Patients In Tertiary Hospital Research Articles

Hospital-acquired pressure ulcers among adult ICU patients in tertiary hospitals in Oman: a one-year prevalence study.

Hospital-acquired pressure ulcer (HAPU) is a significant problem in healthcare settings and is associated with negative impacts on patient health. Although monitoring of pressure ulcers (PUs) among hospitalised patients was started more than a decade ago in Oman, no previous studies have been completed to estimate the prevalence and risk factors of HAPUs among patients in the intensive care unit (ICU). The aim of this study was to estimate the prevalence and identify risk factors for HAPUs among adult ICU patients in selected tertiary hospitals in Oman. A retrospective, cross-sectional, nested, case-control design was used to identify the prevalence rate of HAPUs and risk factors for a cohort of adult ICU patients over one calendar year (1 January-31 December 2019) in two tertiary hospitals in Oman. The prevalence rate for HAPU among ICU patients in Oman was 36.4%. However, when excluding cases of stage 1 ulcer, the rate was 30.37%. The most prevalent location was the sacrum (64.1%), and the most common stage was stage 2 (73.1%). The risk factors for HAPU included male sex (odds ratio (OR): 0.37; p=0.023), organ failure (OR: 3.2; p=0.033), cancer (OR: 3.41; p=0.049), cerebrovascular accident (OR: 12.33; p=0.001), mechanical ventilator (OR: 9.64; p=0.025) and ICU length of stay (OR: 1.24; p<0.001). HAPUs among ICU patients constitute a significant problem associated with severe clinical consequences and result in substantial adverse healthcare outcomes worldwide, including in Oman. Identifying the risk factors and the impact on the healthcare system is the foundation for preventing and managing HAPUs.

Phenotypic Isolation and Characterization of Bacterial Isolates and Incidence of Multi-Drug-ResistantStrains from Surgical Site Infected Patients of Tertiary Care Hospital, Tamil Nadu

Phenotypic Isolation and Characterization of Bacterial Isolates and Incidence of Multi-Drug-ResistantStrains from Surgical Site Infected Patients of Tertiary Care Hospital, Tamil Nadu

How Shift Nurses' Presenteeism is Related to Insomnia and Care Left Undone: A Cross-Sectional Study Using Generalised Structural Equation Modelling.

To examine the association between nurses' insomnia, presenteeism and care left undone and explore the mediating effect of presenteeism on the relationship between insomnia and care left undone among nurses in acute care hospitals, applying a dynamic model of presenteeism and absenteeism. A cross-sectional design. A secondary data analysis was conducted using online survey data collected in January 2023. Participants were 1154 registered nurses who provided direct nursing care to patients in tertiary or general hospitals (hospitals with 300 or more beds) in South Korea. Poisson regression analysis was used to examine the association between nurses' insomnia, presenteeism and care left undone. Generalised structural equation modelling was performed to examine the mediating effect of presenteeism on the relationship between insomnia and care left undone. The prevalence of insomnia was 15.3%. More than half of the participants (63.7%) reported experiencing presenteeism in the past 4 weeks. All reported at least one nursing care left undone during their last shift. Insomnia and presenteeism were positively associated with care left undone, and presenteeism mediated the relationship between insomnia and care left undone among nurses in acute care hospitals. Nurses experienced insomnia and presenteeism, related to higher rates of care left undone. Nurses' insomnia had a direct effect on care left undone and an indirect effect through presenteeism. Nurse managers and administrators need to make greater efforts to reduce insomnia and presenteeism among nurses, thereby reducing care left undone and improving patient safety in acute care settings. Nurse managers and administrators should consider proactive interventions to address nurses' insomnia and foster a workplace with healthy systems and culture to reduce sleep disturbance and presenteeism, which can effectively decrease care left undone. STROBE guidelines. No patient or public contribution.

The relationship between socioeconomic status, medical accessibility, hope and psychological resilience of caregivers of children with chronic kidney disease in China: structural equation model

BackgroundChronic kidney disease (CKD) is the third most common cause of death after cancer and heart disease. The continuous treatment of children with CKD was greatly challenged during the COVID-19 pandemic, which significantly impacted the CKD children’s prognosis and the caregivers’ psychological status. However, the influence mechanism of socioeconomic status, medical delay duration, traffic pressure, and online consultation duration on caregivers’ hope and psychological resilience still lacks relevant evidence.MethodsThis study investigated the general social information, hope, and psychological resilience of 247 caregivers with CKD in 13 provinces of China in March 2020. Factor analysis and an exploratory Structural Equation Model ( SEM ) were used to find the best-fit model, and Bootstrapping was used to calculate the 95% CI of indirect effects.ResultsThe factor analysis obtained four common factors, namely, socioeconomic status (annual family income, education, and career stability), medical accessibility (online consultation duration, medical delay duration, and traffic pressure), hope (positive attitude, positive action, and intimate relationship) and psychological resilience (optimism, tenacity, and strength), with the cumulative contribution rate of 65.34%. Bootstrapping obtains the socioeconomic status β = 0.30 (95% CI [0.14, 0.47], P = 0.002), medical accessibility β = 0.31 (95% CI [0.12, 0.47], P = 0.002), and hope β = 0.40 (95% CI [0.27, 0.52], P = 0.002) has a direct impact on psychological resilience of CKD children caregivers, followed by medical accessibility β = 0.20 (95% CI [0.10, 0.38], P = 0.001) and hope β = 0.23 (95% CI [0.16, 0.32], P = 0.001) plays a mediating role between socioeconomic status and psychological resilience. The indirect impact effect β = 0.35 (95% CI [0.25, 0.50], P = 0.001) is greater than the direct impact effect β = 0.30 (95% CI [0.14, 0.47], P = 0.002).ConclusionsSufficient attention should still be given to children with immunodeficiency after the COVID-19 pandemic, such as CKD, to avoid infection of deadly. Secondly, the government should vigorously develop Primary medical institutions to ensure efficient treatment of severe patients in tertiary hospitals; Finally, the professional literacy of medical workers in remote diagnosis and treatment should be improved to enhance the country’s emergency response capacity for similar major public events and the requirements for normalised epidemic prevention and control.

Assessment of glycemic control and correlation of HbA1c level with lipid profile and duration of diabetes in type 2 diabetes mellitus patients

Background &amp; Objectives: The prevalence of Type 2 diabetes mellitus, or Type 2 DM, is rising globally. A periodic estimation of HbA1c has been recommended to track the state of glycemic control of Type 2 DM patients, in order to control the diabetes associated disorders. The main consequence and cause of death in Type 2 diabetes has been identified as cardiovascular disease (CVD).Optimization of glycemic status along with decreasing CVD risk factors are critical to preventing morbidity and mortality in patients with Type 2 DM. Since there is a lack of data on these CVD risk factors, in Madhesh Province, Nepal, we aimed to evaluate the glycemic status, estimate the lipid profile, and ascertain their correlation, including duration of Type 2 DM among patients in tertiary care hospitals in Madhesh Province, Nepal. Materials and Methods: The tertiary care hospital based cross-sectional study was conducted on 139 Type 2 DM patients, in Madhesh Province, Nepal. In order to gather information of the participants, a systematic questionnaire was introduced. A physical and clinical examination was performed, and an appropriate volume of blood was drawn with prior written consent. The lipid profile parameters, HbA1C, Fasting and post prandial serum glucose were estimated. Results: In 84 (60.3%) and 106 (76.3%) cases, there was an increased fasting and postprandial blood sugar. The mean±SD HbA1c level was 8.40±0.8%. More than half (52.5%) of the patients had poor glycemic control, while 22.3% had inadequate glycemic control, in reference to HbA1c &gt;8% and 7 to 8%, respectively. A substantial increased level of LDL-C, triglycerides and total cholesterol was observed in 122 patients and 85.6% had reduced HDL-C. A significant strong positive association was found between HbA1c level and total cholesterol and triglycerides, in contrast, no discernible association with duration of disease observed. Conclusion: Glycemic control was inadequate. Triglycerides and total cholesterol were significantly positively correlated with HbA1c, but not with HDL-C, LDL-C, or the course of diabetes.

Clinical manifestations and treatment outcomes among hospitalised COVID-19 patients in tertiary hospitals in Tanzania, 2021–2022: a retrospective cohort study

BackgroundThere have been differential mortality rates from COVID-19 in different parts of the world. It is not clear whether the clinical presentation does also differ, thus the need for this...

Epidemiological Features of Chronic Low-Back Pain

Introduction: Chronic low back pain (LBP) is a major cause of abstinence from work in the world. Objective: The aim of the present study was to assess the epidemiological features of chronic low back pain patients in tertiary care teaching hospital. Materials and Methods: A descriptive cross sectional study was conducted from January 2018 to June 2018 among 70 patients attending at Physical Medicine and Rehabilitation outpatient department of the Shaheed Suhrawardy Medical College and Hospital after obtaining requisite consent from the patients. Data were collected through interviewing of the patients. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the epidemiological features of chronic low back pain patients. Results: In a pool of 70 patients, most of the patients (n=34, 48.5%) belong to 31-40 year age group. In a pool of 70 patients, Male patients (52.85%) were more than the female patients (47.14%) at the Shaheed Suhrawardy Medical College and Hospital. In occupational status, most of the patients were Housewife (n=19, 27.14%) followed by service-holder (n=17, 24.28%). In a pool of 70 patients, most of the patients BMI were normal (n=49, 70%). Conclusion: Epidemiological features were characterized by male patients, as from the 31-40 years of life and housewife. Physical functional profile was primarily characterized by patients with normal BMI and overweight. Medicine Today 2024, Vol.36 (2): 107-109

Outcomes of deep venous thrombosis management and associated factors among patients in tertiary hospitals in Addis Ababa, Ethiopia: a multicenter retrospective cohort study

BackgroundPulmonary embolism (PE) and deep venous thrombosis (DVT) are the two most important manifestations of venous thromboembolism (VTE). DVT remains a significant condition since associated morbidity is significant and has elevated healthcare-related costs.MethodsA retrospective cohort study was conducted among DVT patients admitted to Tikur Anbessa Specialized Hospital, Zewditu Memorial Hospital and St. Paul’s Hospital Millennium Medical College on follow-up from July 1, 2017, to July 01, 2020. Data on sociodemographic characteristics, types of DVT, laboratory findings, medications, risk factors of DVT, complications and outcomes of DVT were collected. The data were analyzed using SPSS version 25. Multivariate logistic regression analysis was conducted to determine predictors of DVT recurrence and major bleeding. A P value < 0.05 was considered to identify significant predictors.ResultsThe mean age of the participants was 45.2 years, with SD of 15.36. The major causes of DVT included immobilization (29.9%), previous surgery (27.5%) and cancer (21.1%). The DVT recurrence rate was 22.5%. Nine (2.2%) of the participants died, and 19.9% developed complications. Bilateral DVT (Adjusted odds ratio (AOR) = 2.8, 95% Confidence interval (CI) = 1.14, 6.66), obesity (AOR = 3.3, 95% CI = 1.15, 9.59), hypertension (AOR = 6.5, 95% CI = 2.90, 14.70) and retroviral infection (AOR = 6.3, 95% CI = 2.34, 16.94) were predictors of recurrent DVT. Nineteen (4.7%) patients had major bleeding, and patients with bilateral DVT, active cancer and terminal age had an increased risk of major bleeding.ConclusionsThe overall DVT recurrence rate was alarmingly high and further complicated by PE, post thrombotic syndrome and chronic vein insufficiency, resulting in a 2.2% death rate. Major bleeding after DVT and PE remained high. Close monitoring should be performed for patients with advanced age, active cancer, bilateral DVT, retroviral infection, obesity and hypertension to prevent the recurrence of DVT and major bleeding.

Comparison of Diagnosis-Related Group Rehabilitation Reimbursement Payments With Those of a Novel Patient Classification-Based Payment System

ObjectiveTo compare the difference of reimbursement payments between diagnosis-related group (DRG) and a novel patient classification-based payment system, diagnosis-intervention packet (DIP), among rehabilitation inpatients in tertiary hospitals. DesignRetrospective cohort study. SettingTTertiary hospitals in Shenzhen, China. ParticipantsWe assessed the records of 268,362 individuals who visited tertiary hospitals providing rehabilitation services. InterventionsNot applicable. Main Outcome MeasuresThe outcome variable was the patients’ rehabilitation hospitalization cost of in our study. A quantile regression analysis was conducted to estimate the effects of DIP payment on the rehabilitation hospitalization cost. ResultsThe results showed that the predicted marginal hospitalization cost with DRG payment were 9%, 7%, 14%, and 10% higher than that with DIP payments in 2019, 2020, 2021, and 2022. The total difference in predicted marginal hospitalization cost between DRG and DIP was −1269 RMB (−193 USD). This difference in 2019, 2020, 2021, and 2022 was −1419 RMB (−228 USD), −1088 RMB (−158 USD), −1585 RMB (−246 USD), and −1034 RMB (−154 USD), respectively. All differences in predicted marginal hospitalization cost between DRG and DIP was significant (P<.001), after controlling for patients’ age, sex, public or private hospital, the type of disease, and the length of stay of hospitalization. ConclusionsThe findings of DIP payment reduced the rehabilitation hospitalization cost would be helpful in developing more effectively and efficiently tailored interventions for rehabilitation health care in China. Furthermore, the results of this study could provide advice on building more effective strategies and intervention options for other countries that struggle with controlling rehabilitation hospitalization costs.

Information and Safety Precautions on Air Pollution for Adult Respiratory Patients in Tertiary Hospital

Background: Bangladesh faces escalating air pollution due to urbanization, industrialization, deforestation, and rising energy consumption. This jeopardizes public health, leading to respiratory problems and heightened risks of infections, causing a surge in hospital admissions, deaths, and associated economic burdens. Method: This was a cross-sectional study to assess the level of knowledge and protective practices regarding air pollution among adult respiratory disease patients who attended the medicine OPD of the National Institute of Diseases of the Chest &amp; Hospital (NIDCH) from January 1, 2023, to December 31, 2023. Result: The mean age of the 361 respondents was 37.90±13.77 years and more than half (53.5%) of them were in the age group 21-40 years. About one-third (32.1%) received higher secondary and above education. Almost one-fourth (23.5%) of respondents’ income was between 15000, and personal monthly income was not applicable for more than (56.5%) of respondents. About three-fourths (73.7%) of patients were married, two-thirds (67.3%) belonged to a nuclear family and about half (54.6%) of participants belonged to a member of 1-4 persons. The majority (95.3%) of respondents were Muslim and about two-thirds (67.3%) belonged to the nuclear family. About two-thirds (67%) of patients had poor knowledge and one-third (33%) had average knowledge regarding air pollution. All the respondents had poor protective practices against air pollution. Conclusion: The study's insights will guide future efforts to raise awareness among adult respiratory patients about air pollution risks, respiratory health effects, and protective measures. Empowering these patients not only safeguards their health but also promotes environmental responsibility for cleaner air in the community.

Comparison of treatment outcome between first-line combination immunotherapy (anti-PD-L1 or anti-PD1) with or without chemotherapy and chemotherapy alone in advanced non-small cell lung cancer patients in tertiary care hospital.

Despite promising outcomes of first-line immunotherapy with or without chemotherapy in advanced non-small cell lung cancer (NSCLC), limited accessibility due to reimbursement was remain the problem in low to middle income countries. This study aimed to evaluate real-world effectiveness of immunotherapy in patients with advanced NSCLC in Northern Thailand. A retrospective, single-centered cohort, was conducted. Patients with advanced NSCLC who underwent PD-L1 testing (excluding EGFR and ALK mutations) and were treated with immunotherapy or without chemotherapy or chemotherapy alone were included. The primary end point was progression-free survival (PFS). The secondary endpoints were overall survival (OS), objective response rate (ORR), and adverse events. A total of 123 patients, of which 21 patients received immunotherapy-based regimen and 102 patients received chemotherapy alone. The median PFS was 11.9 months in immunotherapy-based group compared to 5.93 months in the chemotherapy group, with a. hazard ratio (HR) of 0.4 (95% confidence interval [CI], 0.23 to 0.68; p = 0.001). Similarly, the median OS was 26.68 months in the immunotherapy-based group and 11.21 months in the chemotherapy group, with HR of 0.42 (95% CI 0.22-0.8; p = 0.009). ORRs were significantly higher in the immunotherapy-based group, with 65% of patients showing a response compared to 32% in the chemotherapy group (p = 0.006). The result of this real-world study in patients with advanced stage NSCLC indicate that first-line immunotherapy-based regimen was associated with significantly greater PFS, OS, and ORR with a safety profile consistent with pivotal studies.

Analysis of the current status of "pseudo" unplanned endotracheal extubation in ICU patients in China's tertiary hospitals

To analyze the current status of "pseudo" unplanned endotracheal extubation in ICU patients in China's tertiary hospitals and to provide a reference for improving the quality of medical care. Through the National Nursing Quality Data Platform, unplanned endotracheal extubation data reported by ICUs in China's tertiary hospitals from 2019 to 2022 were analyzed. The situation of reported hospitals, causes, and the current status of "pseudo" unplanned endotracheal extubation in ICU patients was analyzed. The indicator of unplanned endotracheal extubation in ICUs of China’s tertiary hospitals is mainly from first-class tertiary hospitals (74.9%), most of which are self-extractions by patients (74.6%). The proportion of "pseudo" unplanned endotracheal extubation is 45.1%. "Pseudo" unplanned endotracheal extubation is common in the ICUs of China's tertiary hospitals. As such, management blind spots deserve attention from managers and clinical staff.

Epidemiological and clinicopathological characteristics of colorectal cancer patients in tertiary hospital in West Java

Problem consideredColorectal cancer (CRC) is the third most frequently diagnosed type of cancer in Indonesia, accounting for around 8.5% of cancer cases. This study aims to know the epidemiological and clinicopathological characteristics of CRC patients in Tertiary Hospital in West Java. MethodsThis study was a cross-sectional study. All the data were obtained from Hasan Sadikin General Hospital CRC Registry from November 2021 until May 2023. Results208 colorectal cancer patients were analyzed. The average age at diagnosis was 52,9 (52 ± 13.1) with 61% diagnosed over 50. More females (51%) were diagnosed. Smoking history included 37.5% active smokers and 41.8% passive exposure. Nutritionally, 65.8% were normal weight, 30.7% underweight, and 5% overweight. The most common presenting symptoms were constipation (49%) and rectal bleeding (38%). Stage III and IV were diagnosed in 77% of patients. Left-sided colon tumors (85%) were most frequent, with adenocarcinoma not otherwise specified (98%) being the dominant histology. Bowel obstruction (68%) was the most common complication. ConclusionCRC in Hasan Sadikin General Hospital was frequently diagnosed at a late stage, with a relatively high percentage of patients were below 50 years. Left-sided CRC and histological types of adenocarcinoma not otherwise specified were still the most common pathological features of CRC. Future research is needed to discover the potential multifactorial causes of this phenomenon.

Randomized Trial of Single-Incision Midurethral Sling and Laparoscopic Burch Colposuspension: Postoperative Surgical Outcomes and Complications

Various retropubic and midurethral sling techniques have shown high cure rates in the treatment of stress urinary incontinence (SUI). This study aimed to compare single-incision midurethral sling (SIMS) and laparoscopic Burch colposuspension (LBC) procedures in patients with SUI in terms of the effectiveness, patient satisfaction, surgical complications and results. This is a prospective randomized study. A university tertiary hospital. Forty patients with clinically and/or urodynamically proven SUI who agreed to surgical treatment were randomized to the SIMS and LBC groups and included in the study. Patients were treated with SIMS and LBC operations. Demographic characteristics of patients, physical and pelvic examination, preoperative and postoperative clinical findings, Kings Health Questionnaire form, Female Sexual Function Index and Prolapse Quality of Life Questionnaire form, postoperative day 1 visual analog scale score, and postoperative complications were recorded. Objective and subjective success rates were recorded by re-evaluating the patients in the first and sixth months of the operation. Objective success was defined as having a negative stress test and subjective success was defined as the absence of stress-induced urine leakage after surgery in a validated questionnaire. The primary result of our study was considered to be objective success, whereas the secondary result was subjective success and life quality tests. Twenty patients each in the SIMS group and the LBC group were included in the study. No significant difference was found in objective success (90% vs 85%, p = .633) or subjective success (85% vs 75%, p = .695) between the 2 groups at 6-month follow-up. A significant improvement in life quality was observed in the postoperative period for both groups; however, the difference between the groups was not significant. There was an improvement in sexual function in both groups. Nonetheless, although this improvement was significant in the SIMS group, it was not significant in the LBC group. In addition, surgery time, catheterization time, and hospitalization time were shorter in the SIMS group than in the LBC group. The visual analog scale score on postoperative day 1 was lower in the SIMS group. Groups were not different in terms of preoperative and postoperative complications. This preliminary study is the first randomized study that compares the LBC and SIMS procedures in the literature. It shows that SIMS and LBC procedures have not different objective and subjective success rates in the short term. It was also observed that they increase both sexual and life quality results in a positive and similar way.

Prevalence of Vitamin D Deficiency among Patients Attending Tertiary Level Hospitals in Bangladesh: Hospital-Based Cross-Sectional Study

Introduction: Vitamin D (Vit D) is essential for calcium and phosphate homeostasis, critical for bone growth and remodeling. Its deficiency leads to conditions like osteomalacia and rickets, with adverse effects on osteoporosis, growth, and skeletal health. This study aimed to assess Vitamin D Deficiency prevalence among patients in Bangladeshi tertiary-level hospitals. Materials and Methods: A prospective cross-sectional study was conducted from January to December 2019 at Cumilla Medical College Hospital and Central Medical College Hospital. We enrolled 1250 patients meeting inclusion criteria and collected data via a pre-designed questionnaire. Results: Most participants (31.8%) were aged 31-40, with a mean age of 37.31±13.37. Male patients constituted 53.3%, and 46.7% were female. Rural residents accounted for 52.6%, while 25.8% lived in urban areas, and the rest abroad, mainly the Middle East. The majority (88.5%) belonged to middle-class families, and only 1.5% reported sufficient sun exposure. Strikingly, 54.2% were Vitamin D deficient, 40% had insufficient levels, and only 6.4% had adequate Vit D. Conclusion: This study highlights a significant prevalence of Vitamin D deficiency among patients in Bangladeshi tertiary hospitals. The data underscore the urgent need for healthcare authorities to address this public health concern. Policymakers and healthcare providers should be aware of the potential long-term health consequences of Vitamin D deficiency, emphasizing the importance of strategies to promote adequate Vit D levels in the population. Medicine Today 2023 Vol.36 (1): 17-22

Relevance Of Orientia Tsutsugamushi Antibodies In Elevated Levels Of Liver Enzymes And Thrombocytopenia Among Patients In Tertiary Care Hospital

Relevance Of Orientia Tsutsugamushi Antibodies In Elevated Levels Of Liver Enzymes And Thrombocytopenia Among Patients In Tertiary Care Hospital

Antibiotic use in tertiary care hospitals in Bangladesh: Revealing the extent through a point prevalence survey

Prevalent use of antibiotics in hospitals results in antimicrobial resistance (AMR), rising mortality, and substantial financial burden. This study assessed the current pattern of antibiotic use among inpatients in tertiary hospitals in Bangladesh. Between August and November 2022, we conducted a point prevalence survey in 4 tertiary hospitals in Dhaka, Bangladesh. The World Health Organization-directed point prevalence survey methodology and tools were followed for the data collection. Descriptive and multivariate statistics were performed using Stata version 15. Of 1,063 hospitalized patients, antibiotics were prescribed to 73.5% (781/1063, 95%confidence interval: 70.8-76.1) of patients. A total of 1,164 antibiotics were prescribed, and 49.1% of patients consumed multiple antibiotics. Only 31.4% of patients were prescribed antibiotics based on microbiology results. The reasons for antibiotic prescribing were mentioned only in 19.3% of patients. Infants (adjusted odds ratio: 8.52, P-value: <.001) and neonates (adjusted odds ratio: 4.32, P-value: <.001) were more likely to consume antibiotics compared to adults. Cephalosporins accounted for the majority (54.0%) of antibiotics used in hospitals. None of the hospitals had any antibiotic use guidelines. Consumption of Watch group antibiotics empirically among all age groups demonstrates irrational antibiotic usage in Bangladeshi hospitals. Implementation of a tailored stewardship program, antibiotic use guidelines, and prescriber-patient awareness could improve the rational use of antibiotics.

Family Decision-Making Path for the Referral of Terminal Patients in Tertiary Hospitals

Objective To gain an in-depth understanding of the motivations,patterns,and related factors in family decision-making regarding the referral of terminal patients in tertiary hospitals. Methods Using purposive sampling,terminal patients and their family members from three tertiary hospitals in Beijing were selected as subjects.Semi-structured interviews were conducted,and the interview data were subjected to thematic analysis. Results Following the saturation principle,a total of 11 patients and 15 family members were included.The interview data were organized and analyzed,yielding six major themes:decision premises,decision patterns,family support,support from the referring hospital's medical team,referral channel conditions,and involvement of volunteer teams and social support.Based on these findings,a flowchart illustrating the family decision-making process for the referral of terminal patients was constructed. Conclusions The study provides a comprehensive analysis of various factors influencing family decision-making in the referral of terminal patients in tertiary hospitals.The results underscore the significance of internal and external factors,emphasizing the integrated impact of decision patterns,family support,medical team support,referral channel conditions,and the involvement of volunteer teams and social support.The research offers profound insights into improving the referral process for terminal patients and enhancing the quality of family decision-making.It provides valuable recommendations for future improvements in medical services and decision support.

Clinical correlation of Magnetic Resonance Imaging (MRI) with symptom complex in prolapsed intervertebral disc disease in the patients of Tertiary Care Hospital, Kharian.

Objective: To assess the clinical correlation of MRI with the symptoms of prolapsed intervertebral disc disease in the patients of Tertiary Care Hospital, Kharian. Study Design: Cross Sectional study. Setting: Tertiary Care Hospital, Kharian. Period: February 2022 to August 2022. Methods: The patients with age range 18 to 50 years, visiting hospital with complaint of low back pain and radicular pain were included in this study. Physical and neurological examination was conducted followed by MRI. The symptoms were correlated with MRI findings through correlation analysis with p&lt;0.05 as significant. Results: The mean age was 38.09 ± 8.4 years with majority (54.6%) of patients in age range 41 to 50 years. The male patients (69.3%) and hard labor workers (59.3%) were more effected. Protrusion was the most prevalent type (60%). SLR was significantly associated with disc bulge and protrusion (p&lt;0.001). The loss of power (56.6%) had significant correlation with disc protrusion (p &lt; 0.001). Majority (55.3%) of the cases comprised of nerve root compression with more (47.3%) and significant prevalence in protrusion (p &lt; 0.001). The multiple nerve root involvement had significant association with disc extrusion (p&lt;0.001). Conclusion: MRI is a good means of indicating disease level in prolapsed intervertebral disc disease. However, some of the clinical symptoms show high association with the radiological findings, whereas, some are not good indicators.

IJCM_302A: Perceptions related to lifestyle modifications among Diabetes Mellitus (DM) patients in tertiary care hospitals in Mangalore

Background: Diabetes is a chronic lifestyle disease which can be kept under control by some simple lifestyle modifications like blood sugar monitoring, dietary modification and exercise pattern. Diabetes mellitus (DM) appears to be a global epidemic and an increasingly major non-communicable disease threatening both affluent and non-affluent sections of the society. Methods: A cross-sectional study was conducted in tertiary care hospitals in Mangalore involving 109 participants. The study utilized the Summary Diabetes Self-Care Activities questionnaire to collect data. Practices were categorized as good or poor based on an average score, with scores above 75% indicating good and lower scores indicating poorer practices. Data analysis was performed using SPSS version 16.0. Results: The dietary modifications were good in 7.3% of the subjects, exercise behavior in 14.67%, foot care practices in 12.6% and sugar monitoring in only 1% of the subjects. Being male and married was associated with better self-care behaviors. People belonging to low socio-economic status had better dietary modification habits. Conclusion: Self-care activities with respect to diet and sugar monitoring are poor in the population studied. The self-care activities relating to exercise behavior and foot care are good. Improving self-care behavior among patients with diabetes in India should start with adequate targeted health education.