Patients In Public Hospitals Research Articles

Case fatality rate and its determinants among admitted stroke patients in public referral hospitals, Northwest, Ethiopia: A prospective cohort study.

According to the global burden of disease 5.5 million deaths were attributable to stroke. The stroke mortality rate is estimated to be seven times higher in low-income countries compared to high-income countries. The main aim of the study was to assess the 28 days case fatality rate and its determinants among admitted stroke patients in public referral hospitals, in Northwest Ethiopia. A hospital-based prospective cohort study was conducted from December 2020 to June 2021. The study population was 554 stroke patients. Based on Akakian Information Criteria, the Gompertz model was fitted to predict the hazard of death. The study included admitted stroke patients who were treated in the general medical ward and neurology ward. The mean age of the participants was 61 ± 12.85 years and 53.25% of the patients were female. The 28-days case fatality rate of stroke was 27.08%. The results from Gompertz parametric baseline hazard distribution revealed that female sex adjusted hazard rate (AHR = 0.27, 95% CI:0.18-0.42), absence of a family history of chronic disease (AHR = 0.50, 95%CI:0.29-0.87), good GCS score (AHR = 0.21, 95% CI:0.09-0.50) and the absence of complication during hospital admission (AHR = 0.16, 95% CI:0.08-0.29) were factors which decrease hazard of 28 days case fatality rate. While, hemorrhagic stroke sub-type (AHR = 1.38, 95% CI:1.04-3.19), time from symptom onset to hospital arrival (AHR = 1.49, 95% CI:1.57-2 .71), time from confirmation of the diagnosis to initiation of treatment (AHR = 1.03, 95% CI:1.01-1.04), a respiratory rate greater than 20 (AHR = 7.21, 95% CI:3.48-14.9), and increase in NIHSS score (AHR = 1.16, 95% CI:1.10-1.23) were factors increasing hazard of 28 days case fatality rate of stroke. At 28-days follow-up, more than one-fourth of the patients have died. The establishment of separate stroke centers and a network of local and regional stroke centers with expertise in early stroke evaluation and management may address challenges.

Understanding South Australia’s blood products usage patterns and outcomes, using data linkage.

ObjectivesThe purpose of this analytical activity was to ensure confidence in the technical capability for extracting, linking, and integrating public hospital inpatient data, public pathology blood transfusions records and blood tests, to optimise records linkage allowing patterns and trends to be then analysed with confidence. ApproachThe SURE secure data platform was essential to ensure data governance and security requirements were met while integrating health data spanning 18 months (January 2018 - June 2019). Data sources came in multiple formats of varying quality. R was chosen for its data wrangling abilities and reproducibility. The phases were: Source data loading and cleaning Linking hospital inpatient and blood transfusions records Summarising linked transfusion data Linking inpatient and blood tests data Summarising linked tests data Integrating hospital data with summarised transfusion and summarised tests data Deriving additional variables based on summarised data ResultsFrom 143,192 transfusion records, 55,053 (38.4%) were excluded as they did not meet the inclusion criteria (e.g., hospital or blood product out-of-scope). From 7,897,451 blood test records, 238,013 (3.0%) were excluded, mostly of poor quality (missing/invalid hospital code). Initially 91.4% of transfusion records were matched with hospital inpatient records. The linkage rate for state-wide blood test records was 62.3% for tests records, noting the low match rate was attributed to tests not performed on public hospital patients, as the blood test data was statewide. Linkage process was improved by adding additional patient codes from public pathology’s internal patient identifiers. The linkage rate improved to 95.5% for transfusion records and 64.4% for test records. Conclusion12 different data sources, with differing file types and formats, needed coding to achieve standardised results, enabling future reproducibility. Over one hundred business rules were implemented to produce a robust solution for future data updates. End results were analysed, and it was determined that linkage and integration quality exceeded previous similar attempts in terms of match rate and accuracy.

Antiretroviral therapy initiation and outcomes of hospitalized HIV-infected patients in Uganda-An evaluation of the HIV test and treat strategy.

Uganda adopted the HIV Test and Treat in 2016. There is paucity of data about its implementation among hospitalized patients. We aimed to determine the proportion of patients initiating anti-retroviral therapy (ART) during hospitalization, barriers and mortality outcome. In this mixed methods cohort study, we enrolled hospitalized patients with a recent HIV diagnosis from three public hospitals in Uganda. We collected data on clinical characteristics, ART initiation and reasons for failure to initiate ART, as well as 30 day outcomes. Healthcare workers in-depth interviews were also conducted and data analyzed by sub-themes. We enrolled 234 patients; females 140/234 (59.8%), median age 34.5 years (IQR 29-42), 195/234 (83.7%) had WHO HIV stage 3 or 4, and 74/116 (63.8%) had CD4 ≤ 200 cell/μL. The proportion who initiated ART during hospitalization was 123/234 (52.6%) (95% CI 46.0-59.1), of these 35/123 (28.5%) initiated ART on the same day of hospitalization, while 99/123 (80.5%) within a week of hospitalization. By 30 days 34/234 (14.5%) (95% CI 10.3-19.7) died. Patients residing ≥ 35 kilometers from the hospital were more likely not to initiate ART during hospitalization, [aRR = 1.39, (95% CI 1.22-1.59). Inadequate patient preparation for ART initiation and advanced HIV disease were highlighted as barriers of ART initiation during hospitalization. In this high HIV prevalence setting, only half of newly diagnosed HIV patients are initiated on ART during hospitalization. Inadequate pre-ART patient preparation and advanced HIV are barriers to rapid ART initiation among hospitalized patients in public hospitals.

Current clinical practice in managing somatosensory impairments and the use of technology in stroke rehabilitation

Stroke-induced somatosensory impairments seem to be clinically overlooked, despite their prevalence and influence on motor recovery post-stroke. Interest in technology has been gaining traction over the past few decades as a promising method to facilitate stroke rehabilitation. This questionnaire-based cross-sectional study aimed to identify current clinical practice and perspectives on the management of somatosensory impairments post-stroke and the use of technology in assessing outcome measures and providing intervention. Participants were 132 physiotherapists and occupational therapists currently working with stroke patients in public hospitals and rehabilitation centres in Singapore. It was found that the majority (64.4%) of the therapists spent no more than half of the time per week on somatosensory interventions. Functional or task-specific training was the primary form of intervention applied to retrain somatosensory functions in stroke survivors. Standardised assessments (43.2%) were used less frequently than non-standardised assessments (97.7%) in clinical practice, with the sensory subscale of the Fugl-Meyer Assessment being the most popular outcome measure, followed by the Nottingham Sensory Assessment. While the adoption of technology for assessment was relatively scarce, most therapists (87.1%) reported that they have integrated technology into intervention. There was a common agreement that proprioception is an essential component in stroke rehabilitation, and that robotic technology combined with conventional therapy is effective in enhancing stroke rehabilitation, particularly for retraining proprioception. Most therapists identified price, technology usability, and lack of available space as some of the biggest barriers to integrating robotic technology in stroke rehabilitation. Standardised assessments and interventions targeting somatosensory functions should be more clearly delineated in clinical guidelines. Although therapists were positive about technology-based rehabilitation, obstacles that make technology integration challenging ought to be addressed.

Self-care practices and associated factors among hypertension patients in public hospitals in Harari regional state and Dire Dawa City administration, Eastern Ethiopia: A multi-center cross-sectional study.

IntroductionHypertension is a silent killer that causes serious health issues in all parts of the world. Hypertension is a risk factor for cardiovascular disease, stroke, and kidney disease. Self-care practices have been identified as an important component of hypertension management. Despite the government's commitment and the interventions of various stakeholders, the burden of hypertension and its sequel remain unabated. A recent study showed that hypertension self-care practices play a vital role in controlling and managing high blood pressure, even though there is poor self-practice among hypertensive patients in Ethiopia. Therefore, this study assessed the level of self-care practices and associated factors among hypertension patients in public hospitals in Harari regional state and Dire Dawa City Administration, Eastern Ethiopia.MethodsHospital-based cross-sectional study was conducted from June 15 to July 15/2021 among 415 adult hypertensive patients on follow-up. The participants were selected using systematic sampling. Hypertension Self-Care Activity Level Effects (H-SCALE) was used to collect data through face-to-face interviews. The SPSS version 24 was used for analysis. Logistic regression analyses were done to determine the association between the outcome and independent variables. For multivariate logistic regression models, variables having a P < 0.25 during bivariate analysis were candidates. The strength of the association was estimated using AOR and 95% CI. The level of statistical significance was declared at a p < 0.05.ResultsThis study revealed that 52% (95% CI, 48.2–58%) had good level of self-care practices. Formal education (AOR = 3.45, 95% CI: 2.1–4.85), good knowledge about hypertension (AOR = 1.5, 95% CI: 1.17–2.1) 1.5, abstain from chewing khat (AOR = 2.01, 95% CI: 1.44–3.94), strong social support (AOR= 1.9, 95% CI: 1.16–3.1), and absence of depression (AOR = 2.03, 95% CI: 1.43–3.92) were statistically associated with a good level of self-care practices.ConclusionsThis study pointed out that about half of the participants had a good level of self-care practices. Formal education, good knowledge about hypertension, abstaining from khat chewing, good social support, and absence of depression showed associations with a good level of self-care practices. Therefore, public health interventions on hypertension self-care practices, and strengthening non-communicable diseases control programs are vital. Moreover, the provision of targeted education to patients can improve disease knowledge and self-care practices.

The Impact of COVID-19 on Pharmaceutical Shortages and Supply Disruptions for Non-Communicable Diseases Among Public Hospitals of South West, Oromia, Ethiopia.

BackgroundCOVID-19 is a pandemic disease that has led to inequitable supply and shortages of essential medicines worldwide due to decreased production capacity, export bans, and national stockpiling which are affecting the global pharmaceutical supply chain. Access to essential pharmaceuticals is dependent on well-functioning supply chain systems that move medicines from the manufacturer to end users at service delivery point.ObjectiveTo assess impact of Covid-19 pandemic disease on pharmaceutical shortages and supply disruptions for non-communicable diseases among public hospitals of South West, Oromia, Ethiopia.Methods and MaterialsA multi-institutional cross sectional study design was employed. Quantitative and qualitative methods were utilized concurrently to gather data from four public hospital warehouses, dispensaries, patients, and local health authorities from March 1–30, 2021 in Ilu-Ababor and Buno-Bedelle Zones, Oromia, Ethiopia. Data were analyzed by using SPSS (version 23.0). A semi-structured interview guide was used to gather qualitative information from key informants from DTC members, patients, and local health authorities and finally analyzed through thematic approach.ResultsFrom six public hospitals in the two zones; cost of medicine increased more in Dedesa hospital compared to the other public hospital found in that zone and the effect of Covid-19 on essential medicines used for treatment of non-communicable diseases was less in Darimu Hospital. Stock status of PFSA and transportation were the major challenges during the procurement process due to Covid-19 pandemic disease. Among the EMs assessed at public hospitals, drugs used for cardiovascular diseases were out of stock for more than 90 days while anti-asthma drugs were out of stock for less than 40 days.ConclusionThe availability of essential medicine was low and there was also poor inventory management practice in some of the public hospitals during Covid-19 pandemic in the study period.

A nationwide study of patients operated for cervical degenerative disorders in public and private hospitals

During the last decades, there has been an increase in the rate of surgery for degenerative disorders of the cervical spine and in the use of supplementary private health insurance. Still, there is limited knowledge about the differences in characteristics of patients operated in public and private hospitals. Therefore, we aimed at comparing sociodemographic-, clinical- and patient management data on patients operated for degenerative cervical radiculopathy and degenerative cervical myelopathy in public and private hospitals in Norway. This was a cross-sectional study on patients in the Norwegian Registry for Spine Surgery operated for degenerative cervical radiculopathy and degenerative cervical myelopathy between January 2012 and December 2020. At admission for surgery, we assessed disability by the following patient reported outcome measures (PROMs): neck disability index (NDI), EuroQol-5D (EQ-5D) and numerical rating scales for neck pain (NRS-NP) and arm pain (NRS-AP). Among 9161 patients, 7344 (80.2%) procedures were performed in public hospitals and 1817 (19.8%) in private hospitals. Mean age was 52.1 years in public hospitals and 49.7 years in private hospitals (P < 0.001). More women were operated in public hospitals (47.9%) than in private hospitals (31.6%) (P < 0.001). A larger proportion of patients in private hospitals had high education (≥ 4 years of college or university) (42.9% vs 35.6%, P < 0.001). Patients in public hospitals had worse disease-specific health problems than those in private hospitals: unadjusted NDI mean difference was 5.2 (95% CI 4.4 – 6.0; P < 0.001) and adjusted NDI mean difference was 3.4 (95% CI 2.5 – 4.2; P < 0.001), and they also had longer duration of symptoms (P < 0.001). Duration of surgery (mean difference 29 minutes, 95% CI 27.1 – 30.7; P < 0.001) and length of hospital stay (mean difference 2 days, 95% CI 2.3 – 2.4; P < 0.001) were longer in public hospitals. In conclusion, patients operated for degenerative cervical spine in private hospitals were healthier, younger, better educated and more often men. They also had less and shorter duration of symptoms and seemed to be managed more efficiently. Our findings indicate that access to cervical spine surgery in private hospitals could be skewed in favour of patients with higher socioeconomic status.

Diabetic health literacy and associated factors among diabetes mellitus patients on follow up at public hospitals, Bale Zone, South East Ethiopia, 2021.

ObjectiveThis study was aimed to assess diabetic health literacy and associated factors among adult diabetic patients in public hospitals, Bale Zone, Southeast Ethiopia.MethodsA hospital-based cross-sectional study was conducted among 402 diabetic patients in three public hospitals and the samples were selected using simple random sampling technique. The comprehensive functional, communicative, and critical health literacy questionnaire was used to measure diabetic health literacy. Descriptive statistics and Ordinary logistic regression analyses were conducted, and a P-value of < 0.05 was considered to declare a result as statistically significant.ResultA total of 402 diabetic patients were involved in the study. Of all respondents, 41.8%, 27.9%, and 30.3% had low, moderate, and high diabetic health literacy respectively. Educational status; can’t read and write (AOR = 0.085;95% CI: 0.03,0.26), can read and write (AOR = 0.10; 95% CI: 0.04,0.30), primary school (AOR = 0.25; 95% CI: 0.09,0.67), secondary school (AOR = 0.37; 95% CI: 0.14,0.99), duration of onset ≤5 years (AOR = 2.05; 95% CI:1.09,4.19), being not member of DM association (AOR = 0.43; 95% CI: 0.26,0.73), having ≤ 3 diabetes mellitus information sources (AOR = 0.15; 95% CI: 0.03,0.77), social support; poor (AOR = 0.40;95% CI: 0.21,0.79), and moderate (AOR = 0.50; 95% CI: 0.28,0.92) were significantly associated with diabetic health literacy.ConclusionA substantial number of diabetic patients had low diabetic health literacy. Educational status, Sources of diabetic information, Member of DM association, and social support were significantly and positively associated with diabetic health literacy. But, duration of diabetes onset was negatively associated with diabetic health literacy of respondents. So, we recommend providing readable and picturized printed materials, and diabetic patient education to be considered.

SURGICAL SITE INFECTIONS: PREVALENCE, ASSOCIATED FACTORS AND ANTIMICROBIAL SUSCEPTIBILITY PATTERNS OF THE BACTERIAL ISOLATES AMONG POSTOPERATIVE PATIENTS IN SANA’A, YEMEN

Background: Surgical site infections (SSIs) are infections that occur one month after a surgical operation or one year after implant surgery and a surgical procedure, either at the injury site or near the injury site. Despite SSIs are still a major problem causing increased morbidity and mortality globally, especially in developing countries, there is a dearth of information in Yemen. Objective: This study was aimed to assess the prevalence of SSIs, associated factors and antimicrobial susceptibility patterns of the bacterial isolates among post-operative patients in public and private hospitals in Sana’a, Yemen. Methods: This is a cross-sectional study carried out on 309 postoperative patients, aged one year and over that underwent surgery in selected public and private hospitals between January 2019 and January 2020 in Sana’a. Patients’ demographic and clinical information were assessed using an interviewer-administered, pretested, structured questionnaire. Wound swabs and aspirates were collected, placed in Stuart transport media and transferred to the Bacteriology Department of the National Center for Public Health Laboratories in Sana’a for bacterial isolation, identification and antimicrobial susceptibility testing.. Results: The mean age of postoperative patients was 34.0±18.3 (SD) years, age group 25-34 years was 93 (30.1%), and females were 105 (33.8%). Total 309 postoperative patients, 98 (31.7%) presented with SSI. Having postoperative antibiotics (OR=7.0, 95%CI: 4.1-12.0), dirty surgical wound (OR=10.5, 95%CI: 5.0-21.9), emergency surgery (OR=3.1, 95%CI: 1.8-5.1), amputation (OR=2.5, 95%CI: 1.1-5.7), excision (OR=2.2, 95%CI: 1.2-4.0), hospital stay &gt; two weeks (OR=5.2, 95%CI: 2.3-11.1) and having diabetes mellitus (OR=2.2, 95%CI: 1.1-4.7) were factors significantly associated with SSIs. Conclusion: This study shows a significant proportion of SSIs among patients in Sana’a, Yemen. Being a female, having a dirty surgical wound, amputation, excision, long hospital stays, diabetes mellitus, and emergency surgery appears to be the major factors associated with SSIs. The most common SSI bacterial etiology is S. aureus, sensitive to vancomycin and rifampicin. Peer Review History: Received: 10 May 2022; Revised: 12 June; Accepted: 30 June, Available online: 15 July 2022 Academic Editor: Prof. Dr. Gorkem Dulger, Duzce University, Turkey, gorkemdulger@yandex.com UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Dr. Bountain Welcome Tebeda,Chemical Pathology Department, Federal Medical Centre, Yenagoa, Nigeria. bountaintebeda@yahoo.com Dr. Esther Marguerite Chase DJANGA, Faculty of Medicine and Biomedical Sciences. Department of Public Health. University of Yaoundé I, Cameroon. e.djanga@yahoo.com Similar Articles: EFFECT OF MOST COMMON ANTIBIOTICS AGAINST BACTERIA ISOLATED FROM SURGICAL WOUNDS IN ADEN GOVERNORATE HOSPITALS, YEMEN PREVALENCE OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) AND ANTIMICROBIAL SUSCEPTIBILITY PATTERNS AT A PRIVATE HOSPITAL IN SANA'A, YEMEN

Adherence to self-care recommendations and associated factors among adult heart failure patients in public hospitals, Addis Ababa, Ethiopia, 2021: cross-sectional study

BackgroundAdherence to self-care recommendations in heart failure (HF) patients is essential to improve the patients’ quality of life, prevent hospital admission, and reduce mortality and morbidity. Nevertheless, poor adherence to self-care recommendations remains to be an extensive problem for HF patients. Thus, the aim was to assess adherence to self-care recommendations and associated factors among HF patients in public hospitals, Addis Ababa, Ethiopia, 2021.MethodsAn institutional-based cross-sectional study was conducted among adult HF patients from February 15 to April 15, 2021, in five public hospitals, in Addis Ababa, Ethiopia. A total of 294 adult HF patients completed an interviewer-administered questionnaire in the Amharic language. The Revised HF Compliance Questionnaire was used to measure the adherence to self-care recommendations of HF patients. Data was collected using the Revised HF Compliance Questionnaire, the Japanese heart failure knowledge scale, the multidimensional scale of perceived social support, and the chronic diseases self-efficacy scale. Study participants were selected through a systematic random sampling technique. Data were entered into Epi-info version 7.1 and then exported to SPSS Version 25 for analysis. Descriptive and logistic regression analyses were performed and the statistical significance of associations between the variables was determined using ORs with 95% CI and p-values < 0.05.ResultsAdherence to self-care recommendations among adult HF patients in public hospitals, in Addis Ababa, Ethiopia was 32.70%. Being female (AOR 4.66, 95% CI 1.58–13.67), patients who had high family monthly income (AOR 10.32, 95% CI 2.00–5.13), NYHA class III (AOR: 7.01, 95% CI 2.18–22.57) and class IV (AOR: 6.30, 95% CI 1.01–39.22), who had good self-efficacy (AOR 7.63, 95% CI 2.64–21.97), and who had good knowledge about HF (AOR 3.95, 95% CI 1.56–9.95) were more likely to have good adherence to self-care recommendations, p-value < 0.05.ConclusionThis study revealed that 32.70% of adult HF patients had good adherence to self-care recommendations. Factors associated with adherence to self-care recommendations of adult HF patients are sex, family monthly income, NYHA classification, self-efficacy, and knowledge about HF. Therefore, interventions focused on sex, family monthly income, NYHA classification, self-efficacy, and knowledge about HF are required to improve adherence to self-care recommendations of adult HF patients.

Experiences of trauma health care professionals when providing healthcare to immigrants in Durban public hospitals, South Africa

Existing research on access to health care for immigrants in South Africa has focused on access and use of services by immigrants. Focus has been on immigrants concerns around issues of citizenship acquisition and the burdening of the country's resource-constrained healthcare system. Limited empirical research has been conducted to explore health care professionals’ views, daily experiences and challenges when attending to immigrant patients in South African public hospitals. This study purports to fill in this knowledge gap by capturing experiences and challenges of trauma health care professionals when providing healthcare to immigrants in Durban public hospitals, KwaZulu Natal province in South Africa. Data were collected based on a multicase qualitative study design through face-to-face in-depth structured interviews with twentytrauma health care professionals from four trauma centers in Durban public hospitals. Criterion based expert purposive sampling was used to recruit participants for the study. Data collected were analysed using thematic analysis. Inability of immigrant patient to converse in English or any other local language posed a major constraint for trauma health care professionals when attending to migrant patients. Poor communication and culturally based differences in interpretations of sickness causality as well as desired treatment were also reported as challenges health professionals face when attending to immigrant patients. Doctors were concerned about how these barriers presented risks of prescribing wrong treatment and the possibility of patient's non-compliance especially those who cannot speak English or any local language. To health professionals’ language and communication barrier, different cultural interpretation of sickness and cause of sickness is a challenge health professionals are facing when attending to immigrant patients. There is need for interpreters at hospitals or for hospitals to make it compulsory for patients who do not speak any of the native languages or English to always be accompanied by an interpreter.

Short-Term Outcomes of Transfemoral Carotid Artery Stenting and Carotid Endarterectomy in Symptomatic Patients: Data from a Multicentric Prospective Registry in Brazil

Transfemoral carotid artery stenting (TF-CAS) and carotid endarterectomy (CEA) are alternative strategies for stroke prevention in patients with atherosclerotic carotid disease. Because their main objective is to prevent future ischemic events, regular reassessment of the outcomes is mandatory for providing the best therapy. The purpose of this study was to describe the practice and the outcomes of TF-CAS and CEA in symptomatic patients in public university hospitals in Brazil, using data from a prospective multicentric registry. A prospective 8-year observational study of patients with symptomatic carotid artery atherosclerotic disease that underwent TF-CAS and CEA in 5 public university hospitals affiliated with the RHEUNI (Registry Project of Vascular Disease in the Public University Hospitals of São Paulo). All consecutive procedures were included. The indications for the procedures were determined by each surgeon's individual discretion, in accordance with a preoperative risk evaluation. The outcome measures were any 30-day follow-up death, stroke, myocardial infarction (MI), and their combined outcome (major adverse cardiovascular events [MACE]). The registration of the study was made at clinicaltrials.gov NCT02538276. From January 2012 through December 2019, 376 consecutive and symptomatic patients were included in the study records. There were 152 TF-CAS procedures (40.4%) and 224 CEA procedures (59.5%). All completed the 30-day follow-up period. Occurrence of death (TF-CAS: 0.66% × CEA: 0.66%, P=0.99), stroke (TF-CAS: 4.61% × CEA: 4.46%, P=0.99), and MI (TF-CAS: 0.66% × CEA: 0%, P=0.403) were similar in both groups, without statistically significant differences. MACE rate did not differ in both groups (TF-CAS: 5.92% × CEA: 4.46%, P=0.633). Data from a prospective registry of 5 Brazilian university hospitals showed that TF-CAS and CEA in symptomatic patients had similar 30-day perioperative rates of death, stroke, and MI and their combination.

Lower access to risk stratification tests and drugs, and worse survival of chronic lymphocytic leukaemia patients treated in public as compared to private hospitals in Brazil: A retrospective analysis of the Brazilian registry of chronic lymphocytic leukaemia.

Chronic lymphocytic leukaemia (CLL) has a highly variable clinical course. In addition to biological factors, socioeconomic factors and health system characteristics may influence CLL outcome. Data from the Brazilian Registry of CLL were analyzed to compare clinical and treatment‐related characteristics in patients with CLL, from public or private institutions. A total of 3326 patients from 43 centres met the eligibility criteria, of whom 81% were followed up at public hospitals and 19% at private hospitals. The majority were male (57%), with a median age of 65 years. Comparing public and private hospitals, patients in public hospitals were older, had more advanced disease at diagnosis, and more frequently had elevated creatinine levels. All investigated prognostic markers were evaluated more often in private hospitals. First‐line treatment was predominantly based on chlorambucil in 41% of the cases and fludarabine in 38%. Anti‐CD20 monoclonal antibody was used in only 36% of cases. In public hospitals, significantly fewer patients received fludarabine‐based regimens and anti‐CD20 monoclonal antibodies. Patients from public hospitals had significantly worse overall survival (71% vs. 90% for private hospitals, p < 0.0001) and treatment‐free survival (32% vs. 40%, for private hospitals, p < 0.0001) at seven years. Our data indicate striking differences between patients followed in public and private hospitals in Brazil. A worse clinical condition and lack of accessibility to basic laboratory tests and adequate therapies may explain the worse outcomes of patients treated in public institutions.

Disparities in Stroke Patient-Reported Outcomes Measurement Between Healthcare Systems in Brazil.

IntroductionAcute stroke interventions, such as stroke units and reperfusion therapy, have the potential to improve outcomes. However, there are many disparities in patient characteristics and access to the best stroke care. Thus, we aim to compare patient-reported outcome measures (PROMs) after stroke in two stroke centers representing the public and private healthcare systems in Brazil.MethodsPROMs through the International Consortium for Health Outcomes Measures (ICHOM) were assessed at 90 days after the stroke to compare two Brazilian hospitals in southern Brazil: a public university and a private stroke center, both with stroke protocols and stroke units.ResultsWhen compared with the private setting (n = 165), patients from the public hospital (n = 175) were younger, had poorer control of risk factors, had more frequent previous strokes, and arrived with more severe strokes. Both hospitals had a similar percentage of IV thrombolysis treatment. Only 5 patients received mechanical thrombectomy (MT), all in the private hospital. Public hospital patients presented significantly worse outcomes at 3 months, including worse quality of life and functional dependence (60 vs. 48%, p = 0.03). Poor outcome, as measured by the mRS score, was significantly associated with older age, higher NIHSS score, and the presence of heart failure. However, the public practice was a strong predictor of any self-reported disability.ConclusionPatients assisted at a good quality public stroke center with the same protocol used in the private hospital presented worse disability as measured by mRS and patient-reported outcome measures, with greater inability to communicate, dress, toilet, feed, and walk.

High Prevalence of Morphological Abnormality on Peripheral Blood Cells Among Patients in Public Hospitals, Southern Ethiopia

Introduction: Morphologically abnormal blood cells in peripheral blood of a person reflect underlying pathological condition affecting formation, function, and lifespan of these cells. A properly identified morphological defect in peripheral blood cells is important to manage anemia, leukemia and other disorders of blood. This study aimed to assess magnitude and severity of morphological abnormality in blood cells of patients with abnormal complete blood count in public hospitals found in southern Ethiopia. Method: A facility-based cross-sectional study was conducted from January 01 to March 31, 2019 among five public hospitals in Southern Ethiopia. Peripheral blood sample and socio-demographic data were collected from 423 patients with abnormal complete blood count. Thin blood smear was prepared by Wedge method, stained with Wright’s Stain, and examined under microscope by 1000X magnification to detect and characterize abnormality in blood cells’ morphology. Descriptive statistical analysis was done using Statistical Package for Social Sciences version 20.0, and results are presented in tables and figures. Result: Prevalence of blood cell morphological abnormality was 63.8%. From this, 21.8% is marked and 78.2% is moderate abnormality. In 41.9% of the affected patients, the defect involved at least two blood cell types mainly affecting red blood cells. Females (73.8%), children (70.1%) and elderly (82.1%) carried higher prevalence of the abnormality. Conclusion: High prevalence of abnormality in PBS morphology was observed, chiefly among female, children and elderly. Stakeholders should work to alleviate the high prevalence, with particular attention to women, children and old-age people.

Information seeking about COVID-19 and associated factors among chronic patients in Bahir Dar city public hospitals, Northwest Ethiopia: a cross-sectional study.

BackgroundThe health impacts of COVID-19 are not evenly distributed in societies. Chronic patients are highly affected and develop dangerous symptoms of COVID-19. Understanding their information seeking about COVID-19 may help to improve the effectiveness of public health strategies in the future, the adoption of safety measures, and minimize the spread of the pandemic. However, there is little evidence on information seeking specifically on COVID-19 in this study setting. Therefore, this study aimed to assess information seeking about COVID-19 and associated factors among chronic patients.MethodAn institutional-based cross-sectional study supplemented with qualitative data was conducted at Bahir Dar city public hospitals in Northwest Ethiopia from April 8 to June 15, 2021. A total of 423 chronic patients were selected using systematic random sampling techniques with an interval of 5. Bi-variable and multivariable logistic regression analysis was fitted to identify factors associated with information seeking about COVID-19. A p-value < 0.05 was used to declare statistical significance. Qualitative data were analyzed using a thematic approach. Finally, it was triangulated with quantitative findings.ResultThe proportion of information seeking about COVID-19 among chronic patients was 44.0% (95% CI = 39.0, 49.0). Being living in urban [AOR = 4.4, 95% CI (2.01, 9.58)], having high perceived susceptibility to COVID-19 [AOR = 3.4, 95%CI (1.98, 5.70)], having high perceived severity to COVID-19 [AOR = 1.7, 95%CI (1.04, 2.91)], having high self-efficacy to COVID-19 [AOR = 4.3, 95%CI (2.52, 7.34)], and having adequate health literacy [AOR = 1.8, 95%CI (1.10, 3.03)] were significant factors associated with information-seeking about COVID-19.ConclusionThe overall proportion of information seeking about COVID-19 among chronic patients was low. Thus, health promotion programs should emphasize the chronic patients living in a rural area; enhance perceived risk and severity of COVID-19, enhancing self-efficacy and health literacy interventions to improve information seeking.

The influence of service flow changes and drug consultation on quality of life of HIV/AIDS-positive patients in Sunan Kalijaga regional public hospital, Demak regency

Human immunodeficiency virus (HIV infection/AIDS) cannot be cured but can be controlled by antiretroviral medicines. Non-compliance with the treatment is influenced by internal and external factors. The internal factors (predisposing factors) include healthcare systems, socioeconomic conditions, and patients. Meanwhile, the external factors (enabling and reinforcing factors) include the condition of the disease and therapy. This study aims to determine the influence of service flow changes and drug consultation on the quality of life of people living with HIV/AIDS in Sunan Kalijaga Regional Public Hospital, Demak Regency. This research employed a quasi-experimental method with one group and a pre-post design. The research subject was HIV/AIDS-positive patients in Sunan Kalijaga Regional Public Hospital, Demak Regency. These subjects had met the inclusion and exclusion research criteria. The data were collected using an in-depth interview, consisting of 14 questions to determine factors in non-compliance with treatment and patients' quality of life. Patient compliance with treatment and quality of life were measured before and after the intervention. The dependent t-test was employed to determine differences in the average score of the compliance and quality of life before and after the treatment. The majority of HIV/AIDS-positive patients in Sunan Kalijaga Regional Public Hospital are in the productive age (49 people or 96.22%), female (33 people or 62.24%), employed in private jobs (16 people or 30.19%), married (34 people or 64.2%), and graduated from primary school (20 people or 37.7%). The majority of the patients have undergone the treatment for &gt; 1 year (32 respondents or 60.4%) and received the drug regimen of ZDV + 3TC + NVP (90.57%). There is no significant difference in the patient compliance with the treatment before and after the intervention with the sig &lt; 0.05. Moreover, the patients have a high quality of life with a compliance value of 80-100% before and after the intervention. The pre-post-interventions have influenced the physical health domain and the social relation domain with the sig &lt; 0.05. The provision of education affects the quality of life on physical health and social relationship factors (sig &lt; 0.005). The implementation of drug consultation could improve the HIV-positive patients' quality of life in physical health and social relationship domains. In contrast, the intervention does not affect the patients' compliance with the therapy.

Nurses' Knowledge, Practice, and Associated Factors with Enteral Nutrition in Adult Intensive Care Units of Public Hospitals.

In critically ill patients, enteral nutrition is recommended as a route for nutrient delivery. Nurses' knowledge and practice of enteral nutrition influence patients' clinical outcomes. Therefore, this study sought to assess nurses' knowledge, practice, and associated factors regarding enteral nutrition in adult intensive care unit patients in public hospitals in Addis Ababa, Ethiopia. A cross-sectional study design was used to collect data from 196 nurses working in public hospitals in Addis Ababa from April 11 to April 30, 2020. The data were entered into Epi Data version 3.1 and analyzed with SPSS version 21. The correlation between independent variables and dependent variables was estimated using bivariate and multivariate logistic regression at a 95% confidence level. The level of inadequate knowledge and poor practice of nurses relating to enteral nutrition was 67.7% and 53.8%, respectively. Bachelor's degree holders were less likely to be knowledgeable (AOR= 0.24, 95% CI: (0.61, 0.93)). Nurses' practice about enteral nutrition was significantly associated with nurses' age (AOR = 0.023, 95 % CI: (0.001,0.52), nurses receiving training on enteral nutrition (AOR = 1.951, 95 % CI: (0.06, 0.60)), and nurses from ICUs having a guideline and protocol on enteral feeding practice (AOR = 3.401, 95 % CI: (1.186, 9.789). In the study, it was revealed that a substantial proportion of nurses had inadequate knowledge of enteral nutrition and practiced poor enteral nutrition.

Is the Duration of Diabetes Diseases Positively Associated With Knowledge About Diabetic Complications? Knowledge of Diabetes Mellitus Complications and Associated Factors Among Type-2 Diabetic Patients in Public Hospitals of Addis Ababa, 2020.

BackgroundAlthough the importance of educational programs in the prevention and control of diabetes mellitus (DM) and its complication is well-recognized, there are concerns about whether these programs are achieving the desired goal of increasing knowledge of DM and its complication in developing countries. Therefore, this study assessed knowledge of DM complications and associated factors among type-2 diabetic patients in public hospitals of Addis Ababa.MethodSimple random sampling technique was used to select 422 participants. Data were entered to EpiData Version 4.6.0.1 and analyzed using SPSS Version 25 software. Multicollinearity and model goodness-of-fit was checked. A multivariate logistic regression model at 95% CI was used to identify the predictors.ResultThe overall knowledge of diabetes complications among diabetic patients in the Hospitals of Addis Ababa was 54.9%. In the fitted model, being a profession of governmental workers [adjusted odds ratio (AOR) = 3.12, 95% CI (1.33, 7.34)] and merchants [AOR = 2.54, 95% CI (1.16, 5.56)]; DM duration 5–10 years [AOR = 0.41, 95% CI (0.23, 0.73)] and ≥10 years [AOR = 0.36, 95% CI (0.19, 0.69)]; family history of DM [AOR = 1.68, 95% CI (1.03, 2.75)]; and participating in diabetic counseling [AOR = 2.41, 95% CI (1.50, 3.86)] were significantly associated with knowledge about DM complications.Conclusion and RecommendationThe overall knowledge of diabetes complications among diabetic patients in the Hospitals of Addis Ababa was 54.9%. It was determined by the duration of DM, current profession, family history, and participation in diabetes counseling. Hence, emphasis on sustaining knowledge about diabetes complications for patients who are more than 5 years since diagnosis and attention is needed about knowledge diabetic farmers.

Patient-Centered Care and Associated Factors among Adult Admitted Patients in South Wollo Public Hospitals, Northeast Ethiopia.

BackgroundThe US Institute of Medicine’s “quality chasm” report defined patient-centered care as care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. Services that lack patient-centered care lead to unimproved health status, decreased patient and family satisfaction, and poor patient outcomes. Therefore, this study aimed to assess patient-centered care and associated factors among admitted patients in South Wollo public hospitals in northeast Ethiopia.MethodsThis was a facility-based quantitative cross-sectional study design supplemented with qualitative analysis conducted from February 10 to March 10, 2020 across South Wollo public hospitals. A total of 618 admitted patients were selected using multistage systematic random sampling and interviewed using a structured questionnaire. Five health professionals were selected for in-depth interviews. Binary logistic regression analysis was carried out to identify associated variables, and potential confounders were controlled using a multivariate logistic regression model, and P<0.05 was considered significant.ResultsOverall, 60.9% (95% CI 57.1%–64.5%) of patients received patient-centered care. Age 25–35 years (AOR 0.39, 95% CI 0.32–0.64) years, rural residence (AOR 2.61, 95% CI 1.62–4.02), social well-being (AOR 2.34, 95% CI 1.45–3.78), perceived high quality of care (AOR 3.69, 95% CI 2.07–6.04), length of stay (AOR 0.13, 95% CI 0.02–0.79), and routine checkups (AOR 1.92, 95% CI 1.15–3.13) were variables significantly associated with patient-centered care.ConclusionThis study revealed that among admitted patients, three in five received patient-centered care. Age, residence, social well-being, length of stay, perceived quality of care, and routine checkups were significantly associated with patient-centered care. Therefore, working on provider improvements in providing consultation and facilitation and decreasing length of stay to improve patient-centered care is needed.