Public Teaching Hospital Research Articles

Early insights from the routine use of patient reported outcome measures in elective hip and knee arthroplasty at a public teaching hospital in South Australia.

For advanced osteoarthritis of the knee and hip, the most clinically effective treatment remains total-knee arthroplasty (TKA) and total-hip arthroplasty (THA). Success of these surgeries have traditionally been appraised by economic and volume-based measures. There has been a shift towards the use of patient reported outcome measures (PROMs) to quantify success and guide treatment. The present study provides analysis of three PROMS which have been validated for use in orthopaedic settings; the Oxford Knee Score (OKS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and the EuroQol-Visual Analogue Scale (EQ-VAS) - a non-disease specific measure of health. PROMs were completed pre-operatively, 6-weeks, and 1-year after elective TKA and THA undertaken in 2018 in a public teaching hospital in South Australia. Post-operative satisfaction/dissatisfaction was measured using a 5-point Likert scale and was collected at the same 6-week and 1-year points. PROMs were collected from 285 eligible elective knee-arthroplasty, and 205 elective hip-arthroplasty patients. There was significant average improvement, greater than minimal clinical important differences between pre-operative and 1-year post-operative scores for all three PROMs tools. Inter-PROM correlation was strongest between FJS and OKS at 1-year post TKA (rs = 0.722), and between FJS and OHS in post-THA at the same interval (rs = 0.609). TKA patients with higher pre-surgical 10-year mortality were weakly associated with lower pre-operative OKS score (rs = 0.169). BMI was weakly negatively associated with pre-operative and 6-week post-operative EQ-VAS scores (rs = -0.291 and rs = -0.149 respectively). Post-TKA satisfaction was 77.2% at 1-year, and THA 88.5% at the same interval. This study provides an early insight from the use of the OKS, OHS, the EQ-VAS and the FJS as PROMs in primary TKA and THA at our centre. All PROMs demonstrate significant increase (improvement) at both 6-week and 1-year post-operative intervals, relative to pre-operative scores. The FJS demonstrated good sensitivity. Pre-existing co-morbidities do not appear to have any significant relation with post-operative PROMs collected in this study.

Pulmonary Embolism Management Audit and Machine Learning Analysis of Delayed Anticoagulation in a Swiss Teaching Hospital.

Background/Objectives: Diagnosing acute pulmonary embolism (PE) is challenging due to its wide range of symptoms and numerous differential diagnoses. Medical professionals must balance performing all essential examinations and avoiding unnecessary testing. This study aimed to retrospectively audit the diagnosis and treatment of acute PE at a Swiss public teaching hospital to determine the adherence to current guidelines and to identify the factors associated with the delayed initiation of anticoagulation in PE patients. Methods: In this retrospective observational cohort study, we included all adult patients hospitalized with PE at the Cantonal Hospital Baselland (KSBL) between November 2018 and October 2020, where the diagnosis was made within the first twelve hours of their arrival to the emergency department (ED). LASSO regression was employed to identify clinical characteristics associated with delayed anticoagulation initiation. Results: A total of 197 patients were included (mean age: 70 years, 54% female). The audit revealed that diagnostic workup was conducted according to guidelines in 57% of cases. Often, D-dimer levels were measured although not strictly necessary (70%). Pretest probability was assessed and documented using the Wells or Geneva score in only 3% of patients, and risk assessment via the Pulmonary Embolism Severity Index (PESI) score was documented in 21% of patients. The median time from ED arrival to CT scan was 120 min (IQR 89.5-210.5), and the median time to anticoagulation initiation was 193 min (IQR 145-277). Factors identified by LASSO associated with delayed anticoagulation included prolonged time from ED arrival to CT scan, the presence of distended jugular veins on examination, ED arrival in the morning, and presenting symptoms of weakness or tiredness. Complementary leg ultrasound was performed in 57% of patients, with 38% of these cases lacking prior clinical examination for deep vein thrombosis. The duration of the anticoagulation treatment was not specified in the discharge report for 17% of patients. A medical follow-up after discharge was recommended in 75% of the patients. Conclusions: In conclusion, while the management of PE at the KSBL generally adheres to high standards, there are areas for improvement, particularly in the morning performance, the use of a pretest probability assessment, D-dimer measurement, risk assessment via the PESI score, the performance of complementary leg ultrasounds, clarification of the anticoagulation duration, and follow-up management.

Diagnosis and Treatment of Acute Heart Failure: A Retrospective Observational Study and Medical Audit.

Background: Acute Heart Failure (AHF) is a leading cause of hospitalizations and remains a significant socioeconomic burden. Despite advances in medical care, mortality and rehospitalization rates remain high. Previous AHF audits have revealed regional differences and a poor adherence to guidelines. This study aimed to assess guideline adherence in a public teaching hospital to identify areas for improvement. Methods: This retrospective observational study examined clinical routine data of patients hospitalized for AHF at a Swiss public teaching hospital between 2018 and 2019. AHF management was evaluated against the relevant guidelines of the European Society of Cardiology. Results: The study included 760 AHF cases of 726 patients (median age 84 years, range 45-101, 50% female). NT-pro-BNP levels were measured in 92% of the cases. Electrocardiography was performed in 95% and chest X-rays in 90% of cases. Echocardiography was conducted in 54% of all cases and in 63% of newly diagnosed AHF cases. Intravenous furosemide was initiated in 76%. In the subgroup of cases with reduced ejection fraction (HFrEF), 86% were discharged with beta-blockers and 69% with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Among cases with left ventricular ejection fraction ≤ 35%, mineralocorticoid receptor antagonists were prescribed in 55%. Conclusions: We observed generally good adherence to guideline recommendations. However, several improvements are needed in initial assessment and documentation, diagnostic procedures such as echocardiography, discharge medication, and lifestyle recommendations. Compared to other studies, our diagnostic workup was more aligned with guidelines, the use of intravenous diuretics was similar, and the duration of hospital stay and mortality rates were comparable.

Predicting Financial Failure of Public Teaching Hospitals: An Application of Fuzzy Clustering Analysis

Purpose –To develop a novel prediction model and determine the variables that best predict hospitals’ financial failures. Design/methodology/approach –A fuzzy C-means clustering analysis was conducted using financial ratios from MoH Hospitals’ financial databases. Hospital Fuzzy Financial Health Scores (HF-HFS) then were calculated the as the degree of financial failure measured through the selected n-cluster model. Findings –The results show that the number of teaching hospitals experiencing financial failure has increased. HF-FHS scores also were compared with the modified Altman Z scoresa commonly used financial distress measure in the hospital service sector. The HF-FHS scores in good and poor financial conditions differ significantly. The HF-FHS scores were also strongly correlated with the Altman Z scores. Discussion –The rising trend in the number of hospitals experiencing financial difficulties over the years may cause some hospitals in financial distress to fail to fulfill their obligations, which may disrupt the services provided. In such a situation, good management skills, which are the most important factor reducing the financial risks of hospitals, will not work after a certain point.Conclusions –The findings indicate Fuzzy C Means clustering as a viable option to evaluate the financial failure of hospitals compared to more traditional methods such as Altman Z scores. Hospitals still face financial pressures due to market and structural factors such as the global budget repayment system, pricing and collection time, and insufficient competition conditions.Predicting hospitals’ financial failures can help develop managerial policies and strategies to recognize and combat risks, improveperformance, and improve the current situation of hospitals.

Iranian midwives’ experiences of using the World Health Organization’s Safe Childbirth Checklist: A qualitative research

BACKGROUND: The goal of natural childbirth care is to have a healthy mother and baby with minimal interventions that are contrary to health. Worldwide, there is concern that non-evidence-based interventions and care in labor and childbirth will remain standard practice. Therefore, access to care related to pregnancy and childbirth is considered a priority. To address safety concerns during organized births, the Safe Childbirth Checklist (SCC) was created by the World Health Organization (WHO). This checklist is a tool that combines evidence-based practices that should be provided before, during, and after childbirth. As midwives have a vital role in using this up-to-date evidence, this study was conducted to explore Iranian midwives’ perception of using SCC. MATERIALS AND METHOD: This qualitative study was conducted from January 2022 to April 2023 in two public (teaching and nonteaching) hospitals in Ahvaz, Iran. Seventeen semi-structured interviews were conducted with midwives who had more than one year of work experience in maternity wards. Participants were selected purposefully. A content analysis approach was used to analyze the data and extract themes. RESULTS: All midwives had a positive attitude toward using SCC. The midwives’ reasons for being in favor of using the checklist during the clinical procedures of childbirth are summarized in four main themes, namely “standardized maternity care practices,” “SCC as a guide for performing essential childbirth practices,” “self-efficacy of midwifery care,” and “improved maternal and neonatal outcomes.” CONCLUSION: Midwives have endorsed this checklist as a guide to standard childbirth management. It seems that the use of this checklist will help to improve the health outcomes of mothers and babies by strengthening the self-efficacy of midwives.

Assessing emergency room leadership of ObGyn residents in a public university teaching hospital of Sindh, Pakistan: a cross-sectional survey

BackgroundLeadership is a critical competency for medical professionals, yet it is often neglected in medical training. For ObGyn residents, leadership training is particularly crucial as it significantly impacts both maternal and newborn outcomes, as well as the operational efficiency of healthcare teams. The main objective of this study was to assess the perceptions of obstetrics and gynecology residents who served as group leaders in the emergency team at the Department of Gynecology, Ward 3, Dr. Ruth K.M. Pfau Civil Hospital Karachi.MethodsA Cross-sectional survey was conducted with purposively sampled 28 year-4 residents who worked as group leaders during last 3 years (from 2018 to 2020) of their residency program at the emergency team in the department of Gynecology Ward 3 Dr Ruth KM Pfau Civil Hospital Karachi. The perceptions on leadership were assessed on 25 items scale sent through a questionnaire on email. Grading of responses was done using a 4-point ordinal scale where 1 meant little importance and 4 was regarded as having great importance. Data was summarized with relevant descriptive statistics and was analyzed on SPSS version 22.ResultsThe mean age of residents was 30.36. The mean leadership scores of the group of residents were calculated to be 77.50 (SD ± 9.57) while 14(50%) residents showed good and 14 (50%) showed excellent leadership skills based on cumulative scores. Of the 25 traits examined in this study, the highest reported trait was humility 3.82 (± 0.39) followed by empowerment 3.68 (± 0.77) and effective communication 3.68 (± 0.77). While responding about learning experiences, 89.3% of participants felt that the experience enhanced their decision-making skills and boosted their confidence in dealing with emergencies.ConclusionOur study highlights the critical importance of leadership development in the training of ObGyn residents, particularly in high-pressure emergency settings. The findings reveal that residents value leadership traits such as humility, empowerment, and effective communication, which are essential for building teamwork and ensuring optimal patient outcomes and patient satisfaction.

Diagnostic Dilemma between Scrub Typhus Meningoencephalitis and Dengue Encephalopathy Resolved! - A Novel Prediction Score.

Scrub typhus and dengue, common etiologies of acute encephalitis syndrome, present with similar clinico-laboratory profiles but differ in management protocol. We aimed to devise a score differentiating between scrub typhus meningoencephalitis (STM) and dengue encephalopathy (DE). A prospective cohort of 204 children, (aged 6 months to 14 years) presenting with acute encephalitis syndrome in a public teaching hospital in northern India was subjected to standardized workup including serum IgM against Orientia tsutsugamushi and Dengue virus. Clinico-laboratory features were compared between STM and DE using univariate and multivariate analysis. Area under the receiver operating characteristic (ROC) curve (AUROC) for the score derived from independent predictors and its sensitivity, specificity, predictive values was calculated at cutoffs. STM and DE IgM ELISA were positive in 38 (18.6%) and 41 (20.1%) children, respectively. Longer duration of fever, prodromal stage, respiratory complaints and pneumonia were significantly frequent in STM; however, swelling, petechiae and myalgia were significantly prevalent in DE. STM had higher blood total leukocyte count (TLC), higher CSF protein and lower CSF sugar compared to DE. At admission, TLC >10,000/mm3, pneumonia, absence of myalgia and petechiae were independent predictors for differentiating STM from DE. AUROC of novel score (range: -5 to 5) was 0.879 (95% CI: 0.805-0.952). Score at cutoff ≥5 had 100% specificity and 100% PPV for differentiating STM from DE. Prediction score may benefit physicians to differentiate between these two infections and treat them accordingly.

A Prospective Study of Hepatic Vein Waveform, Damping Index, and Splenoportal Index in Liver Cirrhosis: Correlation with Child-Pugh Score

Background:Chronic liver disease evaluation is commonly conducted using the Child-Pugh and Model for End-Stage Liver Disease (MELD) scoring systems. While the hepatic venous pressure gradient (HVPG) is the gold standard for measuring portal hypertension in cirrhotic patients, non-invasive alternatives such as Doppler ultrasonography offer a cost-effective, rapid, and less invasive option for assessment. Objective: This study aimed to investigate the correlation between hepatic vein waveform patterns, damping index, splenoportal index, and the Child-Pugh score in patients with liver cirrhosis to evaluate the efficacy of Doppler ultrasound as a non-invasive diagnostic tool. Methods: A prospective cross-sectional study was conducted at the Radiology Department of a public teaching hospital in Rawalpindi, Pakistan, from December 2023 to June 2024. A total of 52 patients with liver cirrhosis were included after excluding those with incomplete data or confounding conditions. Doppler ultrasound was used to assess hepatic vein waveform patterns, damping index, and splenoportal index. The Child-Pugh score was calculated based on clinical and laboratory parameters. Statistical analysis was performed using SPSS version 25, with a p-value of <0.05 considered significant. The chi-square test, Fisher’s exact test, ANOVA, and ROC curve analyses were utilized for data evaluation. Results: The final cohort consisted of 52 patients, with 39 males (75%) and 13 females (25%). The mean age was 55.3 years. The damping index showed a significant increase from Child-Pugh Class A (0.45 ± 0.10) to Class C (0.75 ± 0.15) (p=0.003). The splenoportal index also demonstrated a significant rise from Class A (1.4 ± 0.3) to Class C (2.0 ± 0.5) (p=0.015). The sensitivity and specificity of the damping index (> 0.6) in predicting higher Child-Pugh scores (B + C) were 52.6% and 85.7%, respectively, with a positive predictive value of 90.9%. Conclusion: The study found strong correlations between the severity of liver cirrhosis, as assessed by the Child-Pugh score, and Doppler ultrasound parameters such as hepatic vein waveforms and the damping index. Doppler ultrasound, therefore, presents itself as a precise, non-invasive alternative for evaluating the severity of liver disease, potentially replacing more invasive procedures.

Accuracy and safety of an autonomous artificial intelligence clinical assistant conducting telemedicine follow-up assessment for cataract surgery

Artificial intelligence deployed to triage patients post-cataract surgery could help to identify and prioritise individuals who need clinical input and to expand clinical capacity. This study investigated the accuracy and safety of an autonomous telemedicine call (Dora, version R1) in detecting cataract surgery patients who need further management and compared its performance against ophthalmic specialists. 225 participants were recruited from two UK public teaching hospitals after routine cataract surgery between 17 September 2021 and 31 January 2022. Eligible patients received a call from Dora R1 to conduct a follow-up assessment approximately 3 weeks post cataract surgery, which was supervised in real-time by an ophthalmologist. The primary analysis compared decisions made independently by Dora R1 and the supervising ophthalmologist about the clinical significance of five symptoms and whether the patient required further review. Secondary analyses used mixed methods to examine Dora R1's usability and acceptability and to assess cost impact compared to standard care. This study is registered with ClinicalTrials.gov (NCT05213390) and ISRCTN (16038063). 202 patients were included in the analysis, with data collection completed on 23 March 2022. Dora R1 demonstrated an overall outcome sensitivity of 94% and specificity of 86% and showed moderate to strong agreement (kappa: 0.758-0.970) with clinicians in all parameters. Safety was validated by assessing subsequent outcomes: 11 of the 117 patients (9%) recommended for discharge by Dora R1 had unexpected management changes, but all were also recommended for discharge by the supervising clinician. Four patients were recommended for discharge by Dora R1 but not the clinician; none required further review on callback. Acceptability, from interviews with 20participants, was generally good in routine circumstances but patients were concerned about the lack of a 'human element' in cases with complications. Feasibility was demonstrated by the high proportion of calls completed autonomously (195/202, 96.5%). Staff cost benefits for Dora R1 compared to standard care were £35.18 per patient. The composite of mixed methods analysis provides preliminary evidence for the safety, acceptability, feasibility, and cost benefits for clinical adoption of an artificial intelligence conversational agent, Dora R1, to conduct follow-up assessment post-cataract surgery. Further evaluation in real-world implementation should be conducted to provide additional evidence around safety and effectiveness in a larger sample from a more diverse set of Trusts. This manuscript is independent research funded by the National Institute for Health Research and NHSX (Artificial Intelligence in Health and Care Award, AI_AWARD01852).

Financial Incentives and Prosocial Motivation Among Physicians in a Faith-Based Society

How do healthcare professionals respond to financial incentive within mission-driven public hospitals in a faith-based society? This paper challenges previous research findings that healthcare professionals in mission-driven hospitals are prosocially motivated to serve the poor patients, and that performance-based financial incentives tend to crowd out such motivation. We used data from fifty-six interviews with healthcare professionals from three tertiary public teaching hospitals in Peshawar, Pakistan, to investigate the effect of a performance-related pay scheme. We found that the high professional standards and strong religious beliefs of the physicians were key to maintaining their prosocial motivation to serve the poor patients in their communities. We conclude that financial incentive does not always erode prosocial motivation in public-sector organizations, and that prosocial motivation itself may be determined by professional and social context.

Nursing Competence in Thrombolytic Therapy for Myocardial Infarction: A Public Teaching Hospital Study

Objectives: This study aims to evaluate the knowledge and proficiency of nurses in managing thrombolytic therapy for myocardial infarction. Methodology: A cross-sectional research design was adopted and conducted in a public teaching hospital from May 2020 to September 2020. Registered professional nurses (n=52) working in the emergency department (ED) and cardiac care unit (CCU) were invited to participate. A structured, pre-validated questionnaire was used for data collection. The study received approval from the institutional review board and ethics committee. Data were analyzed using SPSS version 25.0. Results: Fifty ED nurses participated in the study, predominantly male, aged ≤ 34 years, with ≤ 3 years of experience. The overall knowledge score of nurses regarding thrombolytic therapy was 71%, while the practice score was 79%. The lowest level of knowledge was related to contraindications (65%) and treatment protocols (66%), while the highest was for therapy considerations (85.2%). The lowest task performance (47.8%) was observed in the pre-administration phase. There was a negative correlation (r = -0.226) between knowledge and practice. Knowledge levels were higher among male nurses, while task performance was better among those with cardiac certification. Conclusion: The study revealed that while nurses had a favorable level of knowledge about thrombolytic therapy, their practical implementation was poor. This gap highlights the need for targeted educational programs and the establishment of efficient documentation systems to enhance clinical practice.

Age and other criteria influencing nontreatment of patients (pts) with locally advanced or metastatic urothelial carcinoma (la/mUC): Results of a physician survey in five European countries (Eu5).

4570 Background: Real-world studies have shown that a majority of pts with la/mUC do not receive first-line (1L) systemic therapy (tx), despite guideline recommendations. This cross-sectional study assessed the criteria that Eu5 physicians consider when making decisions about 1L tx for pts with la/mUC. Methods: A quantitative online survey of Eu5 physicians was performed in Aug-Sep 2022. Respondents answered questions related to demographics, practice patterns, and criteria considered in 1L decision-making. Descriptive statistics were used to analyze demographics and responses. Logistic regression was used to analyze physician characteristics associated with reporting no age threshold vs any age threshold when defining platinum ineligibility. Results: 503 physicians (69% oncologists and 31% urologists) completed the quota-based survey. Most respondents had been in practice for >10 years (69%) and treated 5-19 pts with la/mUC per month (58%) in public teaching hospitals (40%), public nonteaching hospitals (24%), and private hospitals (20%). Physicians estimated that they do not prescribe 1L tx for ≈25% of their pts. The majority of physicians selected advanced age (62.0%) and poor performance status (PS; 54.7%) as their top reasons for not prescribing 1L tx, followed by pt refusal (45.9%) and poor renal function (43.1%). Most physicians (78.1%) reported having an age threshold above which they recommend against 1L systemic tx (mean, 74.7 years old [Table]). After adjusting for baseline characteristics, physicians were more likely to have an age threshold if they were from Italy vs Germany (odds ratio [OR] 0.22 [95% CI 0.06-0.73]), practiced in a public nonteaching hospital (OR 0.28 [95% CI 0.10-0.73]) or public/private office settings (OR 0.14 [95% CI 0.03-0.57]) vs private hospital, and if they treated <20 pts/month (2-10 pts: OR 0.36 [95% CI, 0.17-0.74]; 11-19 pts: OR 0.25 [95% CI 0.09-0.62]). Conclusions: 1L systemic tx rates self-reported by Eu5 physicians were higher than those previously published. Many physicians reported having an age threshold for not offering systemic tx, which was relatively low compared with the senior age profile of the la/mUC population. Physicians who reported an explicit age threshold may be inappropriately excluding pts from tx; this could be a driver for systemic tx underutilization in la/mUC. [Table: see text]

Neutrophil-to-lymphocyte Ratio as a Marker for Diagnosis and Prognostication of Sepsis.

Exploring the ideal marker for early diagnosis and prognosis of sepsis is crucial due to limitations of available sepsis indicators. Hence, we aimed to evaluate the neutrophil-to-lymphocyte ratio (NLR) as a diagnostic and prognostic marker of sepsis. This prospective case-control study was conducted at a tertiary care teaching public hospital. NLR values among cases and controls were compared for diagnosis. Among cases, serial trends in NLR values, outcome (survival or death), and various parameters [such as Sequential Organ Failure Assessment (SOFA) score, duration of intensive care unit (ICU) stay, etc.] were compared between survivors and nonsurvivors for prognosis. Analysis was performed using MS Excel and PSPP version 1.0.1. A total of 120 patients (60 cases and 60 controls) were analyzed. The NLR among cases was significantly higher (p = 1.31 × 10-16) than in controls. Using binary logistic regression, a high NLR was found to be a statistically significant predictor of sepsis category (p = 2.25 × 10-5). The association of various variables among survivors and nonsurvivors of cases showed statistically significant differences: NLR (p = 5.29 × 10-5), mean = 13.27, interquartile range (IQR) = 5.90, z-value = -4.042), C-reactive protein (CRP) (p = 4.80 × 10-7), mean = 74.40, IQR = 21.30, z-value = -5.034), D-dimer (p = 4.32 × 10-8), mean = 7.09, IQR = 0.88, z-value = -5.477), SOFA score (p = 0.00118, mean = 8.50, IQR = 3.00, z-value = -3.244), and duration of hospital stay (p = 0.03578, mean = 13.45, IQR = 8.00, z-value = -2.099). The NLR emerges as a valuable marker for both diagnosis and prognosis in sepsis. Elevated NLR levels aid in diagnosing sepsis at very early stages, and the trend of NLR demonstrates a dynamic course throughout the disease process. Persistently elevated NLR and high NLR values correlate with poor outcomes in sepsis. Additionally, NLR can be correlated with other prognostic markers of sepsis and mortality. Therefore, we recommend the utilization of NLR as a quick, easy, and cost-effective marker for both early diagnosis and regular prognostication of sepsis.

Career Trajectory and Employees’ Retention in Selected Public University Teaching Hospitals in South-South Nigeria

The study investigated the impact of career trajectory on employee retention in public university teaching hospitals in South-South Nigeria. A cross-sectional survey research design method was adopted. Out of 357 questionnaires administered to nurses and doctors, a total of 313 questionnaires were retrieved representing an 87.7% return rate. The data collected were subsequently subjected to both descriptive and multiple regression analysis. Findings revealed a positive significant relationship between organisational support and employees retention (β=0.281, t = 2.651, P =0.008<0.05) and equally, a positive significant relationship between organisational commitment and employees’ retention (β =0.678, t =6.385, P= 0.000< 0.05). This study suggested among others that hospital management should promote career development, staff welfare, and staff wellness in order to motivate personnel to stay with the hospitals.

Listen to me, I really am sick! Patient and family narratives of clinical deterioration before and during rapid response system intervention.

To explore patient and family narratives about their recognition and response to clinical deterioration and their interactions with clinicians prior to and during Medical Emergency Team (MET) activations in hospital. Research on clinical deterioration has mostly focused on clinicians' roles. Although patients and families can identify subtle cues of early deterioration, little research has focused on their experience of recognising, speaking up and communicating with clinicians during this period of instability. A narrative inquiry. Using narrative interviewing techniques, 33 adult patients and 14 family members of patients, who had received a MET call, in one private and one public academic teaching hospital in Melbourne, Australia were interviewed. Narrative analysis was conducted on the data. The core story of help seeking for recognition and response by clinicians to patient deterioration yielded four subplots: (1) identifying deterioration, recognition that something was not right and different from earlier; (2) voicing concerns to their nurse or by family members on their behalf; (3) being heard, desiring a response acknowledging the legitimacy of their concerns; and (4) once concerns were expressed, there was an expectation of and trust in clinicians to act on the concerns and manage the situation. Clinical deterioration results in an additional burden for hospitalised patients and families to speak up, seek help and resolve their concerns. Educating patients and families on what to be concerned about and when to notify staff requires a close partnership with clinicians. Clinicians must create an environment that enables patients and families to speak up. They must be alert to both subjective and objective information, to acknowledge and to act on the information accordingly. The consolidated criteria for reporting qualitative research (COREQ) guidelines were used for reporting. The consumer researcher was involved in design, data analysis and publication preparation.

Exploring the DNA Methylation Profile of Genes Associated with Bladder Cancer in Bladder Tissue of Patients with Neurogenic Lower Urinary Tract Dysfunction.

DNA methylation is an epigenetic process that commonly occurs in genes' promoters and results in the transcriptional silencing of genes. DNA methylation is a frequent event in bladder cancer, participating in tumor initiation and progression. Bladder cancer is a major health issue in patients suffering from neurogenic lower urinary tract dysfunction (NLUTD), although the pathogenetic mechanisms of the disease remain unclear. In this population, bladder cancer is characterized by aggressive histopathology, advanced stage during diagnosis, and high mortality rates. To assess the DNA methylation profiles of five genes' promoters previously known to be associated with bladder cancer in bladder tissue of NLUTD patients, we conducted a prospective study recruiting NLUTD patients from the neuro-urology unit of a public teaching hospital. Cystoscopy combined with biopsy for bladder cancer screening was performed in all patients following written informed consent being obtained. Quantitative methylation-specific PCR was used to determine the methylation status of RASSF1, RARβ, DAPK, hTERT, and APC genes' promoters in bladder tissue samples. Twenty-four patients suffering from mixed NLUTD etiology for a median duration of 10 (IQR: 12) years were recruited in this study. DNA hypermethylation was detected in at least one gene of the panel in all tissue samples. RAR-β was hypermethylated in 91.7% samples, RASSF and DAPK were hypermethylated in 83.3% samples, APC 37.5% samples, and TERT in none of the tissue samples. In 45.8% of the samples, three genes of the panel were hypermethylated, in 29.2% four genes were hypermethylated, and in 16.7% and in 8.3% of the samples, two and one gene were hypermethylated, respectively. The number of hypermethylated genes of the panel was significantly associated with recurrent UTIs (p = 0.0048). No other significant association was found between DNA hypermethylation or the number of hypermethylated genes and the clinical characteristics of the patients. Histopathological findings were normal in 8.3% of patients, while chronic inflammation was found in 83.3% of patients and squamous cell metaplasia in 16.7% of patients. In this study, we observed high rates of DNA hypermethylation of genes associated with bladder cancer in NLUTD patients, suggesting an epigenetic field effect and possible risk of bladder cancer development. Recurrent UTIs seem to be associated with increased DNA hypermethylation. Further research is needed to evaluate the impact of recurrent UTIs and chronic inflammation in DNA hypermethylation and bladder cancer etiopathogenesis in NLUTD patients.

Prescribing Change: Unpacking Privatization's Impact on Government Teaching Hospitals in Punjab, Pakistan

Lack of financial support is one of the main causes of low-quality services in Government teaching hospitals of developing countries. Recent recommendations for privatization of government teaching hospitals were aimed at improving the services to that of private teaching hospitals. The strategy is expected to increase the efficiency & performance of government teaching hospitals and generate revenues for their continued improvements. The measuring dimensions of hospital performance not only predict the financial performance of a hospital, but also provide assessment on steps required for betterment of the Government teaching hospital. The non-financial performance of a hospital setting is based on non-financial variables such as Reliability, waiting time, sanitary facility, hygiene and information unique to particular treatment. Good human resource practices are one of the key components that may predict the monetary & non-monetary performances of a hospital. This study demonstrated these variables along with their dimensions across the whole public teaching hospitals settings in Lahore Punjab with a sample size of 300 respondents. Respondents were highly qualified Doctors, Nurses and administration staff of public teaching hospitals Lahore, Punjab. Smart PLS-4 was used as a statistical tool and ran reliability, mediation analysis and linear correlation for research findings. The results have been found significant that hospital performance can be increased through privatization. Although there are some limitations such as it was limited to public teaching hospitals only. Public DHQs (District Head-quarters), THQs (Tehsil Head-quarters) & RHC (Rural Health Centers) were not part of study. The opted variables to assess the hospital performance were not total markers, so for future research there is a path for researchers to opt the rest variables to explore the further significance.

Making Our Hospitals a Safe Workplace: Hazard Identification and Risk Assessment at a Tertiary-Level Public Hospital in Eastern India.

Hospitals are complex places with a large number of employees, patients, furniture, equipment, etc. Healthcare workers (HCWs), patients, or the general public are vulnerable to injuries and illness due to unseen hazards at the workplace. This study aims to identify the hazards and assess the risks at a hospital to ensure safety for HCWs, patients, and the public and generate awareness about the same. It helps in reducing the financial obligation of the institution due to the treatment of illnesses of staff, absenteeism, and service disruption and slows down manpower turnover. Hazard Identification and Risk Assessment (HIRA) helps reduce human errors and promote safe behavior. This study aims to identify and study the hazards in a hospital, assess the risks associated with the hazards, and recommend methods to reduce or eliminate the hazards based on the outcomes of the study. An observational study was conducted at a 1000-bed tertiary-level teaching public sector hospital in eastern India. A checklist was used for direct observation, conducting staff interviews, and document reviews. A risk scoring tool was used, and hazards were ranked as per the risk score. Thirty-eight hazards were identified in the study and classified under the categories of natural, physical, chemical, biological, ergonomic, psychological, and safety. The fire risk and occurrence of cyclones had the highest risk scores. The study identified hazards through direct observations, record reviews, and staff interviews. These findings can guide the prioritization of areas requiring necessary action in risk reduction, ensuring a safe workplace for healthcare workers (HCWs), patients, and the public. They can also help the institution shift from a reactive approach to a proactive method for HCW safety.

Relationship Marketing Dimensions and Quality Service of Selected Public Teaching Hospitals in Southwest, Nigeria

Relationship Marketing Dimensions and Quality Service of Selected Public Teaching Hospitals in Southwest, Nigeria

Implementation of a quality improvement initiative for standardising essential newborn care in a teaching public hospital in rural central India

ObjectiveOur aim was to refine the essential newborn care practices by employing the multidisciplinary peer team-led quality improvement (QI) projects.DesignIn 2017, concerning the same, the department focused on early initiation...