Patients In Inpatient Department Research Articles

Impact of Implementation of NABH Standards on Patient Experience and Feedback about Hospital Services

Background: Health care is one of the most important service industry where quality standards need to be maintained for patient treatment and satisfaction. National accreditation boards for hospitals and health care providers (NABH) standards focus on quality, infection control and patient safety. The impact of these standards on patient feedback about hospital services needs to be studied.Objective: To observe the impact of NABH standards on patient feedback and experiences and patient satisfaction.Methods: Patient feedback and experience data collected by Quality department of the hospital for the months of October 2018 (before implementation of NABH standards) was compared with data of October 2023 (5 years of implementation of NABH standards) and the data was analysed using statistical tools. The data was analysed and compared separately for Outpatient department (OPD) and In Patient department (IPD) patients.Results: The data was collected through questionnaire from 400 patients and their relatives (for less than 18 years age patients) each for both months. There was improvement in feedback and experiences for all elements of the questionnaire for both OPD and IPD patients, more significantly for staff behaviour and communication skills of staff. The feedback and experiences for IPD patients were more satisfactory than OPD patients in our study.Conclusion: NABH standards implementation has a positive impact on patient feedback and experiences leading to greater patient satisfaction. IPD patients are more satisfied with hospital services as compared to OPD patients.International Journal of Human and Health Sciences Vol. 08 No. 01 Jan’24 Page: 44-48

Feedback of Patients attending a Tertiary Policy Section Healthcare Institute in Banda District, Uttar Pradesh: A Descriptive Crosssectional Study

Introduction: The term 'patient feedback' can be measured through various formal reactions, including levels of patient comfort, experience, perspectives, and assessments of care in terms of convenience, continuity, and quality. By recording the patient’s viewpoint on the quality of care provided by a tertiary healthcare facility, it can be acknowledged through patient feedback. This data can then be utilised to improve health services and enhance the overall patient experience. Aim: To assess patient satisfaction with the services provided at a tertiary care hospital in Banda. Materials and Methods: This descriptive cross-sectional study was conducted at the government medical college in Banda, a district in the Bundelkhand region of Uttar Pradesh, a northern state of India. The study took place from December 2022 to February 2023 at the medical college and its associated hospital. A total of 400 participants who consented to be part of the study were included. Purposive sampling technique was employed for data collection. Outpatients were interviewed upon exiting the clinics, while inpatients were interviewed in the wards. Results: In the questionnaire, there was a question asking, about patient's overall satisfaction during the visit to the hospital. Since everyone’s score was higher than the 'poor' category, all categories were merged into one word, 'satisfied,' except for the 'poor' category to facilitate better understanding. The majority of patients from the Outpatient Department (OPD) (91, 45.5%) and Inpatient Department (IPD) (198, 99%) were satisfied with the attitude and communication of the doctor. Additionally, 98.5% of IPD patients were satisfied with the doctor's knowledge. A total of 99% of participants responded "yes" when questioned about their preference to return to the hospital for treatment. Conclusion: Overall, it was observed that the behaviour and care provided by hospital staff satisfied the majority of patients, who also expressed satisfaction with the indoor and outdoor services of the hospital.

TO STUDY THE PREVALENCE OF SARCOPENIA IN TYPE-2 DIABETIC PATIENTS IN A RURAL TERTIARY CARE HOSPITAL

Objective: The objective of this study was to study the prevalence of sarcopenia in type-2 diabetic population coming to a rural tertiary care hospital. Methods: A cross-sectional study involving 150 participants including both outpatient and inpatient department patients was conducted at MM Institute of Medical Sciences and Research, Mullana (Ambala) between June 2021 and June 2022 after seeking appropriate permissions and approval from the Institutional Ethics Committee. Patients who consented to participation were enrolled in the study and were evaluated as per the European working group for sarcopenia in older people algorithm using bioelectrical impedance analysis and were asked to fill out a printed proforma (available in Hindi and English languages) to assess their SARC-CalF scores, handgrip strength, calf circumference and comorbidities. Patients were interviewed if they were illiterate, and responses were recorded. Statistical analyses were performed on IBM SPSS Statistics version 26. Results: The overall prevalence of sarcopenia was found to be 3.3% in 150 subjects who were enrolled in the study. Among the cases (diabetics), the prevalence was 4.0% and 2.67% in the controls (non-diabetics). Mean handgrip strength was found to be 18.73 kg among cases and 19.47 kg among controls. Handgrip strength did not show a significant association with diabetes (p=0.435). Handgrip strength was not found to be significantly associated to sex. Mean gait speed (in m/s) was found to be 1.42 in a range of 0.30–2.50 with a standard deviation of 0.59. Mean gait speed was 1.87 m/s in controls and 0.96 m/s in cases. Gait speed was found to be significantly associated with diabetes (p=0.00). No significant association was seen with sex (p=0.95). Mean calf circumference was found to be 33.28 cm among cases and 34.49 cm in controls. Calf circumference was found to be significantly correlated with diabetes (p=0.00). The SARC-CalF questionnaire was shown to have a sensitivity of 40% and a specificity of 100% at the recommended threshold of ≥11. In the study group, the mean HbA1c was found to be 10.1%. Sarcopenia was not found to be significantly associated with diabetes (p=0.649). No statistically significant relationship was found between hypertension and sarcopenia (p=0.394). Conclusion: Sarcopenia is largely an overlooked disease, especially in India. Various efforts to study the prevalence, causation, and effects of sarcopenia have been made, but no large-scale studies have been undertaken so far. Our study concluded that the SARC-CalF questionnaire can be used as a bedside screening tool. Though our study failed to find any statistically significant relationship between sarcopenia and diabetes, large scale studies are still warranted in this regard.

Rational Use of Antibiotics: An Area of Concern

Published on:June 2022Journal of Young Pharmacists, 2022; 14(2):165-168Review Article | doi:10.5530/jyp.2022.14.31 Authors: Sougata Sarkar,1 Vartika Srivastava,2,*Shambo Samrat Samajhdar,1 Chaitali Pattanayak,2 Santanu Tripathi3 1Department of Clinical and Experimental Pharmacology, School of Tropical Medicine, Kolkata, West Bengal, INDIA. 2Department of Pharmacology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha INDIA.3Department of Pharmacology, Netaji Subhas Medical College and Hospital, Patna, Bihar, INDIA. Abstract: Most of the IPD (Inpatient department) and OPD (Outpatient department) patients receive a course of antibiotics either for treatment or prevention of infection or during discharge. The therapeutic outcome with an antibiotic depends mostly on choice of appropriate agent. The selection of antibiotic depends on causative agent, patient factors, clinical pharmacology of antibiotics and its cost effectiveness. Antimicrobial resistance (AMR) occurs when microbes like bacteria, parasites, viruses and fungi become resistant to antimicrobial drugs that are used for treatment of various diseases leading to decreased effectiveness, difficulty in treatment of disease and hence requiring multiple therapeutic options. Antimicrobial stewardship is a coordinated intervention, designed to improve and measure the appropriate use of antimicrobial agents, by promoting the selection of optimal antimicrobial drug regimen including dosing, duration of therapy and route of administration. To strengthen the implementation of rational antibiotic use and reduction of antimicrobial resistance, WHO (World Health Organisation) in 2019 introduced “AWaRe” classification of antibiotics that includes details of 180 antibiotics classified as Access, Watch or Reserve, their pharmacological classes, Anatomical Therapeutic Chemical (ATC) codes and WHO Essential Medicines List status. One health approach is the collaborative effort of multiple health science professions to attain optimal health for people, domestic animals, wildlife, plants, and environment. Recently, WHO issued new guidelines regarding the use of antimicrobials in animals producing food, recommending the restricted use of such medicines in growth promotion or prevention of disease in healthy animals. Hence rational use of antibiotics is important for successful treatment outcome and prevention of emerging drug resistance for broader community.Key words: Antibiotics, Antibiotic resistance, Antibiotic stewardship, AWaRe Classification, One health approach.

Exploring factors influencing patient mortality and loss to follow-up in two paediatric hospital wards in Zamfara, North-West Nigeria, 2016–2018

IntroductionChild mortality has been linked to infectious diseases, malnutrition and lack of access to essential health services. We investigated possible predictors for death and patients lost to follow up (LTFU) for paediatric patients at the inpatient department (IPD) and inpatient therapeutic feeding centre (ITFC) of the Anka General Hospital (AGH), Zamfara State, Nigeria, to inform best practices at the hospital.MethodsWe conducted a retrospective cohort review study using routinely collected data of all patient admissions to the IPD and ITFC with known hospital exit status between 2016 and 2018. Unadjusted and adjusted rate ratios (aRR) and respective 95% confidence intervals (95% CI) were calculated using Poisson regression to estimate the association between the exposure variables and mortality as well as LTFU.ResultsThe mortality rate in IPD was 22% lower in 2018 compared to 2016 (aRR 0.78; 95% CI 0.66–0.93) and 70% lower for patients coming from lead-affected villages compared to patients from other villages (aRR 0.30; 95% CI 0.19–0.48). The mortality rate for ITFC patients was 41% higher during rainy season (aRR 1.41; 95% CI 1.2–1.6). LTFU rates in ITFC increased in 2017 and 2018 when compared to 2016 (aRR 1.6; 95% CI 1.2–2.0 and aRR 1.4; 95% CI 1.1–1.8) and patients in ITFC had 2.5 times higher LTFU rates when coming from a lead-affected village.ConclusionsOur data contributes clearer understanding of the situation in the paediatric wards in AGH in Nigeria, but identifying specific predictors for the multifaceted nature of mortality and LTFU is challenging. Mortality in paediatric patients in IPD of AGH improved during the study period, which is likely linked to better awareness of the hospital, but still remains high. Access to healthcare due to seasonal restrictions contributes to mortalities due to late presentation. Increased awareness of and easier access to healthcare, such as for patients living in lead-affected villages, which are still benefiting from an MSF lead poisoning intervention, decreases mortalities, but increases LTFU. We recommend targeted case audits and qualitative studies to better understand the role of health-seeking behaviour, and social and traditional factors in the use of formal healthcare in this part of Nigeria and potentially similar settings in other countries.

Antibiotic Resistance Pattern of Acinetobacter baumannii Strains: A Retrospective Study from Oman.

Background:Multidrug-resistant (MDR) Acinetobacter baumannii is of serious health concern and associated with high mortality. Data regarding the antibiotic resistance pattern of A. baumannii strains in Oman is limited.Objectives:To determine the antibiotic resistance pattern of A. baumannii from various clinical samples in a tertiary care hospital in the North-Batinah region of Oman.Methods:A. baumannii isolates recovered from various clinical samples in the Microbiology laboratory of Sohar Hospital, Oman, during 2015–2019 were retrospectively analyzed. Organism identification and their antibiotic resistance patterns were performed as recommended by the Clinical and Laboratory Standards Institute.Results:A total of 1890 A. baumannii nonduplicate isolates were found from clinical samples of 1326 patients. The isolates were more frequently isolated from elderly patients (40%) and in-patient department patients (67%). Infection/colonization was more common among patients treated in the medicine, intensive-care unit, and surgery departments. A. baumannii strains were highly resistant (50-83%) to most of the tested antibiotics, with the highest against ceftriaxone (83%) and ceftazidime (75%), and lowest against colistin (1%) and tigecycline (8%). Among the isolates, 67% (1265) were MDR strains. Of these, 22%, 32% and 16% were resistant to all six, five and four classes of the tested antibiotics.Conclusion:The study found that the frequency of isolation of MDR A. baumannii isolates in the northern region of Oman is high.

Натурные испытания биологически активной добавки «Ивлаксин» у больных с острыми воспалительными заболеваниями

Clinical tests were carried out in the representative group of patients with focal left-sided pneumonia (5 men and 7 women aged 18–41). Special-use product was included in in-patient department patients’ diet: 2 tablets in the first intake, then 1 tablet 4 times a day. Course of treatment was 21 days. Biologically active dietary supplement was prescribed together with general therapeutic treatment according to generally accepted standards of care. Control group included 15 patients randomized depending on sex and age who took only medicine. The author measured body temperature, studied the results of general blood tests, determined the level of C-reactive protein and seromucoids, performed R-graphy of lungs, electrocardiogram before and after treatment, analyzed clinical symptoms (cough, type of expectoration, shortness of breath). Composition of the special-use product was scientifically justified taking pharmacological characteristics of its ingredients and their active agents into account. Introduction of the biologically active dietary supplement in addition to the prescribed therapeutic treatment gave positive effect in relation to the inflammatory process: the patients could easier clear their throats from expectoration, coughed less frequently, and had less intense shortness of breath. It was evident that symptoms of disease recrudescence decreased. It appeared in the decreased intensity and length of fever. In case of acute respiratory viral infection the biologically active dietary supplement had antipyretic activity due to the anti-exudative effect of its ingredients. The author determined the anti-inflammatory effect and reduction of acute intoxication symptoms taking the results of general blood analysis into account. Patients who took special-use product had lower values of an inflammatory process marker – seromucoids. Tissues restored easily. The tested product has anti-inflammatory, antipyretic and analgesic properties. It can be used in complex treatment of acute inflammatory diseases and recrudescence of chronic inflammatory processes.

PRELIMINARY EXPERIENCE OF THE AORTO-FEMORAL SHUNTING USING THE DA VINCI SURGICAL SYSTEM

Introduction. Robot surgery is one of the most high-demand and dynamic developing realms of medicine. It is widely used in urology, proctology, thoracic, cardiovascular surgery and gynecology. In February 2018 a robot surgery centre opened in Volga Federal District of the Russian Federation based on the clinic of the Bashkir State Medical University (city of Ufa).Materials and methods. The present paper demonstrates the first successful robot-assisted vascular operations within a master-class called "Aorto-Femoral Shunting with the use of robot-assisted surgical system Da Vinci".Results. Exemplified with three operations: two linear aorto-femoral shunting and lumbar sympathectomy demonstrate technical peculiarities and advantages of robot-assisted vascular surgery. The findings show positive short-term results of the performed surgical interference that combine minimal injury and blood loss which help to reduce hospital stay in an intensive therapy department and intestinal distention duration. These clinical effects enabled to provide early activization of patients and possibility to adequately correct nutritional status with enteral feeding. The above-mentioned advantages eventually resulted in reduction of post-operation stay of patients in in-patient department and of cost of treatment.Conclusion. Robot-assisted surgical system Da Vinci being the most cutting-edge in the realm of endoscopic surgery, enables to carry out operational interference with minimal blood loss and injury of tissues which helps to reduce postoperation and recovery periods.

Comparative study of blood parameters among widal positive and negative cases of enteric fever in a tertiary care teaching hospital in Maharashtra, India

Background: Enteric fever is very common and serious infectious disease in tropical country like India. There is need for research in prognosis of enteric fever on the basis of locality of patient’s i.e. urban or rural area. Also, there is scope for research on fever on the basis of OPD (out patient department) or IPD (In patient department) setting. Methods: We have taken widal positive and negative cases from January to December 2014 and they were compared on the hematological and prognostic parameters. Widal positive cases were grouped into IPD and OPD cases as well as those hailing from rural and urban area. These were also compared on the hematological and prognostic parameters. Results: Widal positive group has significantly higher leucocyte count than widal negative group. Also, widal positive group has more chances of having neutrophilia than widal negative group. Lymphocytes were higher in widal negative group. It is also found that lymphocyte count was significantly lower in widal positive group. We got more platelet count in widal positive cases. We compared IPD versus OPD patients; it was found that IPD patients took lesser time for fever to subside. There was no significant difference in fever duration at admission and duration of fever to subside. Conclusions: IPD care is better than OPD care in enteric patients. Apart from leukocyte count, haemoglobin and platelet count in enteric fever should be analyzed in enteric fever.

Service Quality Evaluation of Private Hospitals using SERVQUAL

Background & objectives: Service Quality Evaluation has become a vital aspect of medical care. Hospitals have expanded in terms of availability of specialties, improved technologies, facilities and increased competition and the expectations of patients and their relatives have increased many fold. The patients and their relatives coming to the hospital not only expect world-class treatment but also other facilities to make their stay comfortable in the hospital. Knowledge of expectation combined with understanding of perceived service quality facilitates designing and implementing programs to satisfy patients. The study was conducted with an objective of measuring service quality of IPD patients in a private hospital of Indore District of Madhya Pradesh. Methods: Cross-sectional study was conducted by collecting primary data from 422 IPD patients on the day of discharge using SERVQUAL questionnaire developed by Parasuraman et al. Results: As per the results of the study the major reason of choosing the hospital for treatment was good word-of-mouth from old patients and from senior consultants, infrastructure, proximity of hospital and expert clinical and non-clinical supportive staff. It was found that patients were highly satisfied with the basic amenities, behavior of doctors and staff of the hospital, timely medication, friendly hospital procedures and transparent billing system. Interpretation & Conclusions: Research findings discussed demonstrate that the more a patient is satisfied the more he/she is expected to recommend the hospital to other patients who need healthcare services. Therefore hospitals should implement patient satisfaction measurement as a quality indicator and thereby actively seek to improve the services provided. Objective: The main objective of the study is to measure the service quality of IPD (Inpatient Department) patients in a private hospital of Indore District of Madhya Pradesh. Keywords: In-patient department, Patient satisfaction,

Occurrence of Venous Thromboembolism and Outcomes of Preventive Protocols at the Bangkok Hospital Medical Center: a Retrospective Review of Years 2012-2013

OBJECTIVE:To determine the occurrence of venous thromboem¬bolism (VTE) of patients at the Bangkok Hospital Medical Center (BMC). To collect data of VTE patients at the BMC about their characteristics, underlying diseases, presenting symptoms and out¬comes of diseases. Evaluate the outcome of preventive methods of VTE when using the BMC protocol.MATERIALS AND METHODS:The retrospective review was conducted from January 1, 2012 to December 31, 2013. The total number of patients diagnosed with VTE is 190 patients. The patients were divided into two groups; in the first group were patients who had been diagnosed in the year 2012, and were not using the preventive protocol, and the second group, were patients who had been diagnosed in the year 2013, and were using the preventive protocol. In both groups, data was collected about their characteristics, underlying diseases, presenting symptoms, and outcomes. Then we further divided patients from both groups into two categories by using BMC protocol criteria; high thrombosis risk and low thrombosis risk. Following this categorisation, we used the Statistical Package for the Social Sciences (SPSS) program to analyze the data collected. We compared populations across both years to verify if there was any difference in any aspect of the baseline characteristics. We evaluated the outcomes of patients who did not develop VTE as a result of using the preventive protocol by comparing high thrombosis risk patients to low thrombosis risk patients across both years to verify if there were any differences in the number of patients who did not receive the protocol (2012), and patients who received the protocol (2013).RESULTS:There were 190 patients with VTE, 104 patients in 2012 (54.73%) and 86 patients in 2013 (45.27%). Their mean age was 63.52 ± 17.70 years. Ninety two patients (48.42%) are Thai nationals, while 98 patients (52.58%) are non-Thai nationals. There were 76 inpatient department (IPD) patients (40%) and 114 outpatient department (OPD) patients (60%). In IPD patients, there were 71 patients with a high thrombosis risk, 39 patients (37.50%) in 2012 and 32 patients (37.21%) in 2013. There are two statistically significant differences in the populations between both years, first the mean thrombosis risk score (which in 2013 had a higher thrombosis risk score ( 4.94 vs. 5.86)) and second, the number of patients that died from VTE (with more deaths occurring in year 2012 (10 vs. 1)). Patients who have a high thrombosis risk score in 2012 represent 37.50% of cases, and in 2013 these patients represented 37.21% of cases. The odd ratio (OR) is 1.013 (0.561 - 1.828), relative risk is 1.008 (0.696 - 1.459), relative risk reduction is 0.77 and numbers needed to treat (NNT) is 344.82. CONCLUSION:From our study we showed a reduction of risk in a number of high thrombosis risk VTE patients when using the risk assessment protocol of BMC with the number need to treat of 344.82. Although it is not statistically significant, due to the limitations of the study, we have seen a trend towards using the protocol to decrease the number of high thrombosis risk VTE patients.

Clinical Profile of Indoor Patients in the Department of Physical Medicine and Rehabilitation, Chittagong Medical College Hospital

Background: This observational study done on the indoor patients of department of Physical Medicine and Rehabilitation, Chittagong Medical College Hospital, admitted during the year 2011. The objective of this study was to see the most prevalent diseases admitted in our department.Methods: Participants (225) were all the patients admitted during the period of 2011. Patients admitted more than once were recorded once only. Patient’s data were taken from hospital records.Results: Spondyloarthropathies (SpA) comprised 18.66% of the patients. Total patient of SpA was 42. Among them AS was 47.62%. Prolapsed lumbar disk (PLID) patients constituted 12.44% (28) of hospital admission. Twenty one (9.33%) patients suffered from other causes lumbago-sciatica. Admitted RA patient number were 12 (5.33%) during this year. Total twelve patients with bone TB (5.33%) were admitted during 2011. Nine TB patients (75% of bone TB) had TB in the hip. Total Stroke patients admitted in that year were 9 (4%). Among them 8 (88.89%) were ischemic.Conclusion: SpA, PLID and other lumbago-sciatica patients comprised the major bulk of the patients in inpatient department of PM&R. Musculoskeletal diseases were the commonest cause of hospital admission for rehabilitation. Neurological causes were next common. Inflammatory musculoskeletal diseases also formed a good number of patients.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i1.19416

Patterns of Congenital Heart Disease in Bangabandhu Sheikh Mujib Medical University, Dhaka:

Congenital heart disease(CHD) is the most common congenital problem in children. Presentation can vary from asymptomatic , accidental finding to severe cardiac decompensation and death. Early recognition has great implication on prognosis. Our aim was to study age wise distribution and clinical spectrum of Congenital heart disease (CHD) in Bangabandhu Sheikh Mujib Medical University, (BSMMU), Shahbag, Dhaka. A retrospective analysis of 272 patients over a five year period was done. Clinical examination, echocardiography and Colour Doppler was used as diagnostic tools. Ventricular septal defect (VSD) was the common lesion (33.45 %) followed by Atrial septal defect (ASD) in 13.6 % & Patent ductus arteriosus(PDA) in 10.6 %. Tetralogy of Fallot (TOF)was the common cyanotic heart disease (15.8 %). Maximum number of children with heart disease 64% was diagnosed between 0-5 yrs of age. This is a retrospective descriptive study on all patients with the suspected & confirmed diagnosis of congenital heart disease referred for echocardiography over a period of 5 years from October, 2006 to December, 2011. Patients from day one of life till 18 years were included. Study was conducted in the pediatric cardiology dept. of BSMMU, Dhaka. Clinical examination, 2D echocardiography & colour Doppler were considered as definitive tools for diagnosis of congenital heart disease. We received patients from lower to upper middle class strata. We retrospectively analyzed the records of all paediatric first visit OPD (outpatient department) & IPD (Inpatient department) patients between 0-18 years, during the same period. Children diagnosed with CHD were analyzed further. Preterms with PDA were followed up and not included in this study if it is closed spontaneously within the period of hospital stay or by managing conservatively DOI: http://dx.doi.org/10.3329/uhj.v8i2.16064 University Heart Journal Vol. 8, No. 2, July 2012