Rural Hospital In India Research Articles

Patient's knowledge and perception of preanesthesia check-up in rural India.

Background:Preanesthesia assessment is an important aspect of patient care. If a patient shows lack of interest during preanesthesia check-up or tries to rush through, it may result in incomplete history and general physical examination, compromising patient care.Aim:The aim of this study was to assess the knowledge of patients presenting for elective surgery to Tertiary Care Hospital in Rural India regarding value and importance of preanesthesia check-up.Settings and Design:This observational study was conducted in a Tertiary Care Teaching Hospital in Rural India. 1000 patients posted for elective surgery coming to preadmission anesthesia consultation (PAC) clinic over a period of 3 months were included in this study.Methods:Patients were asked to fill a questionnaire consisting of 15 questions before start of preanesthesia assessment. Each question was provided with multiple possible choices, out of which patient had to choose the most appropriate according to him/her. Scoring was done, with each question answered correctly being given 1 mark while incorrect answer was awarded 0 marks.Statistical Analysis:Data were expressed as frequencies and percentage. Correlations studies were performed by unpaired t-test and one-way analysis of variance.Results:About 27.4% of patients knew that they had come to PAC clinic for preanesthesia assessment, the rest were not clear. Similarly, only 18.1% knew that only anesthesiologist can perform a preanesthesia examination. 16.5% patients said that they would discuss their fears or queries regarding anesthesia in PAC clinic while 58.6% said that they would share such feelings with the surgeon in ward.Conclusion:Patients had insufficient knowledge about preanesthesia assessment and its role in improving the outcome of surgery.

Awareness of the warning symptoms and risk factors of stroke among adults seeking health care from a rural hospital of India.

Awareness of the warning symptoms and risk factors of stroke among adults seeking health care from a rural hospital of India.

Mycotic keratitis in a tertiary care hospital in rural India

Background: Mycotic keratitis is an important cause of corneal blindness in developing countries including India. It is more common in the tropics and subtropical regions. A retrospective study was done in all patients with clinically suspected fungal keratitis at Peoples Education Society Medical College and Research Institute Hospital, Kuppam, Andhra Pradesh from January 2011 to December 2013 to determine the causative agents and to identify the predisposing factors of mycotic keratitis. Out of 63 cases with corneal ulcer, 39 cases were diagnosed with mycotic keratitis by culture (36 cases) or by potassium hydroxide preparation (three cases). Males were more commonly affected and were mostly in the age group above 50 years Fusarium species (55%) was the most common fungus isolated followed by Aspergillus flavus (22%). Direct microscopic detection of fungal structures in corneal scrapings permits a rapid presumptive diagnosis and early institution of antifungal therapy which is necessary to prevent blindness.

ZargisCardioscan™ Aided Heart Murmurs Recognition has high negative predictive values when correlated and validated with Echocardiography: A Potential Dawn for Valvular Heart Disease Prevalence Studies in Rural India

Background The purpose of this open-label study was to correlate the auscultation findings of ZargisCardioscan™ with the echocardiographic findings in our patient population who were referred for echocardiography so as to investigate and ensure the validity of this technology before instituting its applicability in community health events among rural Indian population. Materials and Methods This was a double blinded prospective correlation study in outpatients presenting for echocardiography. Methods: One hundred patients, who had presented for echocardiography at Cardiology Center of an academic university hospital in rural India, were enrolled in this double blinded prospective correlation study. Principal investigator who is a community medicine physician performed the auscultation of patients’ hearts in sitting position. Subsequently, the ZargisCardioscan™ software was used to analyze the heart sounds auscultated by the 3M™ Littmann® Model 3200 stethoscope. Thereafter, the scheduled echocardiography for which the patient had presented to hospital was performed by co-investigator cardiologist who was blinded to the results obtained by the ZargisCardioscan™.Finally, all these data were statistically analyzed by blinded investigator for the presence of correlation between the two modalities. Results The most important finding was the high 90s negative predictive values when the stethoscope-software combination was used for auscultation and analysis of heart murmurs. Additionally, presence of isolated systolic murmurs had higher incidence of appreciable significant valvular lesions and presence of isolated diastolic murmurs primarily had underlying minimal-mild regurgitant valvular lesion, if any. The Bland-Altman Plot confirmed good correlation between stethoscope-echocardiography findings. Conclusion Stethoscope-software combination, 3M™ Littmann® Model 3200 and ZargisCardioscan™, accurately predicts the absence of valvular heart disease on echocardiography.DOI: http://dx.doi.org/10.3126/nje.v4i3.10665 Nepal Journal of Epidemiology 2014; 4(3): 363-369

Assessment of the impact of pharmaceutical advertisements on patient’s drug consuming behavior: A questionnaire based survey

Objective: To assess of the impact of pharmaceutical advertisements on patients drug consuming behaviour Methods: This was a 6 month cross-sectional survey using a validated open-ended scored questionnaire administered to 300 respondents. The locus of the study was a tertiary care rural hospital in India. The respondents were pre-briefed about the study. Voluntary participation and strict confidentiality were maintained. Responses to the questionnaire were evaluated and analysed statistically. Results: Our results showed that pharmaceutical advertising has an important effect on drug consuming behaviour of patients. It was seen that advertisements featuring antacids, health tonics and supplements, analgesic tablets and creams, antiflatulents and digestives, cold rubs and tablets as well as cough syrups had a high recall value (>50%). It was seen that patients were keen on buying the drugs after an exposure to DTCA. Conclusion: DTCA does have an impact on consumer behaviour. Increasing the health messages in advertisements, with less emphasis on the specific medication and more on the overall disease state is the moral obligation on the part of the pharmaceutical industry. Key words: Direct to consumer advertising, pharmaceutical advertisements.

Blended distance education program for junior doctors working in rural hospitals in India

Distance learning, supported with supervised clinical work, has been successful in helping doctors located in remote rural areas to practice effectively. Graduates of Christian Medical College (CMC), Vellore, India, have a 2-year service obligation to work in small hospitals mainly located in rural areas. The Fellowship in Secondary Hospital Medicine (FSHM) program is a year-long blended on-site and distance learning program, designed by CMC to support and provide education opportunities for its recent graduates working in small hospitals in rural areas. The FSHM program was designed to help junior doctors develop the knowledge and skills to practice effectively in rural hospitals. The FSHM program consists of 15 paper-based distance learning modules focused on helping to develop knowledge to practice in rural hospitals; three contact sessions at CMC, which focused on developing the necessary skills; project work focused on improving local health services; and networking between peers and with faculty. Two years after implementation of the FSHM program in 2007, the vast majority of students (81%) and faculty (80%) rated the distance learning modules as very good or excellent in helping students develop the knowledge to practice in secondary hospitals. Also, most of the students (88%) and faculty (87%) rated the contact sessions as good or very good in helping students to apply what they had learned in secondary hospitals. Focus group discussions revealed that all of the program participants recognized that the distance learning modules and contact sessions helped them in providing patient care in rural hospitals. Well-designed distance learning modules, supported with contact sessions by medical school faculty members, help junior doctors to practice effectively in rural hospitals and reduce their isolation.

Study of Surgical Site Infections following Gynaecological Surgery at tertiary care teaching hospital in Rural India

Objectives: To find out the incidence, risk factors and microorganisms responsible for of surgical site infections. Material and Methods: The prospective observational study was carried out in the tertiary care teaching hospital over a period of two years Consecutive 100 cases of surgical site infections(SSI) following obstetric and gynecological abdominal surgery were analyzed using Statistical Package of Social Sciences version -16.0 Results: The incidence of surgical site infections was 2.8 percent among 3498 surgeries performed during study period. Overweight, previous laparotomy scars, emergency surgery and caesarean section following prolong labour were the common risk factors associated with the development of SSI. Suboptimum peri-operative conditions related to preparation of patient for surgery, below ideal operation theatre conditions, humidity, long list of operations, practice of shaving of part day prior, water scarcity in summer and casual approach by health professionals while surgical scrubbing and donning and uncontrolled movement of patients relatives in the postoperative ward predisposed patients for development of SSI. Staphylococcus aureus and gram negative bacilli like E.Coli and pseudomonas were mainly isolated from the wound specimens. Conclusion: Surgical site infections can be prevented by proper pre-operative assessment of cases, strict compliance with scrubbing and donning protocols, skillful surgery, avoiding overcrowding in operation theatre and post operative wards and by maintaining conducive theatre environment.

A retrospective study of pediatrics burns at general hospital in rural India

Background: Pediatrics Burns are major preventable cause of morbidity and mortality worldwide, particularly in developing countries. Aims & Objectives: The aim of this study is to perform a retrospective analysis of the epidemiology of burns observed in children below 12 years of age in rural India. Materials and Methods: In this study, patients were studied retrospectively with regard to their age, sex, cause of burns, and length of hospital stay, burned body surface area and mortality. Statistical Analysis used: Chi-square test using SOFA software. Results: A total of 84 patients were admitted in burn care unit, out of which, 52 were male and 32 were female. The most common causes of burns, in patients treated on an inpatient basis, were scald burns (69.04%). The mean total body surface area burnt of the patients was 20 %. TBSA >30 % was significant risk factor for mortality in children. The average hospital stay was 10-12 days. Mortality was 9.52%. Conclusion: Burn injury is a major health concern in children, and special consideration to be given in prevention of burn injury.

Prevalence and severity of anaemia stratified by age and gender in rural India.

Anaemia is a major public health problem in India. Although nearly three quarters of the Indian population live in rural areas, the epidemiology of anaemia in rural settings is not well known. We performed a retrospective observational study using routine clinical data from patients attending the out-patient clinics of a rural hospital in India from June 2011 to August 2014. The study included 73,795 determinations of haemoglobin. 49.5% of patients were female. The median haemoglobin concentration was 11.3 g/dL (interquartile range (IQR), 9.8–12.4) in females and 12.5 g/dL (IQR, 10.6–14.2) in males. Anaemia was present in the majority of children <10 years, women after puberty, and older adults. Children <5 years had the highest prevalence of anaemia, especially children aged 1-2 years. The high proportion of microcytic anaemia and the fact that gender differences were only seen after the menarche period in women suggest that iron deficiency was the main cause of anaemia. However, the prevalence of normocytic anaemia increased with age. The results of this study can be used by public health programmes to design target interventions aimed at reducing the huge burden of anaemia in India. Further studies are needed to clarify the aetiology of anaemia among older adults.

Application of Lean Six Sigma methodology to reduce the cycle time of out-patient department service in a rural hospital

This article discusses the implementation of Lean Six Sigma (LSS) methodology in decreasing cycle time of out-patient department service of a rural hospital. The lean principles and Six Sigma define, measure, analyse, improve, and control process (DMAIC) approaches have been used to achieve this result. This article explains the step-by-step approach of LSS implementation in a rural Indian hospital for quality improvement and timely service to the community. This resulted in decreased cycle time of the process from 4.27 minutes to 1.5 minutes. Owing to the project a 97% reduction in average waiting time in the system and 91% decreases in queue length were reported. During this study, data was collected on all possible causes. Statistical techniques and GEMBA were used to analyse the data. Based on analysis conclusions were made. Lean tools such as kanban, 5S, ergonomic design of work place, etc., were effectively used to improve process and sustain the process.

Spectrum of Cytological Findings in Fine Needle Aspiration Cytology of Breast Lumps with Histopathology Correlation: Experience in a Tertiary Care Rural Hospital in India

To determine the pattern of disease in patients presenting with breast lumps and to determine the sensitivity and specificity of fine needle aspiration cytology of benign and malignant diseases as a diagnostic tool by correlating with histopathology findings. This retrospective study was carried out in the Department of Pathology, Maharaja Agrasen Medical College, Agroha, from Jan 2008 to April 2012. Fine needle aspiration cytology was performed on 370 cases and out of these 52 cases were received in the Department for histopathological examination. Fibroadenoma was the most common disease encountered, in 88 (24%), with a peak incidence in second and third decade of life. Fibrocystic disease was second, being common in the third and fourth decades of life. Peak incidences of duct ectasia, granulomatous and tubercular mastitis were seen in the third decade. Gynaecomastia showed two peak incidences in second and sixth decades of life . Out of total 370 cases undergoing fine needle aspiration, benign cases were 316 (85.4%), malignant and suspicious were 54 (14.6%) and 10 (2.70%) respectively. Out of total 22 histological confirmed malignant lesions 19 were interpreted as malignant cytologically while two as suspicious and one as benign. All thirty histologically confirmed benign cases were diagnosed as benign cytologically. The sensitivity, specificity, positive and negative predictive values were 98%, 100%, 100% and 96.4% respectively. FNA cytology is highly accurate for diagnosis of breast masses. However, the clinician should correlate FNA cytological results with physical examination and imaging findings to prevent false negative and false positive events and to obtain optimal management of their patients.

Assessment of adherence to drug information service protocol in a rural Indian Hospital

Background: Drug information service is an essential supportive service to the health care practice. Quality assurance is an ongoing process to improve and maintain quality of drug information services. In this study we focused of assessing the protocol adherence for drug information services. Methods: The study was conducted for the drug information services in a rural South Indian hospital for a period of two years (2011-2012). Assessment was done on adherence to the protocol and satisfaction of customers. Results: A total of 726 queries were answered in the study period which include 335 in 2011 and 391 in 2012. Average number of queries answered per month in 2011 was 28 (SD ± 20.6) and in 2012 was 33 (SD ± 24.8). Consistency of the service was poor the number of queries answered per month range between zero to 92. Most of the May month is a vacation time and the center was not working. Protocol adherence increased in the study period. The highest level of adherence was seen in the months of April, August, October, and November in the year 2012. Customer satisfaction could be achieved above 85% in the months of April, August, September, October, and December of 2012. Conclusion: The protocol adherence in the study center for drug information increased in the study period and thus was the customer satisfaction. Future studies could assess other measures of quality assurance of drug information services.

Cost burden of inappropriate peri-operative antibacterial use in a teaching tertiary-care rural hospital in India

The most common indication for antibacterial chemoprophylaxis is to reduce the risk of surgical infection. Appropriate use of antibacterial is effective in the prevention of surgical site infections, but inappropriate prescribing and excessive use of such drugs increases the cost of therapy, as well as the risk of antibacterial resistance. To study the cost burden of inappropriate peri-operative antibacterial use in a teaching tertiary-care rural hospital in India. A prospective observational study of 200 patients from four surgical departments was conducted from February to October 2010. Data were analysed for class of surgical wound, and the use, appropriateness and cost burden of peri-operative antibacterial therapy. The majority of patients (45.5 %) had class II surgical wounds followed by Class I (26 %), Class III (17.5 %) and Class IV (11 %). In 143 patients with class I or II surgical wounds, inappropriate peri-operative antibacterials were prescribed in 119 (83.2 %) patients. Among these 119 patients, the choice of antibacterial was inappropriate in 76.5 % of patients, the duration of treatment was inappropriate in all patients, and the mean antibacterial cost was Indian rupee 541.29, which was significantly (p < 0.001) higher than calculated ideal cost of 49.3. Inappropriate peri-operative prescribing of antibacterials is a common problem culminating in an increased cost burden. Interventions are warranted to promote the development, dissemination and adoption of evidence-based standard treatment guidelines for antibacterial prophylaxis.

PHP47 - ABC Analysis Of Pharmaceuticals In A Resource Limited Rural Hospital In India

The Pharmacy and Therapeutic Committee in the hospital planned to study the aggregate medicine use in the hospital. After implementation of the Essential Drug List (EDL) 2011, it was important to know the consumption and cost contributed by each pharmaceuticals in the list so that further revisions could be done on the list annually. The study was conducted for one year using Always Better Control (ABC) analysis of pharmaceuticals in the EDL. Pharmaceuticals from the EDL were categorized for A (70%) B (20%) C (10%) categories. The calculations were done from a period of January 11, 2011 to January 11, 2012 using the data from the hospital billing database. The total annual drug expenditure (ADE) was Rs. 2,61,78,251. Out of 311 pharmaceuticals in the list, 47 (15%) were in A group, 60 (19%) were in B group and the remaining 204 (66%) were in C group. In the A group 45% of the pharmaceuticals were belong to ATC category J (Antimicrobials). Out of the top 10 pharmaceuticals, the costlier one was Anti D Immunoglobulin costing Rs. 1995. But it came on sixth position as the consumption was lesser than the other ones in the top. The first one was Lopinavir-Ritonavir combination with an annual cost of 13, 76529. Insulin was on fourth position with an annual expenditure just short of one million Indian Rupees. The top 10 include 3 anti-virals and 2 anti-bacterial preparations showing the high consumption and costs of the anti-microbial agents. The least unit cost in the A category was Rs. 0.18 for ferrous sulphate – folic acid combination. Antimicrobilas consumed major resources of the charity hospital. Control on antimicrobial prescription with updated protocols and adoption of government free supply of anti-retroviral drugs will substantially reduce the hospital budget on medicines.

A profile of adverse drug reactions with risk factors among geriatric patients in a tertiary care teaching rural hospital in India

A profile of adverse drug reactions with risk factors among geriatric patients in a tertiary care teaching rural hospital in India

Evaluation of a Low-Cost Strategy for Enumerating CD4 Lymphocyte Absolute Count and Percentage Using the FACSCalibur Flow Cytometer in HIV-Infected Patients from a Resource-Limited Setting

Enumeration of CD4 lymphocytes is essential for the clinical management of HIV-infected patients, but it can be difficult to afford in developing countries. In this study we evaluated a reagent reduction strategy for reducing the cost of enumerating CD4 cell absolute count and percentage using the FACSCalibur flow cytometer (Becton Dickinson). We compared the protocol recommended by the manufacturer with a protocol that used half of the usual amount of CD3/CD4/CD45 monoclonal antibody reagent in 100 samples from HIV-infected patients in a rural hospital in India. The concordance correlation coefficient between the two protocols was 0.976 for CD4 cell count and 0.984 for CD4 cell percentage. We did not find significant bias when performing Deming regression or Bland-Altman analysis. Sensitivity and specificity were 97% and 98.5% for identifying patients with less than 200 CD4 cells/μL, 98.1% and 93.8% for identifying patients with less than 350 CD4 cells/μL, and 100% and 94.7% for identifying patients with less than 25% CD4 cells, respectively. This reagent reduction strategy can be used for reducing the cost of enumerating CD4 lymphocytes in high-volume laboratories from resource-limited settings.

Socio-demographic Risk Factors Associated with HIV Infection In Patients Seeking Medical Advice in a Rural Hospital of India.

Despite the fact that two thirds of HIV infected people in India are rural residents, risk factors associated with HIV infection in rural areas are not well known. In this study we have collected socio-demographic data of 6406 patients who were tested for HIV infection in a rural hospital of India and we have investigated risk factors associated with HIV. In women the most important risk factor was being a widow and the risk was higher in younger than in older widows. Other variables found to be associated with HIV infection were age between 25 and 45 years in men, low education level (especially those who only completed primary education) and working in a field not related to agriculture in scheduled castes and men from scheduled tribes. The results of this study express the need for HIV screening of widows who live in rural areas of Indian States with high HIV prevalence.

Drug-induced hepatotoxicity in a tertiary care hospital in rural South India.

Background:Liver is the main organ for metabolism of drugs and hepatotoxicity is a potential adverse effect for most drugs.Aims:This study was to study the frequency of drug-induced hepatotoxicity and to find the common drugs causing hepatotoxicity.Materials and Methods:The study was conducted at a tertiary care hospital in rural India. It is a study based on case series analysis. All patients with an abnormal liver function report, between July 2006 and July 2007, were included in the studyResults:The study included 411 patients. Among them 141 patients were females and 270 males. The common cause for abnormal liver function was alcoholic liver disease (30.4%) followed by drug-induced hepatotoxicity (15.8%) and malaria (15.3%). Drug-induced hepatotoxicity was seen in 65 patients. It was common in males (55%) compared to females (44%). The mean age of the patients with drug-induced hepatotoxicity was 43±15.9. Antitubercular drugs were the commonly encountered drugs (44%) causing hepatotoxicity followed by lipid lowering agents (41%). The others drugs included antiretroviral drugs (6%),steroids (5%) and chlorpromazine (2%).Conclusion:A thorough history of drug intake must be taken in all patients presenting with abnormal hepatic function.

A Networking Approach to Reduce Academic and Social Isolation for Junior Doctors Working in Rural Hospitals in India

Graduates from Christian Medical College (CMC) Vellore face many challenges while doing their service obligation in smaller hospitals, including academic and social isolation. To overcome these challenges, CMC aspired through its Fellowship in Secondary Hospital Medicine (FSHM), a 1-year blended on-site and distance-learning program, to provide academic and social support through networking for junior doctors working in rural areas. The purpose of this paper is to report the evaluation of the networking components of the FSHM program, with a focus on whether it succeeded in providing academic and social support for these junior doctors. A mixed method evaluation was done using written surveys for students and faculty and telephone interviews for students. Evidence for validity was gathered for the written survey. Criteria for validity were also applied for the qualitative data analysis. The major strengths of networking with faculty and peers identified were that it provided social support,, academic support through discussion about patient management problems and a variety of cases seen in the hospital, guidance on projects and reminders about deadlines. Recommendations for improvement included use of videoconferencing and Yahoo Groups. It is useful to incorporate networking into distance-learning educational programs for providing support to junior doctors working in rural hospitals.

A profile of adverse drug reactions with risk factors among geriatric patients in a tertiary care teaching rural hospital in India

Aims & Objective: To study the adverse drug reaction profile, its causality, severity, associated risk factors and preventability in geriatric patients in a tertiary care teaching rural hospital. Materials and methods: Four hundred geriatric patients from various inpatient and outpatient departments were observed for occurrence of adverse drug events (ADEs) during August 2007 to October 2009. ADEs were either spontaneously reported or elucidated from personal interviews and analyzed. Results: In forty seven (11.75%) patients, 57 events occurred of which 75.43% occurred in indoor and 24.56% in outdoor patients. Most patients (74.46%) were in the age range of 65 to 74 years. The male to female ratio was 1.47: 1. Majority of ADEs involved gastrointestinal system (43.85%), followed by cardiovascular system (14.03%), endocrine system (12.28%) and skin and mucous membranes (12.28%). 142 drugs were suspected to cause these ADEs. Chemotherapeutic agents were the most commonly suspected drugs followed by cardiovascular drugs, drugs acting on CNS and steroids. On assessing causality, majority of events were rated as ‘possible’ by both WHO-UMC (66.66%) and Naranjo’s criteria (68.42%). Severity assessment (Hartwig scale) showed that 19.29%, 68.42% and 12.28% ADEs were severe, moderately severe and mild respectively. Risk factors for ADR development found were socioeconomic status (p=0.000), number of diseases suffered (p=0.002), number of medicines taken per day (p=0.000), compliance (p=0.048) and inappropriate prescribing (p=0.004). 36.84% ADRs were definitely preventable and 17.54% were probably preventable by modified Schumock and Thornton scale. Conclusion: ADRs is a major problem prevalent in geriatric patients and is significantly associated with socioeconomic status, number of diseases, number of medicines consumed per day, compliance to therapy and inappropriate prescribing.