Hospital Outpatient Departments Research Articles

Prescribing Patterns of Antibiotics Among The Pediatric Patients Attended The Outpatient Departments of The Tertiary Level Hospitals in Nigeria: A Cross-Sectional Study

Rationality analysis of the prescribing pattern of antibiotics for pediatric patients can help to point towards irrationality and can make a consensus among physicians for rational prescribing. This study was aimed at identifying the antibiotic prescription survey in pediatric outpatient prescriptions. This study was carried out in two hospitals namely; Usmanu Danfodiyo University Teaching Hospital, Sokoto, and General Hospital Katsina Nigeria during the period of October to December 2019. A total of 600 prescriptions cumulatively were used as a sample and were selected using the convenience sampling technique. For data collection, a self-designed data collection sheet was used. WHO / INRUD prescribing indicators were used for the analysis of prescription patterns. A total of 600 prescriptions (364 from UDUTHS and 236 from GHKS) were selected and used for the study. Most of the patients admitted to the two selected hospitals were male. The patient’s ages varied from a few months to 12 years, with the majority aged 4 years or less (61.0%) of age. From the 600 prescriptions evaluated, 1564 drugs (912 from UDUTHS and 652 GHKS) were prescribed. The average number of drugs per encounter in UDUTHS and GHKS were 3.0±0.4 and 3.2±0.7 respectively. The percentages of encounters with an antibiotic prescribed in both hospitals were similar: 32.1% for UDUTHS and 31.1% for GHKS. Most antibiotics were targeted at respiratory tract infections Roxithromycin 126 (21.0%) was the most frequently prescribed antibiotic and was prescribed by the proprietary name. This study has revealed inappropriate drug prescriptions in the pediatric outpatient in these hospitals. These include the low rate of prescriptions in generic names; extensive polypharmacy; and inappropriate prescription of antibiotics which could lead to drug-drug interaction and adverse drug reaction is also evident in these hospitals.

A Case Report on Individualized Homeopathic Treatment of Psoriasis

Psoriasis is a chronic dermatosis characterized by an unpredictable course of remission and relapses and presence at a typical site of well-defined erythematous papules and plaques, which are surmounted with large, silvery loose scales. Psoriasis is an immune-mediated genetically determined common dermatological disorder which affects skin, nails, joints and has various systemic associations. One patient suffering from psoriasis was treated in the outpatient department of State National Homoeopathic Medical College and Hospital, Lucknow. Thorough case-taking was done, followed by analysis and evaluation of the case, was done. The patient was prescribed medicines as per homeopathic principles. The condition of the patient was assessed with the Psoriasis Area and Severity Index (PASI) score every month. Homeopathic medicine reduced the PASI score suggesting the utility of homeopathic treatment of a patient suffering from psoriasis.

Use of complementary and alternative medicines in ENT outpatient department of tertiary care hospital in Southern Rajasthan

Background: Complementary and alternative medicine (CAM) use is highly gaining popularity along with main treatment streams these days. Physicians cannot ignore this fact and should question and counsel patients about pros and cons of CAM for cure of different ailments. Aim and Objectives: The objective of the study was to know about use of CAM among patients visiting Ear, Nose, and Throat (ENT) outpatient department (OPD) in tertiary care hospital of Southern Rajasthan. Materials and Methods: An observational cross-sectional study was conducted in ENT OPD for 2 months. Two hundred and fifty patients were considered for the study. Semi-structured questionnaire was prepared and made to be filled by the patients during their visit to ENT OPD after taking informed consent. Various questions were asked like extent of use of alternative therapies, type of CAM used by the patients, patient’s knowledge about ADRs and drug interactions, reasons for which alternative medicine might have been used. Results: Among 250 patients, CAMs were used by 36 patients. The most common CAMs were either Ayurveda or Homoeopathy medicines or both. The majority of patients obtained their information from family and friends. Maximum patients used these alternative medicines for relief of cough and hoarseness of voice. Conclusion: The study throws light on use of alternative drug therapy and streams of medicine along with routine hospital treatment among patients visiting ENT OPD. This knowledge helps to understand about patients’ alternative approach to diseases, about self-medication, patient’s belief about different types of therapies and also ignorance of possible health hazards, side effects, and complications due to use of concomitant main and alternative medicines for treatment purposes.

Prevalence of Chronic Kidney Disease and Associated Factors among HIV Patients in the Era of HAART in Ivory Coast: A Cross Sectional, Analytical Study

Background: Chronic kidney disease (CKD) may be common among HIV patients living in sub-saharan Africa due to the confluence of CKD risk factors and genetic predisposition. Preventive strategy through early detection and treatment has been advocated for CKD in Africa where majority of patients present late and cannot afford the cost of renal replacement therapy which is not widely available. The purpose of this study was to identify the prevalence and factors associated with CKD among HIV infected adults receiving HAART in a teaching hospital in Ivory Coast. Methods: This is a cross-sectional study of HIV patients on Highly Active Anti Retroviral Therapy followed at the HIV clinic of the medical out-patient department of the University teaching hospital of Bouaké from January to December 2021. CKD was defined as a serum creatinine-based estimated glomerular filtration rate ≤ 60 ml/min/1.73 m2. The collected data was analyzed by using Epi Info 2002 software. Results: Four hundred and two HIV-infected adults 18 years and over were recruited during the study period. We noticed 123 (30.6%) males. The mean age was 40 years. CKD was observed in 42 (10.44) patients infected-HIV. Eighty eight point three percent of patients had CD4 more than 500 cells. Low eGFR correlated with age more than 60 years old, worker in public sector, unemployed, no formal education and HIV type 2. Conclusion: Our study identified a prevalence of CKD of 10.44% by CKD EPI equations among HIV patients on HAART that attended the teaching hospital of Bouaké in Ivory Coast. Early screening and follow up of renal functions is important to minimize the risk of developing end stage kidney disease.

The Importance of Uric Acid High-Density Lipoprotein Cholesterol Ratio As an Indicator of Visceral Adiposity

Objective: A number of anthropometric measurements are being developed to detect metabolic risks in overweight and obesity. Our purpose is to investigate the relationship of visceral adipocyte index (VAI), which is useful as a marker of adipocyte dysfunction with the ratio of uric acid to high-density lipoprotein ratio (UHR), an inflammatory marker, considering body mass index groups and accompanying metabolic syndrome (MetS). Material and Methods: In all, 509 female participants aged 18-60 years, admitted to the Outpatient Department of Endocrinology, Erzurum Training, and Research Hospital, were involved in this study. Our study group consisted of 409 patients (63 overweight, 202 obese, and 144 morbid obese) and 100 healthy controls. Anthropometric measurements, including height, weight, and waist circumferences, were measured, and VAI values were calculated for all participants. All subjects had been tested with biochemistry analysis for lipid profile tests and uric acid. Results: UHR level was significantly elevated in the patient group [10.9 (3.8-30.4%)] compared with the control group [7.29 (3.44-19.3 %)]. The highest UHR level was found in the morbid obese group, 12.3 (5.8-30 %), and the lowest UHR level was in the overweight group [8.63 (3.8-17 %)]. A moderately strong positive correlation was found between VAI and UHR in both patient and control groups, and the strongest correlation was found in the overweight group (r=0.586, R2=0.319). In addition, the UHR level was 12.2 (6-30%) in the patient group with MetS and 9.7 (3.8-23%) in the patients without MetS. Conclusion: Since the BMI is insufficient regarding prognosis and obesity-related mortality, it should be supported with VAI, a new anthropometric cardiometabolic risk indicator. UHR might be a sensitive and accurate indicator of visceral fat excess even in the early stages of obesity and MetS.

Acceptance of cord stem cell banking among pregnant women attending outpatient department of tertiary care hospital of Delhi

Acceptance of cord stem cell banking among pregnant women attending outpatient department of tertiary care hospital of Delhi

Validation of asthma management approach according to risk factors

Background Although studies show that most people successfully control their asthma, polls consistently show that this is not the case in real life. The present study aimed to validate assessment of asthma control using a risk stratification approach in comparison with global strategy for asthma management and prevention (GINA) guidelines with particular attention to high-risk group of asthmatic patients. Patients and methods This was a prospective interventional cohort trial that enrolled 30 patients with asthma in the outpatient department of Ain Shams University Hospital between January 2019 and January 2020. There were 10 female patients and 20 male patients, with a mean age of 51.43 ± 14.94 years. They were enrolled and randomly grouped 1: 1 into group A, which followed asthma risk stratification therapy (ARST), and group B, with the standard GINA approach, within 1-year follow-up period. Following visit 1 in a 2-week interval as a washout period, there were five consecutive visits on 3 months apart, and then visit 6 at the end of treatment at a 2-week interval. All patients were subjected to the Asthma Control Test Questionnaire for assessment of asthma control by GINA approach and to objective control assessments in ARST by Morisky Medication Adherence Scale-8 for adherence assessment, pulmonary function test for evaluation of annual decline of forced expiratory volume in the first second, and the annual rate of exacerbations. Results The results obtained from visits 1 to 6 showed nonstatistically significant differences in forced expiratory volume in the first second (75 vs. 81.82 ml, P=0.820) and in adherence scale (Morisky Medication Adherence Scale-8) on visits 2–5 (40 vs. 17, P=0465), or the rate of exacerbation (two exacerbations in each group), with no statistically significant differences (0 vs. 13.3%, P=0.143) in group A and group B, respectively. On the contrary, the assessment of severity tools in ARST was based on the level of sustainability of the asthma stepwise categorization among the duration therapy. Using ARST for the aims of control and severity assessments on the studied group, in comparison with the GINA assessment approach, there were highly significant statistical differences in numbers of controlled patients as well as numbers of patients with mild and moderate asthma for severity assessments (t=13.263, P=0.001 vs. t=22.941, P=0.0001, respectively). It could be concluded that applying the GINA approach on studied group A revealed underestimation of control and probably overestimation of asthma severity, or better called asthma stability. Conclusion ARST is noninferior to the GINA approach in the norms of asthma control when objectivity was measured, whereas the levels of sustainability or stability among the duration therapy for assessment of asthma severity were statistically overestimated when measured by GINA. These measures could help most patients with asthma, and there should be a concerted action for their implementation in epidemiological research.

Descriptive study of sweat dermatitis: A rare dermatoses not so rare in tropics

BackgroundSweat dermatitis is an irritant inflammatory dermatosis commonly encountered in tropics during summers. Profuse sweating triggered by high heat index, friction, clothing, outdoor activities, military training, overcrowding, prolonged working in ill-ventilated places, etc., are responsible or this dermatitis. Aim was to study the clinical, dermoscopic, vapometric, histopathological, and immunohistochemistry (IHC) findings in sweat dermatitis. MethodsTwenty-five patients of sweat dermatitis attending out-patient department (OPD) of tertiary care hospital, were recruited over a period of three months (June to August 2022). A detailed history was followed by dermatological examination, dermoscopy, vapometry, histopathology, and IHC studies. ResultsTwenty-five patients were included in the study. There was male preponderance with male: female ratio of 2.1:1. The mean age of patients was 30.36 years. Dermatological examination in all patients revealed brownish “parchment”-like, shiny “crinkled cellophane paper”-like patches over the entire upper back and shoulder region with areas of exfoliation. Dermoscopy revealed increased skin markings, deep brown pigmentary changes with superimposed whitish scales with islands of eroded skin, and prominent eccrine duct openings. Vapometric analysis revealed increased transepidermal water loss (TEWL) in the affected area in 88% of patients. Histopathological examination showed features of spongiotic dermatitis. IHC with CK7 (cytoplasmic) highlighted the normal eccrine coils. ConclusionSweat dermatitis is common seasonal dermatoses in tropics, but it remains undiagnosed due to lack of awareness. This study aims to sensitize medical doctors and dermatologists about sweat dermatitis and prevention strategies that can be helpful in mitigating it. The study also discusses the role of investigative modalities, such as dermoscopy, vapometry, histopathology, and IHC, in sweat dermatitis.

Integrated Moving on After Breast Cancer and Culturally Adapted Cognitive Behavior Therapy intervention for depression and anxiety among Pakistani women with breast cancer: Protocol of a randomized controlled trial

Objective: The diagnosis and treatment of breast cancer is associated with significant distress that has huge impact on survivors’ quality of life. The objective of this study is to assess the effectiveness of an integrated intervention “Moving on After Breast Cancer (ABC) Plus culturally adapted Cognitive Behavior Therapy” (Moving on ABC Plus). Method: This is a randomized controlled trial that aims to recruit 354 breast cancer survivors from the inpatient and outpatient oncology departments in public and private hospitals in Karachi, Hyderabad, Lahore, Multan, and Rawalpindi in Pakistan. Patients scoring 10 or above on either the Patient Health Questionnaire—9 and/or the Generalized Anxiety Disorder scale (GAD-7) will be recruited. Baseline assessments will include Functional Assessment of Cancer Therapy—Breast; EuroQol-5D; Multidimensional Scale for Perceived Social Support; Intrusive Thoughts Scale; and Rosenberg Self-Esteem Scale. Participants randomized into intervention arm, Moving on ABC Plus, will receive 12 individual therapy sessions over 4 months. Follow-up will be completed at 4- and 6-month post-randomization, using all baseline instruments along with the Client Satisfaction Questionnaire (CSQ-8). We will also explore the participants’, their family members’, and the therapists’ experiences of the trial and intervention. Results: We will be assessing the effectiveness of intervention in reducing depression and anxiety in breast cancer survivors as a primary outcome of the trial. The secondary outcomes will include effectiveness of intervention in terms of reduction in intrusive thoughts and improvement in health-related quality of life, self-esteem, and perceived social support. Conclusion: The results of the study will inform the design of a future larger randomized control trial with long-term follow-up.

Comparison of In-Person Versus Teledermatology Consultation in the Development of a New Score: Analysis of Tinea Corporis Score from Baseline up to Two Follow-Up Visits

Background: Conventionally, dermatophytoses demand at least 6 weeks of treatment. However, frequent follow-up can be a burden for elderly, working population, and COVID-19 pandemic. Teledermatology consultation may reduce follow-up visits. Objective: To propose a new score that provides a periodic clinical audit and minimizes in-person follow-up visits for patient convenience. Materials and Methods: A comparative study between teledermatology and in-person (face-to-face) consultation was conducted in the outpatient department of dermatology JSS Hospital, Mysuru, India from December 2018 to July 2019. The tinea corporis (TC) score constitutes three components: (a) area involvement, (b) erythema intensity, and (c) border visibility. Area involvement by teledermatology consultation was calculated by point counting method of Bahmer. TC score is calculated as the product of area involved and the sum of the erythema intensity and border visibility. These patients were followed up on a weekly basis for a month and values of the proposed score derived from the two methods of consultation were compared. Statistical data collected were tabulated and assessed by the SPSS software version 20 (IBM Corporation, Chicago, USA). Results: There were 150 TC cases. Analysis of 77 patients who completed the first follow-up visit by in-person and teledermatology consultation showed that the tinea corporis score (TCS) decreased from 171.25, 157.94 from baseline to 97.4, 98.61, respectively (P = 0.001). Analysis of 30 patients who completed the second follow-up visits showed a reduction in TCS from 138.2, 152.7 to 68.2, 71.7, respectively (P = 0.001). The Pearson score obtained by the two methods in each visit (0.990, 0.969, and 0.971) resulted in a positive correlation. Conclusion: TC score may be recommended for both in-person and teledermatology consultation. The ease of calculation, objective assessment, and application of TC score in teledermatology consultation are the advantages.

A cross-sectional study of prescription audit in outpatient departments of tertiary care hospital

Background: Prescriptions are medico-legal documents, and it is the duty of every physician to write a complete, legible, and valid prescription to ensure rational drug use and prevent the occurrence of medication errors. A periodic prescription audit is required for the identification of common deficiencies in the prescriptions and to undertake corrective measures for improving the prescribing practices. This is a quality improvement process that seeks to improve patient care. It supports health professionals in making sure their patients receive the best possible care. Aims and Objectives: To find out the common areas of noncompliance in prescriptions by using the prescription audit tool by the National Health Mission. Materials and Methods: A cross-sectional study of prescription audits was conducted using the prescription audit tool by the National Health Mission. Prescriptions were randomly taken from various clinical outpatient departments according to the percentage they contribute to the outpatient population. This tool contains both indicators to check the completeness of the prescription and indicators for the legibility and rationality of the prescription. 235 prescriptions were audited, and the parameters that scored low were identified. Results: The lowest score was seen with parameters like mentioning allergy status (4.89%), duly signing prescriptions (44%), recording follow-up advice and precautions (19%), and mentioning the review date (16.8%). Parameters that need improvement are recording the brief history and salient features of the clinical examination, to write the presumptive diagnosis. Conclusion: Conducting prescription audits frequently in all hospitals help in better understanding the prescribing behavior of the physicians, and followed by constant communication and training of the physicians, this is the most effective way to improve prescription practice within the hospital.

Outcome of Functional Endoscopic Sinus Surgery in Adult Patient with Sinonasal Polyposis

Background: Nasal polyps are a common condition. Their etiology remains unclear. Surgical treatment has been refined significantly over the past 20 years with the advent of endoscopic sinus surgery. Objectives: The objective of this study was to assess the efficacy of functional endoscopic sinus surgery in an adult patient with sinonasal polyposis, by measuring the improvement in symptoms during 6 months of follow-up. Furthermore, record complications and recurrence of nasal polyps. Patients and Methods: A prospective study was conducted between November 2018 to January 2021, which included (39) patients whom attended the Outpatient Otorhinolaryngological Department of AL-Karkh General Hospital and AL-Yarmouk Teaching Hospital and suffered from sinonasal polyposis. This study included patients above 18 years (of either sex) with bilateral nasal polyposis and whom medical treatment failed. Those patients were evaluated by history taking, clinical examination, and computer tomography scan of the nose and paranasal sinuses. All patients had functional endoscopic sinus surgery and visual analog scale assessments was done (both pre- and postoperatively), which followed up for up to 24 weeks. Results: About 79.5% of the patient get improvement in nasal blockage and (66.7%) for hyposmia, (90.5%) for nasal discharge, and (80%) for both headache and postnasal drip associated with significant improvement of symptoms score 24 weeks postoperative to preoperative score for nasal block, hyposmia, nasal discharge, and facial pain, except postnasal drip showed no significant difference. The most frequent complication was a recurrence of polyps, followed by synechiae and minor epistaxis. No major complication was recorded. Conclusion: Endoscopic sinus surgery for sinonasal polyposis is an efficient surgical procedure for nasal polyposis, because it provides an approximate field of vision and illumination, good access, and is associated mostly with minor complications.

An Observation Study to Evaluate the Drug Utilization Pattern for Oral Cancer Patients Receiving Chemotherapy Treatment at a Private and Government Tertiary Care Hospital in Jaipur City

Background: As oral cavity and oropharynx cancers are the second most common type of tobacco-related cancer reported in Jaipur city so it is imperative to study the drug utilization pattern in these cancers. Objectives: The objective of this study was to evaluate the trends in drug usage patterns for oral cancer patients in Jaipur city. Methods: The prescriptions of oral cancer patients attending the outpatient department of SMS and Bhagwan Mahaveer cancer hospital from May 2017 to August 2017 were studied. They were studied for WHO Prescribing indicators for good prescribing practice. Results: A total of 188 prescriptions were studied. An average of 2.6 (0.5) antineoplastic medications were prescribed per prescription. The combination of paclitaxel and carboplatin was the most frequently prescribed antineoplastic drug, prescribed to 29.8% of patients. The drafting of the prescriptions was of average quality. In 5% of the prescriptions, a diagnosis was omitted, and in 48% of the prescriptions, the patient's weight and/or body surface area (BSA) were omitted. Only 52% of the prescriptions contained the medications' generic names. Conclusion: The quality of prescribing was fair and moderately acceptable. To ensure rational prescribing and safe and successful treatment of cancer patients, interventions such as new policy formulation and educational measures should be developed.

Assessment of risk factors and preventive measure compliance against COVID-19 among healthcare workers at tertiary care hospital: a retrospective study.

SARS-CoV-2 has created a significant challenge to healthcare systems, since the disease has spread rapidly, outweighing hospital capacity and exposing Health Care Workers (HCWs) to the risk of infection. The main objective of this study shows the HCW's self-reported use of Personal Protective Equipment (PPE), symptoms, and exposure to revealed and suspected people during the pandemic, as well as the implementation of infection prevention and control (IPC) guidelines that effectively limit the spread of the infection among healthcare personnel. A single-center retrospective cohort study has been done at a tertiary care hospital. There were 3,651 hospital employees of these 1,890 HCWs and 1,761 nonclinical staff among those who were proven or suspected COVID-19 cases and had symptoms were included. The data was gathered using a standardized self-assessment questionnaire. Information about quarantine protocol and line listing was collected through telephonic conversations. The majority of the participants were males (66%). The average age was 32.1±7.62. Out of 432 HCWs, 32.9% with positive SARS-CoV-2 PCR findings were nurses, 19.2% were doctors, and 47.9% were non-clinical employees from the hospital's inpatient and outpatient departments. 31.5% had a higher-risk exposure, 64.1% had a moderate-risk exposure, and 4.4% of practitioners with COVID-19 had a lower-risk exposure. A statistically significant association was found between COVID-19 disease and adherence to PPE and risk exposure. This study represents the healthcare workers' experience with COVID-19 patients in the early stages of the pandemic and emphasizes the measures required to overcome the problems, however, this study highlights that HCWs are being progressively infected with COVID-19 as a result of inadequate/ inappropriate PPE wear.

KNOWLEDGE AND PRACTICES RELATED TODIABETIC RETINOPATHY AMONG DIABETIC PATIENTS ATTENDING MEDICINE OUT PATIENT DEPARTMENT IN TERTIARY CARE HOSPITAL IN CHENGALPATTU DISTRICT

Aim: To assess the knowledge and practices related to diabetic retinopathy among diabetic patients attending medicine out patient department in tertiary care hospital in Chengalpattu district Design: hospital based cross sectional study Methods: study was conducted among 202 adult patients with diabetes between June 2021 to December 2021 , who attended medicine outpatient department in tertiary care hospital in Chengalpattu district. All patients were surveyed with a questionnaire regarding there Knowlegde and practices related to diabetic retinopathy. Statistical Analysis: SPSS software, CHI square test Results: A questionarre based responses was obtained from 202 patients diagnosed with diabetes .Age distribution of diabetes is predominantly high in 40 -60 years .75% of people are treated with oral hypoglycemic drugs .around 61% know that diabetes can cause eye disease .Regular eyecheck up is mandatory in diabetic patients was agreed by 52% patients.only 43% visit ophthalmologist for regular eye checkup in the contrary 83% visit physicians regularly for diabetic control. Conclusion: Our study emphasises the need for expanded educational programmes about DR, its risk factors, available treatments, and follow-up. In our study, the role of physicians was frighteningly minimal, which has to be emphasised.

Spice Intake Among Chronic Gastritis Patients and Its Relationship With Blood Lipid Levels in South India.

Chronic gastritis is one of the most prevalent disorders affecting individuals. It affects hundreds of millions of people in different ways around the world. The objective of the study was to estimate the spice intake and its relationship with the blood lipid level among patients with chronic gastritis in the outpatient department of tertiary care hospital. The study design was a hospital-based cross-sectional study that was done in the Guntur district of Andhra Pradesh. The study population included 208 chronic gastritis patients between 20 and 60 years of age selected by systematic sampling. Detailed information on sociodemographic and lifestyle factors was collected using a questionnaire. Individual dietary intake data were collected by the detailed 24-hour dietary recall. Spice intake was calculated using Diet Calc Software. An independent t-test was used as a test for significance. The correlation was used to study the relationship between spicy food intake and dyslipidemia. P-value <0.05 was significant. A total of 208 patients were enrolled in the study with a response rate of 91%. The mean age of the studied patients was 45.15 ± 9.27years, with46.6% males and 53.4% females. Almost half (45.7%) of the participants had "mild" spicy food in their diet and almost two-fifths (39.9%) of participants had a "moderate or middle" degree of spice in their food. The mean dietary intake of condiments and spices by the participants was 34.19 (±22.18) gm/day.The current study showed higher spice intake was significantly correlated with impaired lipid profile levels with Kendall's tau_b correlation coefficient of 0.17 (p=0.01). Because of the excessive use of spices in the Guntur region of Andhra Pradesh, people have grown accustomed to eating spicy food since childhood and therefore is at a higher risk of developing chronic gastritis, and dyslipidemia.

Prospective audit of the phenotype, causes and correlates of trachomatous and non- trachomatous trichiasis in a peri-elimination setting.

To explore the burden, clinical features and associations of trichiasis due to trachomatous and non-trachomatous aetiologies. Consenting patients presenting with trichiasis of either eyelid (of one or both eyes) attending the outpatient department, cornea and oculoplasty clinics of a tertiary eye care hospital in New Delhi between August 2018 to March 2020 were included. A comprehensive examination including visual acuity and anterior segment evaluation and photography was performed. Grade of trichiasis, laterality, presence and grade of entropion, and information on corneal opacity, conjunctival scarring, Herbert's pits, and pannus, if present, were recorded in the case record form. Overall, 302 patients (454 eyes) with trichiasis were recruited. The most common attributed cause of upper eyelid trichiasis (276 patients, 405 eyes) was trachoma (26% of patients), followed by Stevens-Johnson syndrome (23%), blepharokeratoconjunctivitis (17%) and old age (10%). A total of 296/405 eyes (73%) had some form of corneal involvement. Trachoma was not identified as the cause of trichiasis in any eye with lower eyelid-only disease. Only about a quarter of upper eyelid trichiasis in this peri-elimination setting was attributed to trachoma. A distinction between trachomatous and non-trachomatous trichiasis is imperative to meaningfully determine whether elimination of trachoma as a public health problem has occurred. These data may have implications for population-based estimates of TT prevalence in India and other peri-elimination settings.

Simulation modelling of hospital outpatient department: a review of the literature and bibliometric analysis

The increase in demand for outpatient departments (OPDs) has contributed to overcrowded clinics and patient dissatisfaction. Computer simulation can help decision-makers meet the operational challenge of balancing the demand for outpatient services with considerations of available capacity. The paper presents a synthesis of the literature on simulation modeling in OPD using two approaches: a bibliometric analysis (employing keyword co-occurrence network) and a literature classification focusing on OPD strategy, OPD performance measures, and simulation techniques. Our review is based on 161 papers, published between 2006 and 2020, identified through a methodological search of the literature. The objective of the review is threefold: (1) to identify the major and emerging research issues in general and specialized OPD, (2) to find the commonly used performance measures in OPD and how it is associated with the strategies used to improve the performance, and (3) to identify the commonly used simulation methods for OPD modeling. A key finding from the bibliometric analysis is that most OPD research can be classified under one of the four clusters—“organization and management,”“patient satisfaction,”“overbooking,” and “performance.” We also find that patient waiting time has received much attention among the performance measures reported in the literature, followed by server idle time/overtime (server here is the OPD consultant or other healthcare resource). Our review serves as a key reference point for scholars, practitioners, students, and healthcare stakeholders, and those who use quantitative tools to aid operational decision-making.

Positive experiences of specialist assistants and physicians with respect to the delegation research project StaerkeR : Evaluation of the training and experiences within the framework of this project

The delegation of medical services to rheumatology assistants (RFA) has proven to be safe and effective in the evaluation of the research project "StaerkeR". Afterwards, the experiences of the participating RFAs and rheumatologists with delegation were surveyed and discussed within the framework of an opinion research project. At the end of the project, the participating RFAs and rheumatologists were surveyed via an online questionnaire (quantitative analysis) (21questions for physicians and 44questions for RFAs). In addition, focus group meetings were held for the RFAs, which were led by amoderator and asecretary. The results of the focus group sessions (qualitative analyses) were analyzed according to the structured method of Kuckartz. All 31RFAs and 25rheumatologists involved in the project participated in the online surveys and 9RFAs took part in the 2focus groups. In the online surveys, both the RFAs and the rheumatologists gave predominantly good to very good ratings with respect to RFA training, the implementation of delegation in the practices and outpatient clinics, the role of the RFAs and the overall evaluation of the delegation concept. In the focus group discussions, many possible limitations regarding acceptance and implementation of the delegation concept were mentioned. The delegation of medical tasks to RFAs is aconcept that is positively assessed and highly accepted by both sides, the rheumatologists and the RFAs. In acomparison between the individual practices and hospital outpatient departments, there is still aclear heterogeneity with respect to the willingness and logistical possibilities in the implementation of the delegation concept.

Cognitive adverse effects of epilepsy and its predictors attending outpatient department of South Gondar zone hospitals, Amhara Region, Ethiopia 2020 /2021.

Epilepsy is the most common neurologic disorder which is further complicated by neurobehavioral co-morbidities, cognitive impairment, psychiatric disorders, and social problems. However, assessments of cognitive status of epileptic patients are far too low during clinical visits. This calls for early neuropsychological assessment soon after the diagnosis of epilepsy for a better treatment plan and outcome for epileptic patients. This study aimed to assess the cognitive adverse effects of epilepsy and its predictors attending outpatient departments of South Gondar Zone hospitals Amhara region Ethiopia 2020/2021. A multi-center institutional-based cross-sectional study was conducted. A total of 509 respondents were included with a response rate of 93.9%. Previously adapted pretested structured questionnaire was used containing, socio-demographic, clinical, and seizure related factors. Mini-Mental State Examination (MMSE) was used to measure cognitive impairment. A systematic random sampling technique was applied. Data were entered into Epi data version 4.4.2 then exported to SPSS version 24 for analysis. Descriptive statistics, bivariable and multivariable binary logistic regressions with odds ratios and 95% confidence interval were employed. The level of significance of association was determined at a p-value < 0.05. Prevalence of cognitive impairment in this study was 69.2% (95%CI; 65.4, 73.1). Rural residents (AOR = 4.16,95%CI, 1.99,8.67), respondents who couldn't read and write (AOR = 2.62, 95%CI; 1.24, 5.5,) longer duration of seizure disorder (AOR = 4.59,95%CI; 2.01,10.52), taking combined Phenobarbital and Phenytoin (AOR = 4.69,95%CI; 1.88,11.69), having history of head injury (AOR = 3.29,95%CI;1.30,8.32), having depression (AOR = 4.76,95%CI;2.83,7.98), and anxiety (AOR = 3.11,95%CI; 1.58,6.12) were significantly associated with cognitive impairment. Prevalence of cognitive impairment in this study was high. Regular neuropsychiatric assessment of patients with epilepsy should be encouraged especially for those participants with longer durations of illness, who are rural residents, who take combined Phenobarbital and Phenytoin, participants who had a history of head injury, depression, and anxiety.