Level Public Hospital Research Articles

Evaluation of patients who re-admitted to the emergency department within 24 hours

Aim: It was conducted to investigate the demographic and clinical characteristics of patients who re-admitted to the emergency department within 24 hours and to contribute to studies on reducing the re-admission rate. Methods: The data of patients who re-admitted to the emergency department within 24 hours between November 2021 and September 2023 in a secondary level public hospital were retrospectively examined. Data regarding the patients' demographic information, admission dates and times, clinical characteristics, examinations, diagnoses, consultations, hospitalization and referral status were obtained from the hospital automation system. Results: 496270 patients admitted to the emergency department during the study period. 6991 (1.4%) of the patients were admitted to the emergency department again within 24 hours. 40.3% of these patients were between the ages of 19-35 and 52.4% were women. The most common reason for re-admission to the emergency department was upper respiratory tract diseases. It was determined that 66.7% of the patients applied to the emergency department again 13-24 hours after their first admission. In their second admission, 43 patients were hospitalized or transferred for various reasons; It was determined that 1 of these patients died 5 months after being admitted to the intensive care unit. Conclusion: Effective triage practices, directing green area patients to family physicians, making the referral chain effective, increasing health literacy, making an accurate diagnosis, allocating appropriate time to patients and explaining the treatment and expectations from treatment, ensuring that patients referred to polyclinics are evaluated as soon as possible and returned to the emergency department will significantly reduce applications.

Giant paratubal cyst: report of a case in second level public hospital

Giant paratubal cyst: report of a case in second level public hospital

Antibiotic safety among neonates and paediatrics in a public hospital: KwaZulu-Natal.

The World Health Organization (WHO) guidelines recommend the empiric treatment of infections before definitive treatment begins. However, ethical concerns limit the availability of clinical trials in neonates and paediatrics to fully ascertain the safety profile of antibiotics in these populations. This study aimed to quantify the use of antibiotics among neonates and paediatrics and commented on the use, rationale and appropriateness of antibiotics prescribed. A secondary level public sector hospital located in Durban, KwaZulu-Natal. Demographic and treatment information of neonates and paediatrics were collected retrospectively from January 2022 to June 2022. Data were obtained from patient files and extracted for analysis using Microsoft Excel®. Analytical and descriptive statistics were used to analyse patient demographics and treatment variables. A total of 568 antibiotics, issued to 389 patients, were reviewed. Penicillins (40.1%), aminoglycosides (24.3%) and combination penicillin-beta-lactam inhibitors (23.3%) were identified as the most frequently prescribed antibiotics for inpatients. Most antibiotics prescribed to inpatients were for complications associated with pre-term birth (66.9%). Combination penicillin-beta-lactam inhibitors (34.7%), penicillins (29.5%) and cephalosporins (29.5%) were the most frequently prescribed antibiotics to outpatients. A correlation was found between the route of administration and the duration of therapy; the intravenous route (63.6%) was preferred over the oral route (36.4%) for administration. Many broad-spectrum antibiotics were prescribed, thus increasing the risk of resistance. Antibiotics were being prescribed according to the guidelines; however, there is still a need for therapeutic drug monitoring to ensure the continuation of rational drug use. There was evidence of rational use of antibiotics in the public hospital (KwaZulu-Natal), in keeping with economic and availability factors.

Nurse-patient relationship in a tertiary level Public Hospital

Nurse-patient relationship in a tertiary level Public Hospital

1208. Impact of Selected Antimicrobial Stewardship and Infection Control Strategies in Carbapenem Resistance in a Third Level Public Hospital in Colombía.

Abstract Background Antimicrobial Stewardship (AMS) Programs and Infection prevention and control (IPC) strategies have been shown to effectively reduce antimicrobial resistance. The resources required for the implementation of these programs in low-resource settings could be limited. This study aimed to assess the impact of a few AMS and IPC strategies on carbapenem resistance in a third-level public hospital in Colombia. Methods A retrospective before-and-After study was completed. The baseline period consisted of 6 months (January 2021-Jun 2021) and the intervention period consisted of 18 months (July 2021-December 2022) The AMS intervention consisted of the implementation of prospective audits on prescriptions of meropenem, cefepime, and piperacillin-tazobactam, along with educational seminars. The IPC intervention consisted of screening for carbapenemase-producing-Enterobacterales (CPE) through rectal swabs for every patient transferred to the ICU and weekly for all patients in the ICU. A cohorting area with 24 beds was also established to isolate CPE colonized/infected patients Results During the intervention period, 886 prospective audits were made. We suspended 208, 111, and 55 prescriptions of Meropenem, piperacillin-tazobactam, and cefepime respectively. The length of therapy was shortened in 239, 290, and 99 prescriptions of Meropenem, piperacillin-tazobactam, and cefepime respectively. The antimicrobial consumption was lower in the intervention period for meropenem (24,8 DDD/100 patients-days Vs 74.3 DDD/100 patients-days baseline period). Figure 1 The prevalence of positive rectal swabs showed a downward trend during the intervention period. Figure 2. The prevalence of CPE also decreased and was 0,45 during the baseline period and 0,28 during the last semester of the intervention period. Figure 3 The carbapenem resistance K. pneumoniae laboratory-confirmed bloodstream infection rate also decreased during the intervention period, going from 15.4/10.000 patients-days to 1.17/10.000 patient-days. Figure 4 Conclusion The implementation of selected AMS and IPC strategies in a resource limited third level hospital reduced the prevalence of carbapenemase-producing Enterobacterales and the rate of Carbapenem-resistant K. pneumoniae bloodstream infections. Disclosures GERARDO A. MUÑETON, Infectious diseases and Internal Medicine Specialist, PFIZER: Advisor/Consultant

Webapp for Data Recollection and Presentation in a Head and Neck Tumor Board.

Tumor boards (TB) are increasingly being used during multidisciplinary decision making nevertheless, it might result difficult to register all the questions and decisions reached in TB, for example it has been reported that 60% of TB do not document their recommendations in the United Kingdom. Head and neck TB was implemented in a third level public hospital in Mexico five years ago and one of the main difficulties faced was to timely report all of the decisions and specifications made. A webapp was developed to address this concern and placed on the university webpage (https://cuccuanl.com/tb-cyc/). The webapp allowed the physician who would present the case to fill out a survey with the important clinical information. Afterwards a document with the information was generated and presented at the TB. Simultaneously an API was connected to a database where the patient information could be reviewed by the multidisciplinary team on the different consultations of the patient. A survey was done to assess the app utility and the quality of the TB. The webapp was launched on September 2022 and to date 61 head and neck patients have been discussed. 14 of the 17 regular participants of the TB answered the MARS survey to evaluate quality of med-apps. It was hypothesized that the use of the webapp will translate in high levels of usability and satisfaction among the MDs. A total of 50% of respondents were residents in the 20-30-year age bracket. Regarding the specialties 30% were radio oncologists, 43% medical oncologists and 14.3% otorhinolaryngologists. 85% reported the app was useful and 78.6% that the app helped optimize workflow during the TB. 100% had used the app to present a case during the TB and 78.6% in the subsequent consultation of the patient to revise the TB conclusions and the patient characteristics. Regarding usability 85% reported that the app was easy to use, 92% liked the interphase and 100% that the information presented at the TB was well organized and easy to access. Using the webapp 76% of times, out of the 68 patients, the therapeutic decision was altered. The main complaint has been performance issues when trying to use it on mobile. 93% reported that they will keep using the app the upcoming months and 92% that they would recommend the app to a colleague. The most important features for physicians were: ease of access (85.7%), reviewing information not discussed at TB (57.1%) and a friendly interface (49%). As patient complexity increases it becomes increasingly important to document and access all the information. The use of a webapp in the TB has been well received with high levels of usability and satisfaction, while helping document the important information. Important factors to consider for future apps are that physicians value highly the ease of access and the capacity to review all of the clinical information. Further implementation and research in other TB are warranted.

Development and Evaluation of a Mobile App for Radiotherapy Patient Education

Radiotherapy is an area that is at times complex, with multiple steps to take and great variety of side effect profiles between treatments. It is also an area that patients know little about before their first consultation. This makes it confusing and due to time constraints physicians may not always have the time to fully explain everything that should be covered. Patients may then persist with doubts or recur to online information, which is at times inaccurate. It was hypothesized that there is a high informational need among radiotherapy patients that could be aided by using a mobile app. A mobile app for Android and IOS was developed to address patient informational needs called Canswer. The mobile app format was chosen due to ease of access for patients and to integrate all the information formats (infographics, videos, and 3D models) on a single hub. Patients that came to their first radio-oncology consultation were gifted the app through the app store to review at home and asked to fill out a survey in a third level public hospital in Mexico. Likert scales were used to analyze patient perception using validated questionnaires. A subsequent survey was performed after the start of their treatment to evaluate how their perceptions changed and their final opinion on the app. On the analysis of 100 patients the average age of respondents was 50 years. Regarding the medical consultation 45% agreed/strongly agreed that it was too short, 33% that everything was not fully explained, and 31% had doubts after it ended. 24% reported they were not sure which symptoms were urgent or when to visit the ER. Concerning informational needs 81% of patients reported they would like to receive more information to review at home and 93% that the app will be useful. The patients wished to know more about: alarm signs during treatment (70%), treatment process (70%), managing side effects (67%), and anxiety/depression (38%). The app currently holds a 5.0 score with 58 reviews on the app store and 90% of patients would recommend the app to a family member. 75% of patients reported using the app after their initial consultation. The average content reviewed was 67% of the total content. The section that was the most well received was the infographics. 78% reported they felt calmer after reviewing the information. Regarding feedback patients wished more information on nutrition was included and more images were added. Based on the results there is a high informational need among patients and the app helped them review the most important information at home. A common finding among the patients was that they persisted with doubts after their appointment and that it was too short to fully explain everything radiotherapy entails. In general, the app was well received but there is still room for improvement. Future updates and investigations based on these initial findings are warranted to expand into other areas of cancer care.

Airborne grass pollen and thunderstorms influence emergency department asthma presentations in a subtropical climate

BackgroundGrass pollen is considered a major outdoor aeroallergen source worldwide. It is proposed as a mechanism for thunderstorm asthma that lightning during thunderstorms promotes electrical rupture of pollen grains that leads to allergic airway inflammation. However, most evidence of associations between grass pollen and asthma comes from temperate regions. The objective of this study was to investigate short-term associations between airborne grass pollen exposure and asthma emergency department presentations in a subtropical population. MethodsEpisode level public hospital presentations for asthma (2016–2020) were extracted for greater Brisbane, Australia, from Queensland Health's Emergency Data Collection. Concentrations of airborne pollen were determined prospectively using a continuous flow volumetric impaction sampler. Daily time series analysis using a generalised additive mixed model were applied to determine associations between airborne grass pollen concentrations, and lightning count data, with asthma presentations. ResultsAirborne grass pollen showed an association with asthma presentations in Brisbane; a significant association was detected from same day exposure to three days lag. Grass pollen exposure increased daily asthma presentations up to 48.5% (95% CI: 12%, 85.9%) in female children. Lightning did not modify the effect of grass pollen on asthma presentations, however a positive association was detected between cloud-to-cloud lightning strikes and asthma presentations (P = 0.048). ConclusionAirborne grass pollen exposure may exacerbate symptoms of asthma requiring urgent medical care of children and adults in a subtropical climate. This knowledge indicates an opportunity for targeted management of respiratory allergic disease to reduce patient and health system burden. For the first time, an influence of lightning on asthma was detected in this context. The outcomes support a need for continued pollen monitoring and surveillance of thunderstorm asthma risk in subtropical regions.

Evaluating the acceptability of ATMAN intervention for self-harm in youth in India: A pilot study

Background There is a dearth of psychological interventions for self-harm that have been tested and found acceptable by youth in low- and middle income countries. ĀTMAN (Sanskrit word meaning “self” or “self-existent essence”) is one such contextually adapted psychological intervention developed in India. It has three key elements; problem-solving, emotion regulation, and social network strengthening skills. Objective We delivered ATMAN in a series of young people who self-harm to optimize the content, structure and delivery mechanisms, and to assess their experiences of therapy and engagement. Methods ATMAN was delivered sequentially by a psychiatrist and non-specialist counselor in 16 participants between 14 to 24 years who presented to a tertiary level public hospital in Mumbai with self-harm. Quantitative measurement tools included Beck’s Scale for Suicidal Ideation (BSI), the Patient Health Questionnaire −9 (PHQ-9), Functional Assessment of Self-Mutilation, and session feedback form. Qualitative tools included PSYCHLOPS and exit interviews. Results Eight female and four male participants completed therapy with a mean of five sessions and an average duration of 50 min. There were no differences in module wise feedback ratings of the psychiatrist and counselor. There were significant differences in the pre- and post-therapy scores on BSI (mean difference (confidence interval)) (−16.8 (−20.2, −13.3)) and PHQ-9 (−10.8 (−14.5, −7.04)). Various content modifications were undertaken during this phase. Conclusion ATMAN was acceptable to youth in India who self-harm. Modifications introduced during pilot trial phase make ATMAN better suited to the needs of the youth. ATMAN has the potential to be delivered by non- specialist counselors and to be integrated at all levels of health care settings including primary health care to reduce the burden of suicide in young people. However, an extended randomized controlled trial of ATMAN treatment with multiple counselors will help in identifying key competencies that should be developed during training and supervision, and various quality assurance measures that can be undertaken for effective implementation of ATMAN.

Outcomes of mechanical thrombectomy at a single-centre tertiary level public healthcare hospital in South Africa.

Mechanical thrombectomy (MT) is standard of care for acute ischaemic stroke from large vessel occlusion following randomised controlled trials performed largely in high-income countries. Limited data exists on its effectiveness in the setting of low-and-middle-income countries. We aimed to evaluate the safety and efficacy of MT in a tertiary level public hospital in Cape Town, South Africa. Patients with acute ischaemic stroke presenting consecutively to Groote Schuur Hospital between 1 January 2018 to 1 January 2022 with proximal intracranial occlusion in the anterior circulation treated with MT within 6 h from onset using computed tomography (CT) and CT angiography imaging-based protocols were evaluated. Demographic, clinical, radiological and procedural data were obtained from the stroke unit database. Recanalisation was evaluated post-procedure by modified Treatment in Cerebral Infarction score (mTICI). Functional independence (modified Rankin scores 0-2) and mortality at 90 days were also assessed. Thrombectomies were performed in 84 patients during the study period. The median age was 56 years (interquartile range, IQR) and 51% of participants were female. Median National Institute of Health Stroke Score was 18 and median baseline Alberta Stroke Programme Early CT score was 8. Bridging thrombolysis was given to 65% of participants. Median time from symptom onset to reperfusion was 339 min (IQR). Successful recanalisation (mTICI 2b/3) was obtained in 62%. At 90 days, 34% of participants gained functional independence and mortality was 34%. This study demonstrated similar rates of recanalisation and functional independence to that seen in trials in high-income countries using basic imaging despite a higher mortality and longer median time to reperfusion. This data supports the effectiveness of MT in a tertiary level public hospital in South Africa despite the challenges of providing emergent stroke care in a resource-constrained setting.

Drug Utilization Pattern and Potentially Inappropriate Medications among Elderly Inpatients in a Tertiary Care Hospital in Western Nepal

Introduction: Drug utilization research deals with the quality of care focusing on potentially inappropriate medication (PIM), The objectives of the study were to assess the drug utilization pattern (class of drugs used, average number of drugs per prescription per encounter, number of drug prescribed in generic name and antibiotics in prescription) and potentially inappropriate medications and their categories among elderly inpatients.
 Methods: It was a prospective observational study carried out in the medical department of Western Regional Hospital, one of the tertiary level public referral hospital in Pokhara, Nepal. One hundred and two patients of both sexes, age above 65 years and who were hospitalized in medical department were selected. The patients were followed until their discharge to obtain complete information about the drugs being used. Patient data collection form and Updated 2012 Beers Criteria were used to assess drug utilization patterns and determine PIM respectively.
 Results: Most of the patients were in the age group of 65-70 (37.25%) followed by 71-75 (27.45%) and 76-80 (18.62%). Out of 102 patients, 53 (51.97%) were male and 49 (48.03 %) were female. Antimicrobials were the most prescribed medicines (16.73%). Average number of drugs per prescription per encounters, number of drug prescribed in generic name and number of antibiotics in prescription were 7.26, 9.6% and 21% respectively. About 57% of medicines were prescribed from the national essential medicine list. Among them, 20 (3.91%) of all drugs had at least one PIM. There were 27 drugs in Beers criteria A, one drug in Beers criteria B, and no drug in Beers criteria C.
 Conclusion: Antibiotic prescription was found within the optimal values whereas values of other prescribing indicators were out of the optimal values in comparing earlier studies. PIM was observed in prescriptions that suggest irrational practice and the need for interventions.

Tracheostomy Patient Care Unit. An innovative Otorhinolaryngology solution of a transversal nature for the hospital

Background and objectiveThe care of tracheostomized patients are high risk skills and low incidence. Strategies for improvement of health care in hospital wards and specialties other than otolaryngology based solely on training have not been able to offer an adequate solution. A tracheostomized patient unit is presented directed by the otolaryngology service to attend all tracheostomized hospitalised patients of all specialties. Material and methodsBackground: Third level public hospital with 876 hospitalisation beds and 30 ICU beds for 481,296 inhabitants. Unit model: Transversal unit for the hospital providing attention to all tracheostomized patients, adults, and children, of all specialties, with dedication of 50% of a ENT nurse of hospitalisation that moves to the hospitalisation bed of the specialty of each patient and 50% of another office ENT nurse for ambulatory patients care, with the consultancy of an ENT specialist and coordinated by the ENT supervisor. Results572 patients between 2016 and 2021, 80% men, aged 63 ± 14 years, were attended in the Unit. 14.7 ± 2 tracheostomized patients daily and 96 ± 4 complication annual consultations were attended, rising up to 19 tracheostomized patients daily by 2020 and 141 ± 8.4 consultations by complications in 2020 and 2021, during the COVID-19 pandemic. The mean stay of the non-ENT specialties was reduced in 13 days, increasing the satisfaction of the ENT and non-ENT professionals and the satisfaction of the users. ConclusionsA Tracheostomized Patient Care Unit proactively directed from the Otorhinolaryngology Service to transversally care for all tracheostomized patients improves the quality of health care by reducing stay, complications, and emergencies. Improves the satisfaction of non-otolaryngological professionals by reducing the anxiety of facing care of patients who lack knowledge and experience and that of ENT specialists and nurses by reducing unplanned extemporaneous demands for care. Improves user satisfaction by perceiving adequate continuity of care. The Otorhinolaryngology Services provide their experience in the management of laryngectomized and tracheostomized patients and in teamwork with other specialists and professionals without the need to create new structures outside Otorhinolaryngology.

Evaluation of adolescent pregnancies in terms of maternal and perinatal risks

Objective: We aimed to evaluate adolescent pregnancy rates and both maternal and perinatal adverse pregnancy outcomes in a secondary care public hospital. Methods: Maternal and perinatal pregnancy outcomes of pregnant women of adolescent age who applied to a secondary level public hospital between June 2018 and March 2021 were evaluated. The study was started with 1803 patients. After the exclusion criteria, the study was continued with 1753 patients. Results: When the parameters that are significant in the binary analysis are analyzed by logistic regression analysis; 2.13-fold the risk of preterm birth (CI: 1.319–4.625), 1.621-fold the risk of premature rupture of membranes (CI: 1.461–2.328), 2.412-fold the risk of low birth weight (CI: 2.894–4.297), and 1.768 fold the need for NICU (CI: 1.013–2.121) were observed to increase. Conclusion: Negative characteristics of adolescent pregnancies should also be taken into account while developing health policies in the coming years. Poor outcomes of adolescent pregnancies should be transferred to both healthcare professionals and society, and adolescent pregnancies should be reduced.

Obesity in pregnancy in a resource-constrained setting: Complications and cost implications - a retrospective cross-sectional study.

To investigate the complications and costs associated with managing obese pregnant women in a resource-constrained environment. The files were randomly sampled for women that delivered at the tertiary level public sector Greys Hospital in Pietermaritzburg, South Africa; of the retrieved files, 206 met the inclusion criteria (January-June 2020). Patients were stratified by body mass index (normal, overweight, obese). The main outcomes being the prevalence of obesity, we conducted a logistic regression to compare the incidence of associated obstetric complications, and a direct costs comparison. Of the 206 patients, 117 (57%) were obese and at higher risk for fetal and maternal adverse outcomes. The obese/overweight group had higher incidence of pre-pregnancy complications; history of macrosomia and obstetric complications; and increased risk of failed induction, fetal anomalies, unscheduled prenatal care visits, and postpartum hemorrhage. Neonates born to obese/overweight women were at increased need for neonatal unit admission. The mean cost estimates were 49575.3 South African Rand (ZAR) for normal weight, 49310.5 ZAR for overweight, and 54444.2 ZAR for obese women. The high levels of obesity were associated with feto-maternal complications; the association increased healthcare use, resulting in a substantial increase in direct cost to the healthcare system.

Management of medical store in a tertiary level public hospital in Dhaka city

Cross-sectional descriptive study at Dhaka Medical College Hospital from January to December 2013. This study evaluated the medical supply chain in a Dhaka public tertiary hospital. Respondents were hospital shop employees who kept data on medicine procurement, storage, and distribution. 51-59-year-olds made up 36.6% of respondents. 68.3% of the store's workforce were pharmacists. 82.9% of respondents have a diploma or degree. 70% of personnel lacked retail management training. The investigated store had no AC or chiller. Store had a fridge. The pharmacy's drug procurement and selection committee was present. More than half (55%) of drugs were purchased using open tender. Direct purchases made up 30%, donations 13%, and other methods 2%. The store has an expiration-date section. The store contains updated volatile drug storage, safety stock, a stock ledger, vouchers, and invoicing. The shop had no electronic ledger. Lack of space, shelves, a damp or cracked wall, and a refrigerator were issues. Labor was scarce. Shop managers say improve quality management. During the drug receiving procedure, analytical testing ensures preservation and efficacy. Store management in our nation can be improved by giving refresher training on regulations and legislation and maintaining an electronic ledger via a database system.

Management of medical store in a tertiary level public hospital in Dhaka city

Management of medical store in a tertiary level public hospital in Dhaka city

Acute febrile illness among outpatients seeking health care in Bangladeshi hospitals prior to the COVID-19 pandemic.

Understanding the distribution of pathogens causing acute febrile illness (AFI) is important for clinical management of patients in resource-poor settings. We evaluated the proportion of AFI caused by specific pathogens among outpatients in Bangladesh. During May 2019-March 2020, physicians screened patients aged ≥2 years in outpatient departments of four tertiary level public hospitals. We randomly enrolled patients having measured fever (≥100.4°F) during assessment with onset within the past 14 days. Blood and urine samples were tested at icddr,b through rapid diagnostic tests, bacterial culture, and polymerase chain reaction (PCR). Acute and convalescent samples were sent to the Centers for Disease Control and Prevention (USA) for Rickettsia and Orientia (R/O) and Leptospira tests. Among 690 patients, 69 (10%) had enteric fever (Salmonella enterica serotype Typhi orSalmonella enterica serotype Paratyphi), 51 (7.4%) Escherichia coli, and 28 (4.1%) dengue detected. Of the 441 patients tested for R/O, 39 (8.8%) had rickettsioses. We found 7 (2%) Leptospira cases among the 403 AFI patients tested. Nine patients (1%) were hospitalized, and none died. The highest proportion of enteric fever (15%, 36/231) and rickettsioses (14%, 25/182) was in Rajshahi. Dhaka had the most dengue cases (68%, 19/28). R/O affected older children and young adults (IQR 8-23 years) and was detected more frequently in the 21-25 years age-group (17%, 12/70). R/O was more likely to be found in patients in Rajshahi region than in Sylhet (aOR 2.49, 95% CI 0.85-7.32) between July and December (aOR 2.01, 1.01-5.23), and who had a history of recent animal entry inside their house than not (aOR 2.0, 0.93-4.3). Gram-negative Enterobacteriaceae were the most common bacterial infections, and dengue was the most common viral infection among AFI patients in Bangladeshi hospitals, though there was geographic variability. These results can help guide empiric outpatient AFI management.

Unidad de Atención al Paciente Traqueostomizado. Una solución innovadora desde Otorrinolaringología con carácter transversal para el hospital

Background and objectiveThe care of tracheostomized patients are high risk skills and low incidence. Strategies for improvement of health care in hospital wards and specialties other than otolaryngology based solely on training have not been able to offer an adequate solution. A tracheostomized patient unit is presented directed by the otolaryngology service to attend all tracheostomized hospitalized patients of all specialties. Material and methodsBackground: Third level public hospital with 876 hospitalization beds and 30 ICU beds for 481,296 inhabitants. Unit model: Transversal unit for the hospital providing attention to all tracheostomized patients, adults, and children, of all specialties, with dedication of 50% of a ENT nurse of hospitalization that moves to the hospitalization bed of the specialty of each patient and 50% of another office ENT nurse for ambulatory patients care, with the consultancy of an ENT specialist and coordinated by the ENT supervisor. Results572 patients between 2016 and 2021, 80% men, aged 63±14 years, were attended in the unit. 14.7±2 tracheostomized patients daily and 96±4 complication annual consultations were attended, rising up to 19 tracheostomized patients daily by 2020 and 141±8.4 consultations by complications in 2020 and 2021, during the COVID-19 pandemic. The mean stay of the non-ENT specialties was reduced in 13 days, increasing the satisfaction of the ENT and non-ENT professionals and the satisfaction of the users. ConclusionsA Tracheostomized Patient Care Unit proactively directed from the Otorhinolaryngology Service to transversally care for all tracheostomized patients improves the quality of health care by reducing stay, complications, and emergencies. Improves the satisfaction of non-otolaryngological professionals by reducing the anxiety of facing care of patients who lack knowledge and experience and that of ENT specialists and nurses by reducing unplanned extemporaneous demands for care. Improves user satisfaction by perceiving adequate continuity of care. The Otorhinolaryngology Services provide their experience in the management of laryngectomized and tracheostomized patients and in teamwork with other specialists and professionals without the need to create new structures outside otorhinolaryngology.

Mental health impacts of nurses caring for patients with COVID-19 in Peru: Fear of contagion, generalized anxiety, and physical-cognitive fatigue.

The health crisis caused by COVID-19 has resulted in the physical and emotional deterioration of health personnel, especially nurses, whose emotional state is affected by the high risk of contagion, the high demands of health services, and the exhausting working hours. The objective of this research was to determine the relationship between fear, anxiety, and fatigue of nurses caring for patients with COVID-19 in a second level public hospital in Peru. This study presents a quantitative approach and correlational level, cross-sectional, and non-experimental design. The sample consisted of 145 nurses who attended patients with COVID-19 in health care areas. The results show a significant relationship between fear of contagion and physical-cognitive fatigue (p < 0.001; r = 317) and a significant relationship between generalized anxiety and physical-cognitive fatigue (p < 0.001; r = 480). It is concluded that in this context, both fear of contagion and generalized anxiety are related to physical-cognitive fatigue.

Customer Relationship Management in Selected Public and Private Tertiary Hospitals of Dhaka City

Introduction: Customer relationship management (CRM) is a strategy that helps organizations to build long-term relationship with customer and increase profit through a proper management system. Objective: To understand the present state of CRM in tertiary level public and private hospitals in Dhaka City, by identifying customers’ profile, customers’ expectation, and by assessing customers’ satisfaction. Material and Methods: This cross sectional descriptive study was conducted in two tertiary level hospitals of Dhaka city, from July 2018 to June 2019 among 220 samples from each hospital, by convenience sampling. Data were collected by interview using semi structured questionnaire and reviewing of check list. Results: Among service receivers, high monthly income (&gt;30000 Taka) prefer Uttara Adhunic Medical College Hospital (UAMCH) (23%) than Dhaka Medical College hospital (DMCH) (5%). Doctors explained health condition to patient or relatives in 64% cases in DMCH and 82% cases in UAMCH. Nurses attention for privacy and courtesy towards patient was 75% and 31% in DMCH which was 86.4% and 50% in UAMCH. About 59% and 20% service receivers from public and private hospital respectively were of the view that pharmacy staffs did not explained properly about safe methods of taking drugs. The overall patient satisfaction was found 63.7% and 69.4% in DMCH &amp; UAMCH by using The Patient Satisfaction Questionnaire Short Form (PSQ- 18 scale). Conclusion: All these findings suggest that people are satisfied more with service quality of private hospitals than the public hospitals. Private hospitals trying to fulfill the requirements of the patients according to their service quality demand, in contrast, public hospitals are fighting hard to fulfill patients demand with limited resources. JAFMC Bangladesh. Vol 17, No 2 (December) 2021: 61-64