Tertiary Government Hospital Research Articles

Social Media Promotion of a Telehealth-based Vaccine Delivery System at the Outpatient Department: a Quasi-Experimental Study.

COVID-19 pandemic gave rise to an increase in demand for pneumococcal and influenza vaccines. Several approaches to improve vaccination rates among different populations were investigated to address this need. Social media may be used as a platform to promote and improve vaccination rates. The study aimed to determine the effect of social media promotion, on the number of patients requesting vaccination in a government tertiary hospital. The study was conducted using a quasi-experimental design. A telehealth-based vaccination delivery system was established. The need for vaccination against flu and pneumonia was then promoted on a social media platform during the first month of the study. Posters on the risk of not being vaccinated and safety profile of vaccines were added on the second month. The number of requests for vaccination for each month was compared. Social media metrics of the two months of the study were likewise described. A total of 23 requests for vaccination were recorded, 11 on the first month and 12 on the second month. When a boost in advertising for the posts was implemented, twice as many requests were made during the third week of the second month as compared to the previous month (5 vs 10). Social media promotion with poster showed higher average in reach, engagement and comments per week than without poster. The mean differences among the social media metrics, however, were not statistically significant. Promotion with posters resulted in a slight increase in number of vaccination requests. Further increase in requests may require a more refined social media promotional strategy.

Mobility as an Effective Non-pharmacological Method for Parturition: A Pilot Study

Background Childbirth is a transformative process. Modern healthcare offers pharmacological and non-pharmacological interventions for safe and improved childbirth experience. Studies have found that maternal mobility during the first stage of labour has a significant effect on maternal and child outcomes. A pilot study was done to find the effect of mobility during the first stage of labour on maternal satisfaction and foetal outcome. Method An experimental study was done with 60 primigravida women with uncomplicated antenatal history reporting to the labour room of a tertiary care government hospital in Delhi chosen as study participants. Validated and reliable tools were used to measure labour, maternal and neonatal outcomes within 24 h post-delivery. Results The results showed that there was an impact on mobility intervention during the first stage of labour on parturition ( p = .03) and significant maternal satisfaction ( p = .001). However, the neonatal outcome of both groups was not significant. Conclusion Mobility was an effective non-pharmacological intervention for enhancing parturition and maternal satisfaction. Mobility during the first stage of labour can be recommended for practice guidelines for all midwives in the labour room as a protocol.

Seroprevalence of COVID antibodies in health-care population of tertiary care government hospital in South India

Background: The pandemic coronavirus disease 2019 (COVID-19) caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a worldwide abrupt and significant rise in admissions for pneumonia with multiorgan diseases. Aims and Objective: To determine the positive prevalence of SARS-CoV-2 antibodies in health-care professionals over 6 months. In addition, to make a subgroup analysis and estimate the age, gender, and workforce-based prevalence of SARS-CoV-2. Materials and Methods: An observational cross-sectional study was conducted on 200 healthcare professionals during 6 months. After taking proper informed consent, the study was started. We included subjects aged ≥18 years in this study. Not receiving any other vaccine during the study, suspected or confirmed immunosuppressive condition, imaging confirmed COVID-19 or recent blood transfusions were excluded from the study. Results: Most patients were 26–30 years old. Out of 200 patients, 116 (58%) were males, and 84 (42%) were females. The total positivity of the titers amounts was 57%. In addition, the males had higher mean titers than the females, with 24.186 versus 13.304. Of the 116 males, 68 were positive (58.6%), and of the 84 females, 46 were positive (54.7%). The age-wise positivity of the titers was high among the 26–30 years of age group, of which, in the 53 people, 33 were seropositive, which is 62.2% of this age group and lowest in the 51–55 years age group, of which in the 23 participants 9 were positive (39.31%), and 14 were negative (60.85%). Conclusion: We concluded that male doctors and adults had a greater seroprevalence of SARS-CoV-2 infection, suggesting that they are more susceptible to contracting COVID-19 through patient contact or surgical procedures.

Predictors of Mortality among End-Stage Renal Disease Patients with COVID-19 Admitted in a Philippine Tertiary Government Hospital: A Retrospective Cohort Study

Predictors of Mortality among End-Stage Renal Disease Patients with COVID-19 Admitted in a Philippine Tertiary Government Hospital: A Retrospective Cohort Study

Factors Associated with Prolonged Length of Stay in the Ambulatory Care Unit of a Tertiary Government Hospital.

Length of stay is one of the metrics of crowding in the emergency department. Identification of the factors associated with prolonged length of stay is vital for staffing and policy making to prevent overcrowding at the ambulatory care unit. This study aimed to determine the association of sociodemographic, clinical, and temporal factors with length of stay among patients seen at the ambulatory care unit of a tertiary government training hospital. A retrospective case-control study was conducted between January to December 2019 at the ambulatory care unit of a tertiary government hospital. Charts of patients who stayed for more than six (6) hours were classified as cases, while those who stayed for more than two (2) hours up to six (6) hours were classified as controls. Charts were reviewed to obtain the clinicodemographic profile of patients who satisfied the inclusion criteria. The case group consisted of 86 patients, while the control group consisted of 172 patients. Eight factors had an effect on the probability of prolonged length of stay at the ambulatory care unit: age 40-59 years old (OR = 2.29, 95% CI: 1.16-4.49), ESI 3 at triage level (OR = 3.35, 95% CI: 1.50-8.38), psychiatric complaint (OR = 6.97, 95% CI: 2.53-19.21), medications given and diagnostics done (OR = 2.16, 95% CI: 1.16-3.99), medications given/diagnostics/referral to other services done (OR = 7.67, 95% CI: 2.70-21.80), psychiatric/substance-related case (OR = 6.97, 95% CI: 2.63-18.49), transferred to other services (OR = 3.25, 95% CI: 1.33-7.94), and endorsed to next shift (OR = 6.94, 95% CI = 3.90-12.35). The factors associated with prolonged length of stay were middle-aged adults, conditions with severe presentation, psychiatric/substance-use-related cases, need for more diagnostic test and treatment intervention, and decision to transfer care to other services.

Hospital Waste Management in a Tertiary Private and Government Hospital in Dhaka.

Hospital Waste Management in a Tertiary Private and Government Hospital in Dhaka.

Prevalence of co-morbidities and referral patterns in routine preoperative evaluation: A retrospective observational analysis in a tertiary care government hospital

The initial interaction between patients and anaesthesiologists during pre-anaesthesia check-ups (PAC) is a crucial opportunity to diagnose and pre-optimize co-morbidities that might go unnoticed. This proactive approach contributes to safe anaesthesia administration, uneventful intra-operative experiences, and smooth post-operative recovery. Our study assesses the prevalence of diverse co-morbidities within a tertiary care centre's PAC. After analysing data from 3 months involving 905 patients, 624 individuals exhibited co-morbidities, with 217 cases being newly identified within the PAC clinic. Among female patients, anaemia emerged as the most prevalent anomaly (219 cases), while hypertension dominated among male patients (171 cases). Overall, anaemia constituted the most common co-morbidity (362 cases). A comprehensive clinical assessment during the Pre-Anaesthetic Clinic empowers formulation strategies for pre-optimization and treatment of co-morbidities. Timely intervention is pivotal, not only to prevent surgery delays but also to avert potentially catastrophic outcomes arising from untreated conditions. This approach translates into expedited patient recovery, minimizing anaesthesia-related complications. The Pre-Anaesthetic Clinic plays a pivotal role in diagnosing and intervening in patient co-morbidities. Beyond diagnosis, it is a crucial early intervention and treatment platform, significantly enhancing the overall surgical recovery process.

Use of Artificial Intelligence Tools for Diabetes Care: Protocol for Exploring Patient Attitude and Perspective

The prevalence of diabetes is still rising across the world. The high increase in incidence and economic load from diabetes leads to efforts to seek more effective ways to treat and care for diabetic patients. One of the ways is to explore the significant contribution of artificial intelligence (AI) in healthcare. AI has been defined as the ability of computers to perform tasks typically related to human intelligence and their applications are believed to be an essential part of healthcare services that could be embedded into several aspects of clinical diabetic care. However, there is still a lack of research exploring diabetic patients’ attitudes and perspectives toward AI applications. Thus, in this study, patients' attitudes and perspectives toward the use of artificial tools for diabetic care will be studied. It is important to understand the patients’ views because it will have a positive impact on how research is going to be conducted and to ensure that the work is relevant and useful and that any concerns can be addressed at the beginning. This paper aims to present the preliminary work for this study. A qualitative research design is chosen for this observational study where semi-structured interviews will be used as the data collection method. The participants will be the current patients within a government tertiary hospital located in the south of the royal town of Klang, Selangor, Malaysia. Prior to the study, the concepts of attitude, perspective, and related theories and models are examined. From the literature review, many factors and variables were discovered, and the conceptual framework is proposed as the foundation of this study. The conceptual framework will guide the data collection process whereby a qualitative thematic analysis approach will be employed for this study.

Clinical Profile and Treatment Outcomes Of Acute Cholangitis in Children in a Tertiary Government Hospital in the Philippines: A Five-Year Retrospective Study.

Clinical Profile and Treatment Outcomes Of Acute Cholangitis in Children in a Tertiary Government Hospital in the Philippines: A Five-Year Retrospective Study.

Psychosocial Impact of Prolonged Skeletal Traction of Lower Extremity Fractures in a Philippine Specialty Tertiary Government Hospital

Psychosocial Impact of Prolonged Skeletal Traction of Lower Extremity Fractures in a Philippine Specialty Tertiary Government Hospital

Blood donation practices, processing and utilisation of blood components in government tertiary hospitals in Nigeria: a multicentre cooperative study.

Timely access to safe blood and blood components is still a challenge in Nigeria. This study aimed to determine blood donation practices, processing and utilization of blood components across government tertiary hospitals (THs) in Nigeria. This was a descriptive cross-sectional study done in Nigeria in June-July 2020. Data were analysed with SPSS version 21.0. Data were collected from 50 THs. The majority (68%) of the THs lack facilities for blood component preparation and only 18% and 32% provide cryoprecipitate and platelet concentrate, respectively. Whole blood was most commonly requested (57.04%). All facilities tested blood for HIV, HBV and HCV, but the majority (23 [46%]) employed rapid screening tests alone and nucleic acid testing was not available in any hospitals. The manual method was the most common method of compatibility testing in 90% (45/50) and none of the THs routinely perform extended red cell typing. The average time to process routine, emergency and uncross-matched requests were a mean of 109.58±79.76min (range 45.00-360.00), 41.62±25.23 (10.00-240.00) and 11.09±4.92 (2.00-20.00), respectively. Facilities for blood component preparation were not widely available. Concerned government authorities should provide facilities for blood component preparation.

Comparison of maternal and fetal outcomes between COVID-19 and non-COVID-19 patients in a tertiary government hospital: A retrospective cohort study

INTRODUCTION: Although it is likely that outcomes in pregnancy differ between regions due to differences in health-care delivery, resources, and health protocols, the rampant increase in COVID-19 cases has proven its effects on the maternal and fetal outcomes. But to what extent does COVID-19 in pregnancy affect adverse maternal and neonatal outcomes compared to non-COVID-19 pregnant patients? OBJECTIVES: This study aims to compare maternal outcomes (morbidity, mortality, intensive care unit [ICU] admissions, and cesarean section [CS] rate) and fetal outcomes (prematurity, APGAR score, neonatal ICU [NICU] admission, and mortality) between COVID-19 and non-COVID-19 cases. METHODOLOGY: A retrospective cohort study was done through chart review of 240 patients, 120 for the COVID-19 group and 120 for the non-COVID-19 group. Demographic data, as well as maternal outcomes (i.e., morbidity, mortality, ICU admissions, and emergency CS), and adverse fetal outcomes (i.e., prematurity, low APGAR, NICU admission, and mortality) were gathered. These outcomes were also classified according to disease severity for the COVID-19 group. The effect of using investigational drugs to outcomes was also determined. RESULTS: This study shows that adverse maternal outcomes were significantly increased with COVID-19 infection. Mortality was increased by 10% while morbidities (acute respiratory distress syndrome, disseminated intravascular coagulation, hemorrhage, and sepsis) were increased by 35%. ICU admission for COVID-19 patients was 10.8% higher, and the emergency CS rate was also increased by 10% in the COVID-19 group. Results also showed increased adverse fetal outcomes for the COVID-19 group, with a 10.8% increase in neonates being born prematurely, an 11.67% increase in low APGAR score, a 9.16% increase in mortality, and a 10% increase in NICU admission. The use of investigational drugs in cases of severe and critical COVID-19 did not have any significant benefits to the outcomes. CONCLUSION: COVID-19 infection significantly increases both maternal and fetal outcomes, and these adverse effects correspond to the severity of the disease. The use of investigational drugs in severe and critical COVID-19 cases has no significant benefit to maternal and fetal outcomes.

MO52-5 Prevalence and clinical features of triple-negative breast cancer in a tertiary government hospital in the Philippines

MO52-5 Prevalence and clinical features of triple-negative breast cancer in a tertiary government hospital in the Philippines

Prevalence of Pressure Ulcer in Orthopaedic Bedridden Patients With a Higher Braden Pressure Ulcer Score in a Tertiary Care Government Hospital in Jammu

In this research, our primary objective was to determine the prevalence of pressure ulcers (PU) in bedridden patients with risk of higher Braden Pressure Ulcer scores who were admitted to the orthopaedic wards at the tertiary care government hospital in Jammu. Methodology To achieve this, we conducted a cross-sectional point prevalence study utilising the Braden Pressure Ulcer Risk Assessment Scale and the European Pressure Ulcer Advisory Panel (EPUAP) grading scale and data form. Our research sample consisted of 180 bedridden patients with higher Braden scores admitted to the orthopaedic ward of the selected facility. We monitored these patients using an observational checklist based on the established EPUAP minimal dataset form and grading scale. We conveniently selected patients who had moderate to severe Braden Pressure Ulcer Risk scores. Result Our findings revealed that 22.8% of the bedridden patients with moderate to high-risk Braden pressure ulcer scores developed pressure ulcers. Among the respondents, the majority (67.78%) were categorised as high risk, followed by severe risk (18.89%) and moderate risk (13.33%). Of those who developed pressure ulcers, 28 had Grade 1 ulcers and 12 had Grade 2 ulcers. The most common locations for these ulcers were the sacrum (40%), followed by the iliac region (35%), and the buttocks (25%). We did not observe any significant association between clinical variables and the incidence of pressure ulcers, except for skin turgor.

Trends of Mortality and Morbidity due to Ascariasis: A 14-year Analysis in a Tertiary Hospital in Bangladesh

Background: Ascariasis is still a major public health concern and is termed as neglected tropical disease. There are surgical morbidity and mortality due to ascariasis. Objective: The general objective of the study was to analyze the trend of hospital admission and mortality from ascariasis at a tertiary government hospital in Bangladesh. Methodology: This was a retrospective chart review performed in the department of pediatric surgery at Chittagong Medical College Hospital, Chattogram, Bangladesh from a period of January 2006 to December 2019. Patients of 0 to 12 years of age who were admitted and diagnosed as intestinal or biliary ascariasis were analyzed for yearly trend for admissions, surgeries, and mortalities. Results: There were a total of 33,426 patients with various disease admitted and among them 2799 (8.67%) patients were diagnosed as intestinal ascariasis and 375(1.12%) patients were diagnosed as biliary ascariasis. Admission rate for intestinal ascariasis decreased from 15.87% in 2006 to 8.67% in 2019 and that for biliary ascariasis decreased from 1.87% to 0.98 %. The surgical load for intestinal obstruction decreased from 5.20% in 2006 to 1.09% in 2019 among all surgeries. Only one surgery was performed for biliary ascariasis. Mortality rate of ascariasis among all mortalities decreased from 20% to 5%. There was no death from biliary ascariasis. Conclusion: Surgical morbidity and mortality from intestinal ascariasis decreased over time but ascariasis is still causing loss of valuable lives. Bangladesh Journal of Infectious Diseases, June 2023;10(1):24-30

Integration of phenotypic, qPCR and genome sequencing methodologies for the detection of antimicrobial resistance and virulence in clinical isolates of a tertiary hospital, India.

The emergence of antimicrobial resistance (AMR) and virulence in clinical isolates is a significant public health concern. The rapid and accurate detection of these traits in clinical isolates is essential for effective infection control and treatment. We demonstrated the integration of multiple detection methodologies, including phenotypic testing, quantitative polymerase chain reaction (qPCR), and genome sequencing, to detect AMR and virulence in clinical isolates. One hundred sixty-two gram-negative bacterial clinical isolates were selected for this study from the Shri Vinoba Bhave Civil Hospital, Silvassa, a tertiary government hospital. Antimicrobial susceptibility was detected by determining the Minimum Inhibitory Concentration (MIC) using Vitek-2, whereas the combined disk (CD) method was used for phenotypic detection of carbapenemase activity. The highest sensitivity rates were obtained for antibiotics colistin 87.93%, amikacin 67.52%, tigecycline 63.39%, nitrofurantoin 60.87%, and gentamycin 56.08%. The most resistant antibiotics were ceftazidime (71.93%), ciprofloxacin (67.95%) and trimethoprim/sulfamethoxazole (65.56%). Approximately 46.91% (76) of all the isolates were MBL isolates. The qPCR results confirmed the presence of blaNDM-1 in 29.01% of the isolates. The blaNDM-1 harbouring isolates in descending order, were Acinetobacter, Enterobacter cloacae, and Klebsiella pneumoniae. Klebsiella and Acinetobacter isolates were extensively drug-resistant. Whole genome sequencing performed on one of the Klebsiella pneumoniae isolates revealed the presence of many virulence factors, which increased the pathogenicity of the clinical isolates. The results showed that antimicrobial resistance, including carbapenem resistance, blaNDM-1, and virulence factors, was highly prevalent among isolates from tertiary clinical hospitals. The integration of multiple detection methodologies can potentially improve the detection of AMR and virulence in clinical isolates, leading to better patient outcomes and a reduced spread of these essential traits.

A randomised controlled trial of clinical and cost-effectiveness of the PASS Plus intervention for young children with autism spectrum disorder in New Delhi, India: study protocol for the COMPASS trial

BackgroundAutism Spectrum Disorder (ASD) is a neurodevelopmental disability affecting at least 5 million children in South Asia. Majority of these children are without access to evidence-based care. The UK Pre-school Autism Communication Therapy (PACT) is the only intervention to have shown sustained impact on autism symptoms. It was systematically adapted for non-specialist community delivery in South Asia, as the ‘Parent-mediated Autism Social Communication Intervention for non-Specialists (PASS)’ and extended ‘PASS Plus’ interventions. RCTs of both showed feasibility, acceptability and positive effect on parent and child dyadic outcomes.MethodsThe Communication-centred Parent-mediated treatment for Autism Spectrum Disorder in South Asia (COMPASS) trial is now a scale-up two-centre, two-arm single (rater) blinded random allocation parallel group study of the PASS Plus intervention in addition to treatment as usual (TAU) compared to TAU alone, plus health economic evaluation embedded in the India health system. Two hundred forty children (approximately 120 intervention/120 TAU) with ASD aged 2–9 years will be recruited from two tertiary care government hospitals in New Delhi, India. Accredited Social Health Activists will be one of the intervention delivery agents. Families will undertake up to 12 communication sessions over 8 months and will be offered the Plus modules which address coexisting problems. The trial’s primary endpoint is at 9 months from randomisation, with follow-up at 15 months. The primary outcome is autism symptom severity; secondary outcomes include parent–child communication, child adaptation, quality of life and parental wellbeing. Primary analysis will follow intention-to-treat principles using linear mixed model regressions with group allocation and repeated measures as random effects. The cost-effectiveness analysis will use a societal perspective over the 15-month period of intervention and follow-up.DiscussionIf clinically and cost-effective, this programme will fill an important gap of scalable interventions delivered by non-specialist health workers within the current care pathways for autistic children and their families in low-resource contexts. The programme has been implemented through the COVID-19 pandemic when restrictions were in place; intervention delivery and evaluation processes have been adapted to address these conditions.Trial registrationISRCTN; ISRCTN21454676; Registered 22 June 2018.

Vaccine Breakthrough Infections Among Healthcare Workers in a COVID-19-Designated Tertiary Care Government Hospital in Sikkim.

Introduction Since the emergence of the coronavirus disease 2019 (COVID-19) virus at the beginning of 2020, the world has gone through various waves of pandemics. The health care workers (HCWs) or the COVID warriors as they were termed were the first line of defense against the virus. They were armed with personal protective equipment and prophylactic doses of the COVID-19 vaccine. Despite these precautions, some of the HCWs still contracted the disease and a few others succumbed to it. The objective of this study was to estimate the prevalence of COVID-19 infections and vaccine breakthrough infections (BTIs) in HCWs after receiving the COVID-19 vaccine during the second wave of the pandemic. Methods This was a cross-sectional, hospital-based study conducted over a period of four months from September 2021 to December 2021 on HCWs aged 18 years and above working at the COVID-19-designated tertiary care government hospital in Sikkim. A structured coded questionnaire with no patient identifiers was used to gather details on demographics, vaccination history, breakthrough infection, and other social details. HCWs who had received at least one dose of the COVID-19 vaccine at the time of initiation of the study and were >18 years of agewere included in this study. Results A total of 678 HCWs were screened, out of which 229 (33%) participants tested positive for COVID-19 and the rest of the participants(455; 67%) tested negative. COVID-19 infections and vaccine BTIs (COVID-19 infection >14 days after the second vaccination) were recorded and 137 (20%) respondents had a post-vaccination COVID-19 infection out of which 115 (18.5%) were BTI. The majority of the participants were females and of the age group of 26-35 years. The correlation of COVID-19 infections with the dose gap between vaccination, gender, age, profession, department, area posted during COVID duty, cycles of duty performed, hospitalization due to infection, influenza vaccination, and comorbidity was analyzed. Conclusion COVID-19 vaccines are disease-modifying and they decreasethe severity ofBTIs in HCWs. Pandemics and outbreaks cannot be predicted; therefore, it becomes very important to have healthy frontline workers who are constantly exposed to infectious agents. Monitoring of health and surveillance of infectious diseases among the HCWs should be encouraged.

Availability of subfertility management services in Colombo District, Sri Lanka

Introduction: Affordable and accessible quality services reduce treatment defaults and improve patient satisfaction in subfertility management. Assessment of the available services is a necessity to advocate for the relevant authorities to improve services.Objectives: To assess the availability of subfertility management services at healthcare institutions in Colombo District, Sri LankaMethods: This survey was performed in 2019 in 18 medical officer of health (MOH) units that provide field level healthcare; seven secondary and tertiary level government hospitals; and 32 registered private clinics/hospitals in Colombo District. Two separate checklists were developed for field-level and clinic/hospital-based services assessment. The interviews were performed to administer the checklist for clinical and administrative staff at different units of service provision. The availability of the services was presented as numbers and percentages.Results: Field-level availability of facilities; only 44.5% of MOHs had conducted awareness programmes on subfertility for the public during the past year and only 27.7% of MOHs had referred sub-fertile couples to secondary or tertiary hospitals for further management during the preceding month. Seminal fluid analysis (SFA) was available in 71.5% of the government sector and 84.3% of the private sector hospitals; abdominal and transvaginal ultrasound scans (USS) in 100% of government sector hospitals; and 93.7% of abdominal and 84.3% of transvaginal USS available in the private sector. Intra-uterine insemination (IUI) was available in 71.5% of the government sector hospitals but in only 40.6% of the private sector hospitals. Assisted reproductive technologies (ART) such as in vitro fertilization (IVF) was available in 12.5% of the private sector hospitals while none of the government sector hospitals provided this facility.Conclusions & Recommendations: The provision of field level facilities for subfertility was not satisfactory and less integrated. Notably, the ART services were available in the private sector hospitals predominantly. Rational public health policies need to be developed regarding the provision of field level and advanced care.

120.6: Organ procurement failure in a tertiary government hospital in the Philippines: why are we losing our potential donors?

120.6: Organ procurement failure in a tertiary government hospital in the Philippines: why are we losing our potential donors?