City Public Hospital Research Articles

Sensitivity of Medicaid Claims Data for Identifying Opioid Use Disorder in Patients Admitted to 6 New York City Public Hospitals.

Behavioral health diagnoses are frequently underreported in administrative health data. For a pragmatic trial of a hospital addiction consult program, we sought to determine the sensitivity of Medicaid claims data for identifying patients with opioid use disorder (OUD). A structured review of electronic health record (EHR) data was conducted to identify patients with OUD in 6 New York City public hospitals. Cases selected for review were adults admitted to medical/surgical inpatient units who received methadone or sublingual buprenorphine in the hospital. For cases with OUD based on EHR review, we searched for the hospitalization in Medicaid claims data and examined International Classification of Diseases, Tenth Revision discharge diagnosis codes to identify opioid diagnoses (OUD, opioid poisoning, or opioid-related adverse events). Sensitivity of Medicaid claims data for capturing OUD hospitalizations was calculated using EHR review findings as the reference standard measure. Among 552 cases with OUD based on EHR review, 465 (84.2%) were found in the Medicaid claims data, of which 418 (89.9%) had an opioid discharge diagnosis. Opioid diagnoses were the primary diagnosis in 49 cases (11.7%), whereas in the remainder, they were secondary diagnoses. In this sample of hospitalized patients receiving OUD medications, Medicaid claims seem to have good sensitivity for capturing opioid diagnoses. Although the sensitivity of claims data may vary, it can potentially be a valuable source of information about OUD patients.

Maternal serum uric acid, creatinine and blood urea levels in the prediction of pre-eclampsia among pregnant women attending ANC and delivery services at Bahir Dar city public hospitals, northwest Ethiopia: A case-control study

BackgroundPre-eclampsia (PE) is a metabolic disorder that adversely affects the lives of mother and their infants. Even though, several studies have been conducted on PE, no effective diagnostic and therapeutic agents were developed so far. Hence, this study was designed to evaluate serum uric acid, blood urea and creatinine levels in the prediction of PE. MethodsA hospital-based case-control study was conducted among pregnant women. A simple random sampling technique was applied to select study participants. The socio-demographic and clinical data were collected using an interview-administered questionnaire. Serum samples were used to determine the maternal uric acid, urea and creatinine levels via an automated chemistry analyzer. Independent sample t-test, Pearson correlation test and receiver operating characteristic (ROC) curve analysis were performed to check the association and diagnostic accuracy of variables to PE. ResultsThe mean ages (in years) of the case and control groups were 27.98 ± 5.64 and 27.33 ± 4.45, respectively. The mean serum uric acid and blood urea levels were significantly higher in pre-eclamptic women than in normotensive pregnant women (6.27 ± 0.20 vs 4.43 ± 0.15, and 8.50 ± 3.99 vs 5.67 ± 2.19), respectively but the serum creatinine level is non-significantly increased in cases as compared to controls (0.70 ± 0.05 vs 0.50 ± 0.01). The areas under the ROC curve of serum uric acid, creatinine and blood urea levels were 0.785, 0.735 and 0.764 (sensitivity: 69%, 60.7%, 67.9%; specificity: 73.8%, 75%, 71.4%) with the cutoff points of ≥5.25 mg/dL, ≥0.565 mg/dL and ≥6.5 mg/dL, respectively. ConclusionIn this study, we observed a significantly higher concentration of serum uric acid and blood urea values in pre-eclampsia as compared with normotensive pregnant women. Therefore, this suggested that serum uric acid; blood urea and creatinine values can be associated with PE. Moreover, serum uric acid, blood urea and creatinine levels could be carefully utilized as a diagnostic marker for PE, but their inclusion in routine diagnostic test to PE requires large-scale multi-center prospective studies that corroborate our findings.

How Did Zero-Markup Medicines Policy Change Prescriptions in the Eyes of Patients?-A Retrospective Quasi-Experimental Analysis.

Background: China implemented the zero-markup medicines policy to reverse the overuse of medicine in public health institutions, by changing the distorted financing mechanism, which heavily relies on revenue generated from medicines. The zero-markup medicines policy was progressively implemented in city public hospitals from 2015 to 2017. Objective: This study is expected to generate convincing evidence with subjective measurements and contribute to a more comprehensive evaluation of the policy from both objective and subjective perspectives. Methods: This study was based on a large patient-level dataset with a quasi-experimental design. We employed the difference-in-difference (DID) method, combined with propensity score matching methods, to estimate the causal effect of the policy in reducing overprescriptions from the patient perspective. Results: The study estimated a statistically significant increased probability that the responded outpatients denied overprescription in their visiting hospitals. The mean interacted policy effect, in percentage points, of all observations were positive (logit DID model: 0.15, z = 10.27, SE = 0.01; PSM logit DID model: 0.15, z = 10.26, SE = 0.01; PSM logit DID hospital fixed-effect model: 0.12, z = 3.00, SE = 0.04). Discussion: The policy might reduce overprescription in public hospitals from the patient’s perspective. The patient’s attitude is one aspect of a comprehensive policy evaluation. The final concrete conclusion of the policy evaluation can only be made through a systematic review of the studies with rigorous design and with both objective and subjective measurements.

Time to first optimal glycemic control and its predictors among type 1 diabetic children in Bahir Dar city public referral hospitals, North West Ethiopia: a retrospective follow up study

BackgroundRecognizing the level of glycemic control of a client is an important measure/tool to prevent acquiring complications and risk of death from diabetes. However, the other most important variable, which is the time that the patient stayed in that poor glycemic level before reaching optimal glycemic control, has not been studied so far. Therefore, this study aim to estimate time to first optimal glycemic control and identify predictors among type 1 diabetic children in Bahir Dar city public referral hospitals, Northwest, Ethiopia, 2021.MethodsA Retrospective cohort study was conducted at Bahir Dar city public referral hospitals among a randomly selected sample of 385 patients with type 1 diabetes who were on follow up from January 1, 2016 to February30, 2021.Data were collected by using a data abstraction tool and then entered into Epi-data version 4.6 and exported into STATA 14.0 statistical software. Descriptive statistics, Kaplan Meier plots and median survival times, Log-rank test and Cox-proportional hazard regression were used for reporting the findings of this study. After performing Cox-proportional hazard regression, model goodness-of-fit and assumptions were checked. Finally, the association between independent variables and time to first optimal glycemic control in months was assessed using the multivariable Cox Proportional Hazard model and variables with a p-value < 0.05 were considered as statistically significant.ResultsMedian survival time to first optimal glycemic control among type 1 diabetic clients was 8 months (95%CI: 6.9–8.9). The first optimal glycemic achievement rate was 8.2 (95%CI: 7.2–9.2) per 100 person/month observation. Factors that affect time to first optimal glycemic control were age > 10–14 years (AHR = 0.32;95%CI = 0.19–0.55), increased weight (AHR = 0.96;95%CI = 0.94–0.99), having primary care giver (AHR = 2.09;95%CI = 1.39–3.13), insulin dose (AHR = 1.05;95%CI = 1.03–1.08), duration of diabetes ≥4 years (AHR = 0.64;95%CI = 0.44–0.94), adherence to diabetic care (AHR = 9.72;95%CI = 6.09–15.51), carbohydrate counting (AHR = 2.43;95%CI = 1.12–5.26), and comorbidity (AHR = 0.72;95%CI = 0.53–0.98).ConclusionThe median survival time to first optimal glycemic control in this study was long. Age, weight, primary care giver, insulin dose, duration of diabetes, adherence, and carbohydrate counting, including history of comorbidity were determinant factors. Giving attention for overweight and comorbid illness prevention, increasing either the dose or frequency of insulin during initial treatment; counseling parent (for both the mother and father) about adherence to diabetic care focusing on insulin drugs and how to audit their children’s diet as prescription helps to reduce the length of glycemic control.

Case Study of Intervention using Mint Leaf Aroma Therapy in Bronchial Asthma Patients

Objective: This case study was conducted to present interventions and to see the effectiveness of using mint leaf aromatherapy interventions in improving ineffective breathing problems in clients with bronchial asthma. Method: The research design used was a descriptive method with a case study approach, which included an intensive study of one unit of asthma cases with ineffective breathing patterns. Enforcement of nursing diagnoses refers to the Indonesian Nursing Diagnosis Standards (IDHS). Indonesian Nursing Intervention Standards (SIKI) and Indonesian Nursing Outcomes Standards (SLKI) The focus of the intervention in this case study was giving mint leaf aromatherapy, which was carried out for 3 days in the emergency room at the Banjar City Public Hospital. Nursing evaluations are documented using the SOAPIER method. Result: Based on the results of the study conducted on Mr. S on May 28, 2023, it was found that Mr. S was 48 years old with a medical diagnosis of bronchial asthma with a nursing problem, namely an ineffective breathing pattern associated with difficulty breathing (D.0005). After the act of giving aromatherapy for 3 days to the patient, which aims to reduce shortness of breath by widening the airways and thinning the phlegm, The results obtained in the Tn.S. patient said that it was better than before; there was no coughing up phlegm, no wheezing breath sounds, BP: 140/110 MmHg, pulse: 90x/minute, temperature: 36.5°C, RR: 23x/minute, and SpO: 99%. Conclusion: The mint leaf aromatherapy intervention has proven to be useful for increasing respiration and spo within normal limits, The benefits of this therapy will be maximized if it is carried out periodically and gradually

Determinants of severe acute malnutrition among children aged 6—23 months in bahir dar city public hospitals, Northwest Ethiopia, 2020: a case control study

BackgroundSevere acute malnutrition is a major problem among developing countries and it is one of the major causes of mortality and morbidity in Ethiopia. The impact is more severe among children aged 6–23 months. Severely malnourished children are nine times more likely to die than healthy children. Identification of the determinants of severe acute malnutrition under the age of two years can significantly reduce the burden of child morbidity and mortality. Therefore, this study was aimed to assess determinants of severe acute malnutrition among children aged 6–23 months at Bahir Dar city public hospitals, Northwest Ethiopia, 2020.MethodsInstitutional-based unmatched case–control study was conducted among a total sample size of 201 children (67 cases and 134 controls) in Felege Hiwot Comprehensive Specialized Hospital and Tibebe Ghion Specialized teaching hospital, from February 2020–March 2020. Children diagnosed with severe acute malnutrition were considered as cases and children with other problems were control groups. The study participants were randomly selected from pediatrics units in the two specialized hospitals. Data were collected using a structured pretested questionnaire through interviews and anthropometric measurements. The data were entered into Epi data version 3.1 and exported to SPSS software version 23 for analysis. Variables with (p < 0.25) in the bivariable analysis were entered into multivariable logistic regression. For multivariable analysis, a backward method was selected with a 95% confidence interval. Statistical significance was declared at P < 0.05.ResultsIn this study, 67 cases and 134 controls of children with their mothers had participated with an overall response rate of 100%. Family size > 5 [(AOR = 3.89, 95% CI:(1.19, -12.70)], average perceived birth weight [(AOR = 0.048, 95% CI: 0.015, -0.148)] and large perceived birth weight [(AOR = 0.023, 95% CI:(0.002, -0.271)], introduction of complementary feeding before six months [(AOR = 6.21, 95% CI: (1.44, -26.76)] and dietary diversity score < 5 groups [(AOR = 9.20, 95% CI; 3.40, -19.83)were significant factors associated with severe acute malnutrition.ConclusionIn this study, dietary diversity, family size, perceived birth weight, and initiation of complementary feeding were significantly associated with severe acute malnutrition. Therefore, emphasis should be given to improving infant and young child feeding practices, especially timely initiation of complementary feeding and dietary diversity.

Influence of Health Education Based on IMB on Prognosis and Self-Management Behavior of Patients with Chronic Heart Failure.

As the contemporary society is increasingly entering an aging society, heart failure, as a common disease in the elderly population, has an increasing impact on people. The common one is mainly chronic heart failure. Coupled with the influence of various complications, such as hypostatic pneumonia and venous thrombosis, the mortality and hospital admission rates of patients are very high. Moreover, the current technology is not very effective for the prevention and treatment of chronic heart failure. The per capita consumption level of ordinary people in China is low, and it is not suitable to promote high-cost treatment programs. Based on this, this paper proposes the intervention management of mental failure patients under the intervention of health education based on IMB, in order to explore the impact of the intervention of health education on patients. The research in this paper selected 112 patients with chronic heart failure who were admitted to the cardiovascular ward of a city public hospital in 2017 and divided the patients into two groups. One group received health education intervention, which was the intervention group. The other group was the control group. The control group was given routine education and nursing. The experimental results of this paper show that the satisfaction of the intervention group is higher, accounting for 85.3%, and the satisfaction of the control group is lower than that of the intervention group, about 67.9%. Dissatisfaction with health education and the probability of short-term readmission were higher than those in the intervention group.

Information seeking about COVID-19 and associated factors among chronic patients in Bahir Dar city public hospitals, Northwest Ethiopia: a cross-sectional study.

BackgroundThe health impacts of COVID-19 are not evenly distributed in societies. Chronic patients are highly affected and develop dangerous symptoms of COVID-19. Understanding their information seeking about COVID-19 may help to improve the effectiveness of public health strategies in the future, the adoption of safety measures, and minimize the spread of the pandemic. However, there is little evidence on information seeking specifically on COVID-19 in this study setting. Therefore, this study aimed to assess information seeking about COVID-19 and associated factors among chronic patients.MethodAn institutional-based cross-sectional study supplemented with qualitative data was conducted at Bahir Dar city public hospitals in Northwest Ethiopia from April 8 to June 15, 2021. A total of 423 chronic patients were selected using systematic random sampling techniques with an interval of 5. Bi-variable and multivariable logistic regression analysis was fitted to identify factors associated with information seeking about COVID-19. A p-value < 0.05 was used to declare statistical significance. Qualitative data were analyzed using a thematic approach. Finally, it was triangulated with quantitative findings.ResultThe proportion of information seeking about COVID-19 among chronic patients was 44.0% (95% CI = 39.0, 49.0). Being living in urban [AOR = 4.4, 95% CI (2.01, 9.58)], having high perceived susceptibility to COVID-19 [AOR = 3.4, 95%CI (1.98, 5.70)], having high perceived severity to COVID-19 [AOR = 1.7, 95%CI (1.04, 2.91)], having high self-efficacy to COVID-19 [AOR = 4.3, 95%CI (2.52, 7.34)], and having adequate health literacy [AOR = 1.8, 95%CI (1.10, 3.03)] were significant factors associated with information-seeking about COVID-19.ConclusionThe overall proportion of information seeking about COVID-19 among chronic patients was low. Thus, health promotion programs should emphasize the chronic patients living in a rural area; enhance perceived risk and severity of COVID-19, enhancing self-efficacy and health literacy interventions to improve information seeking.

Statin Use in Hospitalized Patients with COVID-19: A Comprehensive Analysis of the New York City Public Hospital System

IntroductionStatins have been commonly used for primary and secondary cardiovascular prevention. We hypothesized that statins may improve in-hospital outcomes for hospitalized patients with Coronavirus disease 2019 (COVID-19) due to its known anti-inflammatory effects. MethodsWe conducted a retrospective study at the largest municipal health care system in the United States, including adult patients who were hospitalized for COVID-19 between March 1 and December 1, 2020. The primary endpoint was in-hospital death. Propensity score matching was conducted to balance possible confounding variables between patients receiving statins during hospitalization (statin group) and those not receiving statins (non-statin group). Multivariate logistic regression was used to evaluate the association of statin use and other variables with in-hospital outcomes. ResultsThere were 8897 patients eligible for study enrollment, with 3359 patients in the statin group and 5538 patients in the non-statin group. After propensity score matching, both the statin and non-statin groups included 2817 patients. Multivariate logistic regression analysis showed that the statin group had a significantly lower risk of in-hospital mortality (odds ratio 0.71; 95% confidence interval, 0.63-0.80; P < .001) and mechanical ventilation (OR 0.80; 95% confidence interval, 0.71-0.90; P < .001) compared with the non-statin group. ConclusionStatin use was associated with lower likelihood of in-hospital mortality and invasive mechanical ventilation in hospitalized patients with COVID-19.

Impact of Local and Demographic Factors on Early COVID-19 Vaccine Hesitancy among Health Care Workers in New York City Public Hospitals.

Despite the development of several effective vaccines, SARS-CoV-2 continues to spread, causing serious illness among the unvaccinated. Healthcare professionals are trusted sources of information about vaccination, and therefore understanding the attitudes and beliefs of healthcare professionals regarding the vaccines is of utmost importance. We conducted a survey-based study to understand the factors affecting COVID-19 vaccine attitudes among health care professionals in NYC Health and Hospitals, at a time when the vaccine was new, and received 3759 responses. Machine learning and chi-square analyses were applied to determine the factors most predictive of vaccine hesitancy. Demographic factors, education, role at the hospital, perceptions of the pandemic itself, and location of work and residence were all found to significantly contribute to vaccine attitudes. Location of residence was examined for both borough and neighborhood, and was found to have a significant impact on vaccine receptivity. Interestingly, this borough-level data did not correspond to the number or severity of cases in the respective boroughs, indicating that local social or other influences likely have a substantial impact. Local and demographic factors should be strongly considered when preparing pro-vaccine messages or campaigns.

Nurses\u2019 attitudes towards the nursing profession and associated factors in selected public hospitals, Addis Ababa, Ethiopia, 2021: a cross-sectional study

BackgroundUnfavorable attitude toward nursing profession remaining the global issue across in the various level of health institutions attitude is the most important concept in nursing. Because of high ambiguity and role conflict in the profession.ObjectiveThis study aimed to explore nurses’ attitudes toward their profession and associated factors in selected public hospitals, Addis Ababa, Ethiopia, 2021.MethodologyInstitutional based quantitative cross- sectional study design was conducted in five randomly selected public hospitals of Addis Ababa, Ethiopia, from May to April 2021. Systematic random sampling method was used to select sample of 357 nurses working in selected hospitals. Data were collected using standard self-administer questionnaire and the collected data were entered and analyzed by using SPSS 25version. Descriptive, Bi-variate and multiple logistic regression analysis were computed to describe the association between attitude of nurses and independent variables that show P-values ≤0.05 with 95% Confidence Interval consider statistically significant factors for attitude toward professionalism.ResultsA total of 348 nurses were participated in the study, with 97.5% response rate. From this 60.6% (n = 211) of study participants were female nurses. Only 46% of nurses in Addis Ababa city public hospitals had favorable attitude towards their profession. Experienced nurses [(AOR: 1.19; 95% CI: 0.625, 13.37)], had good managerial support [(AOR: 2.40; 95% CI: 0.197, 26.702)], had ethical related training [(AOR: 1.50; 95% CI: 0.35, 6.407)], had positive image toward nursing profession [(AOR: 2.32; 95% CI: 0.166, 34.950)], who believe in our community had positive image toward nursing profession [(AOR: 4.73; 95% CI: 2.136, 88.109)] were positively associated with the overall nurses’ attitude toward their profession.ConclusionThis study offers an interesting insight about nurses’ image toward their profession and associated factors in Addis Ababa city. The overall attitude of nurses in Addis Ababa city public hospitals toward their profession was falls below the average level. Given the importance of the attitude in nursing and various factors, efforts are directed to achieve the desired level and reducing the barriers.

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The Economic Effects on Acute Care Surgery in a New York City Public Hospital During the COVID Pandemic.

Since the start of the COVID-19 pandemic, less acute care surgical procedures have been performed and consequently hospitals have experienced significant revenue loss. We aim to investigate these procedures performed before and after the start of the COVID-19 pandemic, as well as their effect on the economy. This is a retrospective analysis of patients who underwent cholecystectomies and appendectomies during March-May 2019 compared to the same time period in 2020 using Chi-square and t-tests. There were 345 patients who presented with appendicitis or cholecystitis to Elmhurst Hospital Center during the March-May 2019 and 2020 time period. There were three times as many total operations, or about 75%, in 2019 (261) compared to 2020 (84). There was a decrease in the number of admissions from 2019 to 2020 for both acute cholecystitis (149 vs 43, respectively) and acute appendicitis (112 vs 41, respectively). The largest decrease in the number of admissions in 2020 compared to 2019 was observed in April 2020 (98 vs 9, P < .01) followed by May [69 vs 20, P < .01], and March [94 vs 55, P < .01]. Corresponding to the decrease in operative patterns was a noticeable six-time reduction in revenue for the procedures in 2019 ($187,283) compared to 2020 ($30,415). We observed almost a triple reduction in the number of cholecystitis and appendicitis procedures performed during the 2020 pandemic surge as compared to the 2019 pre-pandemic data. Elmhurst hospital also experienced four times the loss of revenue during the same time period.

Practices and associated factors of infection prevention of nurses working in public and private hospitals toward COVID-19 in Bahir Dar City, Northwest Ethiopia: Institution-based cross-sectional study.

Objective:To assess the levels of practices and associated factors of infection prevention of nurses working in public and private hospitals toward coronavirus 2019 (COVID-19) in Bahir Dar City, Ethiopia.Methods:Institution-based cross-sectional study design employed in public and private hospitals in Bahir Dar city from 26 March 2021 to 8 April 2021. A total of 442 study participants were recruited using stratified followed by simple random sampling techniques. A self-administered questionnaire was prepared and pretested on 5% of the total sample. The collected data were checked for completeness and consistency, and then the data were coded, entered, and cleaned with SPSS version 25 software. Descriptive statistics were carried out to display the means and proportions of sociodemographic characteristics. Logistic regression analysis was used to assess the association between the level of prevention practices and the independent variables. An adjusted odds ratio with 95% confidence interval was used to report the results. A significant association was set at p-value <0.05.Results:Of the total 442 samples, 431 (with response rate of 97.5%) answered the questions completely. The mean (±standard deviation) age of the participants was 29.33 (±5.62) years and 217 (50.3%) were females. The proportion of good prevention practices of nurses toward COVID-19 was 39.4% (95% confidence interval: 35%–44%). Female (adjusted odds ratio = 1.77, 95% confidence interval: 1.18–2.68), have training on COVID-19 (adjusted odds ratio = 1.65, 95% confidence interval: 1.10–2.48), personal protective equipment access (adjusted odds ratio = 1.57, 95% confidence interval: 1.01–2.44), availability of infection prevention guideline (adjusted odds ratio = 1.63, 95% confidence interval: 1.06–2.49), and favorable attitude (adjusted odds ratio = 2.05, 95% confidence interval: 1.25–3.36) were factors significantly associated with good infection prevention practices.Conclusion:Most nurses in Bahir Dar City public and private hospitals had poor prevention practices against COVID-19. Training provision, infection prevention guidelines distribution, sustainable personal protective equipment access, and promotion to change their attitudes are intervention areas that required emphasis.

Sero-prevalence and associated factors of hepatitis B virus among pregnant women in Hawassa city public hospitals, Southern Ethiopia: Cross-sectional study design.

This study aimed to determine the prevalence and identify associated factors of hepatitis B virus infection among pregnant women attending antenatal care (ANC) follow-up. An institution-based cross-sectional study was conducted from March 04 to April 03, 2020. A total of 381 women were selected using systematic random sampling after every two consecutive women. Structured and interviewer administered questionnaire was used to collect the data. A 2 ml of venous blood sample was drawn from each participant. The plasma was separated from the collected blood samples and was analyzed using a rapid hepatitis B surface antigen (HBsAg) kit to determine hepatitis sero status. Data were entered into the EPI-Data version 3.1, then exported to the statistical package for social sciences version 25 software and analyzed. Multivariable logistic regression was performed to identify independent predictors of HBsAg B seroprevalence at a p-value <0.05. The prevalence of HBsAg sero-positivity among pregnant women was 6.6%, 95% CI (4.2, 8.9). History of hosptal admission (adjusted odds ratio (AOR) = 4.11; 95% CI = 1.33-12.71), surgical history (AOR = 6.8; 95% CI = 1.93-23.93), history dental procedures (AOR = 4.93; 95% CI = 1.31-18.53), and body tatoo practices (AOR = 6.822; 95% CI = 1.89-24.69) were found to be associated with HBsAg sero-positivity. This study found that HBsAg sero positivity among pregnant women in the study area was in intermediate edemicity. Factors such as history of hospital admission, history of surgery, history of dental procedures, and body tattoo practices were found to be associated with HBsAg sero-positivity. The government of Ethiopia should strengthen screening of all pregnant women for HBV as a part of routine ANC in ANC clinics and treating if they are positive to prevent mother to child transmission.

Knowledge and Practice for Prevention of Bovine Tuberculosis and Its Derivers Among HIV Positive People in Bahir Dar City Public Hospitals, Ethiopia

IntroductionBovine tuberculosis is an important zoonotic disease caused by Mycobacterium bovis, known to exist in all parts of the world especially in un-hygienic environments. It has a public health impact and humans acquire the infection from infected animals through consumption of raw or unpasteurized milk and dairy products.MethodsAn Institutional-based quantitative cross-sectional study was conducted from February to April 2020 to assess the knowledge and practice level along with their derivatives of bovine tuberculosis among adult HIV-positive people in Bahir Dar city public hospitals. The data were collected using structured interviewer questionnaire and systematic random sampling was employed to select study subjects. Thus, a total of 435 people living with HIV were considered for this study.ResultsOut of the total 435 participants 51.5% were male and the mean age was 37.6 years. The overall level of good knowledge and practice of HIV-positive persons for bovine TB were 46.2% and 41.1%, respectively. Moreover, education status, religion, cattle holding, and environmental hygiene were statistically significant associations (p < 0.05) with knowledge level. Likewise, education status, age, and marital status were statistically significant associations with the practice level for bovine TB. Education was a key determinant factor affecting both knowledge and practice.ConclusionIn conclusion, the present study showed that the level of good knowledge and practice of the participant for bovine TB was low. Hence, tailor-made training by medical and veterinary professionals on the identified risk factors is recommended.

The impact and efficiency of medical screening exams in forward treatment areas at New York City public hospitals during the initial COVID-19 surge.

BackgroundNew York City (NYC) emergency departments (EDs) experienced a surge of patients because of coronavirus disease 2019 (COVID‐19) in March 2020. NYC Health and Hospitals established rapid medical screening exams (MSE) and each hospital designated areas to perform their MSE. Five of the 11 hospitals created a forward treatment area (FTA) external to the ED to disposition patients before entering who presented with COVID‐like symptoms. Three hospitals used paper‐based, and 2 used an electronic medical record (EMR)‐based MSE. This study evaluated the effectiveness of safely discharging patients home from the FTA while also evaluating the efficiency of using paper‐based versus EMR‐based MSEs.MethodsCharts were reviewed using standardized data extraction templates. Patients discharged from the FTA were contacted by phone, and a structured interview captured additional data regarding subsequent clinical courses. Chi‐square tests were used to compare proportions of patients hospitalized, as well as proportions of patients with vital signs recorded. Mortality rates were compared with Fisher exact test. A logistic regression model with fixed effects to account for clustering at hospitals was used to compare the odds of being sent to the ED for further evaluation based on vital signs and adjusted for age and sexResultsAcross 5 EDs, 3335 patients were evaluated in their FTAs from March 17, 2020, to April 27, 2020. A total of 970 (29.1%) patients were referred for further evaluation into the ED, of which 203 (20.9%) were hospitalized and 19 (2.0%) died. Of 2302 patients discharged from the FTA, 182 (7.9%) returned to the ED within 7 days, resulting in 42 (1.8%) hospitalizations and 7 (0.3%) deaths. Facilities using EMR‐MSE discharged more patients from their FTA (81.9% vs 65.3%, P < 0.001) and had similar 7‐day return (9.3% vs 7.1%, P = 0.055) and mortality rates (0.49% vs 0.20%, P = 0.251).ConclusionMSEs in an FTA are an effective process to disposition patients safely in a high‐volume situation. Differences exist in paper‐ versus EMR‐based approaches, suggesting EMR‐MSEs provide better data, efficiency, and effectiveness. This suggests prioritizing an EMR‐based MSE should be considered in future circumstances.

HIV Diagnosis and the Clinical Course of COVID-19 Among Patients Seeking Care Within the New York City Public Hospital System During the Initial Pandemic Peak.

Reports conflict on how HIV infection influences the clinical course of COVID-19. The New York City (NYC) public hospital system provides care for over 14,000 people with HIV, was central in responding to the COVID-19 pandemic, and is therefore in a unique position to evaluate the intersection of these concurrent infections. Retrospective chart review of patients presenting to NYC Health and Hospitals (NYC H+H) diagnosed with COVID-19 infection from March 1, 2020, through April 28, 2020, compared people living with HIV (PLWH) and a propensity-matched (PM) control group of patients without HIV to evaluate associations between HIV status and COVID-19 outcomes. Two hundred thirty-four PLWH presented for COVID-19 testing and 110 (47%) were diagnosed with COVID-19. Among 17,413 patients with COVID-19 and without HIV, 1:n nearest neighbor propensity score matching identified 194 patients matched on age, sex, race, and any comorbidity. In the sample with COVID-19 (N = 304), PLWH (9.1%) had lower rates of mortality than controls [19.1%; PM odds ratio (PM-OR): 0.41, 95% confidence interval (CI): 0.19-0.86]. Among hospitalized COVID-19 patients (N = 179), HIV infection was associated with lower rates of mechanical ventilation (PM-OR: 0.31, 95% CI: 0.11-0.84) and mortality (PM-OR: 0.40, 95% CI: 0. 17-0.95). In the extended pandemic period through April 2021, aggregate data by HIV status suggested elevated hospitalization and mortality rates in PLWH versus people without HIV. These results suggest that the direct biological impacts of the HIV virus do not negatively influence COVID-19-related outcomes when controlling for comorbidity and demographic variables.

Effect of decision to delivery interval on perinatal outcomes during emergency cesarean deliveries in Ethiopia: A prospective cohort study.

BackgroundThe National guidelines of most developed countries suggest a target of 30 minutes of the decision to delivery interval for emergency cesarean section. Such guidelines may not be feasible in poorly resourced countries and busy obstetric settings. It is generally accepted that the decision to delivery interval should be kept to the minimum time achievable to prevent adverse outcomes. Therefore, this study aimed to determine the average decision to delivery interval and its effect on perinatal outcomes in emergency cesarean section.MethodsA prospective cohort study was conducted from May to July 2020 at Bahir Dar City Public Hospitals. A total of 182 participants were enrolled, and data were collected using a structured and pre-tested questionnaire. A systematic sampling technique was applied to select the study subjects. Data were cleaned and entered into Epi-Data version 4.6 and exported to SPSS version 25 software for analysis. Logistic regression analysis was performed to identify predictors of outcome variables, and variables with a p-value of <0.05 were considered statistically significant.ResultsThe average decision to delivery interval was 43.73 ±10.55 minutes. Anesthesia time [AOR = 2.1, 95%CI = (1.3–8.4)], and category of emergency cesarean section [AOR = 3, 95% CI = (2.1–11.5)] were predictors of decision to delivery interval. The prolonged decision to delivery interval had a statistically significant association with composite adverse perinatal outcomes (odds ratio [OR] = 1.8, 95% confidence interval [CI] = (1.2–6.5).ConclusionThe average decision to delivery interval was longer than the recommended time. It should always be considered an important factor contributing to perinatal outcomes. Therefore, to prevent neonatal morbidity and mortality, a time-dependent action is needed.

Did the universal zero-markup drug policy lower healthcare expenditures? Evidence from Changde, China

BackgroundThe zero-markup drug policy (also known as the universal zero-markup drug policy (UZMDP)) was implemented in stages beginning with primary healthcare facilities in 2009 and eventually encompassing city public hospitals in 2016. This policy has been a central pillar of Chinese health reforms. While the literature has examined the impacts of this policy on healthcare utilization and expenditures, a more comprehensive and detailed assessment is warranted. The purpose of this paper is to explore the impacts of the UZMDP on inpatient and outpatient visits as well as on both aggregate healthcare expenditures and its various components (including drug, diagnosis, laboratory, and medical consumables expenditures).MethodsA pre-post design was applied to a dataset extracted from the Changde Municipal Human Resource and Social Security Bureau comprising discharge data on 27,246 inpatients and encounter data on 48,282 outpatients in Changde city, Hunan province, China. The pre-UZMDP period for the city public hospitals was defined as the period from October 2015 to September 2016, while the post-UZMDP period was defined as the period from October 2016 to September 2017. Difference-in-Difference negative binomial and Tobit regression models were employed to evaluate the impacts of the UZMDP on healthcare utilization and expenditures, respectively.ResultsFour key findings flow from our assessment of the impacts of the UZMDP: first, outpatient and inpatient visits increased by 8.89 % and 9.39 %, respectively; second, average annual inpatient and outpatient drug expenditures fell by 4,349.00 CNY and 1,262.00 CNY, respectively; third, average annual expenditures on other categories of healthcare expenditures increased by 2,500.83 CNY, 417.10 CNY, 122.98 CNY, and 143.50 CNY for aggregate inpatient, inpatient diagnosis, inpatient laboratory, and outpatient medical consumables expenditures, respectively; and fourth, men and older individuals tended to have more inpatient and outpatient visits than their counterparts.ConclusionsAlthough the UZMDP was effective in reducing both inpatient and outpatient drug expenditures, it led to a sharp rise in other expenditure categories. Policy decision makers are advised to undertake efforts to contain the growth in total healthcare expenditures, in general, as well as to evaluate the offsetting effects of the policy on non-drug components of care.