Paramedical Staff Research Articles

Cloud Computing-Based Framework for Breast Tumor Image Classification Using Fusion of AlexNet and GLCM Texture Features with Ensemble Multi-Kernel Support Vector Machine (MK-SVM).

Breast cancer is common among women all over the world. Early identification of breast cancer lowers death rates. However, it is difficult to determine whether these are cancerous or noncancerous lesions due to their inconsistencies in image appearance. Machine learning techniques are widely employed in imaging analysis as a diagnostic method for breast cancer classification. However, patients cannot take advantage of remote areas as these systems are unavailable on clouds. Thus, breast cancer detection for remote patients is indispensable, which can only be possible through cloud computing. The user is allowed to feed images into the cloud system, which is further investigated through the computer aided diagnosis (CAD) system. Such systems could also be used to track patients, older adults, especially with disabilities, particularly in remote areas of developing countries that do not have medical facilities and paramedic staff. In the proposed CAD system, a fusion of AlexNet architecture and GLCM (gray-level cooccurrence matrix) features are used to extract distinguishable texture features from breast tissues. Finally, to attain higher precision, an ensemble of MK-SVM is used. For testing purposes, the proposed model is applied to the MIAS dataset, a commonly used breast image database, and achieved 96.26% accuracy.

An Investigation into Patient Satisfaction from the Healthcare System in Saudi Arabia: Survey and Analysis of the Major Determinants in the Qassim Region

The main aim of this empirical study is to investigate and assess the degree of patient satisfaction in hospitals in the Al-Qassim region of Saudi Arabia and the primary causes that may contribute to satisfaction or dissatisfaction with the healthcare system. Primary data were acquired from a sample consisting of 292 patients in the Kingdom of Saudi Arabia's Al-Qassim region. The level of patient satisfaction with the healthcare system in Al-Qassim region was investigated using a self-administered questionnaire. The main determinants of patient satisfaction in the healthcare system included patient demographics, expectations, perceptions, and experiences. In Al-Qassim region patient experiences and expectations were the most important elements in influencing their satisfaction level. Further, demographics factors have favorable and substantial effects on people's perceptions and behavior regarding their satisfaction level with healthcare services in the Al-Qassim region. This research will aid healthcare administrators, policymakers, paramedical staff, and physicians in identifying the reasons for patient dissatisfaction and considering viable options to improve patient satisfaction levels in the health care system.

Exploring the challenges in the management of childhood pneumonia-qualitative findings from health care providers from two high prevalence states in India.

India ranks among the top five countries in the world in child deaths due to pneumonia. Apart from poor public awareness, inadequate health infrastructure and treatment services have compromised effective management. This qualitative study guided by components of the Andersen-Newman's health care utilization framework explored contextual and community challenges faced by health care providers (HCPs) in the delivery of care services for children with pneumonia in select districts of Uttar Pradesh (UP) and Madhya Pradesh (MP). Semi structured interviews (SSIs) and focus groups discussions (FGDs) were carried out with a purposive sample of HCPs selected from three districts in each state. The HCPs included doctors and community health workers (CHWs). All SSIs and FGDs were audio- recorded, with consent, transcribed verbatim, entered into NVivo and analysed using thematic analysis. A total of 15 SSIs were conducted with doctors and eight FGDs were carried out with CHWs. Two themes that best explained the data were:, 1. Health systems: barriers faced in delivery of care services and 2. Evaluated Need: perceptions on community awareness and practices. According to the HCPs inadequacies in government health infrastructure both manpower and equipment, and skill deficits of paramedical staff and CHWs contributed to poor quality of care services for management of childhood pneumonia. This combined with inadequate understanding of pneumonia in the community, dependence on unqualified care providers and distrust of government hospitals acted as barriers to seeking appropriate medical care. Additionally, poor compliance with exclusive breast feeding practices, nutrition and hygiene had contributed to the high prevalence of the disease in these states. Strengthening public health facilities, instilling trust and confidence in people about the availability and the quality of these services and enhancing health literacy around childhood pneumonia would be critical towards protecting children from this disease.

Screening for Severe Illness at Diagnosis Has the Potential to Prevent Early TB Deaths: Programmatic Experience From Karnataka, India.

Due to the coronavirus disease (COVID-19) pandemic and its associated response, TB deaths increased for the first time in a decade. In any potentially fatal illness, an assessment of severity is essential. This is not systematically done for adults with TB, mostly due to a lack of policy and/or limited availability of diagnostic and clinical capacity. We developed a screening tool using simple and easily measurable indicators that can be used by paramedical TB program staff to quickly identify people with severe illness. During October-November 2020 in Karnataka, India, the paramedical program staff from 16 districts screened people with TB (aged ≥15 years) notified by public facilities for "high risk of severe illness," which was defined as the presence of any of the following indicators: (1) body mass index (BMI) ≤14.0 kg/m2; (2) BMI ≤16.0 kg/m2 with bilateral leg swelling; (3) respiratory rate >24/minute; (4) oxygen saturation <94%; (5) inability to stand without support. In this cohort study, we determined the incidence of program-recorded early deaths (within 2 months) and its association with high risk of severe illness. Of 3,010 people with TB, 1,529 (50.8%) were screened at diagnosis/notification, of whom 537 (35.1%) had a high risk of severe illness. There were 195 (6.5%, 95% CI=5.7, 7.4) early deaths: 59 (30.2%) within a week and 100 (51.3%) within 2 weeks of treatment initiation. The incidence of early deaths was significantly higher among those with high risk of severe illness (8.9%) at diagnosis compared to those without (3.8%) [adjusted relative risk: 2.36 (95% confidence interval=1.57, 3.55)]. To conclude, early deaths were especially high during the first 2 weeks and strongly associated with a high risk of severe illness at diagnosis/notification. Screening for severe illness should be explored as a potential strategy to end TB deaths.

Prevalence of ST-Segment Elevation Myocardial Infarction (STEMI) in Pakistan and the Role of Primary Percutaneous Coronary Intervention (PPCI)

There are various strategies used for treating ST-segment elevated myocardial infarction (STEMI). Among those approaches, Primary percutaneous coronary intervention (PPCI) is the current treatment of choice for STEMI as it reperfuses the ischaemic cardiac tissue with fewer reported adverse events and a better survival rate. Although thrombolytic therapy is still used for STEMI in approximation, the benefits of PPCI outweigh thrombolytic therapy as thrombolytic therapy is associated with higher bleeding events and higher morbidity. The barriers in implementing a PPCI program and regional differences arise due to limited technologies, lack of proper training of first responders, lack of public awareness, and transport facilities and finances. Therefore, treatment varies between different regions of countries and even between different countries, including Pakistan. PPCI should be used in a timely manner as delayed use of this intervention can significantly reduce the benefits. We lack a coordinated approach to the delivery of this system in Pakistan; mainly, the&#x0D; paramedical staff is not fully familiarised and trained for making a definite diagnosis and lacks referral portals. We need a comprehensive approach and program to identify factors that cause a delay in providing PPCI to STEMI patients and to eliminate the factors responsible for the delay. This will help in improving the survival rate morbidity in STEMI patients.

Knowledge, Attitude, and Practice of Health Care Workers in Management of Bio-Medical Waste – A Cross-Sectional Study

Background: Management of Bio-Medical Waste involves a great concern. Therefore, awareness of Health-Care Workers (HCWs) becomes very important as improper management leads to injuries and the spread of infection to the staff, patients, and environment. The objective is to assess the Knowledge, Attitude, and Practice (KAP) among Health Care Professionals regarding Bio-Medical Waste Management (BMWM). Method: This cross-sectional survey was conducted among HCWs at GMC Jammu, India. Study participants were divided into III groups (Group I- 32 Doctors, group II- 48 Paramedical staff including nurses &amp; laboratory technicians, and group III- 20 sanitary workers). Data was collected using a pre-designed questionnaire regarding BMWM and scored as good, average, and poor. Results: In our study, knowledge regarding symbols of BMWM and awareness regarding categories and segregation of BMW was good in I and II groups but averaged in group III. None in group III has attended CME regarding BMWM in the past. In contrast, this percentage was 61% in group II and 31% in group I. Regarding the capping and destroying of needles, 88% of Paramedics were doing it correctly. None of the class IV employees received the booster dose of HBV vaccination. Conclusion: Knowledge regarding BMWM was average in Group I and Group II, whereas Group III had the slightest knowledge. Attitude regarding the BMW was good in the case of groups I and II, Whereas Group III scored average. Practices were scored average in Group I, good in Group II, and poor in group III.

Design and Implementation of a Medical TeleMonitoring System based on IoT

With the advancement of technology, healthcare and monitoring systems face significant issues. Internet of Things (IoT) in healthcare enables real-time health monitoring at a low cost. This paper aims to provide a medical telemonitoring system based on IoT for healthcare applications for doctors and paramedical staff. The system is made up of many sensors that can capture electrocardiograms (ECGs) in real-time and measure the temperature of the human body. The designed circuit is implemented and the obtained results are analyzed and discussed.

Screening for gestational diabetes, Ahmedabad, India.

ObjectiveTo implement a community-based screening and awareness-raising project for gestational diabetes in Ahmedabad, India.MethodsThe project took place between April 2016 and August 2019 in Ahmedabad. Medical college faculty members and medical officers trained 3582 paramedical staff on screening for gestational diabetes. These paramedical staff tested all pregnant women 24–28 weeks gestation, who were attending village health and nutrition days – also called mamta days – in urban and rural health centres for routine antenatal care, for gestational diabetes. An oral glucose tolerance test was used and blood sugar ≥ 7.8 mmol/L was the cut-off for gestational diabetes. Women with gestational diabetes were referred for counselling and treatment and all women were followed until 6 weeks after delivery.FindingsOf 53 522 pregnant women screened, 6786 (12.7%) had gestational diabetes and were referred for nutritional therapy or medication; 836 (12.3%) of these women started medication. There was no significant difference in the prevalence of stillbirths between women with gestational diabetes (0.8%; 54/6786) and women without (0.7%; 338/46 736; P-value: 0.51). Of the women on treatment, 38 had abnormal blood glucose after delivery and continued with the medication. Two women with gestational diabetes died; they had other associated co-morbidities – pre-eclampsia and anaemia.ConclusionWe found a high prevalence of gestational diabetes, indicating the need for gestational diabetes screening and implementation of this project on a larger scale. Gestational diabetes screening at the community level is operationally feasible using the existing human resources and infrastructure of the reproductive health programmes.

A survey of statistical methods for inequalities in access to healthcare—Kermanshah in West Iran

Background:Access to medical care is one of the major issues affecting human health. This study aims to investigate inequality in access to medical care in the townships in Kermanshah, Iran.MethodsMethodology approach includes a descriptive-analytic study followed by determining the degree of development of the townships calculated in terms of access to medical care through the hierarchical cluster analysis and the combined model of human development index. Additionally, the mean center and standard distance tests are handled in a geographic information system software to identify the deployment pattern of the status of access to medical care indexes.ResultsAs for the ratio of physicians, nursing staff, paramedical staff, administrative staff of health care, dentists, pharmacists, hospitals, general and specialized clinics, radiology, rehabilitation centers and laboratories to a population of 10,000, the results of analyzing the findings were indicative of unequal distribution of facilities at the level of townships. This is based on The results of comparing the mean centers of population and health facilities showed that the centers of both data categories were located in Kermanshah. The two standard distances (i.e., population and health facilities) demonstrated that the health facilities witnessed more dispersion in the northwestern regions than the concentration of population in the central and southeastern regions of the province.ConclusionsThe results indicated that the indexes of development of facilities and healthcare resources were not distributed equitably and with a balance between the townships of the Kermanshah Province.

Awareness regarding prevention and management of needle stick injury among the health care providers in a tertiary care Hospital, Bhubaneswar, Odisha- A qualitative data exploration

Needle stick injuries are preventable causes of fearsome diseases like Hepatitis B and HIV. In spite of this knowledge, the health care providers are quite negligent, and the institutional support too is compromised due to the increased demand for services. The current study is a dipstick audit of the knowledge and practices on NSI (prevention and management) among exposed health care workers, with specific reference to HIV infection in a private health facility in Bhubaneswar city, using an unorthodox tool of Focus Group Discussions among the participants.: The exercise was a part of the academic activity of health promotion on World AIDS Day 2021. Health care workers such as doctors, paramedical staff &amp; utility staff voluntarily participated in the FGD session. Total 3 FGDs were conducted at 3 different places inside the hospital premises. Three moderators were selected previously and after discussing the theme of World AIDS Day, they guided the FGDs with similar probing questionnaires. The sessions were recorded with the help of a recorder and also noted down along with Sociograms. The data gave a real picture of how even premier institutions are complacent regarding the problem. Only 27% knew about the SOPs, and in none of the stations,SOPs were displayed or a register was maintained regarding NSI in their work area. None of the participants were aware of Post Exposure Prophylaxis for the same. This indeed highlighted an ignored aspect of quality health care. The data was an eye-opener in a tertiary care center and from time to time there should be refresher training or sessions to increase the level of awareness.

STAFFING OF THE OUTPATIENT LEVEL IN TVER (RUSSIA)

RELEVANCE: The human resources policy is one of the leading social and economic sectors of society. There is a vast shortage in health professionals on a global scale. This problem is aggravated every year. That’s why it is so relevant now. Public health facilities are affected most of all. They have to compete with private clinics, which provide more favorable working conditions for specialists. The health system needs qualified personnel. The global shortage of doctors due also to “optimisation” processes that have been recognized as ineffective. The human resources policy of health care is aimed primarily to increase the number of medical personnel. The state population's health depends on it. In this regard, the problem of staffing in health care is an important area of ​​analysis. PURPOSE: To analyze employment data in public health facilities in the city of Tver and to evaluate the trends in staff turnover rates. MATERIALS. The data from official reports of polyclinics No. 1, No. 2, No. 3 of City Clinical Hospital No. 7 in Tver (Russia) was analyzed. The assessment was carried out for the period from 2011 to 2020 by comparing three time periods: 2011-2014, 2015-2017, 2018-2020. In the course of its work, mathematical calculations on the validity of the investigated data were made. RESULTS. The analysis of data from polyclinic No. 1 shows a decrease in the percentage of employment among doctors by 38% (p=0.197) and among nurses by 17.5% (p=0.559). The employment of paramedical staff did not change and remained below 50% throughout the decade. There is a clear shortage of outpatient personnel. The indicators of polyclinic No. 2 indicate a stable positive dynamics of staff employment in the field. However, nursing and paramedical personnel require an increase in involvement in the specialty, because there are a large number of free positions. The indicators of polyclinic No. 3 have not changed for 10 years. This polyclinic has a minimum number of rates for the work of medical personnel. It may be due to the peculiarities of the territorial location of this medical institution. CONCLUSION: A decrease in the percentage of staff employment was noted in the polyclinics of the City Clinical Hospital No. 7 for the period 2011-2020 for various reasons. In general, the decrease in indicators was observed among doctors. The grounds for termination of employment may be: the remoteness of the workplace, low wages, high professional loads, including the additional work. It is necessary to develop the right strategy to compensate for the vacant positions of specialists. One of the main reference points can be monitoring the employment of hospital staff. This issue remains relevant in the regions of the Russian Federation.

STAFFING OF THE OUTPATIENT LEVEL IN TVER (RUSSIA)

RELEVANCE: The human resources policy is one of the leading social and economic sectors of society. There is a vast shortage in health professionals on a global scale. This problem is aggravated every year. That’s why it is so relevant now. Public health facilities are affected most of all. They have to compete with private clinics, which provide more favorable working conditions for specialists. The health system needs qualified personnel. The global shortage of doctors due also to “optimisation” processes that have been recognized as ineffective. The human resources policy of health care is aimed primarily to increase the number of medical personnel. The state population's health depends on it. In this regard, the problem of staffing in health care is an important area of ​​analysis. PURPOSE: To analyze employment data in public health facilities in the city of Tver and to evaluate the trends in staff turnover rates. MATERIALS. The data from official reports of polyclinics No. 1, No. 2, No. 3 of City Clinical Hospital No. 7 in Tver (Russia) was analyzed. The assessment was carried out for the period from 2011 to 2020 by comparing three time periods: 2011-2014, 2015-2017, 2018-2020. In the course of its work, mathematical calculations on the validity of the investigated data were made. RESULTS. The analysis of data from polyclinic No. 1 shows a decrease in the percentage of employment among doctors by 38% (p=0.197) and among nurses by 17.5% (p=0.559). The employment of paramedical staff did not change and remained below 50% throughout the decade. There is a clear shortage of outpatient personnel. The indicators of polyclinic No. 2 indicate a stable positive dynamics of staff employment in the field. However, nursing and paramedical personnel require an increase in involvement in the specialty, because there are a large number of free positions. The indicators of polyclinic No. 3 have not changed for 10 years. This polyclinic has a minimum number of rates for the work of medical personnel. It may be due to the peculiarities of the territorial location of this medical institution. CONCLUSION: A decrease in the percentage of staff employment was noted in the polyclinics of the City Clinical Hospital No. 7 for the period 2011-2020 for various reasons. In general, the decrease in indicators was observed among doctors. The grounds for termination of employment may be: the remoteness of the workplace, low wages, high professional loads, including the additional work. It is necessary to develop the right strategy to compensate for the vacant positions of specialists. One of the main reference points can be monitoring the employment of hospital staff. This issue remains relevant in the regions of the Russian Federation.

Clinical Hand Over: A neglected domain in our Health Care

Clinical handover or shift handover refers to “the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis1. It is considered a vital and valuable affair in healthcare pathway in a clinical practice. In fact, it is a complex domain in advanced communication skills in medical sciences, which is being recognized increasingly to enhance patient care and safety. It involves the effective communication of high‑quality clinical information while transferring the patients care responsibility to other person or clinical team or at change of shift or any time or transferring to another hospital2. In clinical practice, if relevant clinical information’s were not shared timely and accurately, may results delay in diagnosis, delayed or inappropriate treatment, any adverse events or omission of care. To overcome this, an effective and accurate clinical handover is very crucial in promoting health care continuity and patient safety3. The World Health Organization, Association of American Medical Colleges and Joint Commission4 has also recognized the importance and emphasize the need to improve handovers quality. These organizations have declared it a core entrustable professional activity and issued a mandate by emphasizing the health care institutes to standardize the handovers process and incorporate handover training of their employees in order to improve the consistency and minimize the vulnerability to errors5,6. It is estimated that in USA over 300 million, in Australia more than 40 million and in UK above 100 million clinical handovers are conducted each year7. Arguably, this number is making this practice most frequent and significant process in communication between clinicians and paramedical staff in providing safe patient care. Due to increasing emphasis on person-centered medical care all over the world, a change from traditional to structured handover’s practices is being developed. Literature is now favoring the use of a structured handover framework and advocates patient’s placement at the centre of their care. It is purely a communicative event which can only be achieved through linguistic exchange, by clinicians or paramedics discussion and writing which is conducted between outgoing and oncoming staff at the time of shift change or during patient hand over. This acts a key tool in ensuring the continuity of patient’s information’s which in turns are very important for the continuity of care8. For better outcome technological support like templates, internet, computers, soft wares etc are also used to enhance the effectiveness and safety of this process5,7. To meet the colleague, organizational and patients’ requirements, the staff and doctors should be made aware about its importance and trained to deliver an effective handover9,10. It is also imperative that doctors and paramedical staff should identify any potential barriers encountered during handovers to effectively address these obstacles. As a part of Good Medical Practice, it is recommended and expected that all health professionals should learn and practice excellent handover skills, in order to ensure effective communication between each other of important patients’ clinical information, to ensure patient safety and enable inter-professional collaboration10. It has been reported in literature that the poorly conducted shift handovers, most likely threaten patient’s quality of care, safety and continuity of care2.

A Comprehensive Study on Common Infectious Diseases in Particular Hospital - Acquired Infections in Any Healthcare Facility - An Analysis

Healthcare Facility Associated/Acquired infections are one of the biggest challenges that healthcare providers face in the patients safety, quality care. These healthcare associated infections acquired during stay in the healthcare facility especially in intensive care units, critical care units, neonatal care units are more compared to other areas of the healthcare facility. Hence it is obligatory on the part of the healthcare professionals and providers to follow the Disinfectant Programs strictly and also the hygienic conditions and guidelines imparted by the healthcare providers as self regulated guidelines in accordance with the facility i.e. in question. Of these, frequent hand washing remains the single most important in infection control program. However identifying mechanisms to ensure compliance of healthcare professionals, Para medical staff remains a perplexing problem. The covid-19 pandemic has given a big lesson for the healthcare providers in strictly following healthcare facility infection control that have surfaced during this Pandemic period. Gloves, Gowns, PPE Kits, masks have played a major role in preventing infections and maintaining physical distance in preventing infections caused due to contacts. In this article, an honest attempt is made in identifying the healthcare facility infections, their symptoms, cause of infections, and remedial measures that are to be followed not only by the healthcare professionals, Para medical staff, providers but the patients and the visitors. These infections place havoc in increasing procedural costs to the patients extra stay than the normal procedural stay in the facility, use of heavy antibiotics that causes loss of immunity in the patient and thereby prolong the recovery time. These infections that are contracted during healthcare facility stay in addition to the above losses the patient lose his/her earnings if he/she is an earning person and at times if the infection is severe and any permanent disablement will lose his/her earnings, finally death will jeopardize the families existence. The regulatory authorities like World Health Organization, NABH in India, JCI, National guidelines for infection, prevention and control in healthcare facilty’s (NGIPCHC) etc are playing an important role not only in the preparation of guidelines but also to improvise them with the help of statistical material that are being collected from time to time. Whatever may be regulatory authorities’ guidelines people associated with the healthcare and the patients should maintan personal hygienic, frequent handwashing and maintaining physical distance is more and more important.

Violation of Professional Behavior Towards Nurses in Pakistan: An Ethical Violation in Healthcare Settings

Professional behavior violation is a ravaging issue worldwide. Incidents of violation of professionalism toward nurses are common in every healthcare setting either in public or in private sectors. Nurses are more vulnerable to workspace violence due to the nature of the job and tasks performed by them in healthcare settings. Lack of respect towards the nursing profession in Pakistani society is a significant contributing factor in violation of professional behavior in the workplace toward nurses. &#x0D; An ethical violation is a conduct that is against the code of ethics and policy of the institute. There are many categories of ethical violation in workplace but the nurses are facing mostly sexual harassment, safety violation, discrimination, professional boundaries violation, abusive and threathening behviour on daily basis. There are many reported cases in which nurses experience rape, unwanted sexual deeds, workplace bullying, and physical violence from patients, their family members and other paramedical staff which leads to the psychologically and physically detrimental effects on the health as well as on the career of the nurses. Yet nothing specific has been done to control the ethical violation at the healthcare settings in Pakistan. In Pakistan on the basis of the job description and direct contact of the nurses with patients and their family members, many incidents are yet disclosed because of the lack of security and threatening behavior toward the nurses in Pakistani society. There should be a strict penalty for those who are incriminated in any type of delinquency to help out the nurses to get through from the ethical violation efficiently and in a decent way. A protective and respectful work environment will give life to the nursing profession and improve the image of the nurses in healthcare settings.&#x0D;

Sehat Sahulat Program: Assessing the awareness and utilization effectiveness of Sehat Insaf Card among the general population of District Rawalpindi.

Objective: To determine the awareness of using Sehat Insaf Card and to determine the utilization effectiveness of Sehat Sahulat Program. Study Design: Cross Sectional study. Setting: Sehat Insaf Card Authorized Hospitals. Period: July 2020 to December 2020. Material &amp; Methods: Data was collected via self-administered questionnaire. The sample size was 316. Non-probability purposive sampling was done. The questionnaire consisted of three parts; Part A: Demographics, Part B: Awareness, Part C: Utilization Effectiveness. IBM, SPSS statistics version 25 was used for data entry. Descriptive statistics like frequency, percentage and proportion were measured. Results: Most of the participants belong to the rural area and fall into the category of 10 – 20 thousand monthly income. The awareness about program came from 2 main sources; Word of mouth and campaign by a local party representative. Majority of the services availed were curative services i.e. 72.8%. Before the launch of SSP, 3/4 of the participants self-paid their medical bills and with this program, its 100% free. 72.8% of the total participants were satisfied with the transportation charges covered in SSP. 92% of the total participants felt no discrimination in hospital in any regard, either from the doctor or the paramedical staff. 99.4% of the total participants were of the opinion that Govt of Pakistan should launch similar new programs. Conclusion: Sehat Insaaf Card distribution among the under-privileged citizens was almost similar in the urban and rural population of Rawalpindi. More involvement of females is need of the hour.

Risk Perception Mental Health Impact and Coping Strategies during Covid 19 Pandemic among Health Care Workers

Objective: To assess the risk perception mental health impact and coping strategies during Covid-19 pandemic among health care workers. Study Design: Cross-sectional study. Place and Duration of Study: Department of Community Dentistry, Frontier Medical &amp; Dental College, Abbottabad from 1st January 2021 to 31st December 2021. Methodology: Two hundred health care workers were given questionnaire for complete detailing their information regarding demographic, occupational, anxiety scoring and depression state. Results: The age of the health care workers was mostly within 26-40 years followed by greater than 18 years. It was observed that anxiety was presented at a mild score within doctors and other health care worker staff while it was seen to a moderate level within the nursing health care workers. Furthermore, the gender distribution of anxiety showed higher level of anxiety among females than males. Within genders a low risk perception was seen within males than females. Among the health care workers, the risk perception was highest in nurses followed by paramedic and other health care staff. Conclusion: Covid-19 has caused devastating effects on the psychological stability of the health care workers which needs to be properly assessed and addressed. Keywords: Covid-19, Health care workers, Anxiety, Risk perception

Screening adults with tuberculosis for severe illness at notification: programme experience from Gujarat, India.

National tuberculosis (TB) programmes in high-burden countries do not systematically assess severity at diagnosis followed by referral for inpatient care. Due to limited capacity, comprehensive assessment of all TB patients is not practical. In three districts of Gujarat (West India) in June 2021, we determined the feasibility of screening for severe illness by paramedical staff of public facilities and the burden of 'high risk for severe illness' at notification among adults (≥15y of age) with TB. In this cross-sectional study, the screening criteria for high risk for severe illness was the presence of any one of the following: body mass index (BMI) ≤14.0kg/m2, BMI ≤16.0kg/m2 with bilateral leg swelling, respiratory rate >24/min, oxygen saturation <94% or inability to stand without support. We summarized the feasibility indicators and burden using proportion (95% confidence interval [CI]) and median, as applicable. Of 626 notified adults, 87% were screened. The median time interval for screening was 3d from notification and all indicators were collected in 97% of patients. The burden of high risk for severe illness was high, at 41.6% (95% CI 37.5 to 45.8). High burden and feasibility (high coverage, acceptable time interval and minimal missing data) makes a strong case for routine screening of severe illness.

Knowledge and apprehension score correlation among healthcare workers in COVID-19 block of tertiary care hospital

COVID-19 was first detected in Wuhan (China), in December 2019. Mode of transmission was by respiratory droplets)or by surface transmission. Changing symptoms, treatment guidelines, and increased transmissibility of the virus were a concern among the healthcare workers. During the pandemic, the anxiety and stress levels were high among HCWs as they were disturbed by the increased caseload with colleagues testing positive. The present study aimed to find a correlation between knowledge and fear among health care workers working in COVID-19 areas of a tertiary care government hospital. This was a hospital-based study conducted at a tertiary care hospital, Rishikesh, Uttarakhand. It was an observational study with a cross-sectional study design. The study was conducted in OPD and IPD of COVID-19 for a period of three months. Study participants were consultants, residents, nurses, hospital attendants, and paramedical staff. Pre-structured questionnaires for knowledgeand fear assessment were utilized. A total of 358 study participants were enrolled. The mean age of study participants was 29± 6.17. The mean knowledge and fear score of all study participants was 9.85 ± 1 and 19.86 ± 5.2 respectively. A negative correlation (r= - 0.04) was found between the knowledge and fear scores. There was a significant difference in knowledge among different groups of HCWs, but the level of fear was not significantly different It was established that the negative correlation between the knowledge and fear score among health care workers working in COVID-19 situation in tertiary health care hospitalRegular training and dissemination of the new updates regarding the pandemic can help in allaying the fear. Making appropriate personal protective equipment available at the healthcare center will boost the confidence of the health workers.

Challenges to radiologists regarding reporting of medico-legal cases (MLC)

During the past few decades, the world of radiologists has been remarkably influenced by the progress in advanced technology. A multi-parametric analysis is required regarding pathological alterations and in-depth details corresponding to each case because of extended the imaging spectrum. The total dependency is mostly upon imaging. Therefore, radiologists need to meet up the complex health quality standards. Radiologists mostly report and scan cases referred from Surgical, Medicine, Pediatrics, orthopedics and Gynecology. And on the other hand they face certain critical issues and challenges in dealing with medico-legal cases. Although they have to follow medical protocols but medico-legal cases are still very difficult to handle. This research highlights all the issues and challenges regarding medico-legal cases faced by the department of Radiology and Emergency of Saidu teaching Hospital Swat. This study was conducted at this Saidu Teaching Hospital Swat, and the study duration was 6 months (April 2021-September 2021). More than 116 people (doctors, radiologists, nurses, and paramedical staff) have participated in this research. Results show that radiologists and other medical staff handle the unexpected and critical challenges in these cases. While writing examination findings, reporting CT scans, MRI, X-Rays and doing ultrasounds, they face political, patient attendant, hospital, and other party pressure to alter the reports to make other party guilty. This article addressed all the issues and challenges that radiologists meet in medical-legal cases.