Eastern Hospital Research Articles

Evaluation of functional outcome of intracapsular fracture neck of femur with Austin Moore prosthesis at a tertiary care hospital in Srikakulam

Introduction: Fractures of the femoral neck are common injuries occurring in the elderly population due to osteoporosis. They present a significant challenge to Orthopaedic surgeons because of the high rate of complications like nonunion, avascular necrosis, and associated comorbidities. Historically, Austin Moores prosthesis has served as an exemplary implant over the years in the management of intracapsular fracture neck of femur in older individuals. Our aim of the study is to asses postoperative function in these population and to validate the use of AMP in current Orthopaedic practice. Methods & Materials: This is a hospital-based cohort study. We did this study in thirty patients who had the fractured neck of the femur using Austin Moore Prosthesis, who are admitted to the Department of Orthopaedics in Great Eastern Medical School & Hospital, Srikakulam from Dec 2017 to Dec 2019. All patients were followed for twelve months. It is a patient-reported outcome study based on a questionnaire using a Harris hip score. Results: Harris hip score, which is the gold standard in the assessment of postoperative function in hip surgeries was used in this study. We graded the patients as excellent, good, fair, and poor depending on the functional outcome based on each criterion in this scoring system. The functional results were excellent in 50%, good in 23.3%, fair in 23.3%, and poor in 3.3% of cases. The poor results are due to moderate hip pain after surgery. The complication rate was low. Conclusion: Hemiarthroplasty with Austin Moore Prosthesis proved to be a good choice for the management of fracture neck femur in the elderly population with limited physical demand and low economic background. The mortality and morbidity are low; the operative procedure is simple with satisfactory functional results and fewer complications.

Predictors of physicians\u2019 intentions to use clinical practice guidelines on antimicrobial in tertiary general hospitals of China: a structural equation modeling approach

BackgroundWith inappropriate use of antimicrobials becoming a great public health concern globally, the issue of applying clinical practice guidelines (CPGs) to regulate the rational use of antimicrobials has attracted increasing attention. Taking tertiary general hospitals in China for example, this study aimed to identify factors to investigate the comprehensive influencing mechanism for physicians’ intention to use CPGs on antimicrobials.MethodsBased on the integration of Theory of Planned Behavior (TPB), Technology Acceptance Model (TAM), and Technology-Organization-Environment framework (TOE), a questionnaire survey was conducted covering potential determinants of affecting physicians’ intentions to use CPGs on antimicrobials at the individual level (attitude, subjective norms and perceived risk), technical level (relative advantage and ease of use), and organizational level (top management support and organizational implementation). Data were collected from 644 physicians in tertiary general hospitals in eastern, central and western China, which were obtained by multi-stage random sampling. The structural equation modeling (SEM) was used to link three-level factors with physicians’ behavioral intentions.ResultsThe majority of the participants (94.57%) showed a positive tendency toward intention to use CPGs on antimicrobials. The reliability and validity analysis showed the questionnaire developed from the theoretical model was acceptable. SEM results revealed physicians’ intentions to use CPGs on antimicrobials was associated with attitude (β = 0.166, p < 0.05), subjective norms (β = 0.244, p < 0.05), perceived risk (β = − 0.113, p < 0.05), relative advantage (β = 0.307, p < 0.01), top management support (β = 0.200, p < 0.05) and organizational implementation (β = 0.176, p < 0.05). Besides, subjective norms, perceived risk, relative advantage, ease of use, and top management support showed their mediating effects from large to small on the intentions, which were 0.215, 0.140, 0.103, 0.088, − 0.020, respectively.ConclusionsThis study revealed the significance of multifaceted factors to enhance the intention to use CPGs on antimicrobials. These findings will not only contribute to the development of targeted intervention strategies on promoting the use of CPGs on antimicrobials, but also provide insights for future studies about physicians’ adoption behaviors on certain health services or products.

Excretion of SARS-CoV-2 in breast milk: a single-centre observational study

BackgroundBreast feeding by SARS-CoV-2-infected mothers has been a concern because of the possibility of excretion of virus in breast milk.ObjectiveTo detect SARS-CoV-2 in expressed breast milk (EBM) of mothers infected...

An External Validation of Scoring Systems in Mortality Prediction in Veno-Venous Extracorporeal Membrane Oxygenation.

Veno-venous extracorporeal membrane oxygenation (VV ECMO) offers the last resort in the treatment of acute respiratory distress syndrome (ARDS). Various scoring systems have been established, yet external validation of these scoring systems in the Asian population remains scarce. We aim to identify factors associated with hospital mortality and to validate various scoring systems in the prediction of hospital mortality. A retrospective analysis of adults admitted to Pamela Youde Nethersole Eastern Hospital intensive care unit who received VV ECMO from January 1, 2010 to June 30, 2019 was performed. Demographics, ventilation strategies, rescue therapies, and clinical outcomes were compared. The primary outcome was hospital mortality and secondary outcomes were intensive care unit (ICU) mortality, ICU, and hospital length of stay. There were 122 VV ECMO performed for ARDS, of which 78 survived and 44 died. VV ECMO performed for viral pneumonitis was significantly associated with better survival (55.1% vs. 25%, p = 0.001) compared with other causes. As for prediction scores, the PREdiction of Survival on ECMO Therapy-Score had the highest area under receiver operator curve of 0.733 (95% confidence interval [CI]: 0.643-0.823), whereas that of PRedicting dEath for SEvere ARDS on VV ECMO score was 0.662 (95% CI: 0.561-0.764), Respiratory Extracorporeal Membrane Oxygenation Survival Prediction score was 0.657 (95% CI: 0.553-0.761), Sequential Organ Failure Assessment score was 0.652 (95% CI: 0.547-0.757), and VV ECMO mortality score was 0.637 (95% CI: 0.532-0.742). In our cohort, VV ECMO performed for viral pneumonitis was associated with a higher hospital survival. Prediction scores are helpful in our population and provide a useful reference to hospital mortality.

Why do people purchase antibiotics over-the-counter? A qualitative study with patients, clinicians and dispensers in central, eastern and western Nepal

IntroductionOver-the-counter (OTC) use of antibiotics contributes to the burgeoning rise in antimicrobial resistance (AMR). Drawing on qualitative research methods, this article explores the characteristics of OTC sales of antibiotic in...

Cytokine Storm in Head Injury Patients and its Management in COVID-19 Era

Sunny Chi Lik Au is currently working as a Medical Doctor in Tung Wah Eastern Hospital, 9/F, MO office, Lo Ka Chow Memorial Ophthalmic Centre, 19 Eastern Hospital Road, Causeway Bay, Hong Kong.

English

BACKGROUND Lens induced glaucomas are common in India. There were different types of lens induced glaucomas based on clinical features and morphological features. This study was undertaken to evaluate the various characteristics and presentations of glaucomas, to define the risk factors and to evaluate as to how they influence the post-operative visual acuity, intra ocular pressure, inflammation and optic disc changes. METHODS This longitudinal study included 90 cases of lens induced glaucoma admitted in the ophthalmic wards of the Great Eastern Medical School and Hospital, Srikakulam, during the period March 2018 to March 2020. All consecutive patients diagnosed as lens induced glaucoma on the basis of clinical symptoms and signs were included. At presentation, visual acuity, IOP, inflammation including corneal changes were recorded, which were repeated after institution of medical line of treatment and postoperatively patients were followed up regularly at 2, 4 and 6 weeks intervals and the same parameters were evaluated including optic disc changes. RESULTS Occurrence of lens induced glaucoma in the hospital during the study period was 1.72 %. The mean age of presentation of various types of glaucomas was 60.57 years and the female to male ratio was 2:1. The most frequent type of lens induced glaucoma was phacomorphic glaucoma (70 %). In 34.4 % patients best corrected visual acuity was found to be better than 6 / 18. In 14.4 % of cases, visual acuity was found be worse than 6 / 60. In patients who presented with symptoms of less than two weeks duration, better visual acuity of 6 / 12 or more was noted (76.2 %, P &lt; 0.01). In 60 % patients who presented with IOP levels of less than 35 mmHg, better visual acuity of 6 / 12 or more was noted in 76.2 %. The mean IOP noted in patients with symptoms of 2 to 4 weeks duration was found to be 40.33 ± 9.36 mmHg. Inflammation was more severe in patients who were symptomatic for more than 2 weeks (37.50 %, P &lt; 0.05) and also in cases with IOP more than 35 mmHg (40 %). Optic disc of the presented eye was found to be damaged in 35.5 % of cases and in patients presenting with symptoms of more than 2 weeks’ duration it was 62.5 % (P &lt; 0.01). CONCLUSIONS Presentation with intraocular pressure value greater than 35 mm of Hg and with symptoms of more than two weeks would result in severe inflammation further affecting the cornea and causing optic nerve damage which would ultimately jeopardize vision. This can be prevented by early presentation and regular screening of people above 60 years of age. KEYWORDS Lens-Induced, Glaucoma, Cataract

Anemia among Adult Diabetic Patients Attending a General Hospital in Eastern Ethiopia: a Cross-sectional Study.

BackgroundAlthough anemia is a common condition among patients with diabetes mellitus, there is little evidence on anemia among this segment of population in Ethiopia at large and in the study setting in particular. Thus, this study aimed at assessing the magnitude of anemia and its associated factors among adult diabetic patients attending a general hospital in Eastern Ethiopia.MethodsA health facility-based cross-sectional study was conducted among 325 randomly selected adult diabetes mellitus patients attending a follow-up clinic at Gelemso General Hospital, Eastern Ethiopia. Data were collected through an interview using a pre-tested and structured questionnaire followed by physical and laboratory measurements. Data were then entered into EpiData Version.3.1 and analyzed by using STATA version 16.0. Binary logistic regression models were fitted to identify factors associated with anemia. All statistical tests were declared significant at p-value < 0.05.ResultsThe magnitude of anemia among adult diabetic patients was 30.2% (95% confidence interval (CI): 25.4%-35.4%). Anemia was higher in males (36%) than females (20.5%). Male gender (Adjusted Odds Ratio (AOR) = 2.1, 95% CI: 1.2, 3.8), DM duration of ≥5 years (AOR= 1.9, 95% CI: 1.0, 3.7), presence of comorbidity (AOR= 1.9, 95% CI: 1.0, 3.7), and having diabetic complications (AOR= 2.3, 95% CI: 1.3, 4.2) were significantly associated with anemia.ConclusionAnemia was a moderate public health problem among adult DM patients in the study setting. Being male in gender, duration of DM, presence of DM complications, and DM co-morbidities were factors associated with anemia. Therefore, routine screening and appropriate management of anemia targeting males, DM patients with longer duration of DM, and those with complications and co-morbidities should be devised to improve patients’ quality of life. Early diagnosis and regular monitoring of DM could also help to minimize further complications.

A Cross-sectional Study on Morphology and Position of Pterion in Andhra Pradesh Population

Introduction: Pterion is the important surgical landmark in temporal fossa, deeper to which vital areas of the brain are located. Injuries are common at this suture area due to confluence of multiple bones which are relatively slender and weak. Since the variations in morphology of the pterion is common, thorough knowledge of its location, types and subtypes, helps health professionals of varied speciality to confidently explore this area and perform the necessary interventions. Aim: This study is aimed to determine the prevalence of different types of pterion, position of pterion, and compare the morphological variance between the right and left side among adult human skulls in Andhra Pradesh. Materials and Methods: This cross-sectional study on human skull bones was conducted in Apollo institute of medical sciences and research, Chittoor, and Great eastern medical school and hospital, Srikakulam of Andhra Pradesh state in India from June 2020-August 2020. The study was conducted on 54 adult dried human skulls with well-defined sutures. The pterions of both sides of the skulls were keenly observed and studied for the type and subtypes of Pterions based on Murphy’s classification. The position of pterion was measured from Frontozygomatic Suture (FZS) and Midpoint of Zygomatic Arch (MZA) with Vernier callipers. Data was analysed with descriptive statistics and also compared with earlier research works. Results: Sphenoparietal 89 (82.4%) was the commonly observed pterion type in the present study, frontotemporal pterion was not found. Pterion was positioned at a Mean distance of 3.16±0.48 cm and 3.20±0.50 cm from frontozygomatic arch on right and left side, respectively. From MZA the pterion was present at 3.70±0.35 cm and 3.78±0.35 cm on right and left side, respectively. Conclusion: The present study reveals variations in sutural morphology pattern and position of pterion in the skulls oftentimes. Notable difference was observed while comparing the position of pteria with other country population. Cognizance of such variations would help the radiologists, neurosurgeons and forensic experts to diagnose opine and treat judiciously.

Contraception, unintended pregnancy, and induced abortion within 24 months of delivery in China: a retrospective cohort study

ObjectiveTo explore the prevalence of contraceptive use, unintended pregnancy, and induced abortions within 24 months postpartum in eastern, central, and western regions of China and in China overall. Study DesignWe conducted a retrospective cohort study and selected women who delivered a live birth between 12 and 24 months before the survey at 60 hospitals in eastern, central, and western regions of China. We used structured questionnaires for data collection and applied life-table analyses to estimate the prevalence of contraception, unintended pregnancy, and abortions. We used clustered log-rank tests to compare trends and rate differences at each time interval between/among regions. ResultsA total of 19,939 postpartum women were contacted, and 18,045 (90.5%) of them agreed to be interviewed. The 6-, 12-, and 24-month rates for modern contraceptive methods were 62.7% (95% confidence interval [CI] 58.9–66.4), 72.4% (95% CI 68.8–75.7), and 73.2% (95% CI 69.6–76.6), respectively. Condoms accounted for 79% of contraceptive initiators. The 6-, 12-, and 24-month rates were 1.4% (95% CI 1.2–1.7), 5.3% (95% CI 4.5-–6.1), and 13.1% (95% CI 11.3–14.8) for unintended pregnancy; and 1.1% (95% CI 0.8–1.3), 4.0% (95% CI 3.4–4.6), and 10.4% (95% CI 8.9–11.8) for induced abortion, respectively. By 24 months postpartum, 3-quarters of unintended pregnancies ended in abortion. The 24-month rates of modern contraceptive methods (75.2% vs73.4%, 71.1%), unintended pregnancy (15.3% vs 11.1%, 12.6%), and induced abortion (11.8% vs 9.9%, 9.4%) were higher in the western region relative to the eastern or central regions. ConclusionPostpartum contraception use was relatively high in China but dominated by less-effective methods, and these may contribute to higher risks of unintended pregnancy and induced abortion during the postpartum period. Use of long-acting reversible contraceptives and effective and reliable short-acting methods should thus be fostered in postpartum family planning services in China. ImplicationsA national postpartum family planning program is needed in China. Service providers should work on counselling postpartum women and their partners with respect to long-acting reversible contraceptive methods, and to effectively and reliably use short-acting methods during the postpartum period.

Use of music in reducing pain during outpatient hysteroscopy: Prospective randomized trial.

To evaluate the effect of music in reducing pain during outpatient hysteroscopy under no anesthesia. We conducted a prospective randomized controlled trial From June 2019 to December 2019 in Pamela Youde Nethersole Eastern Hospital in Hong Kong. A total of 107 patients were randomized to music group (n = 54) or non-music group (n = 53). Music was played during outpatient hysteroscopy in the music group. Patients in the non-music group had the procedure done in the same setting without music. Primary outcome was the level of pain measured using the visual analog scale (VAS) score before and during the procedure. Secondary outcomes were vital parameters that reflect the level of pain including blood pressure and heart rate. Patients in the music group experienced significantly less pain during outpatient hysteroscopy (VAS score 4.54 ± 2.89 vs 5.88 ± 2.90; P = 0.02). The anticipated pain level was similar in both groups (VAS score 5.59 ± 2.27 vs 6.11 ± 2.43; P = 0.27). There was no statistically significant difference between the two groups in all the vital parameters. Listening to music during outpatient hysteroscopy under no anesthesia significantly reduces pain in a well-matched Chinese population. Music is easy to provide with low-cost equipment and manpower. We recommend the routine use of music during outpatient hysteroscopy to improve patient care.

Clinicopathological study of gall bladder carcinoma with special reference to its management in a tertiary care hospital

Background: Incidence of gallbladder carcinoma is increasing progressively among Indians and is regarded as a major cause of mortality and morbidity. In spite of this, limited studies have been conducted so far. Objective of the study was to know the prevalence, clinicopathological aspects, and prevalent treatment protocol of gall bladder cancer in a tertiary care hospital in Eastern India.Methods: 64 cases of histologically proven gallbladder cancer patients were studied. Patient characteristics were recorded using pretested proforma along with relevant investigations, and histopathology and treatment provided were recorded.Results: Our study reveals that gallbladder cancer has a prominent peak in the 7th decade of life with male: female ratio of 1:2.2. Most of the patients were having body mass index between 20.0 and 24.99, which is in sharp contrast to the available literatures. Pain is the most common symptom followed by constitutional symptoms. Majority of cases presented at advanced stage (64.1%) with significantly elevated CA19.9 level, and were managed with palliative chemotherapy.35.9% of our cases were respectable at the time of diagnosis, and extended cholecystectomy could be performed in 31.3%. Log rank test showed pattern of survival of the patients who were resected was significantly better than those of who were not resected.Conclusions: We know gallbladder cancer is a disease with very few patients amenable to surgery at the time of presentation. Thus, instead of retrospectively analyzing individual institutional data, high volume institutions with the necessary expertise for treating gallbladder cancer should collaborate with a view of generating strong evidence-based surgical guidelines.

Effects of baby-friendly practices on breastfeeding duration in China: a case-control study

BackgroundThe Baby-Friendly Hospital Initiative is generally considered an effective way to promote breastfeeding. Although China has the largest number of baby-friendly hospitals in the world, research on baby-friendly practices in China is limited, and the rate of exclusive breastfeeding (EBF) at 6 months, 20.7%, compared to the 2025 global goal of 50% is low. It is, therefore, important to determine the factors that remain significant barriers to EBF in China. To explore how the key baby-friendly practices affect EBF duration in China, we used a case-control study to compare the effects of baby-friendly-related practices on both EBF and non-breastfeeding (NBF) mothers at 3 months and to investigate the effects of both single and comprehensive baby-friendly practices in promoting EBF duration at 3 months, which is one step toward EBF at 6 months.MethodsParticipants were recruited from four maternal and child health hospitals in western (Chongqing), eastern (Qingdao), southern (Liuzhou), and central China (Maanshan). A total of 421 mothers (245 in the EBF group, 176 in the NBF group) of infants aged 3 months were surveyed through a self-reported questionnaire from April 2018 to March 2019. The experience of baby-friendly practices and breastfeeding during hospitalization were assessed with yes/no questions. Socio-demographic factors that influenced breastfeeding at 3 months were analyzed using bivariate and multivariate logistic regression analyses.ResultsOf mothers in the EBF group, 65.57% reported engaging in at least seven baby-friendly practices compared to 47.72% of mothers in the NBF group. Significantly more mothers in the EBF group engaged in baby-friendly practices than in the NBF group. These practices included “breastfeeding within one hour after birth” (74.29% vs. 59.09%), “breastfeeding on demand” (86.48% vs. 75.00%), and “never use a pacifier” (46.53% vs. 31.25%). After adjusting for confounding variables, we found that the mothers who engaged in fewer than seven baby-friendly practices were about 1.7 times less likely to breastfeed than were those who engaged in seven or more baby-friendly practices (odds ratio [OR] 1.720, 95% confidence interval [CI] 1.106, 2.667). Further, the mothers who did not breastfeed on demand were as likely to not breastfeed up to 3 months (OR 2.263, 95% CI 1.265, 4.049), as were mothers who did not breastfeed during hospitalization (OR 4.379, 95% CI 1.815, 10.563).ConclusionsThese data from hospitals in China suggest that higher compliance with baby-friendly practices may have a positive impact on EBF at 3 months, particularly in terms of promoting the implementation of breastfeeding on demand and breastfeeding during hospitalization in China.

Hospital-Level Antibacterial Prescribing and Its Completeness in Ethiopia: Did It Adhere to Good Prescribing Practice?

BackgroundAntibacterial agents are an integral part of chemotherapy and play a critical role in the prophylaxis and treatment of bacterial infections. However, prescribing errors such as incomplete prescriptions that do not adhere to good prescribing practice have become a contemporary concern in hospitals in resource-limited settings. Therefore, this study aimed to assess antibacterial prescribing and its completeness among prescriptions dispensed at four governmental hospitals in Eastern Ethiopia.MethodsA cross-sectional study was employed to assess a total of 1308 prescription encounters containing at least one antibacterial agent obtained with simple random sampling from annual antibacterial-containing prescription data of four hospitals. The data were collected retrospectively using a structured checklist.ResultsA total of 2,855 drugs were prescribed from 1308 prescribing encounters with 1496 (52.39%) being antibacterial agents. The name, age, sex, and diagnosis of the patients were written in 1158 (88.3%), 815 (62.31%), 796 (60.58%), and 183 (13.99%) prescriptions, respectively. Besides, the route of administration, strength, duration, quantity, dose, and dosage form of the drug were recorded in 2322 (81.33%), 2118 (74.19%), 1516 (53.10%), 1525 (53.42%), 746 (26.13%) and 563 (19.72%) prescriptions, respectively. Nearly 50% of the prescribing encounters were documented without a prescriber name. Dispenser name and signature were also obtained in less than 10% of the prescriptions. Combining the data of all hospitals, amoxicillin, ceftriaxone, and ciprofloxacin were identified as the top three prescribed antibacterial drugs, whereas diclofenac, paracetamol, and tramadol were the most frequently co-indicated drugs. Regarding the pharmacologic class of antibiotics, penicillins were the most commonly prescribed antibiotics (n = 596, 39.77%) followed by cephalosporins (n = 318, 21.26%) and fluoroquinolones (n=285, 19.05%).ConclusionIncomplete information about patient-related factors and major diagnosis, medication regimens, prescribers and dispensers was identified as a potential prescribing error and did not adhere to good prescribing practice. This can be considered as one part of the inappropriate use of antibacterial agents, a driving force for the emergence of antimicrobial resistance. This problem requires immediate and sustained action from the management of the hospitals to ensure the accountability of health professionals involved in the medication use process and to establish antimicrobial stewardship programs in such resource-limited settings.

A Prospective study on Gastrointestinal Perforation Peritonitis in Andhra Pradesh, India

Introduction: Perforation is defined as an abnormal opening in a hollow organ or viscus. All overthe world, perforation peritonitis is the most prevalent surgical emergency tackled and treated by asurgical team. The etiology leading to peritonitis in tropical countries shows a different spectrumfrom its western world. The present study was conducted to highlight the spectrum of hollow viscusperforation peritonitis in terms of etiology, clinical presentations, site of perforation, surgicaltreatment, postoperative complications, and mortality encountered. Methods: The study was aprospective observational study conducted from March 2016 to March 2019 in the Department ofGeneral Surgery, Great Eastern Medical School and Hospital, Andhra Pradesh. A total of 320 patientswith perforation peritonitis were included in the study and underwent exploratory laparotomy.Results: Out of 320 patients, there were 276 males (86.25%) and 44 females (13.75%). Duodenalperforation was the most common type (34.38%), which was mainly due to Acid peptic diseasefollowed by Jejunal and Ileal perforations. Wound infection was the most common complication. Themortality rate was 8.44% (27 patients). Conclusion: Early diagnosis, resuscitation with fluids, andtimely surgical intervention are the most important factors deciding the fate of the patient withperforation peritonitis.

Esansiyel trombositoz ve polisitemi vera hastalarında depresyon ve anksiyete düzeyleri ile yaşam kalitesi arasındaki ilişki

Aim: This study was conducted to assess the correlation between depression and anxiety and quality of life in ET and PV patients. Methods: The study was conducted in the Hematology Clinic of a training and research hospital in the Aegean region of Turkey between July 2016 and May 2017. A total of 60 patients (30 ET patients, 30 PV patients) were included in the study. Eastern Cooperative Oncology Group (ECOG), Karnofsky scale, EORTC QLQ-C30, and Hospital Anxiety and Depression Scale (HADS) were used to collect the data. The data was analyzed using SPSS 20.0 packaged software. The results were assessed at the confidence interval of 95% and significance level of p<0.05. Results: The age average of ET and PV patients were 60.3±11.2/ years and 58.7±11.7/ years, respectively. ECOG and Karnofsky performance scores were similiar in two group. There was no significant difference between the groups in terms of EORTC QLQ-C30 overall quality of life and HADS-D scores. HADS-A score mean rank was higher in PV patients (p=0.000) (ET: 22.1 in, PV:38.9). Score mean rank of EORTC QLQ-C30 fatigue, dyspnea and financial difficulty subscales (41.5, 38.2, 38.1) in ET patients and score mean rank of EORTC QLQ-C30 cognitive functioning, pain and diarrhea subscales (43.8, 38.9, 41.1) in PV patients were higher (p=0.000). There was a significant correlation between HADS-A and HADS-D scores and EORTC QLQ-C30 overall quality of life score (p<0.01) in ET patients. Conclusions: As depression and anxiety levels of ET and PV patients increased, their quality of life impaired.

A Cross sectional study on distribution of ABO and Rh blood group antigens among the blood donors at a tertiary care hospital in Andhra Pradesh, India

Aims: The study is aimed to determine the distribution pattern of the ABO grouping and Rh typing among blood donors in Great Eastern Medical School and Hospital, Srikakulam and to correlate it with the available data from studies inside India and other parts of the world. Materials and Method: The present study was conducted at Great Eastern Medical School and Hospital, Srikakulam, a tertiary care teaching hospital. All blood donors were done counseling as per NACO guidelines and considered fit for blood donation were included in this study. A total of 5868 blood donors was considered physically screened and declared fit and accepted for blood donation. Results: Out of 5868 donors, 5850 (99.6%) were males and 18 (0.4%) were females. The majority of donors belonged to the age group 26-35 years. The commonest ABO blood group present was B (36.4%) followed by O (35.08%), A (24.4%), and AB (4.12%) while 5743 (97.86%) donors were Rh-positive and 125(2.13%) donors were Rh-negative. Conclusion: Knowledge of the distribution pattern of the different blood groups is very crucial for blood banks and blood transfusion services which significantly contribute to the Health System of the Nation. Knowledge of blood group distribution is important for clinical studies, geographical information, and forensic studies in the general population.

Changes in Cardiovascular system among smokeless tobacco users attending tertiary care hospital in Andhra Pradesh, India

Background: Tobacco can be consumed as cigarettes and also as smokeless tobacco. Smokeless tobacco is a harmful tobacco product that contains over 3,000 chemicals, 7 including 28 known carcinogens (cancer-causing agents). Various forms of smokeless tobacco (mainly snuff and chewing tobacco) cause an immediate increase in heart rate and blood pressure. However, the relationship between smokeless tobacco uses on blood pressure remains unknown, especially in tertiary level hospitals. Our aim is to find out the smokeless tobacco use influence on cardiovascular parameters, for instance, pulse rate and blood pressure. Methods: This cross-sectional study was carried out to assess cardiovascular changes among adult male smokeless tobacco (ST) users. For this purpose, 50 male respondents were selected. The participants were selected from the medicine outpatient department of Great Eastern Medical School and Hospital, Srikakulam, Andhra Pradesh. Pulse rate and blood pressure were measured and ST uses behavior was assessed using self-reports. Statistical analysis was done by SPSS20. Results: In this study, the mean (±SD) of pulse rate was 83.2±12.3 beats/min. The mean (±SD) of systolic blood pressure was 158.72±24.84 mm of Hg and the mean (±SD) of diastolic blood pressure was 98.78±9.87 mm of Hg in smokeless tobacco users. Conclusion: Mean systolic and diastolic blood pressures were higher in smokeless tobacco users in the tertiary level hospital. However, the mean pulse rate was within the normal range.

Attitudes of registered nurses about the end \u2013 of \u2013 life care in multi-profile hospitals: a cross sectional survey

BackgroundEnd-of-life care is provided in a variety of healthcare settings, not just palliative care hospitals. This is one reason why it is very important to assess all barriers to end-of-life care and to provide safe and quality services to patients. This study was aimed at describing nurses’ attitudes in providing end-of-life care and exploring barriers and facilitating behaviors of nurses in multi-profile hospitals in Eastern Europe.MethodsA descriptive, correlational design was applied in this study, using a cross-sectional survey of 1320 registered nurses within 7 hospitals in Lithuania.ResultsRegistered nurses working in the three different profiles emphasized safe and effective care and the importance of meeting the patient’s spiritual needs at the end of life. The main barriers assigned by nurses caring for patients at the end of life were angry family members, inadequate understanding of nursing care by the patient’s relatives; lack of time to talk to patients, lack of nursing knowledge to deal with the bereaved patient’s family, lack of evaluation of nurses’ opinions, and the evasion by physicians to talk about the diagnosis and their over-optimistic view of the situation. The main facilitating behaviors to improve nursing care were end-of-life training, volunteering, and family involvement.ConclusionsSpiritual needs were identified by nurses as the primary needs of patients at the end of life. Family-related barriers remain one of the main barriers to end-of-life care. Also, the behavior of physicians and their relationship with nurses remains one of the most sensitive issues in end-of-life care.

Implementation and Promotion of Quality Control Circle: A Starter for Quality Improvement in Chinese Hospitals.

PurposeTo analyse the quality control circle (QCC) implementation status, tool modification and promotion in hospitals in mainland China.MethodsData were collected from the 2013–2018 National Quality Control Circle Competition of Chinese Hospitals. A total of 1913 participating QCCs implemented by 34,023 hospital staff from 915 hospitals across 31 provinces and municipalities were included in this study to analyse the characteristics of QCC implementation status in mainland China, using descriptive analyses.ResultsThe majority of participating QCCs came from central and eastern hospitals. Most of the QCCs were carried out in tertiary hospitals and focused on themes of safety and patient care. The QCC has been modified in terms of its classification, implementation process, participation mechanism, and ways of dissemination. A series of promotion strategies have been made to promote the implementation of QCCs nationwide, including establishing a professional promotion organization, developing standardized training programmes, and organizing QCC academic events.ConclusionAfter years of promotion, QCCs are widely used in hospitals and have been modified to fit the practice of healthcare institutions. The QCC promotion strategies in China can offer valuable insights for other countries that are also making efforts to continuously improve care quality in healthcare institutions.