Department Of Tertiary Hospital Research Articles

Analysis and countermeasures on the correlation between self-efficacy and occupational burnout in nurses of emergency departments in tertiary hospitals

Objective: To understand the current status of self-efficacy in nurses working in the emergency department of tertiary hospitals in a prefecture-level city and to explore the correlation between self-efficacy and occupational burnout. Methods: A questionnaire survey was conducted with 140 registered nurses working in the emergency departments of seven tertiary hospitals in a certain city using a general information survey, the General Self-Efficacy Scale, and the Maslach Burnout Inventory. Descriptive analysis, univariate analysis, and correlation analysis were performed to analyze the data. Results: A total of 136 valid questionnaires were collected (97.14%). The average score for general self-efficacy was (2.62 0.53), indicating a moderate level. The scores for the various dimensions of occupational burnout in emergency department nurses were as follows: Emotional Exhaustion (26.61 10.87), Depersonalization (12.06 6.67), indicating severe burnout; Personal Accomplishment (40.64 9.95), indicating mild burnout. The self-efficacy score of emergency department nurses was negatively correlated with emotional exhaustion and depersonalization (P < 0.01) and positively correlated with personal accomplishment (P < 0.02). Conclusion: Occupational burnout in emergency department nurses should be addressed, and improving their self-efficacy can help reduce burnout.

Clip Myringoplasty.

Perforations of the tympanic membrane result mainly from otitis media or trauma, and we need grafting when a perforation is chronically persistent to prevent recurring infections and to enhance hearing. In the present study, we assessed the success rate, feasibility, and efficacy of endoscopic transcanal tympanoplasty using tragal cartilage grafts via the clip technique. This prospective study was performed between September 2017 and December 2021 and was conducted in ENT departments in tertiary hospitals. Forty patients underwent endoscopic clip technique tragal cartilage type 1 tympanoplasty. Patients with dry (for 3 months at least) small (less than 3 mm), medium (3-5 mm), or large (more than 5 mm) central perforations but not marginal perforations. TM perforation healing following the procedure for 6 months was achieved in 100% of the patients with small perforations, 18 of 19 (94.73%) with medium perforations and 11 of 12 (91.6%) with large perforations. At 6 months post-surgery, hearing improvement, as confirmed by audiometric results, was approximately 12.41 ± 1.01 dB. There was a highly significant improvement in the A-B gap (air-bone gap). Endoscopic chondro-perichondrial tragal graft with the clip technique for the repair of small-, medium-, and large-sized nonmarginal TM perforations is a minimally invasive, safe and effective technique compared with the conventional myringoplasty technique. It provided good results (closure of both the perforation and the air-bone gap), minimized morbidity, reduced the operative time, increased patient compliance, and reduced the duration of hospital admission.

Health professionals’ cardiopulmonary resuscitation capability at emergency departments in tertiary hospitals, Addis Ababa, Ethiopia, 2022

BackgroundImmediate and efficient Cardiopulmonary resuscitation (CPR) increases both survival rate and post-arrest quality of life. Continual updated knowledge and practices of healthcare professionals regarding cardiopulmonary resuscitation were crucial to save lives. In limited resource countries like Ethiopia, there is scarce data describing the basic knowledge and practice of CPR among Healthcare providers (HCP).ObjectivesTo assess health care professionals’ knowledge, practice, and associated factors toward CPR.MethodsInstitutional-based descriptive survey study design was used. The study was conducted from March to April 2022 in Addis Ababa Ethiopia, A total of 163 individuals were randomly selected from Tikur Anbesa Hospital. St. Paul’s Hospital and Yekatit 12 Hospital. The data was collected using a pre-tested structured questionnaire. The descriptive statistics frequency, percentage, median, and range were computed. Inferential statistics Bivariate and multivariate logistic regression were analyzed. Ethical approval was received from the Institutional Review Board.ResultOut of 162 respondents, 81(50%) were nurses followed by 59 (36.4%) residents. The participants’ ages ranged from 24 to 49 years, median age of 29 years. More than half, 89(54.9%) of participants were female. Ninety (55.6%) participants had good knowledge of CPR. The majority of 126(79.6%) responded correctly about chest compression. Occupation type (AOR = 3.15, 95% CI 1.193–5.834) and participating in mock (AOR = 8.33, 95% CI 1.53–45.45) were associated with knowledge of health care professionals, Routinely reviewing data (COR = 3.3, 95% CI 1.41–7.82), and time of participating in mock codes (COR = 5.05, 95% CI 1.43–17.85) were associated with practice of health care professionals.ConclusionIn conclusion, the level of knowledge and practice of health professionals towards CPR was suboptimal. Having a higher educational level and participating in mock codes were associated with good knowledge, whereas gender, routinely reviewing the data, and participating in mock codes were associated with good practice. Therefore; healthcare professionals must continuously improve their knowledge and skills in CPR for the sake of professionalism and patient safety.

Epidemiological, clinical and psychological aspects of victims of female child sexual abuse in the gynaecology and obstetrics department of tertiary hospital, Karnataka

Child sexual abuse is an alarming reality that although is recognized as a serious violation of human well-being and of the law often goes unreported or overlooked. The present study was planned to identify the clinic-social profile of victims of child sexual abuse, circumstances under which these heinous crimes have occurred and study the psychological status of the victims. A retrospective record-based study from January 1, 2017 to December 31, 2021 conducted in a tertiary care hospital of north Karnataka, India. All the female patients aged less than 18 years admitted during our investigation period who were victims of child sexual abuse were included in the study. All case reports obtained from the medical record division and fulfilling the inclusion criteria were scrutinized by the authors for completeness of data. The data was entered in MS excel master sheet and statistical analysis was performed using SPSS software version 22. A total of 158 victims of female child sexual abuse were documented in our centre. The age of the victims ranged from 1 to 17 years and that of abusers varied from 15 years to 75 years. For most incidents, the offenders were known to the victims. The highest incidence of sexual assault was reported in abusers’ home, followed by victim’s home. Majority of the female children were abused multiple times (45.6%). There is an urgent need for comprehensive prevention programs, awareness campaigns, accessible support services, public awareness campaigns and legal enhancements to address CSA effectively in schools and communities that educate children on recognizing and reporting abuse.

A National survey describing the quality of care in Paediatric Emergency Departments of Tertiary Hospitals in Nigeria

A National survey describing the quality of care in Paediatric Emergency Departments of Tertiary Hospitals in Nigeria

The Impact of Caregiver Support on Symptom Improvement in Post-Stroke Patients

The Impact of Caregiver Support on Symptom Improvement in Post-Stroke Patients

Need for the dedicated emergency department in health care services; Postgraduate doctors’ perspective.

Objective: To explore the perspectives of post graduate residents working on emergency floor about the need of dedicated emergency department in healthcare department. Study Design: Qualitative Exploratory study. Setting: Allied Hospital, Faisalabad (AHF), Pakistan A Tertiary Care Public Sector Hospital in Punjab. Period: January 10, 2024, to January 30th, 2024. Material & Methods: Post-graduate residents of surgery and medicine department were included in study and interviews were conducted after taking their consent till the data saturation. Total 18 interviews were recorded and then transcribed. Thematic narrative analysis was performed. Results: Out of 18 participants, 14 (77.7%) were males while 4(22.2%) were females. From surgical floor, 8 Residents participated in the study out of which 1 (12.5%) was female and 7 (87.5%) were males while 10 residents participated from medical floor out of which 3 (30%) were females and 7(70%) were males. Theme 1: The problems faced on the emergency floor: All the participants agreed that the working condition of emergency floor is quite hectic and stressful. With sub themes (1a) Over-burdened emergency of tertiary care centers: 1b) Faulty Referral system: (1c) Patient interactions: (1d) Lack of facilities: (1e) Guidance & facilitation center: Theme 2: Dedicated Emergency Department: The Participants when asked about their suggestions regarding improvement of working condition at emergency floor, they all had a clear idea of establishment of a dedicated emergency department with specially trained and recruited staff for this purpose. With subthemes (2a) Filtration clinics: (2b) Rotational Duties: (2c) Proper Training: (2d) Public Awareness. Conclusion: The emergency departments in tertiary hospitals should be a separate department with dedicated staff, proper triage system and adequate facilities to deal with the critical patients.

The acceptance of traditional Chinese medicine among patients with Parkinson’s disease: A hospital survey

ObjectiveThe efficacy of medications for Parkinson’s disease (PD) tend to decline over time, which has a serious impact on patients’ health and quality of life. To some extent, traditional Chinese medicine (TCM) can resolve the distressing problem of ineffective dopaminergic medication in PD patients. The purpose of this study was to investigate the attitude, acceptance, and independent predictors of TCM in PD patients admitted to the outpatient department of a tertiary hospital. MethodsA cross-sectional study of PD patients was conducted in the outpatient department of a large tertiary hospital in Beijing from March 2022 to June 2023. A self-report questionnaire was developed to investigate PD patients’ attitudes and acceptance of TCM based on the questionnaire. Multivariate logistic regression analyses were also performed to further clarify the independent predictors influencing patients’ adoption of TCM therapy. ResultsA total of 397 patients completed the questionnaire, of which 78.09% were willing to be treated with TCM and 21.91% indicated that they were not willing to use TCM. Multifactorial logistic regression analysis showed that several parameters were correlated with a patient’s willingness to include TCM in their therapeutic regime. These included education level of a bachelor’s degree (odds ratio [OR) = 8.554; 95% confidence interval [CI]: 4.112–17.794; P < 0.001, vs junior high school education), living in an urban setting (OR = 8.022; 95% CI: 4.577–14.060; P < 0.001, vs rural), having other underlying diseases (OR = 5.126; 95% CI: 3.078–8.537; P < 0.001, vs none), having previously used TCM (OR = 3.083; 95% CI: 1.852–5.134; P < 0.001, vs not used), believing that TCM therapy is safe (OR = 3.530; 95% CI: 1.446–8.616; P = 0.006, vs not thought), believing that TCM therapy is effective (OR = 3.859; 95% CI: 1.482–10.047; P = 0.006, vs not understood), and being willing to discuss ongoing TCM therapy with an attending physician (OR = 62.468; 95% CI: 30.350–128.574; P < 0.001, vs not informed). ConclusionThis study initially investigated the acceptance, attitude, and independent predictors of TCM use among PD patients. To expand the prevalence of TCM use among patients with PD, we recommend to broadening the public outreach for TCM via contemporary means of Internet and broadcast communication, enhancing access to TCM services in rural communities, and strengthening the communication between doctors and patients.Please cite this article as: Wang P, Hong J, Tang ZQ, Gong BZ, Qi XR, Jiang H, Pan B, Chen Q. The acceptance of traditional Chinese medicine among patients with Parkinson’s disease: A hospital survey. J Integr Med. 2024; 22(2): 180–187.

Ethical Awareness and Practices Among Emergency Department Personnel in Riyadh's Tertiary Hospitals: A Cross-Sectional Analysis.

Ethical dilemmas in healthcare, particularly in emergency medical services (EMS), present significant challenges for healthcare workers (HCWs), necessitating a profound understanding of ethics and decision-making. This study assesses the ethical awareness and practices among HCWs in emergency departments of tertiary hospitals in Saudi Arabia, aiming to identify areas of strength and opportunities for improvement. A cross-sectional survey was conducted among 256 HCWs, including physicians, nurses, and administrative staff, in emergency departments across tertiary hospitals in Riyadh, Saudi Arabia. The questionnaire evaluated participants' knowledge of healthcare ethics, their experiences with ethical dilemmas, and the sources from which they derived their ethical understanding. The majority of participants exhibited a commendable level of ethical knowledge and practice, with frequent encounters of ethical or legal issues highlighting the pervasive nature of ethical challenges in emergency healthcare settings. Key sources of ethical knowledge included experiential learning and academic lectures, with a notable emphasis on practical experience. Despite the satisfactory level of ethical awareness, areas requiring further educational focus were identified, emphasizing the need for enhanced ethics training tailored to the emergency medical context. The findings underline the critical importance of incorporating ethics into the core of healthcare education and ongoing professional development for HCWs. Establishing a culture of continuous ethical dialogue and learning is essential for fostering patient-centered care and making informed ethical decisions in the fast-paced environment of emergency services. The study advocates for revising current ethics training programs to ensure they are comprehensive, relevant, and accessible, preparing HCWs to effectively address both current and future ethical challenges.

Configurations associated with the efficiency of the ophthalmology departments in public hospitals of Central South China.

Improving the efficiency of ophthalmology service is a global challenge to fight vision impairment, yet there is little concrete evidence of the current efficiency status. This study aimed to examine the efficiency of ophthalmology departments in the Hunan Province, China, and determine the associating factors of low-efficiency and high-efficiency ophthalmology departments. This cross-sectional study included a province-level survey of ophthalmology departments of public hospitals. All the ophthalmology departments of public hospitals in Hunan Province were invited to complete an online survey on ophthalmic competence resources. Bootstrap Data Envelopment Analysis was conducted to describe the service efficiency status of the ophthalmology departments using Maxdea (version 8.0) software. Then, we employed Fuzzy Set-Qualitative Comparative Analysis to explore the recipes of low-efficiency and high-efficiency ophthalmology departments using Fs-QCA (version 3.0) software. One hundred and ninety-five ophthalmology departments (87 in tertiary and 108 in secondary public hospitals) completed the survey. The mean efficiency score was 0.78 for ophthalmology departments in tertiary hospitals and 0.82 for secondary hospitals. The number of ophthalmologists and equipment positively contributed to the efficiency of ophthalmology departments in tertiary and secondary hospitals. While increasing the bed capacity was not always beneficial to improving the efficiency of ophthalmology departments in secondary hospitals. For ophthalmology departments in tertiary hospitals, simply increasing the number of nurses did not universally increase efficiency unless there were enough ophthalmologists and equipment to support the nurses' work. This study also revealed 2 configurations for ophthalmology departments in secondary hospitals and 5 configurations for those in tertiary hospitals that could guide their efficiency improvement efforts. Moderate efficiency levels in ophthalmology departments at both tertiary and secondary hospitals were found. Prioritizing the number of ophthalmologists and equipment was recommended to achieve high efficiency for ophthalmology departments in tertiary and secondary hospitals. We also proposed that blindly increasing the number of beds and nurses was meaningless, and ophthalmology departments should flex the bed capacity and number of nurses after premising having high numbers of ophthalmologists and equipment.

Characteristics and direct causes of death in severely ill patients admitted to a neurology department.

The study aimed to analyze the characteristics of patients admitted to the neurology department of a tertiary hospital who subsequently died, focusing on those with high disease severity. We conducted a retrospective cohort study of patients who died among those admitted to the neurology department of a regional tertiary hospital from 2013 to 2021. Clinical, radiological, and laboratory results of the included patients were collected, and their primary diagnoses, duration from time of admission to death, and direct causes of death were analyzed. Furthermore, the patients were categorized into subgroups based on sex (male and female), primary diagnosis (ischemic and non-ischemic stroke), and cancer diagnosis for comparative analysis. Of 187 deaths, the primary diagnoses were ischemic stroke (131 cases), seizures (19 cases), encephalitis and encephalopathy (18 cases), and other conditions (19 cases). The direct causes of death included ischemic stroke in 68 patients, sepsis in 33, cerebral hemorrhage in 19, pneumonia in 15, acute kidney injury in nine, status epilepticus in seven, and other causes in 36. Pneumonia, cerebral hemorrhage, acute kidney injury, and status epilepticus were the more prevalent direct causes of death in men, whereas ischemic stroke and sepsis were more prevalent in women. Additionally, sepsis, pneumonia, acute kidney injury, and status epilepticus, as direct causes of death, were significantly higher among patients with a primary diagnosis of non-ischemic stroke than among those with a primary diagnosis of ischemic stroke. Furthermore, there were differences in some pre-existing diseases and laboratory findings when comparing between the cancer group and the non-cancer group. Ischemic stroke was the primary diagnosis and direct cause of death in a high proportion of patients. Other noteworthy direct causes of death were cerebral hemorrhage and infections such as sepsis and pneumonia. Based on these findings, the characteristics and prognoses of patients admitted to neurology departments can be predicted and used for management.

Perceived Causes and Effects of Overcrowding Among Nurses in the Emergency Departments of Tertiary Hospitals: A Multicenter Study.

Emergency department (ED) overcrowding is a significant concern in many hospitals in Saudi Arabia, resulting in long waiting times, delays in treating patients who need urgent care, and, consequently, decreased patient satisfaction. Additionally, ED overcrowding has been linked to increased nurse turnover rates. Therefore, this study aimed to assess nurses' perceived causes and effects of overcrowding in the EDs of five tertiary hospitals in Saudi Arabia. This study used a descriptive cross-sectional design. We surveyed 311 nurses working in the EDs of five tertiary hospitals in Saudi Arabia using the convenience sampling technique. The self-administered questionnaires used in the study were developed by the researchers. The study was conducted from October 16 to November 10, 2022. Consensus-Based Checklist for Reporting of Survey Studies was followed. The results revealed that the primary perceived causes of ED overcrowding in five tertiary hospitals were unnecessary visits due to a lack of standard procedures (mean = 2.70; SD = 0.58) and lack of inpatients beds (mean = 2.69; SD = 0.65). The perceived effect of overcrowding was stress and burnout among nurses (mean = 2.85; SD = 0.47). The perceived causes and effects of overcrowding in the ED were found to be highly significant (p <0.001) based on Pearson correlation and Spearman's rank correlation. Unnecessary visits due to a lack of standard procedures lead to overcrowding. In addition, a lack of inpatient beds in the ED affects the care provided to patients seeking immediate medical attention. This may prolong patient waiting time, causing their conditions to deteriorate and prolonging hospital stay. Overcrowding leads to increased stress and burnout among nurses. The results of this study can be used to develop a comprehensive action plan to address ED overcrowding and its effects on patients, staff, and ED flow.

Exploring the needs and coping strategies of family caregivers taking care of dying patients at home: a field study

BackgroundMost Chinese patients chose to die at home, therefore there is a reliance on the family caregivers to be involved in their palliative care. The needs and coping strategies of family caregivers in home-based palliative care are rooted in culture. Little is known about the needs and coping strategies of family caregivers taking care of dying patients at home.MethodsA field study using semi-structured interview, participant observation, documents and records collection was employed. The study was conducted in two palliative care outpatient departments in tertiary hospitals and four communities in Beijing, China from March 2021 to July 2022. Using purposive sampling, twenty-five family caregivers were recruited. All collected data were analyzed using content analysis approach.ResultsFive themes emerged, including three care needs and two coping strategies. Family caregivers need to learn care skills and acquire care resources, including (i) decision-making about home-based palliative care, (ii) improving patient’s quality of life, and (iii) signs of final hours and funeral procedures. In facing the care burden, family caregivers coped by (iv) balancing the roles of caregivers and individuals: giving priority to patient care while maintaining their own normal life. In facing the death of a loved one, family caregivers responded by (v) making room for coming death by facing death indirectly and “rescuing” patients for consolation while preparing for the coming death.ConclusionFamily caregivers strive to balance the roles of being caregivers and being themselves. As caregivers, they actively prepare patients for good death with no regrets. As individuals, they preserve themselves from being hurt to maintain normal life. The needs of family caregivers focus on caregiver role and are manifested in care skills and resources.Trial registrationNot registered.

Perceived organizational support, self-efficacy and cognitive reappraisal on resilience in emergency nurses who sustained workplace violence: A mediation analysis.

The aims of this study were as follows: (a) to examine the relationship between perceived organizational support and resilience; (b) to investigate the potential mediating role of general self-efficacy and cognitive reappraisal among emergency nurses who have experienced workplace violence; and (c) to explore the application of Kumpfer's resilience framework to emergency department nurses. A cross-sectional study. From February 17, 2021, to March 8, 2021, 825 emergency nurses working in the emergency departments of tertiary hospitals in Shanghai, China, completed an online survey. Data on resilience, organizational support, cognitive reappraisal and general self-efficacy were collected through questionnaires. The Spearman analysis was employed to investigate the relationship between variables, while the mediation analysis was conducted using AMOS 23.0 statistical software. The findings of a study involving 825 emergency nurses who reported experiencing workplace violence reveal a positive correlation between perceived organizational support and resilience. Additionally, it has been observed that the relationship between these two factors is mediated by both cognitive reappraisal and general self-efficacy. Furthermore, the mediating effect of cognitive reappraisal is more significant in this relationship. Kumpfer's resilience framework is found to apply to emergency nurses. Perceived organizational support, an environmental factor, affects resilience directly and positively. In addition, cognitive reappraisal and general self-efficacy, which are individual factors, mediate this influence path. These findings suggest an interaction between environmental and individual factors in determining the resilience of emergency nurses. These findings have implications for developing resilience intervention strategies for emergency nurses exposed to occupational violence. Enhancing personal attributes such as general self-efficacy and cognitive reappraisal is as significant as strengthening external organizational support environments for enhancing nurses' resilience. Emergency nurses participated in the pilot test of our questionnaire survey and gave their opinions on the questionnaire design. What is already known about the topic? In emergency rooms, workplace violence is prevalent, and it seriously endangers nurses' physical and mental health. Enhancing resilience can improve nurses' ability to self-regulate after experiencing violence. However, the drivers and mechanisms of resilience among emergency nurses who have experienced workplace violence remain unidentified. What this paper adds? This study confirms the applicability of Kumpfer's resilience framework to emergency nurses who have experienced workplace violence. Nurses' self-efficacy and cognitive reappraisal mediate the relationship between perceived organizational support and resilience after exposure to workplace violence. The resilience process for emergency nurses involves the interaction of individual and environmental factors. Implications for practice/policy. Managers and researchers should consider the interaction between individual and environmental factors when developing resilience intervention strategies for emergency nurses who have suffered workplace violence. It is essential to support emergency nurses from the dyadic dimensions of the environment and the individual. A supportive organizational environment and individual positive adjustment strategies are equally important in promoting resilience among nurses.

Panton-Valentine Leukocidin (PVL) genes may not be a reliable marker for community-acquired MRSA in the Dakahlia Governorate, Egypt

BackgroundMethicillin-resistant Staphylococcus aureus is linked to both nosocomial and community infections. One of the key virulence factors of S. aureus is Panton-Valentine leukocidin (PVL). The PVL genes are mostly associated with community-acquired MRSA (CA-MRSA). This study evaluates the prevalence of PVL genes as a marker for CA-MRSA at tertiary hospitals in Mansoura, Dakahlia, Egypt. S. aureus was isolated from clinical specimens obtained from different departments of tertiary hospitals, outpatient clinics, and hospital healthcare workers (HCWs). PCR was used to detect the mecA, PVL, and SCCmec genes among the recovered isolates. Standard broth microdilution method was used to determine the minimum inhibitory concentrations (MIC) of nine antibiotics against S. aureus.ResultsTwo hundred S. aureus isolates were recovered and identified out of the total isolates (n = 320). The mecA gene was detected in 103 S. aureus isolates (51.5%). Among the MRSA isolates, 46.60% were PVL-positive. The incidence of the PVL genes of MRSA in nosocomial (HA), outpatient clinics (CA), and HCWs was 46.66%, 56.52%, and 42%, respectively. All MRSA isolates showed resistance to cefoxitin. The percentage of resistance to most tested antibiotics was high, except for ciprofloxacin (6.85%). Both antibiotic resistance and multidrug resistance among MRSA isolates were generally higher in PVL-positive isolates than in PVL-negative isolates in HA- and CA-MRSA isolates. While SCCmec type V was the most prevalent in PVL-positive MRSA stains, type I was the most prevalent in PVL-negative isolates.ConclusionThis study revealed that PVL genes are generally highly prevalent among mecA-positive MRSA isolates, whether they are CA-MRSA, HA-MRSA, or HCW isolates. Therefore, PVL is not a valid marker for CA-MRSA in Mansoura, Dakahlia Governorate, Egypt, as has been reported in other countries. Further epidemiologic studies are required to track the incidence of PVL in HA-MRSA, CA-MRSA, and HCW isolates in other Egyptian governorates.

Analysis of Factors Related to Domestic Patient Safety Incidents Using Decision Tree Technique.

To address the increasing number of patient safety incidents, their scope and extent should be assessed and the situations in which they occur determined. This study employed a decision tree analysis based on patient safety incident cases to identify groups at high risk for adverse patient safety incidents and provide data to develop prevention strategies for minimizing their occurrence or recurrence. In total, 8934 patient safety incidents were analyzed using the "2021 Patient Safety Report Data", which were systematically collected by the Korea Institute for Healthcare Accreditation. A decision tree analysis (Chi-square Automatic Interaction Detection) was employed to identify the characteristics associated with the degree of risk for patient safety incidents. The groups most vulnerable to adverse events were those who experienced healthcare-associated infections (HAI) in long-term care facilities, followed by those experiencing HAI in tertiary hospitals, general hospitals, or clinics, and those experiencing fall-related events in neuropsychiatry departments of tertiary hospitals, general hospitals, or clinics. The most important factor in the degree of harm in patient safety accidents was the type of accident, followed by the type of medical institution, and then the treatment department. Particularly, HAI and falls are the most important factors determining the degree of harm in patient safety accidents.

Drug Prescribing Pattern among the Inpatients in the Surgery Department of Tertiary Hospital of Eastern Nepal

Background: Prescription is a written instruction by a health care personnel to pharmacist to dispense drug(s). Irrational drug prescribing is a global problem, particularly in developing and transitional countries. This study was conducted to see the status of World Health Organization (WHO) core prescription indicators, complementary indices and prescription errors. Methods: It was a quantitative cross-sectional descriptive study carried out among inpatients of general surgery of tertiary hospital in eastern Nepal. Ethical approval for the study was obtained from the Institutional Review Committee. It was a convenience sampling. Calculated Sample size was 224. Enrollment of patients started on 16 May 2018 with the last case being enrolled on 1 Oct 2019 after obtaining informed consent. Relevant data was entered in a semi-structured proforma. Microsoft excel 2016 and IBM Statistical Package for the Social Sciences (SPSS) v. 21 were used for descriptive statistics. Results: Median age of inpatients was 40 (24 - 54) years with male: female ratio being 1.05. Total 1492 drugs were prescribed in 224 prescriptions. Mean number of drugs prescribed was 6.66 ± 2.33. Percentage of drugs prescribed by generic name was 25.60%. Prescriptions with at least one antimicrobial agent was 89.3%. Prescriptions with at least one injection was 92.9%. Percentage of drugs prescribed from the WHO Essential Medicine List was 66.48%. Other complementary prescribing indicators and prescription errors were also calculated. Conclusions: Most prescription indicators were inadvertently deviated away from WHO standards. Prescription errors were comparable to other studies.

Colonization of patients hospitalized at orthopedic department of tertiary hospital in Uganda with extended-spectrum beta-lactamase-producing enterobacterales

BackgroundBeta-lactamase production remains the most contributing factor to beta-lactam resistance. Extended-Spectrum Beta-Lactamase-Producing Enterobacterales (ESBL-PE) are associated with risk factors both in hospital and community settings.ObjectivesTo assess the incidence and risk factors for intestinal carriage of ESBL-PE among patients admitted to orthopedic ward of Mulago National Referral Hospital, and to analyze the acquisition of ESBL-PE during hospital stay and associated factors.MethodsWe screened 172 patients aged 18 years old and above who got admitted to the orthopedic ward of Mulago National Referral Hospital between May to July 2017. Stool samples or rectal swabs were collected at admission, every 3 days until fourteen days and screened for ESBL-PE. Data on demographic status, antibiotic use, admission and travel, length of hospital stay, hygiene practices and drinking boiled water were analyzed by logistic regression and cox regression model.ResultsAt admission, 61% of patients showed intestinal ESBL-PE carriage. Co- resistance was common but no Carbapenem resistance was detected. Of the ESBL-PE negative, 49% were colonized during hospitalization. On admission, prior antibiotic use was significantly associated with carriage, but none was associated with acquisition during hospitalization at p-value < 0.05.ConclusionCarriage of ESBL-PE on admissions and acquisition at orthopedic ward of Mulago Hospital were high, and dissemination into the community are of substantial concern. We suggested refinement of empirical treatment based on risk stratification, and enhanced infection control measures that target health care workers, patients and attendants.

Pattern of Acute coronary syndrome (ACS) at the Emergency Department of tertiary hospital, Addis Ababa, Ethiopia

BACKGROUND: Acute coronary syndrome (ACS) is the leading cause of death and disability-adjusted life years globally, with low- and middle-income countries (LMIC) bearing a high proportion of the burden. In this study, we aimed to assess the pattern of ACS at St Paul's hospital Emergency department. METHODS: A cross-sectional study was carried out from September 1, 2017, to October 31, 201at St Paul's Hospital Millenium Medical College . Patients age &gt;18 years old, presented to the Emergency department and had diagnosis of Acute Coronary Syndrome were included. Structured checklist were used to collect data from patient charts. Data was analayzed using SPSS version 25. RESULTS: 103 patients were enrolled during the study period. The majority were males (n = 69, 64.5%). The average age was 55.65 ±13.96 years. The majority of patients (n = 67, 65.1%) arrived to the emergency department by taxi, and 60 patients (58.3%) were referred. The most common chief complaints were chest pain (n = 79, 76.7%), easy fatigability (n = 58, 56.3%) and epigastric discomfort (n = 44, 42.7%).The mean duration of symptoms before presentation to the ED was 3.4 ± 2.83 days. The most common risk factors identified were hypertension (n = 47, 45.6%) and diabetes mellitus (n = 31, 30.1%). Types of ACS included ST-elevation myocardial infarction (STEMI)(n = 74,71.8%),non-ST-elevation myocardial infarction (NSTEMI)(n = 22, 21.4%) and unstable angina (n = 7, 6.8%). Heart failure was the most common complication at presentation. The most common echocardiography findings were wall motion abnormalities (85.4%) and decreased ejection fraction (60.2%). The ED mortality rate was 6.8%. CONCLUSION: The majority of patients with ACS used taxi and arrived at the hospital late.The most common presentations were chest pain and easy fatigability. STEMI was the most common type of ACS identified.

Utility and impact of early diagnostic assessment of sepsis on mortality in an emergency department of a tertiary hospital in Lagos, Nigeria.

Currently, little is known about the timely application of clinical screening tools and blood sampling for decision-making in the management of patients with suspected sepsis in the accident and emergency units of hospitals in Nigeria. The aim of the study was to ascertain the association between the time taken for the conduct of serum lactate and blood culture investigations following a clinical suspicion of sepsis, and the mortality of patients admitted to a Nigerian tertiary hospital. Over a 6-month period (November 2021 to April 2022), 119 patients hospitalised for sepsis or septic shock at the Lagos University Teaching Hospital were followed until discharge or death. The proportion of patients whose serum lactate, serum procalcitonin and blood culture samples was taken was also determined. Predictors of mortality were determined using bivariate analysis and logistic regression. Kaplan-Meier plots were used to predict survival using sepsis diagnostic criteria. Eighty (67%) of 119 sepsis patients met systemic inflammatory response syndrome or quick sequential (sepsis-related) organ failure assessment criteria. Only 3 (2.5%) patients had blood cultures and serum procalcitonin and 0 (0%) had serum lactate tests. Forty-one (34.5%) patients died, but clinical and laboratory procedures for sepsis management were not linked to death. A shorter hospital stay increased the death risk (χ2 = 14.83, P = 0.002). This study revealed low compliance with sepsis care guidelines and no impact of timely clinical and laboratory procedures on sepsis mortalities. Further study is needed to explore patient care models that can improve the objective assessment and treatment of sepsis patients in emergency departments of busy tertiary hospitals.