Hospital Division Research Articles

Frequency of Different Neuropsychiatric Manifestations of Systemic Lupus Erythematosus at a Tertiary Care Hospital in Pakistan

Objective: To determine the frequency of different neuropsychiatric manifestations of systemic lupus erythematosus
 Study Design: Cross-sectional study.
 Place and Duration of Study: Division of Rheumatology Lady Reading Hospital, Peshawar Pakistan, from Sep 2020 to Feb 2021.
 Methodology: 31 patients who fulfilled the 2019 ACR/EULAR criteria for SLE diagnosis were included in the study. Different features of neuropsychiatric manifestations of systemic lupus erythematosus were recorded on a proforma.
 Results: Our study sample included 27 females and four males. Most of the patients were young, with a mean age of 23.12 ± 10.74 years. All patients had positive Anti-nuclear antibodies (100%), while anti-double standard DNA antibody was found in 21 patients (67. 74%). Seizures were the most common neuropsychiatric feature, i.e., found in 18 patients (58%), followed by headache (25.8%), acute confusional state (25.8%) and CNS demyelinating disease (19.3%).
 Conclusion: We found that seizures, headache and acute confusional state were the most common neuropsychiatric manifestations of systemic lupus erythematosus.

P1716: REGULAR HOSPITAL VISITS IMPROVE THE PROGNOSIS OF MULTIPLE MYELOMA PATIENTS

Background: Multiple myeloma（MM）is a common hematological cancer. The overall survival rate of individuals with MM has risen significantly in the previous decade, primarily as a result of the advent and advancements of innovative treatments. As a consequence, given the possibility that cancer will progress to the stage of chronic illness, the post management and regular hospital visit of MM patients are particularly important. Although it seems that long term chronic disease management by regular hospital visit has increased medical expenditure, from the perspective of whole process treatment, it is the best way to achieve standardized treatment and monitoring and may improve the prognosis of MM patients The regular hospital visits means regular hematologist visits with regular treatment and monitor. Irregular hospital visits means visits to other hospital divisions or with no hospital visits. Aims: The aims of this study were to investigate the relationship between regular hospital visits and prognosis of MM and to suggest methods to avoid poor prognoses in MM. Methods: We performed a multicenter retrospective analysis of data from 832 MM patients across 9 centers in China from 2006 to 2020. Sociodemographic (including whether regular hospital visits) and clinical factors at diagnosis and treatment regimens were recorded, and univariate and multivariate analyses were performed. Results: Overall, 30.3% of patients had irregular hospital visits. Patients with irregular hospital visits levels differed from those with regular hospital visits in that they were more likely to be older, and a higher proportion lived in rural areas, were unemployed, and with lower education levels, had lower annual incomes and lacked insurance. Additionally, compared to patients with regular hospital visits, patients with irregular hospital visits had a higher proportion of international staging system (ISS) stage III classification, time to diagnosis is longer and underwent transplantation less often. Patients with regular hospital visits had a median progression-free survival (PFS) of 52.04months, which was better than that of patients with irregular hospital visits (20.3 months, p < 0.001). Similarly, patients with egular hospital visits had a median overall survival (OS) of 107.4months, which was also better than that of patients with irregular hospital visits (37.1 months, p < 0.001). In the multivariable analysis, patients with regular hospital visits had lower relapse rates and higher survival rates than did those with irregular hospital visits in terms of PFS and OS (hazard ratio (HR) = 1.95, p < 0.001; HR =2.80, p < 0.001, respectively). Summary/Conclusion: Irregular hospital visits may independently predict poor survival in MM patients in China.

UP- PGH Division of Cardiovascular Medicine Fellowship Training and COVID-19: Opportunities and Innovations

BACKGROUND: The COVID-19 pandemic greatly affected training programs because of changes in patient load and service assignments. This posed certain challenges in the implementation of the pre–COVID-19 training curriculum recommendations by the Philippine Heart Association Specialty Board on Adult Cardiology. OBJECTIVE: This article describes the challenges, training adjustments and innovations, and the impact on the training program of these changes instituted by the University of the Philippines–Philippine General Hospital (UP-PGH) Division of Cardiovascular Medicine (DCVM) during the COVID-19 pandemic. METHODS: This is a descriptive article based on review of changes and improvements of the UP-PGH DCVM training manual and guidelines adopted during the COVID-19 pandemic. FINDINGS: The COVID-19 pandemic challenges provided opportunities for innovation of the training program. The program emphasized focus on maximizing team-based learning from every clinical encounter toward achievement of learning outcomes and competency. The training committee closely monitored the learning environment and trainee’s learning progress to achieve outcomes beyond the traditional metrics such as census and procedural numbers. It adopted online clinical encounters, conference, and case discussion. To enhance learning, virtual engagement supplemented physical encounters between consultants and training fellows assigned to various clinical rotations. Real-world research results on the impact of COVID-19 on cardiovascular health were utilized to enhance knowledge. Risk mitigation and transmission reduction strategies were adopted to ensure safety of all staff. The division also incorporated a strong wellness program to provide holistic approach to trainees’ and trainers’ health. New competencies were developed such as telemedicine, infection prevention and control, and creation of virtual patient education programs. CONCLUSION: The training institution met the challenges posed by the COVID-19 pandemic with resiliency and unity. The adjustments and innovations in training instituted by PGH DCVM proved useful in addressing the challenges posed by the pandemic. The situation was viewed as an opportunity to innovate and pursue a better program adaptive of the ever-changing environment, toward forming competent future cardiologists by enhancing focus not only on numbers but rather on the process of achievement of learning outcomes, embracing virtual and online strategies, institutionalization of wellness program, and development of new guidelines in the approaching patient management cognizant of both health care provider and patient safety and new competencies such as patient virtual education and telemedicine in cardiology.

Frequency of extra articular manifestations in ankylosing spondylitis patients presented at independent university hospital Faisalabad.

Objective: To determine the frequency of extra articular manifestations in Ankylosing spondylitis patients at Independent University Hospital Faisalabad. Study Design: Cross-sectional study. Setting: Rheumatology Division of Internal Medicine Independent University Hospital, Faisalabad. Period: June 2020 to June 2021. Material &amp; Methods: Consecutive one hundred and thirty-nine adult patients with baseline Ankylosing Spondylitis fulfilling the Assessment of spondyloarthropathy society criteria at early stage and Modified New York criteria in chronic form of disease, and fulfilling the selection criteria, were selected through Non-Probability Convenient Sampling technique for this study. Chi square test was used to compare the frequency of extra articular manifestations among disease duration, age groups and treatment group. A p-value ≤ 0.05 was considered statistically significant. Results: In this study, 139 number of patients were selected with confirmed diagnosis of ankylosing spondylitis. Mean age of patients was 32.60 ± 8.5 years with age range of 18 to 50 years. Extra articular manifestations were assessed in all selected patients of ankylosing spondylitis. Enthesitis and dactylitis were found in 8.6% (12) of patients. Uveitis was found in 5% (7) of patients. Similarly, psoriasis was found in 4.3% (6) of patients. Lung fibrosis was found in 3.6% (5) of patients. Inflammatory bowel disease was found in 2.9% (4) of patients. Conclusion: Assessment of extraarticular manifestations in AS was very important. Timely intervention with specific therapy decreases morbidity and mortality related to disease.

Elimination of Hepatitis C in Southern Italy: A Model of HCV Screening and Linkage to Care among Hospitalized Patients at Different Hospital Divisions.

Background: Free-of-charge HCV screening in some key populations and in 1969–1989 birth cohorts has been funded in Italy as the first step to diagnosing individuals who are infected but asymptomatic. The aim of this study is to evaluate the feasibility of an opportunistic HCV screening and its linkage to care. Methods: A hospital-based HCV screening was conducted as a routine test for in-patients admitted to the Evangelical Hospital Betania of Naples from January 2020 to May 2021. All consecutive in-patients were screened for the HCV antibody (HCV-Ab) at the time of their admission to the hospital, and those born prior to year 2000 were included in the study. HCV-RNA testing was required for those not previously treated and without antiviral treatment contraindications. For in-patients with an active infection, treatment started soon after hospital admission. Results: Among 12,665 inpatients consecutively screened, 510 (4%) were HCV-Ab positive. The HCV-Ab positivity rate increased with age, reaching the highest prevalence (9.49%) in those born before 1947. Among patients positive for HCV, 118 (23.1%) had been previously treated, 172 (33.9%) had been discharged before being tested for HCV-RNA, and 26 (5.1%) had not been tested for short life expectancy. Of 194 (38% of HCV-Ab+) patients who were tested for HCV-RNA, 91 (46.2%) were HCV-RNA positive. Of patients with active infection, 33 (36%) were admitted to the liver unit with signs of liver damage either not previously diagnosed or diagnosed but unlinked to care for HCV infection. Of the patients positive for HCV-RNA, 87 (95.6%) started treatment; all achieved sustained virological response. Conclusion: HCV active infection has been frequently found in patients with comorbidities admitted in the hospital in Southern Italy. To achieve HCV elimination in Italy, broader screening strategies are required. In addition to screening of the 1969–1989 birth cohort of individuals unaware of their infection status, diagnosis and linkage to care of patients with known liver damage is strictly required. Hospital screening is feasible, but prompt reflex testing for identifying HCV-active infections is necessary to increase diagnosis and subsequent linkage to care.

ACTIVITY BASED COSTING METHOD IN DETERMINING UNIT COST OF LITHOTRIPSY FOR TREATMENT OF URINARY BLADDER CALCULUS AT VITA INSANI HOSPITAL PEMATANGSIANTAR

Objective: To determine the unit cost of lithotripsy for treatment of urinary bladder calculus at Vita Insani Hospital Pematangsiantar. Material &amp; Methods: This study is a descriptive quantitative study, in which the data was obtained from the finance division of Vita Insani Hospital. The research object is the unit cost of accommodation that occurs in patients with urinary bladder calculus with lithotripsy cases from January 2020 to December 2020. Results: The unit cost of lithotripsy for urinary bladder calculus services at Vita Insani Hospital Pematangsiantar which is calculated using the activity-based costing (ABC) method is Rp 4.167.009. There is a difference in cost among the ABC method, hospital calculations, and INA CBG’s rates with the following details: the amount calculated for the hospital is Rp 4.996.718, while the calculation using ABC method is Rp 4.167.009; the difference in costs is Rp 829.709. INA CBG’s rates Rp 6.137.500, and compared to calculation of hospital, the difference cost is Rp 1.140.782. Compared to the INA CBG’s rates, to the unit cost of the ABC method, there is a difference, amounting Rp 1.970.491. Conclusion: The results of unit cost lithotripsy for treatment of urinary bladder calculus through the ABC method are lower compared to hospital calculation and INA CBG’s rates.

Implementing a Multifaceted Intervention among Internal Medicine Residents with Audit and Educative Data Feedback Significantly Reduces Low-Value Care in Hospitalized Patients.

Background: The dissemination of recommendations on low-value care alone may not lead to physicians’ behavioral changes. The aim of this study was to evaluate whether a multifaceted behavioral intervention among internal medicine residents could reduce low-value care in hospitalized patients. Methods: A pre–post quality improvement intervention was conducted at the Internal Medicine Division of La Tour hospital (Geneva, Switzerland) from May 2020 to October 2021. The intervention period (3 months) consisted of a multifaceted informational intervention with audits and educative feedback about low-value care. The pre- and post-intervention periods including the same six calendar months were compared in terms of number of blood samples per patient day, prescription rates of benzodiazepines (BZDs) and proton pump inhibitors (PPIs), as well as safety indicators including potentially avoidable readmissions, premature deaths and complications. results: A total of 3400 patients were included in this study; 1095 (32.2%) and 1155 (34.0%) were, respectively, hospitalized during the pre- and post-intervention periods. Patient characteristics were comparable between the two periods. Only the number of blood tests per patient day and the BZD prescription rate at discharge were significantly reduced in the post-intervention phase (pre: 0.54 ± 0.43 vs. post: 0.49 ± 0.60, p ≤ 0.001; pre: 4.2% vs. post: 1.7%, p = 0.003, respectively). PPI prescription rates remained comparable. Safety indicators analyses revealed no significant differences between the two periods of interest. Conclusions: Our results demonstrate a modest but statistically significant effect of a multifaceted educative intervention in reducing the number of blood tests and the BZD prescription rate at discharge in hospitalized patients. Limiting low-value services is very challenging and additional long-term interventions are necessary for wider implementation.

Development and validation of a prediction model for treatment failure in peritoneal dialysis-associated peritonitis patients: a multicenter study

To develop and validate a risk prediction model of treatment failure in patients with peritoneal dialysis-associated peritonitis (PDAP). We retrospectively analyzed the data of patients undergoing peritoneal dialysis (PD) in 3 dialysis centers in Jilin Province who developed PDAP between January 1, 2013 and December 31, 2019. The data collected from the Second Hospital of Jilin University and Second Division of First Hospital of Jilin University) were used as the training dataset and those from Jilin Central Hospital as the validation dataset. We developed a nomogram for predicting treatment failure using a logistic regression model with backward elimination. The performance of the nomogram was assessed by analyzing the C-statistic and the calibration plots. We also plotted decision curves to evaluate the clinical efficacy of the nomogram. A total of 977 episodes of PDAP were included in the analysis (625 episodes in the training dataset and 352 episodes in the validation dataset). During follow-up, 78 treatment failures occurred in the training dataset and 35 in the validation dataset. A multivariable logistic regression prediction model was established, and the predictors in the final nomogram model included serum albumin, peritoneal dialysate white cell count on day 5, PD duration, and type of causative organisms. The nomogram showed a good performance in predicting treatment failure, with a C-statistic of 0.827 (95% CI: 0.784-0.871) in the training dataset and of 0.825 (95% CI: 0.743-0.908) in the validation dataset. The nomogram also performed well in calibration in both the training and validation datasets. The established nomogram has a good accuracy in estimating the risk of treatment failure in PDAP patients.

Esthetic evaluation of conventional and socket shield technique immediate implant restoration

Objective: To evaluate the pink and white esthetics of conventional and socket shield technique (SST) immediate implant restoration. Methods: Thirty volunteers were recruited according to preset criteria, and were assigned to 3 groups. Natural teeth group (ten undergraduates or postgraduates from Peking University School and Hospital of Stomatology in January 2020, n=10): all volunteers' maxillary anterior teeth were natural teeth with healthy gingiva, and none of the teeth were restored by crowns or composite. Conventional group and SST group (patients had a maxillary central incisor immediate implant placed in Department of Prosthodontics, Peking University School and Hospital of Stomatology during October 2016 to January 2021, n=10 for each group): the volunteer had an unrestored natural maxillary central incisor, and the contralateral maxillary central incisor was restored by conventional or SST immediate implant placement, temporization and all ceramic final restoration, photos were taken 12 months post-surgery. Three groups of evaluators namely layperson (staff from Second Clinical Division of Peking University School and Hospital of Stomatology and 2 family members, n=10), dental students (class 2015 undergraduates from Peking University School and Hospital of Stomatology, n=10) and prosthodontists (from Department of Prosthodontics, Peking University School and Hospital of Stomatology, n=10) were invited to assess the esthetics using pink esthetic score (PES) and white esthetic score (WES). The results were statistically analyzed. Results: PES and WES of natural teeth group [9(8, 10) and 8(7, 10)] were significantly higher than conventional group [7(6,8) and 7(6,9)] (H=287.08, 132.79,P<0.01) and SST group [7(6, 9) and 8(7, 9)] (H=216.01, 101.21, P<0.01). SST group yielded higher PES than the conventional group (H=-71.06, P<0.01), yet had similar WES (H=-31.57, P>0.05). Dental students had significant lower PES and WES than prosthodontists (H=-120.90, -218.86, P<0.01) and layperson (H=-109.55, 134.97, P<0.01). Prosthodontists and layperson got similar PES (H=-11.36, P>0.05), however yielded different WES (H=-83.89, P<0.01). Conclusions: SST immediate implant placement obtained better pink esthetics than conventional protocol 12-month after implant surgery, profession may have significant impact on evaluators during pink and white esthetic evaluation.

Pattern of diseases of police personnel attending outdoor department of divisional police hospital, Rajshahi

Pattern of diseases of police personnel attending outdoor department of divisional police hospital, Rajshahi

Telehealth Intervention Program for Older Adults (TIP-OA) for Stress and Mental Health Symptoms: Predictors of treatment response

Telehealth Intervention Program for Older Adults (TIP-OA) for Stress and Mental Health Symptoms: Predictors of treatment response

CYP2C19 Genotyping in Anticoagulated Patients After Percutaneous Coronary Intervention: Should It Be Routine?

HomeCirculationVol. 145, No. 10CYP2C19 Genotyping in Anticoagulated Patients After Percutaneous Coronary Intervention: Should It Be Routine? No AccessArticle CommentaryRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessArticle CommentaryRequest AccessFull TextCYP2C19 Genotyping in Anticoagulated Patients After Percutaneous Coronary Intervention: Should It Be Routine? Dimitri J. Maamari, MD, Farouc A. Jaffer, MD, PhD, Amit V. Khera, MD, MSc and Akl C. Fahed, MD, MPH Dimitri J. MaamariDimitri J. Maamari https://orcid.org/0000-0003-2797-9370 Center for Genomic Medicine (D.J.M., A.V.K., A.C.F.), Massachusetts General Hospital Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (D.J.M., A.V.K., A.C.F.). Search for more papers by this author , Farouc A. JafferFarouc A. Jaffer https://orcid.org/0000-0001-7980-384X Division of Cardiology (F.A.J., A.V.K., A.C.F.), Department of Medicine, Massachusetts General Hospital Cardiovascular Research Center, Cardiology Division (F.A.J., A.C.F.), Massachusetts General Hospital Department of Medicine, Harvard Medical School (F.A.J., A.V.K., A.C.F.) Boston. Search for more papers by this author , Amit V. KheraAmit V. Khera https://orcid.org/0000-0001-6535-5839 Center for Genomic Medicine (D.J.M., A.V.K., A.C.F.), Massachusetts General Hospital Division of Cardiology (F.A.J., A.V.K., A.C.F.), Department of Medicine, Massachusetts General Hospital Department of Medicine, Harvard Medical School (F.A.J., A.V.K., A.C.F.) Boston. Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (D.J.M., A.V.K., A.C.F.). Search for more papers by this author and Akl C. FahedAkl C. Fahed Correspondence to: Akl C. Fahed, MD, MPH, Cardiovascular Research Center, Massachusetts General Hospital, 185 Cambridge Street, CPZN 3.218, Boston, MA 02114. Email E-mail Address: [email protected] https://orcid.org/0000-0002-4849-6389 Center for Genomic Medicine (D.J.M., A.V.K., A.C.F.), Massachusetts General Hospital Division of Cardiology (F.A.J., A.V.K., A.C.F.), Department of Medicine, Massachusetts General Hospital Cardiovascular Research Center, Cardiology Division (F.A.J., A.C.F.), Massachusetts General Hospital Department of Medicine, Harvard Medical School (F.A.J., A.V.K., A.C.F.) Boston. Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge (D.J.M., A.V.K., A.C.F.). Search for more papers by this author Originally published7 Mar 2022https://doi.org/10.1161/CIRCULATIONAHA.121.057028Circulation. 2022;145:721–723FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page 723.Circulation is available at www.ahajournals.org/journal/circCorrespondence to: Akl C. Fahed, MD, MPH, Cardiovascular Research Center, Massachusetts General Hospital, 185 Cambridge Street, CPZN 3.218, Boston, MA 02114. Email [email protected]harvard.edu

Characteristics and Influencing Factors of Healthcare Utilization in Post-conflict Primary Care Attendees in Northern Sri Lanka.

Sri Lanka's healthcare systems attempts to provides access to universal healthcare services for all citizens and is designed to be free of out-of-pocket payments. Despite a 30-year civil conflict, natural disasters, and COVID-19, the healthcare system within the country remains robust and strong. However, due to a lack of formalized pathways and centralized record keeping, the pattern of service utilization is still relatively unknown, which raises concerns regarding effective allocation of scarce resources and efficiency of referral pathways. To address this gap in knowledge, part of the parent study (COMGAP-S), consisted of a survey on healthcare service use conducted among adults attending primary care facilities. The results from this quantitative data analysis indicate the majority of people seeking care originate from rural areas, are older (50+), attend divisional hospitals, and report paying fees at point of contact. Our findings indicate a need for more efficient use of healthcare services, creation of referral routes to ensure limited healthcare resources are used effectively. Additionally, further investment in services is needed to ensure Sri Lanka's healthcare system meets the standard of universal healthcare as proposed by the World Health Organization. These findings address a gap in knowledge for national decision-makers within Sri Lanka along with other similar post-conflict healthcare settings across the globe.

In-Hospital Outcome of Stroke at a Divisional Hospital of Pakistan

Background: Stroke having two major types, is a clinical presentation which presents loss of brain function; risk factors &amp; complications may vary and which ultimately can lead to death Objective: To determine stroke outcome and its association with factors and complications. Methods: Observational cross-sectional study, conducted from Nov 2015 to Aug 2016 at DHQ Teaching Hospital, KMU Institute of Medical Sciences, Kohat. A pre-designed questionnaire was adopted for data extraction. SPSS 25.0 was used; descriptive and inferential statistics were applied where needed Results: From 100 patients, male were 54% with mean age of 67.48±13.77 years, having 88% Ischemic stroke patients. Hypertension (79%) and family history (39%) were major risk factors while constipation (59%) and aspiration pneumonia (44%) were major complications with in-hospital mortality of 10%. The factors had a higher Prevalence Ratio (PR) for drug abuse (1.330), hypercholesterolemia (1.166), and hypertension (1.036) in ischemic stroke, while in hemorrhagic stroke PR was high for family history (1.918), heart diseases (1.173) and sedentary lifestyle (1.030). In complication, ischemic stroke had a higher PR for constipation (0.996), while hemorrhagic stroke had a higher PR for bed sores (3.286). The results shows an overall mortality of 10% only. Conclusion: The study concluded in-hospital mortality with ischemic stroke more common then hemorrhagic stroke. Hypertension and constipation were a prevalent risk factor and complication respectively. Family history, heart diseases, sedentary lifestyle and all complications were associated more with the hemorrhagic stroke while all other risk factors and no complications had a higher association with ischemic stroke.

Healthcare Provider's Culture and Its Impact on End-Of-Life Discussions.

To examine the openness to communication in end-of-life care of three major ethno-cultural groups of healthcare providers (HCPs) (in Israel: Israeli Arabs (Arabs), Israeli Jews (Sabras), and Immigrants from the Soviet Union (Russians). An anonymized set of three questionnaires was distributed among 240 physicians and nurses (HCPs) from the three ethno-cultural groups, yielding a response rate of 91% (and 82% when including hospital division). Sabra ethno-cultural group was more open to communicating about and relating to end-of-life with terminally ill patients. While recent exposure to death and external locus of control decreased the effect of ethno-cultural background, the latter remained statistically significant. Gender, age, marital status, and specialty were not found to be influential factors.This research highlights the importance of increasing awareness and responses to the effects of HCPs' culture on end-of-life care as varied cultures and medico-legal requirements come into contact in society.

Impact of simulation training for teamwork and communication intervention on patient safety in the emergency department

Background: The emergency department (ED) is the hospital division that is most vulnerable to poor communication and teamwork-based medical errors that affect patient safety. One approach to prevent medical errors is by training and assessing healthcare workers using simulation-based (SB) teamwork and communication training. This study aimed to explore the extent to which SB training could improve teamwork and communication and reduce preventable medical errors in the ED. Method: The study was conducted at the Ministry of National Guard Health Affairs, a tertiary care center with a 39-bed ED, in Saudi Arabia. A total of 123 ED healthcare staff participated in the study. This study adopted a single-subject experimental design with the intervention of simulation training in ED cases. The methodology focused on three domains: 1) patient safety in the ED, 2) inter-professional and multidisciplinary simulation team training, and 3) team dynamic enhancement use. Staff perceptions regarding teamwork and communication pre-and post-intervention and the relationship between changes in their perception of performance in the ED and patient outcomes. The chi-square test was used for univariate analysis, and a generalized linear regression model was adjusted for demographics in multivariate analysis. Results: Staff perceptions were collected from all multidisciplinary team members before and after simulation training. The data revealed a significant improvement in overall staff perceptions toward teamwork and communication (8% to 34%, p-value = 0.001). Conclusion: SB communication and teamwork training in the ED resulted in a sustained and measurable improvement in ED staff perceptions toward teamwork and communication. The results suggest that simulation sessions may improve staff perceptions and multidisciplinary team communication during critical situations in the ED.

COMPARING PRE AND POST PHOTOTHERAPY VALUES OF TRANSCUTANEOUS BILIRUBIN LEVELS AND TOTAL SERUM BILIRUBIN LEVELS IN TERM INFANTS WITH NEONATAL HYPERBILIRUBINEMIA

BACKGROUND: This is a prospective observational study to compare pre and post phototherapy values of Trans-cutanoeus Bilirubinometer(TcB) levels and Total Serum Bilirubin(TSB) in term infants with neonatal Hyperbilirubinemia in a Teritiary care centre. METHODS: All term new-born babies with Period of Gestation &gt;37 weeks are included in our study. This is a prospective observational study carried out in neonatal division of a teritiary hospital. The pre and post transcutaneous bilirubin values of neonates who received phototherapy were recorded and compared to the standard Serum Bilirubin values. RESULTS: In our investigation, it was found that rebound hyperbilirubinemia does not signicantly differ between 2 groups, as phototherapy stopped at serum bilirubin ranges of 1- 2.9 mg/dl and ≥3mg/dl below its level under which, phototherapy initiated. There was a strong correlation in our study 44.9% of infants are born via Normal Vaginal Delivery and 54% via Cesarian section. majority of the Child 38(38.8%) are B+ Blood Group, 22(22.4%) are O+ Blood group, 22(22.4%) of Child are A+ and O+ Blood Group equally, 13(13.3%) of Child are AB+ Blood Group and 3(3.1%) of Child are B- Blood Group. Rh Status, 97(99.0%) of respondents having Positive remaining only one respondent belonging into negative group. ABO Status, 82(83.7%) of respondents responded negative, whereas the remaining 16 (16.3%) respondents responded belonging into present group. DCT, 96(98.0%) of respondents having Positive remaining only two respondents belonging into negative group. There is a positive correlation between TcB values before and after phototherapy. CONCLUSION: Neonatal Hyperbilirubinemia is a fairly common condition in newborns with mostly with recovery. But in few cases where the Serum bilirubin value measurement is not feasible

Mycoplasma pneumoniae Infection and Subsequent Wheezing in Childhood Asthma- A Cohort Study

Introduction: Prevalence of asthma in children &lt;18 years is approximately 7-8%. Mycoplasma pneumoniae has also been found to be an important trigger of asthma. Many studies have shown the association of Mycoplasma pneumoniae with acute exacerbation of asthma in adults. But the data is limited to determine the role of Mycoplasma pneumoniae in causing subsequent wheezing in children with asthma. Aim: To study the role of Mycoplasma pneumoniae infection in causing subsequent wheezing episodes in asthma in children between 1-14 years of age. Materials and Methods: This was a prospective cohort study conducted from October 2019 to October 2021 at the Paediatric Division of Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India. Consecutively 60 patients with bronchial asthma aged between 1 to 14 years were included during the first year of study period. The diagnosis of bronchial asthma was as per Global Initiative for Asthma (GINA) guidelines. Venous sample was tested for Immunoglobulin M (IgM) Mycoplasma pneumoniae antibody with Calbiotech Mycoplasma pneumoniae IgM Enzymelinked Immunosorbent Assay (ELISA) kit. Clinical follow-up for subsequent wheeze was done at 3 months, 6 months, and 12 months starting after 2 weeks of being declared symptom free. All data were recorded and analysed by Statistical Package for Social Sciences software (SPSS) version 22.0. Results: Out of 60 patients, males comprised of 46 (76.67%) and females 14 (23.33%) with the mean age 5.56±4.21 years. Family history of wheeze was also taken and found to be 38.33% among asthamatics (23/60). Among asthmatics, 23 cases (38.33%) were IgM positive. Episodes of subsequent wheeze were present in all the patients with a mean of 4.5±2.7 episodes in one year. On subgroup analysis, mean wheezing episodes were documented as 5.43±3.00 in IgM positive group which was statistically higher than IgM negative group in which mean wheezing episodes were 3.92±2.42 (p-value=0.036). Conclusion: Subsequent wheeze was observed in all patients with asthma. The mean wheezing episodes were statistically more in Mycoplasma pneumoniae infected asthmatics in comparison to non Mycoplasma pneumoniae infected asthmatics.

Assessment of Readiness for the Implementation of the Hospital Health Information System Under Primary Health Care Reorganization in Selected Hospitals in Kalutara District

<strong>Introduction: </strong>Organizational resources and technical structures such as hardware and software are very essential requirements in the redesign of electronic projects. (Ajam, 2011) Before implementation of Hospital Health Information System (HHIS) in primary health care institutions it is essential to conduct an assessment of readiness of institutions. <strong>Objective: </strong>To assess the readiness for the implementation of Hospital Health Information System under primary health care reorganization in selected Hospitals in Kalutara District. <strong>Methodology: </strong>Cross-sectional study was carried out in Divisional Hospitals Bandaragama, Gonaduwa and Haltota. A readiness assessment tool was used to study readiness in Technology and Infrastructure, Human Resources, and Workflow. Technology and infrastructure readiness and workflow readiness were assessed by interviewing medical officers in charge (MOICs) of relevant three hospitals and by direct observation. For assessment of human resource readiness, a validated and pretested self-administered questionnaire was used for all staff supposed to be involved in the operational process of proposed HHIS in selected hospitals. <strong>Results and discussion:</strong> Although all three Hospitals show a total readiness of more than 50%, technology, infrastructure readiness and workflow readiness of Divisional Hospital Gonaduwa and Haltota are less than 50%. Higher level of Human resource readiness has increased the total readiness of these two hospitals more than 50%. However, divisional hospital Bandaragama shows more than 50% readiness of all three types. <strong>Conclusions and recommendations:</strong> It is important to have more than 50% of readiness for all three major sections of the tool individually.

Clinical effect of semilunar-tunnel technique in guided tissue regeneration

Objective: To evaluate the clinical effectiveness, safety, short-term and long-term clinical and radiographic outcomes of a novel surgical approach, the semilunar-tunnel flap technique (SLTT), applied to guided tissue regeneration and to provide a theoretical basis for the exploration of a more minimally invasive, reliable and stable technique for periodontal tissue regeneration. Methods: Totally 20 patients, who received initial periodontal treatment in the Fourth Clinical Division of Peking University School and Hospital of Stomatology from January 2019 to June 2020, with at least 1 affected tooth in anterior region in the mouth and with intrabony defects were selected and randomly divided into two groups with 10 cases in each group. The test group used the SLTT technique and the control group used the modified papilla preserved technique (MPPT) for guided tissue regeneration. The changes in clinical indices such as clinical attachment level (CAL), probing depth (PD), bleeding index (BI), papilla height loss (PHL, distance from interproximal contact area to the zenith of the papilla), defect depth (distance from bone crest to bottom of the defect) before and 6 months after surgery were evaluated. The early wound healing index (EHI) at 2 weeks after surgery in each of the groups were observed. Results: There were significant reductions in PD [test group: (6.50±0.85) mm before and (2.10±0.74) mm after surgery, control group: (6.60±0.97) mm before and (2.40±0.70) mm after surgery], CAL [test group: (8.70±0.95) mm and (4.00±1.15) mm, control group: (8.40±1.17) mm and (4.50±1.18) mm], BI [test group: 3.00 (2.75, 3.00) and 1.00 (1.00, 2.00), control group: 3.00 (2.00, 3.00) and 1.00 (0.75, 1.25)] and defect depth [test group: (4.71±0.95) mm and (-0.20±0.85) mm, control group: (4.38±0.97) mm and (0.99±0.80) mm] between two groups after surgical treatments in 6 months (P<0.05). The changes in PHL [test group: (2.20±1.03) mm and (2.00±0.94) mm; control group: (1.80±1.23) mm and (2.10±0.99) mm] were not significant. The EHI at 2 weeks postoperation was significantly lower in the test group (1.30±0.48) than in the control group (2.10±0.99) (P=0.042) and the improvement in defect depth change was significantly higher in the test group [(4.91±1.18) mm] than in the control group [(3.39±0.95) mm] (P<0.05). The radiographic bone fill rate in test group (1.05±0.17) was significantly higher than that in the control group (0.78±0.14) (P=0.001). There were no significant differences in the PD, CAL, BI, and PHL change between the test and control groups. Conclusions: The SLTT technique applied to guided tissue regeneration was safe and effective. The technique allowed overgrafting in the bone defect area, obtained more effective hard tissue regeneration and achieved possibly better postoperative aesthetic results.