Hospital In India Research Articles

Predicting lung cancer treatment response from CT images using deep learning

AbstractLung cancer is the deadliest type of cancer and is one of the most frequently occurring cancers. It is primarily diagnosed in later stages when treatment becomes difficult. For better treatment and higher chances of survival, the treatment response of lung cancer patients needs to be analyzed to check whether the patients are responding to the treatment or not. This analysis can be done with the help of follow‐up computed tomography (CT) imaging before and after the treatment. However, manually analyzing the baseline and post‐treatment CT scan images of so many lung cancer patients is a tedious task. This study proposes an intuitive approach based on deep learning to analyze lung cancer through CT scan images before and after the treatment. In this approach, we utilized a segmentation network to segment the lung tumor in the follow‐up CT images. The segmented tumor is then analyzed to check the treatment effect, as suggested by the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines. The segmentation network combines a vision transformer and a convolutional neural network. The segmentation network is first trained on a public dataset and then fine‐tuned on the local dataset to improve the segmentation performance. For this study, we have collected a lung cancer dataset from an Indian hospital. The dataset is divided into two parts dataset I and dataset II. Dataset I consists of 100 CT scans, which we use to fine‐tune the proposed segmentation network. Dataset II comprises 220 CT scans of 110 patients, consisting of baseline and post‐treatment scans. We use dataset II for testing. We achieved significant performance.

Clinicomicrobiological Profile of Infections by Achromobacter: An Emerging Nosocomial Pathogen in Indian Hospitals.

Achromobacter causes opportunistic nosocomial infections in immunocompromised patients with high mortality. It is underreported as it is often misidentified by conventional microbiological methods. The aim of the study is to access the clinicomicrobiological profile and antibiogram of Achromobacter spp. from clinical isolates. It is an observational study done from July 2020 to December 2021 in our hospital. All nonduplicate isolates of Achromobacter from blood and respiratory samples were initially identified with VITEK-2 GN card system and further confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antibiogram and treatment outcomes were also studied. Achromobacter spp. was isolated from 14 patients. Blood samples yielded most isolates (71.4%; n = 10) followed by tracheal aspirate and bronchoalveolar lavage fluid. Bacteremia followed by pneumonia was the most common clinical manifestation of Achromobacter infection. All the isolates were identified as A. xylosoxidans denitrificans and showed 100% susceptibility to minocycline and piperacillin-tazobactam. Diabetes mellitus and malignancy were the most common underlying condition in these patients. A favorable outcome was seen in 78.6% of the individuals with timely institution of antibiotics and proper diagnosis. Infections due to Achromobacter are on the rise in developing countries like India. Resistance to many classes of antimicrobials makes its treatment more challenging therefore it should always be guided by antibiograms. The present study highlights the significance of this rare bacterium in patients with malignancies in India and advocates greater vigilance toward appropriate identification of this organism.

Use of a regression model and a statistical process control method to assess AWaRe classification-based antimicrobial consumption in an Indian tertiary care hospital over 5 years

Introduction: The World Health Organization (WHO) recommends quality-based “AWaRe classification of antibiotics” for the monitoring of antimicrobial consumption. It classifies commonly used antimicrobials into five main categories: Access, Watch, Reserve, Not-recommended (NR), and Others. At least 60% of total consumption should be from the Access category and <10% should be from the Reserve category to minimize the further development of resistance. However, we do not know how these recommendations compare with current trends in antimicrobial consumption in India. Hence, a study was planned to statistically evaluate the AWaRe classification-based trend of antimicrobial consumption over 5 years. Materials and Methods: A retrospective study was conducted to retrieve the antimicrobial consumption data of SMS Hospital, Jaipur, from January 2017 to December 2021 as per AWaRe classification. Regression and statistical process control analysis was carried out separately for all five categories of antimicrobials on MATLAB 2016a (9.0.0.341360). Results: Regression analysis revealed that the consumption of Access, NR, and Others significantly decreased while that of Watch and Reserve increased between 2017 and 2021. Statistical process control analysis showed that the use of Access, Watch, and Others was within prescribed statistical limits but that of Reserve and NR was higher than statistical thresholds at times. Conclusion: The increased consumption of Watch and Reserve antimicrobials combined with surpassing of upper control limit by Reserve and NR antimicrobials at certain times raises concern. Hence, there is an acute need to take measures to generate awareness about the incorporation of the WHO recommendations in practice to support the antimicrobial stewardship program. The core competencies addressed in this article are: Medical knowledge, Systems-based practice, Practice-based learning and improvement, Professionalism.

Decolonization the what, whyand how: A treatieson Indigenous nursing knowledge.

Decolonization the what, whyand how: A treatieson Indigenous nursing knowledge.

Effects of Two Weeks Finasteride Therapy on Per-Operative Decrease in Haemoglobin Patients after Transurethral Resection of Prostate (TURP)

Aim: To compare the per-operative mean decrease in haemoglobin level in patients undergoing transurethral resection of prostate taking finasteride for two weeks before transurethral resection of prostate versus without pre-treatment of finasteride. Study Design: Randomized control trial Place and Duration of Study: Department of Urology, Indus Hospital, Karachi from 23rd May 2017 to 22nd November 2017. Methodology: Sixty patients were included and divided into two groups. In Group A, patients were finasteride (5 mg/day) for two weeks before surgery and Group B (control group) no drug will be given before surgery. All patients underwent transurethral resection of prostate and then had intra-operative bleeding noted. Results: Only 4 (8.7%) of the patients had the history of supplement use. No significant difference was observed in age, baseline creatinine, protate size, duration of BPH, before surgery hemoglobin and after surgery hemoglobin between both the groups. There was slight decrease in hemoglobin in placebo group adjusting for age, baseline creatinine, duration of BPH and prostate size. However, the results did not reach statistical significance. Conclusion: Finesteride given 2 weeks prior to surgery does not significantly decrease intra-op bleeding. Keywords: Effect, transurethral resection of prostate (TURP), Finasteride

An Assessment of Hand Hygiene Practices among Health Care Providers in Operation Theatre

Aims: To assess the frequency of hand hygiene opportunities available to health care providers during surgeries and to assess the frequency of hand hygiene practices of health care providers in those hand hygiene opportunities. Study design: Cross sectional study Place and duration of study: Operation theatre and recovery room at The Indus Hospital Korangi Campus and Sheikh Saeed Memorial Campus from 21stMarch 2021 to 30th August 2021 Methodology: Two hundred and eighty one health care professional for 55 surgeries were included for hand hygiene opportunities and their hand hygiene practice. Every opportunity to practice hand hygiene was observed and noted as having occurred (hand wash or hand rub) or missed. Throughout the period, the PI was recorded opportunities for hand hygiene and missed opportunities using WHO’s hand hygiene observational form. Results: The average age of the health care provider was 31.22±8.15 years. The overall adherence to hand hygiene practice according to WHO guidelines was 16.1% while 83.9% were not according to WHO hand hygiene guideline. Failure of hand hygiene practice was significantly high in all type of hand hygiene opportunity. Rate of missed/failure hand hygiene practice was significantly high in nurses and technician and also their qualification (p<0.05). Conclusion: The poor hand hygiene compliance was frequently noticed among health care workers. Hand hygiene should be an educational priority and it needs to be implemented effectively. Therefore, hand hygiene resources is an integral part for better strategic and improvement strategy. Keywords: Hand hygiene, Contamination, Health care associated infections; Prevention.

Microbiology Clinical Culture Diagnostic Yields and Antimicrobial Resistance Proportions before and during the COVID-19 Pandemic in an Indian Community Hospital and Two US Community Hospitals

Studies comparing the impact of the COVID-19 pandemic on diagnostic microbiology culture yields and antimicrobial resistance proportions in low-to-middle-income and high-income countries are lacking. A retrospective study using blood, respiratory, and urine microbiology data from a community hospital in India and two community hospitals (Hospitals A and B) in St. Louis, MO, USA was performed. We compared the proportion of cultures positive for selected multi-drug-resistant organisms (MDROs) listed on the WHO's priority pathogen list both before the COVID-19 pandemic (January 2017-December 2019) and early in the COVID-19 pandemic (April 2020-October 2020). The proportion of blood cultures contaminated with coagulase-negative Staphylococcus (CONS) was significantly higher during the pandemic in all three hospitals. In the Indian hospital, the proportion of carbapenem-resistant (CR) Klebsiella pneumoniae in respiratory cultures was significantly higher during the pandemic period, as was the proportion of CR Escherichia coli in urine cultures. In the US hospitals, the proportion of methicillin-resistant Staphylococcus aureus in blood cultures was significantly higher during the pandemic period in Hospital A, while no significant increase in the proportion of Gram-negative MDROs was observed. Continuity of antimicrobial stewardship activities and better infection prevention measures are critical to optimize outcomes and minimize the burden of antimicrobial resistance among COVID-19 patients.

Effectiveness of Popliteal Nerve Block in below Knee Surgeries

Aim: To observe the effectiveness of sciatic nerve block in popliteal fossa (popliteal nerve block) and saphenous nerve block on the medial site of upper tibia in local population Study design: Descriptive cross-sectional study Place and duration of study: Department of Anesthesia, The Indus Hospital, Karachi from 11th March 2013 to 15th March 2014. Methodology: One hundred and fourteen patients with elective operations like wound debridement of foot, amputation of toes were included. After 15 minutes of giving the block, and at the time of incision, the patient was asked about his/her pain level by showing the pain scale. If the patient points at level 0, the surgery was proceed and the block was termed as effective. Results: Most of the patients were between 51-70 years of age and mean age was 58.83±9.21 years. There were 73(64.04%) males and 41(35.96%) females. Seventy four (64.91%) were in ASA-III, 32(28.07%) were in ASAIV and 8(7.02%) were in ASAV. The pain was not reported in 103(90.35%) patients while 11(9.6%) had pain in which 4 patients had mild pain, 5 moderate and 2 had severe pain. Block was effective in 103(90.35%) cases and ineffective in 11(9.65%) cases. Conclusion: Sciatic nerve block in popliteal fossa (popliteal nerve block) and saphenous nerve block on the medial site of upper tibia be taken as an anaesthesia method for surgeries below the knee as well as for the control of the post-operative pain specifically in patients where spinal anaesthesia is not favorable Keywords: Below knee surgery, Sciatic nerve block, Popliteal nerve block

Effect of Intravenous Lignocaine vs Placebo on Hemodynamic Responses during Direct Laryngoscopy

Aim: To determine the effect of placebo vs intravenous lignocaine pre-intubation on hemodynamic responses during direct laryngoscopy. Study design: Randomized control trial Place and duration of study: Department of Anaesthesia, Indus Hospital, Karachi from 1st March 2017 to 31st August 2017. Methodology: One hundred and twenty patients were included and divided into two groups. In one group, lignocaine arm (1.5mg/kg I/V lignocaine) was given while placebo arm was given (6ml normal saline pre-intubation) in group two. In both groups after arrival at the operation theatre, base-line parameters like the heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure was measured non-and later hemodynamic assessment was done before giving lignocaine, prior and post intubation and after 3,5 and 10 minutes of intubation. Results: Fifty six (46.15%) were male while 64 (53.85%) were females. No patients were found to have asthma, COPD, ischemic heart disease, TB, CHF, Cushing syndrome, phenochromcytoma, and drug allergy. No significant association was found between the two groups when comparing the gender, BMI, comorbids, ASA grade and Mallampati grade. The systolic blood pressure at 3,5 and 10 minutes was significant in the two groups, while diastolic was not significantly associated. The pulse rate at3 and 10 minutes was found to have a significant association while at 5 minutes was insignificant. MAP showed no significant association between the two groups. Conclusion: Hemodynamic stability is only affected in terms of systolic blood pressure, while other parameters are not significantly affected. Keywords: Lignocaine, Hymodynamic changes, Laryngoscopy

Enriching healthcare service quality by leveraging service experiences in Indian private hospitals: application of fuzzy-AHP approach

PurposeOver the years, despite the best efforts to evaluate service quality through multiple techniques, the connotation between service deliverance and consumer expectation remains sporadic. In the quest to quantify service quality from an innovative perspective, the current study has leveraged consumer-perceived experiences to unveil the novel intricacies of healthcare quality.Design/methodology/approachAnchoring on the dimensions of patient experience (PX), field data were collected from 244 patients at different private hospitals operating across India. Further, this study incorporated a fuzzy analytic hierarchy process (F-AHP) to evaluate consumer preferences and prioritised the dimensions of PX in three categories of Indian hospitals, namely nursing homes (NHs), mid-tier corporate hospitals (MCHs) and top-tier corporate hospitals (TCHs).FindingsThe results establish a performance ranking by demonstrating that MCHs outperform the rest alternatives on the grounds of perceived experiences. Tukey's honestly significance difference (HSD) test was executed to confirm the heterogeneity among the participants' preferences across three different hospital categories. The results reveal that for most of the alternatives, the mean scores of the criterion were statistically significantly different.Originality/valueIn healthcare studies, PX dawned as an entity with an ability to propel healthcare quality in a better way than the classical techniques did. The study's findings present a comprehensive picture of a care delivery system by identifying relatively significant dimensions of PX, hence improving the quality quotients by adjusting healthcare offerings in alignment with consumer expectations and organisational strategies.

Spectrum of Primary Gastric Lymphoma in India: A Series of 30 Patients.

Primary gastric lymphoma is uncommonly reported in India. We retrospectively analyzed their data in a northern Indian teaching hospital. During a 12-year period (2000-2012), endoscopic and surgical biopsies were assessed for gastric neoplasm. Gastric biopsies from normal-looking areas, rapid urease test, and Helicobacter pylori serology were done, with 2 of 3 tests positive being considered diagnostic. We aimed to study (i) the frequency of primary gastric lymphoma among gastric neoplasm patients, (ii) its clinical profile, (iii) the diagnostic procedures needed, and (iv) the frequency of H. pylori infection among them. Thirty out of 324 (9.2%) patients (age 56 years, range 25-72, 73.3% male) with gastric neoplasm had primary gastric lymphoma. Presentations included dyspepsia (n = 9, 30%), gastric outlet obstruction (n = 7, 23.3%), upper gastrointestinal bleeding (n = 5, 16.7%), dysphagia (n = 4, 13.3%), malignant ascites (n = 3, 10%), and others (n = 2, 6.7%). H. pylori infection was confirmed in 7 (23.3%), 12 (40%), and 21/29 (72.4%) patients by rapid urease test and histopathology and positive anti-H. pylori IgG serology, respectively. By 2 tests, H. pylori was detected in 12 (40%) patients. Though in 60% primary gastric lymphoma was diagnosed on endoscopic biopsy, in 40%, surgical resection was required. The endoscopic and surgical diagnosis groups were comparable in age (53.4 years vs. 52.7 years), sex (male 77.8% vs. 66.7%), H. pylori infection (38.9% vs. 16.7%), presentation with dyspepsia (38.9% vs. 16.7%), organic symptoms (61.1% vs. 83.3%), and the need for repeated endoscopic biopsies before diagnosis (12.% vs. 33.3%). Primary gastric lymphoma is not uncommon (9.2%) in India, often missed on endoscopic biopsy and is associated with H. pylori infection (40%).

Colonial tuberculosis legacies and the Dynevor Indian Hospital (1908-1934).

Tuberculosis (TB) remains a legacy of colonialism in Canada; far higher rates persist among First Nations and Inuit people than non-Indigenous, Canadianborn individuals.[1][1] The roots of this disparity lie in historical governmental policies, which extend to the institutionalization of Indigenous

Assessment of outcomes after intralesional bleomycin sclerotherapy of lymphatic malformations in children.

To evaluate the efficacy of bleomycin in the treatment of lymphatic malformations, and the concordance between photographic and radiological assessments of the outcome. The retrospective study was conducted at the Vascular Anomalies Centre of Indus Hospital, Karachi, and comprised data of patients enrolled with diagnosis of macrocystic or mixed lymphatic malformations from January 2017 to November 2019. All patients had been treated with injection bleomycin 0.6-1mg/kg/session. Size and location of lesions, ultrasonographic findings, photographic documentation and post-procedure complications were reviewed. Photographic and radiographical assessment outcomes were categorised as excellent, good or poor, and compared for concordance. Data was analysed using Stata 14. Of the 31 children, 22(68.8%) were boys. Mean age at presentation was 54.2±44 months (range: 2 months to 15.7 years). There were 32 lymphatic malformations; 29(90.6) macrocystic and 3(9.4%) mixed. Head and neck region was mostly involved 19(59.4%). Most lesions 23(71.9%) presented during the first year of life, and 29(90.6%) lesions were purely macrocystic. Excellent, good and poor response was seen in 16(50%), 15(46.9%) and 1(3.1%) lesions on photographic assessment, and 21(65.6%), 11(34.4%) and 0(0.0%) lesions on radiological assessment, respectively. Concordance in photographic and radiological outcomes was 22(69%). No complications were seen and no statistically significant difference was observed for photographic and radiographic assessment with respect to gender, malformation type, region involved, and number of sessions (p>0.05). Intralesional bleomycin sclerotherapy was found to be effective in the treatment of lymphatic malformations. Clinical observation was reliable in assessing progress on routine follow-up, with additional radiology done when management decisions needed to be reviewed.

Metagenomic Insight into Microbiome and Antibiotic Resistance Genes of High Clinical Concern in Urban and Rural Hospital Wastewater of Northern India Origin: a Major Reservoir of Antimicrobial Resistance.

India is one of the largest consumers and producers of antibiotics and a hot spot for the emergence and proliferation of antimicrobial resistance genes (ARGs). Indian hospital wastewater (HWW) accumulates ARGs from source hospitals and often merges with urban wastewater, with the potential for environmental and human contamination. Despite its putative clinical importance, there is a lack of high-resolution resistome profiling of Indian hospital wastewater, with most studies either relying on conventional PCR-biased techniques or being limited to one city. In this study, we comprehensively analyzed antibiotic resistomes of wastewater from six Indian hospitals distributed in rural and urban areas of northern India through shotgun metagenomics. Our study revealed the predominance of ARGs against aminoglycoside, macrolide, carbapenem, trimethoprim, and sulfonamide antibiotics in all the samples through both read-based analysis and assembly-based analysis. We detected the mobile colistin resistance gene mcr-5.1 for the first time in Indian hospital sewage. blaNDM-1 was present in 4 out of 6 samples and was carried by Pseudomonas aeruginosa in HWW-2, Klebsiella pneumoniae in HWW-4 and HWW-6, and Acinetobacter baumanii in HWW-5. Most ARGs were plasmid-mediated and hosted by Proteobacteria. We identified virulence factors and transposable elements flanking the ARGs, highlighting the role of horizontal gene transmission of ARGs. IMPORTANCE There is a paucity of research on detailed antibiotic resistome and microbiome diversity of Indian hospital wastewater. This study reports the predominance of clinically concerning ARGs such as the beta-lactamases blaNDM and blaOXA and the colistin resistance gene mcr and their association with the microbiome in six different Indian hospital wastewaters of both urban and rural origin. The abundance of plasmid-mediated ARGs and virulence factors calls for urgent AMR crisis management. The lack of proper wastewater management strategies meeting international standards and open drainage systems further complicates the problem of containing the ARGs at these hospitals. This metagenomic study presents the current AMR profile propagating in hospital settings in India and can be used as a reference for future surveillance and risk management of ARGs in Indian hospitals.

Point Prevalence Study (PPS) of Antibiotic Usage and Bacterial Culture Rate (BCR) among Secondary Care Hospitals of Small Cities in Central India: Consolidating Indian Evidence.

Objective Indian hospitals (especially government-run public sector hospitals) have a nonexistent antimicrobial stewardship program (AMSP). After successfully initiating AMSPs in tertiary care hospitals of India, the Indian Council of Medical Research envisages implementing AMSP in secondary care hospitals. This study is about the baseline data on antibiotic consumption in secondary care hospitals. Materials and Methods It was a prospective longitudinal observational chart review type of study. Baseline data on antibiotic consumption was captured by a 24-hour point prevalence study of antibiotic usage and bacterial culture rate. The prescribed antibiotics were classified according to the World Health Organization (WHO) Access, Watch, and Reserve classification. All data were collated in Microsoft Excel and summarized as percentages. Results Out of the 864 patients surveyed, overall antibiotic usage was 78.9% (71.5% in low-priority areas vs. 92.2% in high-priority areas). Most of the antibiotic usage was empirical with an extremely low bacterial culture rate (21.9%). Out of the prescribed drugs, 53.1% were from the WHO watch category and 5.5% from the reserve category. Conclusion Even after 5 years of the launch of the national action plan on AMR (NAP-AMR) of India, AMSP is still non-existent in small- and medium-level hospitals in urban cities. The importance of trained microbiologists in the health care system is identified as a fulcrum in combating antimicrobial resistance (AMR); however, their absence in government-run district hospitals is a matter of grave concern and needs to be addressed sooner than later.

Clinical pharmacist-initiated assessment and amelioration of appropriate antibiotic use in surgical units at a South Indian tertiary care hospital - A handshake approach

Studies on the appropriateness of antibiotic use among surgical patients are limited in developing countries, notably in India. Therefore, we aimed to evaluate the inappropriateness of antibiotic use, demonstrate the impact of clinical pharmacist interventions and determine the predictors of inappropriate use of antibiotics in the surgical units of a South Indian tertiary care hospital. This was a 1-year prospective interventional study on in-patients of the surgical wards to determine the appropriateness of the prescribed antibiotics by reviewing medical records using available antimicrobial susceptibility test reports and medical evidence. When inappropriateness in antibiotic prescriptions was identified, the clinical pharmacist discussed and conveyed apt suggestions to the Surgeon. Bivariate logistic regression analysis was applied to evaluate its predictors. Among the 660 antibiotic prescriptions of 614 patients that were followed and reviewed, about 64% were inappropriate. Most inappropriate prescriptions were witnessed in the cases that involved the gastrointestinal system (28.03%). Among the inappropriate cases, 35.29% were attributed to an excessive regimen of antibiotic use which marked the highest. Based on the category of use, most of the antibiotics were used inappropriately as prophylaxis (76.7%) followed by empirical (71.31%). The increase in the percentage of the appropriate use of antibiotics resulting from pharmacist intervention was 95.06%. There was a significant link between inappropriate antibiotic use and the presence of two or three comorbid conditions, the use of two antibiotics, and length of hospital stay of 6-10 days and 16-20 days (p < 0.05). An antibiotic stewardship program in which the Clinical pharmacist is an integral part along with well-framed institutional antibiotic guidelines must be implemented to assure appropriate antibiotic use.

Clinical Outcomes Following the Implementation of a Novel One-Year Training Program in Emergency Medicine in Karachi, Pakistan.

Most Emergency Departments (EDs) in low- and middle-income countries (LMICs), particularly in Pakistan, are staffed by physicians not formally trained in Emergency Medicine (EM). As of January 2022, there were only 13 residency training programs in EM throughout all of Pakistan. Therefore, an intermediate solution-a one-year training program in EM-was developed to build capacity. To determine the impact of a novel training program in EM on clinical metrics and outcomes. The first cohort of a novel, one-year training program-the Certification Program in Emergency Medicine (CPEM)-completed the program in June 2019. The program consisted of two arms: CPEM-Clinical (CPEM-C), which included physicians from the Indus Hospital and Health Network (IHHN) ED; and CPEM-Didactic (CPEM-D), which included physicians from EDs across Karachi. Both groups participated in weekly conferences, such as didactics, small group discussions, workshops, and journal clubs. CPEM-C learners also received clinical mentorship from local and international faculty. Mortality, length of stay (LOS), and time-to-evaluation, as well as metrics in four key areas-patients at risk for cardiovascular disease/acute coronary syndrome, sepsis, respiratory illness, and intra-abdominal trauma-were assessed before and after the initial cohort at IHHN and compared with other groups in IHHN. More than 125,000 patients were seen from July to December 2017 (pre-CPEM) and July to December 2019 (post-CPEM). Overall, there were significant improvements in all clinical metrics and outcomes, with the exception of LOS and time-to-evaluation, and a trend toward improved mortality. In comparing CPEM graduates to other groups in IHHN ED, most metrics and outcomes significantly improved or trended toward improvement, including mortality. Implementation of a medium-duration, intensive EM training program can help improve patient care and the development of EM as a new specialty in lower-resource settings.

Monocyte Distribution Width, a Novel Biomarker for Early Sepsis Screening and Comparison with Procalcitonin and C-Reactive Protein.

Objectives Monocyte distribution width (MDW) can be used for the early recognition of sepsis. The study compared the diagnostic accuracy of the MDW with two well-known sepsis biomarkers, procalcitonin (PCT) and C-reactive protein (CRP). Materials and Methods A study was conducted from July 2021 to October 2021, on 111 patients admitted to the Indus Hospital and Health Network. Patients from the ages of 1 to 90 years were enrolled if hospitalized for more than 24 hours for suspected sepsis to avoid inclusion of patients who had short-term stay in the emergency department. According to the Sequential Organ Failure Assessment score, the clinical team did the characterization of cases as with sepsis or without sepsis. SPSS version 24 was used, and the diagnostic accuracy of MDW was assessed and compared using the area under the curves (AUCs) acquired from receiver operating characteristic curves. Pearson's chi-square/Fisher's exact test (as per need) was applied to determine the association. A p -value of less than 0.05 was considered significant. Results Among 111 patients, 81 (73%) patients were labeled with sepsis and 30 (27%) were without sepsis. We have reported significantly higher MDW, PCT, and CRP levels in septic patients ( p < 0.001). The AUC of MDW was comparable with PCT (0.794). Significant cutoff value for the MDW was greater than 20.24 U with 86% sensitivity and 73% specificity. Conclusion MDW may have a predictive ability similar to PCT and CRP in terms of sepsis and, thus, can be used as a standard parameter for the timely diagnosis of sepsis.

Analysis of profit efficiency of corporate hospitals in India during COVID-19 – An DEA-MPI based approach

ABSTRACT Healthcare organizations must operate efficiently to provide affordable care without compromising their sustainability and competitiveness. The purpose of this is to measure the profit efficiency of select Indian Corporate Hospitals during the COVID-19 pandemic. Further, the study attempts to analyze the productivity changes in select corporate hospitals during COVID-19 and postimplementation of the national insurance policy in India. The study used the Data envelopment analysis (DEA) technique to measure the efficiency of corporate hospitals. It utilizes Constant Return to Scale (CRS), and Variable Return to Scale (VRS) to estimate profit inefficiency. DEA-based Malmquist Productivity Index (MPI) was used to examine the productivity change during the last three years since the outbreak of COVID-19. The DEA-MPI model is iterated for panel data for Financial Year 2018–2021. with year-wise employee benefits and operating expenses as the input parameters and year-wise net sales as the output parameter. The study reveals surprising results and requires critical analysis. Out of select hospitals, 80% of hospitals were found inefficient using CRS while 70% of the hospitals were found inefficient using VRS. The findings of this study are useful for healthcare administrators and managers to highlight improvement programs for efficiency maximization .

Hospital-based antimicrobial stewardship, India.

To establish a framework for implementing antimicrobial stewardship in Indian tertiary care hospitals, and identify challenges and enablers for implementation. Over 2018-2021 the Indian Council of Medical Research followed a systematic approach to establish a framework for implementation of antimicrobial stewardship in Indian hospitals. We selected 20 Indian tertiary care hospitals to study the feasibility of implementing a stewardship programme. Based on a questionnaire to lead physicians before and after the intervention, we assessed progress using a set of process and outcome indicators. In a qualitative survey we identified enablers and barriers to implementation of antimicrobial stewardship. We found an improvement in various antimicrobial stewardship implementation indicators in the hospitals after the intervention. All 20 hospitals conducted monthly point prevalence analysis of cultures compared with three hospitals before the intervention. The number of hospitals that initiated formulary restrictions increased from two to 12 hospitals and the number of hospitals that started practising prescription audit and feedback increased from six to 16 hospitals. Respondents in 15 hospitals expressed their willingness to expand the coverage of antimicrobial stewardship implementation to other wards and intensive care units. Six hospitals were willing to recruit the permanent staff needed for antimicrobial stewardship activities. Antimicrobial stewardship can be implemented in Indian tertiary hospitals with reasonable success, subject to institutional support, availability of trained manpower and willingness of hospitals to support antimicrobial stewardship-related educational and training activities.