the electronic medical record for pathology-proven cases from 2012 to 2023, finding 69 patients (46 sarcomas, 23 cardiac hematologic neoplasms). Imaging features including tumor size, atrioventricular (AV) groove involvement, right coronary artery (RCA) encasement by 180°, pericardial effusion, lymphadenopathy, and metabolic activity on fluorodeoxyglucose PET were reviewed by a radiology fellow. Statistical analysis was performed using Fisher exact test and Wilcoxon test. Cardiac sarcoma patients were younger (median age 49 years) compared to patients with cardiac hematologic malignancies (66 years, P = 0.006). While tumor size and chamber involvement were similar between the 2 categories, hematologic malignancies exhibited a notable predilection for AV groove involvement (70% vs 43%, P = 0.04) and RCA encasement (52% vs 26%, P = 0.02). Pulmonary metastases were more frequent in sarcoma cases (33% vs 4%, P = 0.006). There was no significant difference in fluorodeoxyglucose uptake. Lymphadenopathy was similar between the 2 disease groups. A decision tree constructed using AV groove involvement and patient age achieved 75% accuracy in predicting the diagnosis of the mass. Overall, there is a substantial overlap in imaging features of cardiac sarcomas and hematologic malignancies involving the heart. Involvement of the AV groove and RCA encasement can allow a radiologist to favor hematologic malignancy. Ultimately, biopsy is required to establish a diagnosis.

Prehospital use of spinal precautions by emergency medical services in children and adolescents.

Limited evidence exists to guide the management of children with possible spinal injuries in the prehospital setting. As a first step to address this, we set out to describe the epidemiology and management of children <18 years presenting with possible cervical spinal injuries to EMS in Victoria, Australia. Retrospective case record review of all children with concerns of head or neck trauma and/or documented cervical spine collar use presenting to the statewide Ambulance Victoria (AV) EMS service, Victoria, Australia, between 1 July 2019 and 30 June 2020. Demographic, clinical features, mechanism of injury and spinal immobilisation practices were extracted. 2100 children were included; 61% were male and the median age was 13 years (interquartile range: 9-15). Over half of the children were transported to suburban (32.2%) and rural/regional (22.9%) EDs, with 37.5% taken to designated trauma centres. The most common mechanisms of injury were sports/activity, motor vehicle accidents and falls in 35.4%, 27.9% and 26.3%, respectively. Spinal precaution use was recorded in 93.7% of cases; cervical collar use was the most common procedure recorded (87.1%). Younger age groups were less likely to have spinal precautions initiated; 51% of children aged 0-3 years, compared to 96.3% of children aged 12 and older (odds ratio = 23.8; 95% confidence interval = 14.5-37; P < 0.001). Prehospital spinal precautions were initiated commonly in children, with use increasing with age, and most were transported to suburban, regional and rural hospitals, not trauma centres. These data will inform the integration of emerging paediatric-specific evidence into prehospital guidelines to risk stratify children.

Evaluation of health-related quality of life and adherence among pre-extensively drug-resistant tuberculosis patients receiving either Bedaquiline or Delamanid regimen at a teaching hospital in Eastern India

ABSTRACT Background: The foremost concern and challenge in managing drug-resistant tuberculosis is ensuring a high health-related quality of life (HRQoL). The effectiveness of pre-extensively drug-resistant (Pre-XDR) tuberculosis management hinges on patients adhering to therapy, a crucial factor in averting the development of drug-resistant strains, ultimately enhancing HRQoL. Methodology: This analytical longitudinal study spanned two years at a teaching hospital and involved collaboration between the Departments of Pharmacology and Pulmonary Medicine. A case record form was utilized to gather baseline data, encompassing patient demographics, medication details, WHO BREF HRQoL scores, and treatment adherence. Patients were classified as either adherent or nonadherent using three distinct criteria: the guidelines of the Revised National Tuberculosis Programme (RNTCP), the Morisky-Green-Levine Scale (MGLS), and the Batalla test. The sample size was determined based on 30% nonadherence rates from preliminary analysis of prior data, resulting in 86 patients included in the study. The association between the improvement of HRQoL score from the baseline with the predictor variables was assessed with a linear regression model. Comparison of nonadherence with the different predictors of the study population was assessed with binary logistic regression model. Results: Analysis of demographic data revealed no notable differences in age and BMI between the Bedaquiline and Delamanid groups. However, there was a gender-related difference in treatment distribution, with more men in the Bedaquiline group. Other factors, such as marital status, socioeconomic status, employment status, stigma/discrimination, comorbidity, and addiction, showed no significant differences between the groups. Comparing HRQoL scores at baseline and after six months showed substantial improvements in all domains, indicating a positive impact of the treatment. Linear regression analysis revealed a strong association between QoL improvement and adherence. Adherence patterns did not significantly differ between the two treatment groups, as assessed by various criteria. The patients with high stigma, newly diagnosed Pre-XDR cases, and the presence of adverse events had higher odds of nonadherence. Conclusion: This study highlights the substantial impact of Bedaquiline and Delamanid treatment on the HRQoL of Pre-XDR TB patients in Eastern India. Adherence to treatment plays a crucial role in improving QoL, and factors like stigma, newly diagnosed Pre-XDR patients, and adverse drug reactions influence adherence adversely. The findings emphasize the importance of patient support and education to enhance treatment outcomes.

Clinical profile of newborns admitted in Special Newborn Care Unit of a tertiary teaching hospital of Arunachal Pradesh: A Retrospective Cross Sectional Study

Introduction: The neonatal period presents the greatest daily risk of death compared to any other stage of childhood. Objective: To study the clinical profile of neonates admitted in Special Newborn Care Unit (SNCU) in a tertiary teaching hospital of a tribal area. Materials and Methods: A retrospective case record analysis of all admissions between January 2017 to December 2022 was done based on medical record data. The neonates with complete record were included in the study. Results: Total of 1476 newborns were admitted from the year 2017 to 2022 in SNCU of TRIHMS, out of which, 860 (58.3%) patients were male and 612 (41.5%) were females. 84.4% admissions were inborn and 15.6% were outborn patients. Major causes of admission were neonatal jaundice (22.4%) followed by prematurity (15.4%), neonatal sepsis (15.1%) and birth asphyxia (11.4%). The outcome rates for survival, referral, deaths and LAMA were 79.3%, 9.7%, 5.8% and 5.1% respectively. The leading causes of mortality were birth asphyxia (22.3%), prematurity (21.2%) and sepsis (11.8%). Conclusion: In our SNCU, common causes of deaths are birth asphyxia, prematurity, sepsis respiratory distress syndrome and congenital heart disease. Enhancing antennal care, improving access to healthcare facilities, ensuring timely referral of high risk cases, building capacity and providing intensive interventional management can significantly reduce neonatal mortality and its associated complications. Surveillance and training interventions for managing these causes should be established and reinforced. Keywords: Neonates, morbidity, mortality, preterm, sepsis.

Understanding Adaptive Competencies of a Woman in Her 80s: Toward the Development of Therapeutic Guidelines

This article describes the adaptive competencies of an older woman who lived well into her 80s in deprived environments, to serve as a basis for developing therapeutic guidelines for older individuals in contexts of adversities. This retrospective, instrumental case study draws on the theoretical lens offered by the person-environment-fit (PEF) framework in the context of adaptive aging. Multiple data sources (Mmogo-method 1 —a visual projective technique—interviews and extant texts) yielded textual and visual data which were analyzed to present a case record and relevant themes. Personal competencies that enabled this woman’s adaptation were industriousness, courageous and generous caring, and agency. Four types of relationships and associated competencies emerged: ancestral heritage (being rooted), peer group (mobilizing resources), intergenerational (being concerned for continuity), and spiritual (having a commitment script). Therapeutic guidelines for older women include: using a life story approach to identify the nature (flexible/rigid) of the environments and older women’s adaptive competencies; assessing the different environments (e.g. physical, relational) to determine the focus of intervention; challenging unfair social practices; and supporting older women’s agency and active participation to adapt to ‘unfit’ environments while also being aware of what additional complementary support/protection older women would need to embrace adaptive aging.

Prevalence of Hypertension and Its Associated Factors in a Rural Population of Southeastern Bangladesh

Background: More than 75% of the population live in rural area in Bangladesh and morbidity and mortality due to Non-Communicable Diseases (NCDs) has increased over the last few decades in this country. Hypertension is a significant risk factor for NCDs, specifically cardiovascular disease. This study aimed to determine hypertension prevalence and associated factors among Bangladeshi adults in rural areas. Materials and methods: This cross-sectional study was conducted in selected rural areas in the Chattogram district of Bangladesh from January 2014 to December 2014. A total of 2500 individuals aged 18 years and above were determined by a multistage sampling method. Self-reported sociodemographic and hypertension-related data were collected using a structured case record form, and blood pressure was measured. Results: The overall prevalence of hypertension was 32.5% (812/2500) [95% confidence interval (CI), 30.7-34.3] (Men: 34.4%, Women: 30.9%). The prevalence of hypertension was 21.1% and 43.6% in the £40 and &gt;40 years age group, respectively (p&lt;0.001). Hypertension had no association with the gender, educational level and monthly income of the respondents. Overall, 1268 (50.7%, 95% CI 48.8-52.7%) of the study participants had ever had their blood pressure measured. Among the 812 people with hypertension, 478 (58.9%, CI 55.5-62.2%) were aware of the disease. Of those familiar with the disease, 404 (84.5% CI 81.0-87.5%) were on treatment, and 285 (70.5%, CI 64.2-74.9%) had achieved disease control. Only 315 (38.8%, CI 35.542.2) were controlled among all people with hypertension. Conclusion: Hypertension is highly prevalent (One in three) in Bangladeshi rural adults, while awareness, treatment, and control are low. The integrated context specific program must be designed and implemented at scale through a primary healthcare approach. IAHS Medical Journal Volume 6(2) December 2023; 78-82

Correlating Cases of Soil-Transmitted Helminths and Remote Sensing Covariates: A Case Study Utilizing 2015, 2017, and 2019 Metadata of Camarines Sur, Philippines.

Soil-transmitted helminth (STH) is a group of helminths that are considered to be neglected tropical diseases (NTDs) and, globally, affect more than 1.5 to 2.6 million people yearly. Depending on the species, they can be acquired by ingesting embryonated eggs from contaminated matter or by skin penetration. Most species of STH are found in the tropics, such as the Philippines. Despite the Mass Drug Administration (MDA), the cases of STH infection continue to rise in the country. Surveys from the Research Institute of Tropical Medicine (RITM) indicate that a high prevalence of STH (Ascaris lumbricoides, Trichuris trichiura, and Necator americanus) was primarily observed in the provinces of the country, such as in Camarines Sur. To correlate remote sensing covariates such as Normalized Difference Vegetation Index (NDVI) and Normalized Difference Built-up Index (NDBI) - to STH-infected cases of the 37 municipalities of Camarines Sur. The available public health record of STH cases from 2015 to 2019 were calculated using the Quantum Geographic Information System (QGIS)and correlated using Pearson Correlation Coefficient. The results showed that infection was higher in children than adults, and A. lumbricoides caused 60% of infection. No correlation of indices with infection cases during 2015 and 2017 was observed; however, 2019 showed a moderate strength (p = 0.037) in correlation. This indicates that infection relied not mainly on vegetation and urbanization but on additional environmental factors and non-environmental variables.

Association of QRS Duration with Echocardiographic Left Ventricular Dimensions

Background: QRS duration (QRSd) is used to diagnose left bundle branch block (LBBB) and is important for determining cardiac resynchronization therapy eligibility. Others have reported associations of left bundle branch block (LBBB) and interventricular conduction delay with left ventricular (LV) systolic and diastolic dysfunction in patients without clinical HF. Individualized QRSd thresholds may improve diagnosis and intervention strategies. The goal of this study was to assess the relations of QRS duration to echocardiographic left ventricular (LV) dimensions in individuals. Methods: This was a hospital-based cross-sectional analytical study. A total of 134 purposively selected respondents were included in the study from the patients attending the outpatient or inpatient department of cardiology, Dhaka Medical College Hospital, advised for an echocardiogram. They were divided into two groups depending on their QRS complex duration (Group I≤100 ms and Group II&gt;100 ms). After taking informed written consent, a case record form was filled and Echo measurements were taken following standard procedure with confidentiality. Results: Among the respondents, the mean age was found 52.68 ± 14.24 years. The majority were male (68%), and around 1/3rd of the respondents were overweight or obese. Males were found to have less QRS duration than females (p&lt;0.001) but there was no difference in age (p=0.814) between the groups. All the risk factors considering obesity, diabetes mellitus, hypertension, family history, smoking status, and dyslipidemia were found in similar proportions in both groups (p&gt;0.05). The study found that the interventricular septum thickness and inferolateral wall thickness were higher among those having a QRS duration of more than 100 ms (Group II), but this difference was not significant (p &gt; 0.05). On the other hand, left ventricular diastolic dimension, systolic dimension, and left ventricular mass were found to be increased significantly (p&lt;0.05) with a reduction in ejection fraction in Group II (p&lt;0.05). Conclusion: Left ventricular diastolic and systolic dimensions along with left ventricular mass significantly increase according to QRS duration among the patients. Meanwhile, a reduction in ejection fraction was also evident. (Bangladesh Heart Journal 2024; 39(2): 144-150

Antibiotic Usage Pattern against COVID-19 in Patients of a Tertiary Care Hospital

The coronavirus disease of 2019 (COVID-19) emerged as a pandemic at the end of 2019. The clinical presentation of COVID-19 was comparable to bacterial infections, and due to the ambiguity of an effective treatment method, the healthcare professionals routinely used antibiotics to treat the patients. So, this study evaluated the antibiotic usage patterns at our hospitals among COVID-19 patients, considering the World Health Organization (WHO) AWaRe (Access, Watch, and Reserve) classification. The present study was a retrospective observational hospital record-based study on COVID-19 patients admitted from March-August 2020. A total of 256 COVID-19 patients were enrolled, considering inclusion and exclusion criteria. Data collection utilizing a standardized case record form to capture all information methodically based on age, sex, comorbidities, duration, and nature of the symptoms. Drug data, for example antibiotic usage patterns were collected with detailed prescription analysis, including route, dose, frequency and number of antibiotics used. A structured proforma was used to analyze data, and descriptive statistical analysis was performed and presented as Histograms. The WHO AWaRe antibiotic classification was used to determine the antibiotics’ suitability for empirical therapy. The mean age of the participants was 40.00 ± 15.46 years with male predominance, 188 (73.43%) in number, compared to females, with 68 (26.56%). Almost all the current study participants received one or more antibiotics during their hospital stay, and a maximum of the patients 126 (49.22%) received 2 antibiotics during treatment, 78 (30.47%) subjects who were managed with 3 antibiotics, and the rest, 52 (20.31%) participants received only 1 antibiotic during their hospital stay. To treat moderate to severely ill patients, the most used antibiotic was doxycycline, followed by meropenem and piperacillin/tazobactam. The findings of this study will provide baseline data that will help to generate strategies to reduce antibiotic prescriptions for the formulation of better antibiotic stewardship programs (ASP) and institutional policies to fight against any infection in a better way in the near future.

The relationship between lobar distribution and primary lung cancer histological types

Background: Lung cancer is the primary cause of cancer-related deaths globally. Accurate tumor location and subtype characterization are critical for optimizing treatment and predicting outcomes. This study aims to identify the relationship between lobar distribution and primary lung cancer histological types and describe the most recent patterns at the country-level origin. Methods: This cross-sectional study was conducted at a major tertiary care hospital in Bangladesh, including 165 patients recruited using purposive non-probability sampling. Data were collected using a semi-structured case record form and analyzed using SPSS version 28.0. Results: Tumors were most commonly found in the central area (58.2%). Squamous cell carcinoma was the most prevalent type (46.1%), followed by adenocarcinoma (38.8%), small cell carcinoma (13.9%), and large cell carcinoma (1.2%). The incidence of squamous cell carcinoma was significantly higher in the upper lobe of the right lung (55.9%) compared to other forms, particularly in the central region of the right lung (P &lt; 0.001). Squamous cell carcinoma was more common in the lower part of the left lung (42.9%), while adenocarcinoma was exclusively observed in the lingular portion of the left lung (100%). The major bronchus of the left lung primarily exhibited squamous cell carcinoma (60%), but this finding was not statistically significant (p=0.899). Conclusion: The study highlights the significant association between lobar distribution and histological types of primary lung cancer, emphasizing the need for precise tumor characterization for better treatment strategies and prognostic evaluation.

Facilitators and barriers to implementing successful exclusion among children with shiga toxin-producing Escherichia coli: a qualitative analysis of public health case management records

BackgroundShiga toxin-producing Escherichia coli (STEC) infections are a significant public health concern as they can cause serious illness and outbreaks. In England, STEC incidence is highest among children and guidance recommends that children under six diagnosed with STEC are excluded from childcare until two consecutive stool cultures are negative. We aimed to describe the barriers and facilitators to implementing exclusion and the impact of exclusion policies on young children and their families.MethodsIndividual level data was obtained from a wider study focusing on shedding duration among STEC cases aged < 6 years between March 2018 – March 2022. Data was extracted from England’s public health case management system. The case management system includes notes on telephone conversations, email correspondence and meeting minutes relating to the case. Collected data consisted of free text in three forms: (1) quotes from parents, either direct or indirect, (2) direct quotes from the case record by health protection practitioners or environmental health officers, and (3) summaries by the data collector after reviewing the entire case record. We analysed free text comments linked to 136 cases using thematic analysis with a framework approach.ResultsThe median age of included cases was 3 years (IQR 1.5-5), with males accounting for 49%. Nine key themes were identified. Five themes focused on barriers to managing exclusion, including (i) financial losses, (ii) challenges with communication, engagement and collaboration, (iii) issues with sampling, processing, and results, (iv) adverse impact on children and their families and (v) conflicting exclusion advice. Four themes related to facilitators to exclusion, including (i) good communication with parents and childcare settings, (ii) support with childcare, (iii) improvements to sampling, testing, and reporting of results, and (iv) provision of supervised control measures.ConclusionsQualitative analysis of public health case records can provide evidence-based insights around complex health protection issues to inform public health guidelines. Our analysis highlights the importance of considering wider social and economic consequences of exclusion when developing policies and practices for the management of STEC in children.

Impact of team performance on the surgical safety checklist on patient outcomes: an operating room black box analysis.

Surgical safety checklists reduce adverse events, but monitoring adherence to checklists is confounded by observation bias. The ORBB platform can monitor checklist compliance and correlate compliance with outcomes. This study aims to evaluate the association between checklist compliance and patient outcomes using the ORBB platform. This is a retrospective analysis of data from the electronic medical record of cases performed in ORBB-equipped operating rooms at a single quaternary referral center. All patients who did not opt out and underwent surgery at UT Southwestern Medical Center in ORBB-equipped rooms from August 2020 to September 2022 were included. The ORBB platform was set-up in five operating rooms and surgical safety checklist compliance was monitored by way of AI-based video review. Overall, 4581 patients were included in this analysis.. Performance on the checklist was associated with lower mortality (OR, 0.96; 95% CI, 0.94-0.98; P < 0.05), and decreased length of stay (estimate [E]: -0.02days; 95% CI, -0.03 to -0.005; P < 0.05). Performance during "timeouts" was associated with mortality (OR, 0.97; 95% CI, 0.94-0.99; P < 0.05). "Debriefings" were independently associated with mortality (OR, 0.98; 95% CI, 0.96-0.99; P < 0.05), length of stay (Estimate, -0.0009days; 95% CI, -0.02 to -0.001; P < 0.05), and ICU admission (OR, 0.99; 95% CI, 0.98-0.99; P < 0.05). Procedures performed by surgical teams who performed better on the surgical safety checklist tended to have better outcomes. This innovative technology could substantially enhance our ability to understand and mitigate threats to patients in real-time.

Automated Versus Semi-Automated Lab Value Extraction for the VA Cardiac Surgical Quality Improvement Program

IntroductionThe Veterans Affairs Surgical Quality Improvement Program (VASQIP) trains surgical quality nurses (SQNs) at each Veterans Affairs (VA) hospital to extract or verify 187 variables from the medical record for all cardiac surgical cases. For ten preoperative laboratory values, VASQIP has a semiautomated (SA) system in which local lab values are automatically extracted, verified by SQNs, and lab values recorded at other VA facilities are manually extracted. The objective of this study was to develop and validate a method to automate the extraction of these ten preoperative laboratory values and compare results with the current SA method. Materials and methodsWe developed methods to extract ten preoperative laboratory values and measurement dates from the VA Corporate Data Warehouse using Logical Observation Identifiers Names and Codes. Automated (A) versus SA information extraction was compared in terms of agreement, conformance to data definitions, proximity to surgery, and missingness. ResultsFor surgeries with both A and SA lab values, the intraclass correlation coefficients for the ten variables ranged from 0.90 to 0.98. For several variables, the A method resulted in much lower rates of missing data (e.g., 2.4% versus 22.5% missing data for high-density lipoprotein) and eliminated out-of-date-range entries. ConclusionsAlthough SQN-extracted data are widely considered the gold standard within National Surgical Quality Improvement Programs, there may be advantages to fully automating extraction of lab values, including high congruence with SA SQN-extracted or verified values and lower rates of missingness and out-of-date-range data.

Clinical and Audiological Outcome of Surgical Treatment in Patients with Adenoid Hypertrophy

Background: Adenoid hypertrophy is a common condition in childhood, which may be associated with recurring acute otitis media, otitis media with effusion (OME), and obstructive sleep apnoea syndrome. There is close relationship between adenoids and possible middle ear pathology leading to conductive deafness. Objective: To find out the outcome of surgery regarding clinical features and hearing status in children with adenoids. Methods: This hospital based prospective study was conducted at the Department of Otolaryngology&amp; Head-Neck Surgery, Shaheed Suhrawardy Medical College &amp; Hospital, for a period of 6 months following approval from IRB. Patients having enlarged adenoids with or without OME of 3-12 years and both sex group were approached for inclusion of the study. Informed written consent was taken from the guardian. Proper surgical intervention was chosen according to condition of the child. Before and after intervention, data were collected by the researcher himself. Data were recorded into the case record form. Following collection, data were analyzed by the SPSS 26 (SPSS Inc, Chicago, IL, USA). Results: Among 100 patients, 66% were males and 34% were females. Mean age was 7.2±2.34 SD (years). Of all, 60% underwent adenoidectomy (AT), 20% underwent adenoidectomy with myringotomy (AM), and remaining 20% underwent adenoidectomy with myringotomy with grommet insertion (AMG). The PTA findings (baseline) of adenoidectomy, adenoidectomy with myringotomy, and adenoidectomy with myringotomy with grommet insertion group were 15.466±1.395, 37.8±3.349 and 38.2±3.548 db, respectively. Similarly, significant improvement was noticed in all of the three groups as evidenced by PTA value in three groups were 11.91±1.12, 18.65±.933 and 17.45±1.31 db, respectively (p&lt;0.05). Improvements in PTA among different groups also showed significant changes following operation (p&lt;0.05). Conclusion: Clinical improvement are noticed following surgical intervention in both ............

Retrospective Observational Analysis of Tocilizumab Outcomes in COVID-19 Patients at a Tertiary Care Hospital

Background: Tocilizumab (TCZ), a monoclonal antibody against interleukin-6 (IL-6), was recommended for treatment of Covid-19 patients with a risk of cytokine storm but showed variable effect on outcome. The aim was to assess the association of outcome following tocilizumab administration with various physiological, pathological and pharmacological factor in Covid- 19 patients Methods: Retrospective observational study from June 2020 to July 2020. All indoor Covid positive patients who received tocilizumab were included and relevant information was captured in the case record form. Data was analyzed to the study association of various physiological factors, comorbidities, severity of disease, laboratory parameters and co-administered drugs with the outcome following tocilizumab administration. Results: Total 25 patients received tocilizumab during study period. Older age group (p=0.001), high NEWS score, hypertension (OR: 3.62; p=0.05) and hydroxychloroquine(HCQ) administration (OP=6.66; p=0.009) showed significant association with a worst outcome. Hypertension and hydroxychloroquine usage was analyzed after adjustment with NEWS score using MH adjusted analysis, which revealed a trend of worst outcome in HCQ recipients but the association was not significant with hypertension. High pre-treatment IL-6 (death 570.11+498.76; discharge110.31+ 49.68; p: 0.0011); high post-treatment ferritin level (death 1756.5+ 1622.03; discharge 711.71+ 421.23; p: 0.019) as well as post-tocilizumab rise in ferritin level was associated with worst outcome (p= 0.029). Conclusion: Participants having higher cytokine level/or high NEWS score were unlikely to benefit from tocilizumab. Increased in ferritin level even after tocilizumab appeared to be an indicator of failure of treatment.