Duty Doctors Research Articles

CLIENT SATISFACTION AND WAITING TIME IN MCH EMERGENCY

The emergency departments are often a source of complaints. Due to the COVID-19 pandemic, we are facing an increase in the number of patients in MCH ER. The patients are referred from all over the country, which increases the burden on the facility compared to the available resources. The department has to face the burden of non-booked patients secondary to the COVID-19 pandemic presenting to the MCH ER, leading to increased complaints about client dissatisfaction regarding the Emergency department. Hence, we decided to audit our current ER and plan interventions to improve our practices. We propose to formulate recommendations for other facilities facing similar challenges. This study aimed to determine the waiting time and total length of stay in the mother and child health care emergency of the Pakistan Institute of Medical Sciences to plan interventions to reduce client dissatisfaction. An audit study was conducted from 1st September 2021 to 30th September 2021, and then a re-audit with interventions was carried out from 1st April 2022 to 30th April 2022 at the Emergency of Mother and Child Health and Care Center of Pakistan Institute of Medical Sciences. The Study had the active participation of duty doctors, nurses, paramedics, statisticians, computer operators, personnel from HMIS, workers, and patients. This study was conducted to determine our practices in an emergency. The data was collected from maintained existing paper-based doctors' and staff nurses’ registers. The duty doctor manually enlisted patient’s data on worksheets, this data was then shared in the "MCH ER WhatsApp group" and compiled. The data was entered on SPSS 25 and analyzed. Primary Outcome measures were waiting time for assessment, primary (registration to triage time), secondary assessment (triage to decision time), and total length of stay in ER (Door to deposition time). Secondary outcome measures included client dissatisfaction rate. A total of 1447 patients were included, of which 46 % were from Islamabad and 38% were from Rawalpindi. The first assessment by a duty ER doctor within 5 minutes (registration to triage time) was 16.4%, which increased to 25.5%, and 59.2% at 30 minutes, which increased to 70.7% in the re-audit. The second assessment by senior (doctor to decision time) within 30 minutes was 59% and increased to 69% in re-audit. Admissions were offered to 33.6%, 1.1% left against medical advice (LAMA), and 38 % were lost to follow-up. The total length of stay in MCH ER (Door to deposition time) was 3 hours mean (195 min) in 60% of the patients (37.9% of patients were admitted, 22.1% were discharged). In the re-audit, 69.6% were admitted after interventions, 27.6% were discharged (97% door to deposition time within 3 hours with a (mean time of 180 min ), 1.8% LAMA and only 1% were lost to follow-up. Both study cycles had no significant change in CTGs, ultrasounds, or baseline investigation frequency. Complaints can be curtailed by taking measures such as adding another duty doctor in emergency for immediate triage, early second assessment by seniors to shorten the triage to decision time, and avoiding unnecessary ultrasounds and baseline investigations. The most significant determinant of client satisfaction in the ER is the short length of Stay in the ER that is, arrival to deposition time.

A Study on the Attitude of Healthcare Professionals Towards Quality Accreditation

Accreditation of hospitals is considered one of the most relevant mechanisms to achieve improvement in the quality and safety of healthcare (8). Worldwide, accreditation is gaining popularity as an effective mechanism for external assessment of healthcare quality. It is considered a method to address the issue of healthcare quality and safety. Accreditation is the independent and systematic assessment of a hospital against defined standards and recognition of a certain level of achievements of those standards by an external body. It is a process of certifying the credibility of an organization. In healthcare, accreditation recognizes and certifies the capability of a healthcare organization in delivering an acceptable standard of healthcare services, which is based upon excellent and safe practices. In this study, healthcare professionals' attitude toward quality accreditation is examined to know about their accountability. Total of 604 healthcare professionals such as; consultant physicians/surgeons, duty doctors, nursing staff, paramedical staff/allied healthcare staff, hospital administrators/managers, others (housekeeping in-charge/blue collar employees and healthcare academicians from public, private and run by Trust located in the North and Central India were randomly chosen. Through the application of factor analysis two components are explored, i.e., service quality and adaptability. One way of ANOVA was applied and found that a difference among the categories of healthcare professionals is observed for these components.

IMPACT OF TYPE OF HEMODILAYSIS ACCESS ON HRQOL ON PATIENT S UNDERGOING HEMODIALYSIS

OBJECTIVE
 The aim of the study was to measure the relationship between the type of vascular access and HRQOL in patients undergoing dialysis in a tertiary care hospital
 STUDY DESIGN
 Cross-sectional study
 PLACE AND DURATION OF STUDY
 Department of Vascular Surgery and Nephrology from January 2021 till June 2021
 PATIENTS AND METHODS
 Data was collected by dialysis center nurse and duty doctors on patients meeting the inclusion criteria . It was a short form survey 36 ( SF -36 ) questionnaire which included health related quality if life in terms of physical symptoms, social functions and access related complications in last 4 weeks on a score of 0 to 3 .Higher scores means poorer quality of life.
 RESULTS
 A total of 80 patients were recruited in the study. A total of 80 patients participated in the study. Male predominance was observed ( n = 59, 73.8 % ). Mean age was 53 +/− 13.9 . 2. Mean HRQOL score in AVF 3.8 +/− 4.8 which was the lowest followed by tunnelled dialysis catheter ( TDC) 9.7 +/−4.5 and non tunnelled double lumen catheter( NTDC ) 11.8 +/−9.1 .
 CONCLUSION
 The HRQOL assessment in ESRD patients can inform the medical personnel of the effectiveness of treatment interventions, it also plays an important role in improving patient's care, assessing patient's needs, setting treatment goals and monitoring disease progression.

Comparison of Conventional Hand Wash and Isopropyl Alcohol Hand Rub among Healthcare Workers and Doctors Working in Gastromedicine ICU: An Observational Study

Nosocomial infection rate is often higher for intensive care unit (ICU) than other units of hospitals, and hands of health-care workers (HCWs) as well as on resident duty doctors play a major role in the transmission of the infections. Aim of this study was to compare the efficacy of conventional hand wash with the Isopropyl alcohol Hand rub in reducing the transient bacterial flora on the hands of nurses and posted doctors in a Gastromedicine ICU. The 32 nurses and 14 resident duty doctors posted in our ICU during JanuaryMarch 2022 were included in this observational study. A total of 250 samples were collected for the residual bacterial flora on fingers using the impression method on MacConkey agar plates. The subjects then used Isopropyl alcohol hand rub or conventional hand wash and the residual bacterial flora was rechecked by testing the impression of fingers on MacConkey agar. Escherichia coli, Klebsiella spp., non-lactose fermenting Gram-negative bacilli, staphylococci, and streptococci formed the transient bacterial flora on the hands. Moderate to heavy bacterial density was seen in more than 94 % of the hands before washing or hand rub application. Conventional hand wash resulted in a drastic reduction in the transient bacterial flora on hands in 55 % of cases whereas Isopropyl alcohol hand rub achieved the effect in 97 % of the samples. Compared with conventional hand wash, Isopropyl alcohol hand rub is far more efficient in reducing transient bacterial flora on the hands of HCWs, and in resident duty doctors it is more convenient and timesaving. It is recommended as a hand hygiene practice in critical areas especially in the gastro medicine ICU because most of the patients are immunocompromised and it may act as a protective barrier.

Some Results from a Sociological Hospital Patient’s Survey on Neurosurgery Assistance in Mongolia

Introduction: In Mongolia, there is a number of geographical and national characteristics that affect the accessibility and organization of neurosurgical care for the population. Objective: Identify problems and directions for optimizing neurosurgical care in Mongolia from the consumer`s of medical care point of view – patients. Methods of Research: Sociological, statistical methods. Results: The results of the conducted research showed that the aggregated priority directions of neurosurgical care optimization according to the interviewed patients of hospitals in Mongolia are optimization of providing neurosurgical care organization, optimization of personnel and logistical support, and patient handling. Conclusions: 1. The results of a sociological patient’s survey revealed that the work of the reception department in surgical clinics is organized insufficiently effectively in relation to neurosurgical profile patients. 2. Technology of therapeutic and diagnostic processes (the regularity of patient’s examination by medical personnel, such as attending physicians, duty doctors, and heads of departments) is not fully maintained. 3. Informing patients and their relatives about the results of the examination and the course of treatment is not organized at the proper level. 4. According to the patients, the main problems in the organization of neurosurgical care are: a long queue for examination and treatment in public clinics, unsatisfactory conditions of hospital stay, as well as a high workload of medical personnel. 5. According to the patients, priority directions of neurosurgical care optimization are: improvement of the stages of neurosurgical care organization, personnel and logistical support optimization, and organization of informing population about the work of the neurosurgical service.

Advance Directives and Palliative Medical Care in Nursing Homes: A Study on Everyday Life and Relevance in Out-of-Hours Medical Care

The percentage of nursing home residents that have documented advance directives (AD) is increasing. However, there are no studies concerning the consideration of these directives within the out-of-hours primary care or the emergency service. There is also a lack of information on the differences in the attitudes of doctors on duty in various disciplines towards therapeutic options in palliative situations. In the context of research about the medical care of nursing home residents outside regular practice hours, the existence of AD and their consideration by the doctors on duty or emergency doctors was investigated (n=101). Furthermore, the attitudes of the doctors on duty (n=60) and of a reference group of palliative doctors (n=19) towards experience in palliative medicine, asking for AD of the patients and the approach in a fictive palliative case were recorded. 71% of the 82 residents had documented a living will. In 54% of the 101 cases, the doctors on duty and emergency doctorsmade enquiries about AD. In 92% of cases, the doctors followed the given directives. Significant differences between doctors on duty and emergency doctors could not be confirmed. Given a fictive palliative case, 92% of the doctors on duty and 95% of the reference group stated they would enquire about an AD. In acute palliative situations, general practitioners, internists and palliative physicians were more likely to use rapid-acting opioids and anxiolytics, were less likely to call the emergency doctor and were less likely to admit patients to hospital. This distinguishes them from other disciplines. In only 54% of all contacts between patient and doctors on duty or emergency doctors, enquiries were about an AD. That is why doctors need to be further sensitized on the issue of making enquiries about AD from unknown. Additionally, the patient's will should be visible in short form in the respective patient file. Arrangements made with foresight, early involvement of doctors with palliative experience (AAPV, SAPV) as well as increased palliative medical training could improve the care of nursing home residents.

Accessibility and quality of haemodialysis services in an urban setting in South India: a qualitative multiperspective study

ObjectiveTo explore the accessibility and quality of existing haemodialysis services in an urban setting.SettingThe study was conducted in Bangalore city, India.ParticipantsA total of 28 stakeholders including 2 nephrologists, 7 duty...

Workplace Violence Against Doctors in Bangladesh: A Content Analysis.

Workplace violence in healthcare settings is a common global problem, including in Bangladesh. Despite the known presence of workplace violence in healthcare environments of developing countries, there is limited understanding of factors that lead to hospital violence in Bangladesh. This study aims to explore factors that influence incidents of violence against healthcare professionals in Bangladesh, as reported by doctors via social media forum. Content analysis was conducted on 157 reported incidents documented on “Platform,” the online social media most used by medical students and doctors in Bangladesh. Posts by doctors detailing experiences of physical or verbal violence at their workplace between July 2012 and December 2017 were included in this study. The majority of reported incidents were reported by male doctors (86%) and from government hospitals (63.7%). Findings showed that primary healthcare centers experienced more violence than secondary and tertiary facilities. This may largely be due to insufficient human and other resources in primary care settings to meet patient demand and expectations. Most of the events happened at night (61%), and as a result, entry-level doctors such as emergency duty doctors and intern doctors were commonly affected. Six themes were identified as vital factors in workplace violence against doctors: patients’ perspectives, delayed treatment, power practice, death declarations, extreme violence, and care-seeking behaviors. Most incidents fell under the categories of delayed treatment and power practice at 26.8 and 26.1%, respectively. This study identified possible factors for reported violence in hospital settings. To address and reduce these incidents, hospital administrators should be aware of risk factors for violent behavior and design appropriate measures to prevent workplace violence. Further qualitative and quantitative research is needed to appropriately address the consequences of violence on healthcare workers and implement measures to mitigate these events.

Willingness of Body donation

Cadavers are an incomparable resource for teaching labs in Anatomy. Without dissection of cadavers teaching and learning anatomy barely impossible; due to difficulty in correlating theoretical knowledge with practical knowledge. The objective of the study was to evaluate the awareness regarding the body donation after death. A survey was randomly distributed among older than 18 years, which included MBBS students, Dental students, and duty doctors in Bangalore. A total 380 participants filled up the questionnaire and consent letter providing information on demographic, educational, and religious aspects specific ones related to the willingness to donate own bodies. On the 380 participants, 140 (37%) were women and 240 (63%) were men, with ages from 18 to 45 years. Reasons to donate, majority 92.63% of the respondent expressed their positive attitude; 7.4% had negative attitudes. Main motives to donate were related to support teaching, research, and science, while the main reason for not to donate was associated with lack of sufficient information. The profile of potential donors was obtained from the analysis of all the respondents, and we also compared with different studies demonstrating that not only cultural, ethnic and religion aspects may determine the willingness to donate but also the level of public information and facilities to register as donors. KEY WORDS: Body donation, Cadavers, awareness, knowledge, future generations.

Improving remote prescribing in a CAMHS community team during the COVID-19 pandemic

AimsPrior to the COVID-19 pandemic, prescriptions were usually collected by patients/families in person from the CAMHS community team base. Due to social distancing measures introduced during the pandemic, face-to-face contact between staff and patients had to be minimised. This led to an increase in remote prescribing, including from home. Feedback from team doctors was that the process of following the Remote Prescribing Protocol (RPP) was taking up a significant portion of their day, preventing them from doing other clinical work.Our aim was to reduce the time taken to complete a remote prescription to pre-pandemic levels (under 15 minutes).MethodWe used PDSA methodology in this QI project: 1)Plan: Survey sent out to team duty doctors to identify the most time-consuming steps in RPP which could be safely delegated to administrative staff2)Do: Email sent requesting administrative staff clarify several details with patients/families when they request a prescription. This included the names and doses of medication, how many days they had left, where they wanted the prescription sent to (home/pharmacy) and the relevant address. If the patient usually received their repeat prescription from their GP, they were re-directed to their GP3)Study: Following the intervention above, team doctors recorded how long it took to complete a remote prescriptionResultThe average time taken to complete a prescription fell from 31 minutes (pre-intervention) to 22 minutes (post-intervention). The range of time taken also dropped from 10-241 minutes (pre-intervention) to 0-46 minutes (post-intervention). The medications taking above the average time to complete were more likely to be non-controlled drugs rather than controlled drugs (which one may typically think would be more time-consuming to write out).ConclusionWhilst we have successfully reduced the time for remote prescribing, we have not reached the target of reducing it down to less than 15 minutes (pre-pandemic timings). As part of the next PDSA cycle, we have carried out a survey to ask what barriers remain. Checking patient's notes and recent prescriptions can still be inefficient. We propose introducing an intervention whereby this can also be safety delegated to administrative staff e.g. including a copy of the most recent prescription in the request.In the future, we will continue to improve the RPP with further PDSA cycles and carry out an audit on the system on a regular basis to ensure standards are met.

Febrile Seizures: Evidence for Evolution of an Operational Strategy from an Armed Forces Referral Hospital.

PurposeCurrent recommendations for ‘Febrile seizures’ management include emergency first aid and treatment along with intermittent prophylaxis. Evidence of practices, efficacy, side-effects, and complications should lead to refined and rational management strategies.Patients and MethodsStudy of cases referred and treated at a tertiary level hospital, providing referral services to a large state in India. Evidence sought for the research questions identified, these were (i) immediate treatment: First aid components and practices; response to drug treatment (ii) intermittent prophylaxis: effectiveness, compliance, and side-effects (iii) complications arising due to treatment side-effects: quantifying the number of cases of CNS infections missed as a result of alterations in consciousness levels due to benzodiazepines.ResultsA total of 85 febrile seizure cases were studied. Full correct “First Aid” was provided by only 13 parents. Total 35 cases (41.18%) had seizures lasting more than 05 minutes. Emergency treatment for these included rectal diazepam in 14 cases with 57.14% success in terminating seizure, and intranasal midazolam in 21 cases with 71.43% success. The cases with persisting seizures were managed as status epilepticus treatment algorithm. Intermittent prophylaxis prevented recurrence of seizures in 90%, however side-effects were reported in 36.36%. There was no case of CNS infection missed.ConclusionSafe and effective management strategy should include “Health education” for correct first aid and ‘Protocols’ for timely and correct emergency treatment by parents/pre-hospital teams/emergency duty doctors. Intermittent prophylaxis is effective but refinements needed to minimize side-effects. Vigilant clinical monitoring obviates the fear that treatment may mask CNS infection.

Emergency room ophthalmology practice during COVID-19 related lockdown: A cross-sectional Study

ABSTRACT
 This report depicts the effect of COVID-19 related lockdown on emergency room ophthalmology practice in a tertiary care setup of Punjab. A cross sectional study was designed at department of Ophthalmology, Gujranwala Medical College/ Teaching Hospital from 24th March 2020 to 9th May 2020 (47 days lockdown period). All the patients who presented to eye emergency room during this period are described. The protective strategies adopted by the duty doctors are also described. Total 454 patients presented to eye emergency room, out of which 24 patients underwent emergency surgical procedure. The burden of patients presenting to eye emergency room was less than routine during lock down period. All the duty doctors used N95 (Giko1200F) particulate respirator during patient examination. Problems faced by ophthalmologists while wearing face masks were misting of spectacles, eyepieces of slit-lamp bimicroscope and condensing lenses. In perspective of keeping population indoor and avoiding unnecessary visit to hospitals the lockdown remained effective.

On the absence of a doctor's dilemma in India: Reflections on impatient violence.

On June 10, 2019, Mohammed Sayeed, a 75-year-old patient was admitted to the Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal (1). He died that night due to a cardiac arrest and this led to a scuffle between the patient's family and duty doctors. In retaliation, the doctors refused to discharge the body, asserting that since the family claimed it was a suspicious death, a post-mortem was required. A mob arrived, and in the confrontation, a doctor was injured. The medicos struck work. Doctors and medical associations across the country have voiced unanimous support for the doctors, and called for protective legislation against the violence of the public. As a consequence of these nationwide doctors' protests, the Supreme Court has now proposed a law that protects doctors by severely punishing those who attack them (2). Meanwhile, it does seem as if such attacks are increasing.

Electrocardiogram Interpretation: An Exploration of Knowledge and Practice among Secondary Care Hospital's Emergency Physicians

Background: An electrocardiogram (ECG) is a simple, easy, low cost and routine diagnostic tool. Nearly all private secondary hospitals of Pakistan have this facility. It is non-invasive, cardiac evaluation test. It has unsophisticated handling procedure. It is very important for duty doctors in their busy clinical practice to have good command on ECG interpretation. Likewise it is prime responsibility of doctors to timely order the ECG when warranted. A good physician has to interpret ECG precisely for timely manage and refer the cardiac related patients to tertiary care facility. Aim and Objectives: The aim of this study was to take a survey among the secondary level private hospital doctors, regarding their knowledge and interpretation skills for timely decision making. Methodology: Total five lethal ECGs were recorded and distributed among 470 doctors, working in the emergency departments of 12 private secondary hospital, of Karachi city, in different shifts from June, 2017 to December, 2017. They were asked to give only one diagnosis with at least five interpretation points to support their diagnosis. The answers were matched with definite diagnosis made by a cardiologist who has more than 15 years experience and currently working as Professor in cardiology. Results: Almost all of the doctors (93%) had readily asked for ordering an ECG for certain epigastric and chest pain evaluation. However, only 30% given the correct diagnosis regarding the lethal cardiac conditions. Interestingly, only 23% rightly interpret the lethal ECGs. Conclusion: According to results shown, the doctors working in private secondary hospitals of Karachi city were good at initiating the ECG recording order. However, ER doctors are advised strongly to gain in depth knowledge and correct interpretation skills as it can save millions of lives in their career.

NEWBORN BODY TEMPRATURE;

Objectives… To identify comparative study to see the impact on newbornbody temperature after skin contact of mother and newborn v/s conventional method. StudyDesign: Cross sectional, analytical study. Place and Duration: Department of Obstetrics andGynecology (Unit-III) Liaquat University Hospital, Hyderabad Sindh from May 2013 to April2014. Methods: All the laboring women with no any antenatal complication and with cephalicpresentation admitted at term pregnancy for normal vaginal delivery along with new born withApgar score more than 6 were approached by duty doctors. Written as well as verbal consentwas obtained and women have allocated numbers, 1 to 120. The women were divided intwo groups. Group A (baby warmer group 60 patients) and Group B (Skin to skin contact 60patients). Results: 120 patients were recruited and randomly equally divided into two groups.There over all mean age of these patients was 26.7+- 5.0years. In group A the gravida wasfound as between 1 to 6 children in 60% (n=30), Compared with Group B, 64% (n=32). Theoverall mean hospital stay was as 6.6+_ 1.6 hours. Personal health response like was foundin 76% (n =38) patients with group A compared with Group B 86% (n=43). Mother responselike was found in 76% (n=38 patient in group A) compared with group B 76% (n=38). Thereis statically significant mean difference in ◦F after one hour was observed (P=0.001) betweengroup A and group B, no significant mean difference in temperature ◦F after 1 and 5 minuteswere observed ( P > 0.05)compared with in group B 76% (n=38) patients. Conclusion: Skinto skin contact reduces the hypothermia, so it should be encourage and continue. Skin toskin contact is easy, cheap and helps in bonding of mother and baby. With this practice wewill achieve the millennium development goal (MDG) that is to decrease neonatal mortality inPakistan.

Emergency medicine in the general practice internship in Finnmark county.

It is preferred that duty doctors in municipal health services participate in call-outs in emergency situations. The frequency of participation has previously been shown to vary. We wanted to examine the newly qualified doctors’ expectations and experiences – both before and after the general practice internship – of emergency medicine and ambulance call-outs. All 23 of the interns who were to undertake their general practice internship in Finnmark county in the period 2015–16 answered a questionnaire and participated in a focus group interview before the start of the internship. Twenty-one of the interns participated in the focus group interview after completing the internship. Each doctor took part in two interviews. We analysed the transcripts from the focus group interviews using the grounded theory method. The responses from the questionnaire before the general practice internship showed that the interns felt they needed more training in intravenous cannulation and in teamwork. Their expectations in connection with the challenges of call-outs are best characterised by the core category ‘Can I do anything useful?’ from the focus groups before the internship. After the internship, however, the core category ‘It all went well in the end’, was the best fit. Due to short transport times and their knowledge of certain patients, some of the doctors chose not to take part in call-outs. During the general practice internship, the interns were initially anxious about whether they might be superfluous in call-outs, but eventually found their footing in the call-out role. The study shows that there is a need for more practice in certain practical procedures, and that doctors’ non-technical skills need to be improved. This can be done through training in team leader roles before the general practice internship.

Telemedicine in India: current state, challenges and opportunities

Purpose – The purpose of this conceptual paper is to present the scope of telemedicine, current state of telemedicine in India, challenges in its diffusion and suggest the way forward for implementation of such initiatives. Design/methodology/approach – This is a viewpoint paper that is prepared based on authors’ exposure and knowledge about research topic and the context. A number of appropriate and current citations have been utilised to illustrate current state on the topic as well as to support authors arguments presented in this paper. Findings – The discussion presented in this paper suggests that optimal utilisation of technology in healthcare delivery system requires overcoming barriers at multiple levels including policy, resources and socio-cultural levels. Successful implementation of telemedicine entails involvement of all the stakeholders, namely, the specialists, general duty doctors, paramedical personnel, technical staff, coordination staff, policymakers and, most importantly, the target community, from the design stage itself. Originality/value – The primary value of this paper lies in providing an overview of current state of telemedicine development in India. It is believed that this article will act as a precursor to future articles on this topic.

Diagnostic accuracy for heart failure – data from the Akershus Cardiac Examination 2 Study

Diagnosing heart failure in an on-call setting can be difficult, and international studies report diagnostic accuracy among duty doctors, as measured using area under the ROC curve (AUC), to be 0.76-0.90. This study has examined the accuracy with which doctors in the internal medicine out-of-hours service in a Norwegian university hospital distinguish heart failure from no heart failure in patients with dyspnoea. Information was gathered on 468 patients admitted to Akershus University Hospital with dyspnoea between June 2009 and November 2010, and 314 patients were included in the study. The duty doctors estimated the probability of heart failure (0-100%) before N-terminal pro-B-type natriuretic peptide (NTproBNP) concentrations were known. The final diagnosis for the hospital admission was made retrospectively by two independent doctors after review of the medical records, including supplementary tests and the patient outcome. Heart failure was considered the cause of hospitalisation in 143 patients (46%). Patients with heart failure were older, more often men, had a higher prevalence of heart disease, reduced/impaired renal function, and higher NTproBNP concentrations than patients with non-heart failure dyspnoea. The diagnostic accuracy among duty doctors for heart failure (AUC) was 0.86 (95% confidence interval 0.82-0.90). The doctors' diagnostic accuracy was lower when the patient had heart failure with left ventricular ejection fraction [LVEF] ≥ 50% (n=52): AUC 0.83 (0.77-0.87). The duty doctors at Akershus University Hospital from 2009-2010 demonstrated similar diagnostic accuracy for heart failure as previously reported from international centres. Diagnostic accuracy was lower for heart failure patients with LVEF ≥ 50%.

Preinstallation hurdles and postinstallation benefits of biometric access control system (BACS) in a government hospital mess

Background: The risk of violence against doctors working in a government hospital is a known phenomenon. The duty rooms and doctors’ mess in hospital premises are the soft and easy targets for these incidences. To provide a stress-free work environment and better security and privacy, a fingerprint-based biometric access control system (BACS) was installed in the doctors’ mess at J.N. Medical College and Hospital, Aligarh. Objective: To identify the preinstallation hurdles and postinstallation benefits of a BACS in the doctor’s mess. Materials and Methods: This was a cross-sectional study conducted in the J.N. Medical College and Hospital, A.M.U., Aligarh, Uttar Pradesh, India. The study population consisted of the members of the Resident Doctors Association (RDA) and the staff and members in charge of the RDA mess. The study was conducted in two phases through different questionnaires—phase A: to assess the main hurdles in the installation of BACS, and phase B: to assess the perception of benefits of BACS installation. Result: The main hurdle was organizational challenges (47%) including consensus building and affordability, followed by operational (29%), and user-based challenges (24%). The main benefits perceived by the members of the mess were restriction of entry of the patients and attendants (44.2%) and influential outsiders (37.2%), followed by a better sense of privacy and security (10.4%) and restriction in free flow of infections from wards through the attendants (8.2%). The staff workers reported a positive change in the work atmosphere with a reduction in rude and intimidating behavior against them and improvement in service, delivery time, and quality. Conclusion: The BACS is a cost-effective solution for security, although not a foolproof solution. Apart from security, it has other benefits, and if linked with attendance systems, it can find a solution to the problem of ghost doctors in medical colleges and rural health facilities.

Salient Features Regarding Medicolegal Certificate

General duty doctors in all major hospitals -Govt and Private-are often unclear regarding when to label a case as medicolegal. This paper attempts to give general guidelines to doctors regarding this problem.