Hospital Institute Research Articles

A Study of Improving Quality of Care and Patient Satisfaction through Effective Hospital Management with Reference to Select Hospitals in Delhi

This study examines how effective hospital management can improve the quality of care and patient satisfaction at AIIMS, MAX HOSPITAL, and SRI BALAJI ACTION MEDICAL INSTITUTE in Delhi. Using a combination of quantitative and qualitative methods, the research looks at current management systems, identifies areas for improvement, and proposes specific actions to take. It focuses on three main areas: putting patients first, getting staff involved, and using technology wisely. By studying both how hospitals are run and what patients think, the research offers practical advice on how to keep getting better and making sure patients are happy

Subjectivity through the lens of Guattari: A key concept for nursing.

Félix Guattari, a French philosopher and psychotherapist often recognized for his collaboration with Gilles Deleuze, also published important work of his own. The way he conceptualizes subjectivity and schizoanalysis (later developed into institutional analysis) can incite us to interpret our social contexts differently and to help frame an emancipatory path in nursing. At La Borde, a psychiatric clinic, subjectivity was seen as the real power that lies within the institutions; invisible and flowing through all levels of the hierarchal structure-like waves-each of them unique but still part of the same ocean. Even with its elusive character, this concept can be wielded through psychotherapeutic techniques of analysis which aim to reduce hierarchies, encourage collaborations, decentralize levers of powerand promote initiatives that arise from the base. These concepts deserve further exploration when it comes to modern institutional issues like the ones present in Quebec's (Canada) healthcare system. Therefore, this article borrows theorizations elaborated through psychotherapy and applies them to the hospital institution which is seen as an organized, stable structure (the molar line), while paying attention to fluid, changing processes and the multiplicity of desires for transformation (the molecular line), to promote nursing movements that escape and abolish these structures, creating new possibilities and new forms of thinking (the line of flight).

Dashboard for assessing patient flow management in hospital institutions

Proactive control of hospital processes has a significant influence on patient performance and satisfaction. The objective of the research is to develop a dashboard for the evaluation of patient flow management in hospital institutions. Based on a descriptive quantitative study, a procedure is proposed for the development of a dashboard for the evaluation of patient flow management in hospital institutions, structured in five stages and nine steps, including procedures for the identification of key variables and aggregation of indicators. A dashboard was developed for the General Surgery service of a Clinical Surgical Teaching Hospital, which is composed of 18 indicators, six synthetic indexes and one comprehensive indicator. Among the positive implications for healthcare managers is the possibility of monitoring and comparing strategies with a process vision between different departments in support of proactive and strategic decision making in order to improve hospital performance.

An Analysis on Link of Maternal Lipid Profile and Gestational Diabetes Mellitus: A Case Control Study of 120 Women

BACKGROUND: Gestational diabetes mellitus GDM is a clinical condition, or disease, wherein, a marked reduction in the sensitivity of insulin, during pregnancy, is attributed to the metabolic disturbance that occurs widespread. Although, information on the association among dyslipidaemia and GDM remains uncertain till date. The main objective of the present investigation is to detect any correlation between lipid profile of GDM subjects and healthy control women,using biochemical indicators. METHODS: A careful clinical case study was performed, involving a total of 120 subjects, comprising two distinct groups. Group I includes 60 pregnant women, those were recently detected as GDM cases. Group ll covers healthy control subjects collected from Open Patients unit and Registry of Diabetic Unit of Dhanalakshmi Srinivasan Institute Medical science and Hospital, Perambalur, Tamil Nadu. Both groups' subjects were bifurcated, based on their age groups, and found to be 25 to 45 years. Estimation of glycemic condition, in prior and post fasting was performed, using an analyzer appropriately. Similarly, maternal lipid profile for both groups was also determined. Moreover, HbAl c, an important biochemical indicator was also detected for both groups of subjects with respect to their age, using HPLC technique. Received data were pooled and a statistical analysis was performed, using Student t test to identify the significance difference or association between GDM group and healthy subjects, in specific, on the maternal lipid profile. FINDING: Analysis showed that there is a significant difference observed in the maternal lipid profile of GDM group, when compared with healthy subjects. The P value of Very Low Lipid protein VLDL, low density lipoprotein LDL, High density lipoprotein HDL was found to be 0.01, 0.028, and 0.038 respectively. Whereas, p value for HbAl c was recorded as 0.02, and found significant difference at 0.01 percent level. Interestingly, no difference was observed in the limit of FG, and Triglycerides limit, and were reported as p _0.28, and p- 0.316 respectively. A marked difference was also detected among the 30 to 35 yrs age group. INTERPRETATION: Present investigation elucidated that there is a strong correlation between GDM subjects and dyslipidemia. Further, this study strengthened and promised that elevated maternal lipid profile is highly linked with GDM condition.

THANATOPHORIC DYSPLASIA: Birth, death, and the experience of family support and neonatal palliative care

Tanatophoric dysplasia is a usually lethal genetic syndrome in the perinatal period, which has a significant psychological impact on the pregnant woman and family. It necessitates careful monitoring by the health professionals involved in the care. The objective of this work is to present an experience report on the psychological and multidisciplinary monitoring of a pregnant woman diagnosed with type 2 tanatophoric dysplasia during prenatal screening. The methodology of the present study involves presenting a clinical case with a description of the clinical and psychological conditions of the pregnant woman, along with the interventions carried out by the health professionals involved in the case. The pregnant woman sought psychological care after receiving the diagnosis of type 2 tanatophoric dysplasia. Subsequently, the psychologist coordinated with other health professionals involved in the case and the institution where the delivery would take place, leading to the development of a collaborative planning and management approach. Upon discussion, the pregnant woman and her family opted for palliative care for the newborn. The team of professionals aligned their approach to meet the family’s wishes and needs. The newborn received supportive measures but survived for only a few hours before passing away. The integrated performance of the health team professionals and the flexibility of the hospital institution allowed the adequate planning of care actions and facilitated a positive reception experience for the family. This case highlights the importance of psychological support, individualized planning, and the relevance of teamwork in providing comprehensive care during such challenging circumstances.

Médiations culturelles : modalités de mise en œuvre dans une institution de pédopsychiatrie

ContextArt-mediated activities and cultural care have become a component of most hospital institutions for children and adolescents. Yet their funding is not specified. Based on the experience of a university hospital department, we would like to consider measures that might encourage their continuation. MethodsWe conducted an observational study and interviews (n=15) to list all the activities carried out by an external contributor in 2023, their themes, the target audience, their objectives, the nature of the contributors, the existence of a formalized agreement, funding, as well as their frequency and duration. ResultsThirty-five different partners carried out 685 actions in 2023, 10% of which were carried out outside the hospital. The themes addressed are extremely varied (sports, performing arts, literature, visual arts, etc.). These activities represent an average of 210 interventions per unit, or 4 per week. However, they are less numerous in the intensive care unit and units for autistic patients with challenging behaviors, and virtually absent from outpatient units. Finally, specific funding or agreements are often absent. DiscussionDespite their frequency and the substantial investment made by the team and its partners, there are a number of weaknesses. We are developing the idea that the creation of a cultural policy co-constructed between a cultural and sponsorship department and the clinical components (in our case, child psychiatry) would make it possible to resolve some of these weaknesses and promote a better inclusion in patient care.

Comparison of Recovery Rate and Early Complications Between Primary Resection and Two-stage Operation in the Treatment of Acute Non- Complicated Sigmoid Volvulus

Background: This study compares recovery rates and early complications associated with primary resection and a two-stage operation in treating acute sigmoid volvulus, a gastrointestinal emergency requiring prompt intervention. Proper diagnosis and appropriate operative approaches are crucial for lifesaving treatment. Objectives: This study was aim to compair of recovery rate and early complecations between two operative procedures. Methods: The cross-sectional analytical study was conducted from May to October 2015in National Institute Cancer Research and Hospital, Mohakhali, Dhaka, Bangladesh, involved 50 patients with acute non-complicated sigmoid volvulus, randomly divided into two groups, with the outcome variable being the only difference between two groups. Results: Two stage operation patients experienced 24% stomal complications, while one stage operation patients did not experience any late complication. The mean time for one stage operation was longer, and one stage operation resulted in 200 ml blood loss compared to 156 ml in two stage operations. Conclusion: In consideration of anastomotic leakage, operative time, operative blood loss post-operative hospital stay, two stage operation was better than primary resection. J Rang Med Col. March 2024; Vol. 9, No. 1: 59-64

Les soins palliatifs au Liban, un essor freiné mais une résilience à toute épreuve

The history of palliative care in Lebanon is marked by resilience and perseverance. Supported by personal initiatives, legislative battles and private donations, Palliative Care has managed to gradually anchor itself in the medical landscape, despite the meager means offered by the State. The delivery of Palliative Care in Lebanon has the particularity of being supported mainly by non-profit NGOs, whose operation is halfway between French HAD (Home hospitalization) and EMSP (Mobile palliative care units) and which offer free care to patients. More than 30% of patients followed by the NGO BALSAM suffer from chronic non-cancerous diseases. Pediatric palliative care is almost non-existent, with BALSAM being the only NGO providing support for children in their homes. Faced with the major financial difficulties facing the country, these NGOs are now turning to international partnerships, both to ensure the means to pursue their missions, and to reserve a place on the world stage. The Lebanese model developed by BALSAM is presented in developing countries as a possible example of operation in a crisis context. A delegation from the Medical-Chirurgical Center for Rehabilitation of Massues (CMCR) in Lyon also intervened at the Rafik Hariri Hospital Center in Beirut to discuss three themes: management, rehabilitation and palliative care. The same difficulties that we encounter in France regarding the temporality of intervention in care could be noted: It is uncommon for Lebanese medical colleagues to seek palliative care support early. The place of palliative care within the hospital institution is still new, and the resources allocated are too low, both in terms of nursing time and suitable premises. The road remains long, but everything is being done to ensure that palliative care continues to be talked about and extends ever deeper within the Lebanese health system.

Mental health sequelae in survivors of cardiogenic shock complicating myocardial infarction. A population-based cohort study.

Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short- and long-term morbidity and mortality. However, there are limited data on mental health sequelae that survivors experience following discharge. We conducted a retrospective, population-based cohort study in Ontario, Canada of critically ill adult (≥ 18years) survivors of AMI-CS, admitted to hospital between April 1, 2009 and March 31, 2019. We compared these patients to AMI survivors without shock. We captured outcome data using linked health administrative databases. The primary outcome was a new mental health diagnosis (a composite of mood, anxiety, or related disorders; schizophrenia/psychotic disorders; and other mental health disorders) following hospital discharge. We secondarily evaluated incidence of deliberate self-harm and death by suicide. We compared patients using overlap propensity score-weighted, cause-specific proportional hazard models. We included 7812 consecutive survivors of AMI-CS, from 135 centers. Mean age was 68.4 (standard deviation (SD) 12.2) years, and 70.3% were male. Median follow-up time was 767days (interquartile range (IQR) 225-1682). Incidence of new mental health diagnosis among AMI-CS survivors was 109.6 per 1,000 person-years (95% confidence interval (CI) 105.4-113.9), compared with 103.8 per 1000 person-years (95% CI 102.5-105.2) among AMI survivors without shock. After propensity score adjustment, there was no difference in the risk of new mental health diagnoses following discharge [hazard ratio (HR) 0.99 (95% CI 0.94-1.03)]. Factors associated with new mental health diagnoses following AMI-CS included female sex, pre-existing mental health diagnoses, and discharge to a long-term hospital or rehabilitation institute. Survivors of AMI-CS experience substantial mental health morbidity following discharge. Risk of new mental health diagnoses was comparable between survivors of AMI with and without shock. Future research on interventions to mitigate psychiatric sequelae after AMI-CS is warranted.

Abstract PO3-12-08: Hypersensitivity reactions to paclitaxel and carboplatin in breast cancer: safety and effectiveness of desensitization

Abstract Introduction. Taxanes and platinums are first line treatment of breast cancer for early stages and metastatic disease and constitute the most commonly implicated chemotherapeutics in hypersensitivity reactions.1 Clinical manifestations range from mild skin reactions to anaphylaxis.2 Hypersensitivity reactions (HSR) to paclitaxel and carboplatin occur in a significant percentage of patients, with estimates of 30% and 40% respectively,3,4,5 leading to discontinuation of treatment.6 Using alternative drugs can be poorly tolerated or much less effective, entailing to high morbidity and mortality.7 Desensitization is the procedure performed to achieve a tolerance to the drug to which a HSR previously occurred, in order to maintain first-line treatment.8 The evaluation of the oncological response remains in the importance of assessing the shrinkage of the tumor and the time of progression of the disease.9 Objective: To describe the hypersensitivity reactions to paclitaxel and carboplatin, and the safety and effectiveness of desensitization protocols after anaphylaxis in patients with breast cancer. Materials and Methods: Original, retrospective, descriptive, and analytical study, approved by the Bioethics and Research Committee ON23-00016 code, included patients >18 years with breast cancer who developed a hypersensitivity reaction to first-line chemotherapy and performed a 3-bag-12-step desensitization according to the Brigham and Women's Hospital, Dana Farber Institute, Boston protocol. Results: Forty-five desensitization to paclitaxel or carboplatin were performed in 8 women with breast cancer, mean age 38.6 years. 6 patients developed HSR to paclitaxel, 83% of which were in the first application, and 2 patients developed HSR to carboplatin after several cycles. The most predominant symptom of HSR was cutaneous in 87% of the cases, and all patients presented cardiovascular HSR to paclitaxel. No patients developed HSR during desensitization. Currently, only 1 patient developed disease progression, while the rest presented a complete response to treatment. Discussion. HSR to paclitaxel appear in the 1-2 cycle,10 while to platinums after various exposures ( >6 cycles) similar to our study.3,4 The symptoms associated with paclitaxel are cardiovascular10,11 while urticaria is the most frequent in carboplatin.3,11 The desensitization protocol implemented did not develop HSR in any of the patients. Neoadjuvant chemotherapy in breast cancer has been shown to yield better disease-free interval results alongside improved pathological response.12 Conclusions. The program implemented in our hospital's chemotherapy desensitization clinic, replicating the model of the Dana-Farber Cancer Institute, Brigham, and Women's Hospital in Boston, has enabled cancer patients to continue with first-line treatment, thus improving their prognosis and quality of life, opening new areas of opportunity in the multidisciplinary management of these patients to improve overall survival. Characteristics of patients with hypersensitivity reactions HSR: hypersensitivity reactions ND: No data m: months yrs.: years Desensitization protocol to Paclitaxel IV (300 mg) IV: intravenous mg: milligram mL: milliliter h: hour Citation Format: Rosalaura V. Villarreal-González, Oscar Vidal-Gutiérrez, Javier A. Martínez-Moyano, Marianela Madrazo-Morales, Kathia S. Sáenz-Cantú, Patricia Rodríguez-Niño. Hypersensitivity reactions to paclitaxel and carboplatin in breast cancer: safety and effectiveness of desensitization [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-12-08.

Discrete simulation applied to the improvement of patient flows in hospital institutions

Discrete simulation applied to the improvement of patient flows in hospital institutions

Enhancement Patterns in Differentiated and Undifferentiated Gastric Carcinoma: Multiphasic Contrast-Enhanced Computed Tomography Versus Histopathology.

Background Gastric adenocarcinoma (GCA) poses a significant global health burden due to its prevalence and high morbidity and mortality rates. GCA is classified into three main histological types: well-differentiated (intestinal type), poorly differentiated (diffuse type), and mixed or indeterminate forms. These types vary in causes, epidemiology, and genetics, with the diffuse type often associated with the worst prognosis. Endoscopic biopsy is the primary method for characterization, but it has its limitations. There is potential in using contrast-enhanced computed tomography (CT) to differentiate between histological subtypes of gastric adenocarcinoma, which could aid subtype differentiation. Building on this, our study aims to assess CT's effectiveness in distinguishing between broad histological groups of gastric adenocarcinoma based on enhancement patterns, contributing to improved diagnostic accuracy Objective Our research focuses on evaluating the effectiveness of multiphasic contrast-enhanced computed tomography (CECT) in distinguishing between the three broad histopathological subtypes of gastrointestinal cancers. Methods This study was a prospective, analytical observational study that was approvedand carried out in our institutional tertiary care hospital. Consecutive individuals who had undergone endoscopic-guided biopsy and demonstrated histological evidence of GCA were taken into consideration for participation in the study. In order to complete the clinical staging process, further multiphasic CT scans were carried out on each of the fifty patients and were categorised accordingly based on the findings of histopathology. Results In the differentiated type, segmental distribution was: 5.5% upper segment, 16.7% middle segment, 66.7% lower segment, and 11.1% diffuse type. Esophageal involvement was 5.6%, duodenal involvement was similar, and lymph node involvement was approximately 38.8%. TNM staging: 38.8% IIIB, 22.2% III, 27.8% IVA, and 11.1% IVB. In the undifferentiated type, segmental distribution: 6.2% upper segment, 31.2% middle segment, 50.0% lower segment, and 12.5% diffuse type. Esophageal involvement was around 6.25%, duodenal involvement was 18.75%, and lymph node involvement was about 71.8%. TNM staging: 34.4% IIIB, 21.8% III, 28.1% IVA, and 15.6% IVB. Conclusion Multiphasic CT evaluations provide valuable insights into the prognostic aspects of gastric carcinomas by assessing peak enhancement. Differentiated tumors typically exhibit arterial phase enhancement, while undifferentiated tumors show venous phase enhancement, reflecting their microvascular architecture. Recent studies emphasize the importance of understanding gastric carcinoma characteristics for diagnosis and prognosis. Our research aligns with this, revealing distinct contrast enhancement patterns between differentiated and undifferentiated types. However, discrepancies in histological classifications and contrast enhancement patterns across studies warrant further investigation. Integrating histopathological and radiological insights is essential for accurate diagnosis and treatment planning.

Juxtaglomerular (JG) cell-specific deletion of the NADPH oxidase accessory protein, NOXA1, decreases pro-renin and proteinuria in vivo in a mouse model of diabetes

A large fraction of patients with diabetes develops diabetic nephropathy. Plasma pro-renin levels are elevated in diabetic patients and thought to contribute to hypertension, renal damage and inflammation. Studying the mechanisms by which diabetes reprograms JG cells to increase pro-renin release could provide new targets for kidney disease. We previously found that JG cells from diabetic mice had higher reactive oxygen species production (superoxide and H2O2), pro-renin expression and pro-renin and renin release. We hypothesized that increased ROS production by specific NADPH oxidases (NOXs) in JG cells is responsible for higher pro-renin release and contributes to glomerular damage in diabetes. Western Blots showed that the NADPH oxidase isoform NOX1 and NOXA1 are upregulated in JG cells from diabetic mice (C57=100%; Akita=147±10%; n=4; p<0.05), whereas NOX2 or NOX4 were not different. Confocal microscopy showed that NOX1 and NOXA1 are present in JG cells and co-localize with renin-containing granules (n=3). Silencing NOX1 in primary cultures of JG cells from diabetic mice decreased renin release to C57 control levels; (n=6; p<0.01) whereas silencing NOX4 had no effect (n=6). To study the role of NOXA1 and NOX1 in JG cells in vivo, we used Cas9 mediated silencing in kidneys of control mice. Adenoviruses expressing Cas9 under control of the Ren1 promoter (AV-Ren1-Cas9) and AAV-gRNA-NOXA1 were loaded into 28-day minipumps and delivered into the renal subcapsular space in C57 mice. After 5 weeks, we obtained control (non-transduced) and Ren-Cas9-NOXA1-edited kidneys and isolated JG cells. NOXA1 expression was reduced by 60±22% in isolated JG cells and pro-renin expression was decreased by 46±19% compared to non-transduced kidneys (n=3). We then specifically deleted NOXA1 from JG cells in diabetic mice by subcapsular delivery of AV-Ren1-Cre in the kidney cortex of transgenic NOXA1 floxed diabetic Akita mice. JG cell-specific deletion of NOXA1 in diabetic mice decreased urinary ROS (8-Isoprostane pg/24hrs: Akita=4091±307; NOXA1 JG/KO=3086 ±137; n=4; p<0.05), and glomerular damage as indicated by decrease proteinuria (24h Ualbumin Akita= 98.6± 9.4; NOXA1 JG/KO= 57.8± 16.4 μg/24h; n=4; p<0.05). We conclude that enhanced NOX1/NOXA1 induced ROS in JG cells drive enhanced pro-renin release from JG cells which contribute to glomerular damage in diabetes. Thus, NOXA1/NOX1 in JG cells are a potential new target for diabetic nephropathy. DK105300-RO3 Henry Ford Hospital Institutional Funds. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

The lived experience of South African men having a premature baby.

Much has been written about fathers, fatherhood and premature babies. However, in the South African context, studies about the experiences of fathers having a premature baby are lacking. This study aimed to explore how South African fathers (n = 10) experience having a premature baby using a descriptive phenomenological approach. This research study was conducted online using various social media platforms such as WhatsApp, Google Meet and through telephonic conversations. A descriptive phenomenological approach that allowed for the distillation and elucidation of common core experiences among fathers who had a premature baby. The findings demonstrated that the participants experienced intense fears regarding the survival and well-being of their children. They reported experiencing financial difficulties related to hospital bills and experienced being alienated by hospital institutions. Despite these reported barriers, these fathers were adamant in their resolve to support their children and partners during this challenging time. The experiences of fathers were riddled with fear, uncertainty, ambiguity and alienation, which placed them in very precarious situations when trying to navigate their role in a more sensitive and enlightened way. Having a premature infant calls into question the systems that men are positioned within as these systems to a large extent shape these events and how they are experienced. This study is original as no other published studies seem to exist in South Africa that speaks to fathers' lived experiences of having a premature baby.

The Case to Discard Hospital Mission Statements and Replace It with A Statement of Goals

Background: Hospitals and healthcare institutions spend a considerable amount of time and capital on constructing an appropriate mission statement for themselves. Methods: A review of the purpose of mission statements and the statements made by different healthcare organizations was undertaken. For institutions in the USA, their mission statements were examined in the context of their national ratings. Results: The mission statements of healthcare organizations are often too abstract, using similar phraseology about caring for patients. Concern for the community that the hospital serves is stated by both a hospital listed as one of the best US hospitals and an institution that was considered to be in the lowest tier in the same country. Similarly, the recognition of ‘research’ or ‘innovation and discovery’ was stated by respectively both a top institution in the USA and one in the bottom tier. Conclusions: Healthcare institutions should replace their mission statements with clear and attainable statements of concrete goals, and indicate how successful the institution is at attaining those goals and improving the experience of its patients and staff.

Analysis of the cause of death among the adult population in the provision of poor-quality medical services in public health institutions of the Republic of Tajikistan

Introduction. The trend of increasing cases of harm to health/life of patients in the provision of poor-quality medical services is of particular importance in the field of public health. The purpose of the study. Analysis of the cause of death among the adult population in the provision of poor-quality medical services in public health institutions of the Republic of Tajikistan. Materials and methods. The study was conducted on the basis of data on deaths among the adult population (over 18 years) of the Republic in the structure of hospital institutions of the Republic of Tajikistan 0ver period of 2019–2021 and 6 months of 2022. Results. Over period of 2019–2022 there were registered 1881, 4119, and 2567 deceased patients older 18 years, respectively, the hospital mortality rate was 0.2; 0.6, and 0.3%. The frequency of respiratory diseases during 2020 compared to the previous year (n = 70; 0.2%) due to complications of COVID-19 increased by more than 15 times (n = 1577; 3.1%), and in 2021 decreased to 2.2 times (n = 541; 1.4%). In the structure of causes of death there were dominated complications of diseases of the circulatory system (39.5%), the consequences of surgical interventions (12.7%), followed by injuries (10.7%), tumors (3.8%) and the endocrine system (3.3%). The duration of the period before hospitalization of patients who died from surgical diseases was 8.5% — up to 1 day, 68.5% — up to 5 days and 22.8% — from 5 to 15 days. Research limitation. Pathological anatomical examination of the corpses of deceased patients, which is of key importance in establishing the causes of deaths in healthcare institutions, is carried out in the republic at an extremely low number for religious reasons. Conclusion. In state healthcare institutions of the Republic, the registration of deaths due to the provision of poor-quality medical services in the period before and after hospitalization does not correspond to reality, which requires the improvement of the reporting system in accordance with international standards.

Real world data in mechanical thrombectomy: who are we losing to follow-up?

BackgroundMissing outcome data (MOD) is a common problem in clinical trials and registries, and a potential bias when drawing conclusions from these data. Identifying factors associated with MOD may help...

Antimicrobial activity of cefepime-tazobactam combination against extended spectrum beta-lactamase and/or AmpC beta-lactamase- producing gram-negative bacilli

BackgroundThe problem of resistance to beta-lactam antibiotics, which is caused by ESBL and AmpC β-lactamases, is getting worse globally. Infections caused by bacterial isolates harboring these enzymes are difficult to treat with carbapenems being the sole effective treatment option for such infections. The objective of this study was to determine the frequency of ESBLs and AmpC-producing Gram-negative bacilli isolated from clinical specimens and to evaluate the sensitivity of cefepime-tazobactam combination against them.MethodsThis is an observational cross-sectional study carried out on 100 Gram-negative bacilli at Theodor Bilharz Research Institute Hospital during the period from February 2015 to January 2016. ESBL production was screened by using the disc diffusion test followed by confirmation by the combined disc confirmatory test, the screening for AmpC production was conducted using the cefoxitin disc test, which was subsequently confirmed by the AmpC disc test. Isolates confirmed positive for ESBL and/ or AmpC production were investigated for their susceptibility to antibiotics.ResultsAmong 100 Gram-negative bacilli, 44 isolates were confirmed as ESBL producers by the combined disc confirmatory test out of 56 isolates that tested positive for ESBL production through the disc diffusion test. The presence of AmpC production was assessed using the cefoxitin disc test, 32 isolates were screened to be AmpC producers, and the AmpC disc test confirmed AmpC production in 9 isolates of them. Using the Mast® D68C set, 32 isolates were ESBL producers, 3 were AmpC producers, and 4 isolates were ESBL/AmpC co-producers. The highest sensitivity was to cefepime-tazobactam (91.48%) followed by the carbapenems.ConclusionCefepime-tazobactam showed remarkable activity against ESBL and/or AmpC-producing Gram-negative bacilli and may be considered as a therapeutic alternative to carbapenems.

Evaluating the moderating role of management inspection between safety hazards in hospital working conditions: A study of hospitals in Islamabad

The study identifies the relationship between safety hazards and hospitals working conditions. The management inspection role supported by the management in hospitals is identified to bring safety measures precautions and effectiveness for the healthcare staff and make the hospital working conditions better. The hospital management inspection role helps to accomplish occupational safety and better working conditions. The objective of this study is to identify the relationship of management inspection role in tackling with the safety hazards to find out working conditions in Al-Shifa International hospital and Pakistan Institute of Medical Sciences hospital. The study used various statistical tests like Pearson’s correlation and KMOs Bartlet’s test to evaluate the predictors of safety barriers, working conditions and management inspection role. Data was gathered using research questionnaire and the response rate was 73%. Among the 500 respondents, 75% were males while 25%were females. The age range was 40 or above years with a mean of 2.5. The reliability analysis for the constructs is in the acceptable range. The management lacking in providing the safety information rated as 0.61 correlation matrix. The medical doctors’ responded noise as the most detrimental factor resulted with 0.70 communality and lack of health facility comes as 0.61. The structure matrix shows biological hazards rated as 0.66 and physical explosion hazards rated as 0.70 which is analyzed through KMO Bartlet’s test. The safety hazards existence in the hospitals calls upon the attention on conducting research on inspection, detection and reporting of the hazards.

The mediating role of cardiac patients’ perception of nursing care on the relationship between kinesiophobia, anxiety and depression in rural hospitals: a cross-sectional study

BackgroundKinesiophobia could act as a significant barrier against physical activity following cardiac procedures worsening cardiovascular health problems and potentially leading to conditions like hospital-acquired anxiety and depression among patients with cardiovascular disease (CVD). Nurses are the vanguard health care team who can aid patients in taking proactive steps to overcome fear of movement following cardiac procedures.AimThe overarching aim is to investigate the relationship between kinesiophobia, anxiety and depression, and patients’ perception of nursing care.MethodA descriptive correlational research design in two rural hospitals, conducted at cardiac intensive care units of Kafr Eldawar Hospital and Damanhur Medical National Institute. Data were collected from 265 nurses, using the following patient-reported outcome measures, the Tampa Scale for Kinesiophobia (TSK), the Hospital Anxiety and Depression Scale (HADS), the Person-Centered Critical Care Nursing Questionnaire (PCCNP) and the patients’ demographic and clinical profile.ResultA significant negative correlation was found between HADS and PCCNP (r: -0.510, p < 0.001) however, Kinesiophobia was significantly and positively correlated (r: 0.271, p < 0.001). A direct effect of PCCNP in the presence of the mediator was found to be not statistically significant (-0.015, CR = 0.302, p = 0.763). Nonetheless, PCCNP indirectly affects kinesiophobia through HADS (p=-0.099).Implication for nursing practiceCustomizing individualized cardiac rehabilitation (CR) programs based on the emotional experience of cardiac patients will be conducive to rehabilitation and prognosis for patients, thereby lessening the physical burden and improving their quality of life.