Public Teaching Hospital Research Articles

Continuing cancer care delivery during the peak of COVID-19 in the Bronx, New York: experience from a public teaching hospital.

IntroductionWe report our experience with cancer care delivery during the peak of COVID-19 pandemic in New York City.MethodsRetrospective analysis of the patients treated from the 1st of March, 2020 to the 8th of May, 2020.ResultsTeam huddles, infection screening and patient selection strategies were implemented. One hundred and seventy patients were treated in 576 visits. Six developed severe COVID-19 requiring hospitalization, two died. Their median Charlson Comorbidity Index was 9, higher than the rest of the cohort.ConclusionsCancer care delivery is safe and feasible using an approach focused on careful patient selection, team communication and infection control.

Incidence and preventability of adverse events in adult patients admitted to a Brazilian teaching hospital.

To analyze the incidence and preventability of adverse events related to health care in adult patients admitted to a Brazilian teaching hospital. A retrospective cohort study, in which the incidence and preventability of adverse events related to health care were based on a two-stage retrospective review of 368 medical records (nurses and pharmacist review of medical records, followed by physicians review of triggered medical records) of adult patients whose hospitalizations occurred during 2015 in a high-complexity public teaching hospital located in Brazil. Data were collected from February 2018 to February 2019. A total of 266 adverse events were observed in 124 patients. The incidence of adverse events related to health care was 33.7% (95% CI 0.29-0.39), and the incidence density was 4.97 adverse events per 100 patient-days. Adverse events were responsible for 701 additional days of hospitalization, and the estimated length of additional hospital stay attributable to them was, on average, 6.8 days per event. The most common types of events were related to general care (60; 22.6%), medications (50; 18.8%), nosocomial infection (35; 13.2%), any other type (11; 4.1%), and diagnoses (2; 0.8%). Regarding the severity of adverse events, it was found that 168 (63.2%) were mild, 55 (20.7%) were moderate, and 43 (16.2%) were severe. In addition, it was estimated that 155 (58.3%) events were preventable. The length of a patient's hospital stay was identified as a risk factor for the occurrence of adverse events (RR 1.20; 95% CI 1.04-1.39). Through knowledge of the incidence, nature, severity, preventability, and risk factors for the occurrence of adverse events, it is possible to create the opportunities to prioritize the implementation of strategies for mitigating specific events based on reliable data and concrete information.

Patients’ falls in different sectors in a public-teaching hospital in Brazil

Objective: Describe characteristics of adults and seniors falls in different sectors of a public teaching Hospital of Minas Gerais, Brazil. Methods: Quantitative study, with a descriptive and retrospective approach, on reported falls of adults and seniors from different sectors of a teaching Public Hospital in Belo Horizonte, Minas Gerais (MG), Brazil such as the emergency room, medical wing and surgical wing. Data was collected through notifications and charts. Result: Most falls occurred in men with ages between 55 and 62 years old. Presence of assistive devices, difficulty walking, altered emotional state, pain, and use of medications were found to be associated with high risk of falls. Bed falls at night were the most frequent. There are few nursing assessments that are relevant in preventing falls. Conclusion: The greatest number of falls occurred in male patients during the night shift.The main comorbidities found were hypertension, diabetes mellitus, diseases of the circulatory system and diseases of the nervous system. The most common type of falls were in regards to falling from bed and falling from proper height. The identification of the risk of falling and the use of preventive measures reduce falls.

Urology Residents Simulation Training Improves Clinical Outcomes in Laparoscopic Partial Nephrectomy

Partial nephrectomy (PN) is the preferred modality of treatment for small renal masses. Laparoscopic partial nephrectomy (LPN) has been adopted worldwide and a fundamental role is played by surgical skills. The need for skill instruction outside the operating room is well recognized in the modern models of surgery residency training. We aim to investigate the impact of residents' laparoscopic surgical skills training on the successful implementation of LPN in a reference public teaching hospital in southern Brazil. We accessed all patients undergoing LPN by senior's urology residents at Hospital de Clínicas de Porto Alegre. Patients were stratified in 2 periods of time named 'LPN eras' 1 and 2, to report the training impact on the outcome. LPN era 1 was from October 2012 to February 2017 and LPN era 2 from March 2017 to June 2019. All the senior residents of LPN era 2 followed a simulation training divided into 4 years with a total training time of 244 hours before performing the LPN. Residents from LPN era 1 did not have simulation training. 124 patients underwent LPN during the study period, 53 (42.7%) of those were performed in LPN era 1 and 71 (57.3%) in LPN era 2. Baseline characteristics of the patients in the two groups were similar. The training performed by LPN era 2 residents was able to significantly reduce estimated blood loss, ischemia time and LOS with p value respectively 0.007, 0.001 and 0.001. LPN era 2 group also reached Trifecta in 77.5% of patients, being significantly more than in the LPN era 1 (p = 0.007). Simulation in residents surgical training was able to improve clinical outcomes in LPN. These data reinforce the fundamental importance of adequate residents training before performing surgery on a patient.

FACTORS INFLUENCING NURSES’ PARTICIPATION IN CLINICAL RESEARCH : A CROSS-SECTIONAL SURVEY IN HOSPITAL PUTRAJAYA, MALAYSIA

Background: Although the nurses in Malaysia are shouldering an important daily responsibility for providing optimal nursing care to the patients, Bashar (2019) had noted that a majority of nurses who were working in a public teaching hospital in Malaysia had rarely applied evidence-based practice (EBP) when discharging their daily duties and responsibilities, despite having a positive attitude toward evidence-based nursing (EBN). Therefore, it seems likely for these Malaysian nurses to be encountering many barriers in their involvement in clinical research [and also in research utilization (RU)]. Objective: This cross-sectional survey utilized a self-administered questionnaire within a study population of the Malaysian nurses working in a government hospital to determine the level of involvement of nurses in clinical research at Hospital Putrajaya from May to August 2015, which led to an assessment of the level of association between a list of pre-specified demographic and job-related characteristics and the involvement of nurses in clinical research, in order to identify any plausible factors which might have an association with either facilitating or hindering these nurses from their involvement in clinical research. Methods: After having prepared and validated the self-administered questionnaires for this study, they were then distributed to a total of 406 nurses working in Hospital Putrajaya. This self-administered questionnaire was specifically designed to achieve the objectives of this study which aimed to collect the baseline socio-demographic information of the respondents, and also information pertaining to their nursing practice and their participation in activities that were related to nursing research. Results: This study had found that among 406 nurses from Hospital Putrajaya who received the questionnaires, a total of 300 nurses had completed this questionnaire, meaning that the response rate was 300/406 or 73.9%. The baseline socio-demographic characteristics of the respondents were mostly female (94.3%), of Malay ethnicity (94.0%), with a mean age of 30.9 years, having an average 7.9 years of service and were married (77.3%). Most of these respondents were Staff Nurses (75.2%), followed by Community Nurses (13.1%), Sister-KUP (7.7%) and Sister (4.0%). A majority of the respondents reported that they were not interested in doing research (59.7%) and the two main reasons for their lack of interest in doing research was that they had no interest in research (41.7%) and also they did not have enough time to do research (25.7%). Less than half of the nurse respondents were previously involved in research (31.5%), in several specific areas such as clinical trials (36.6%) and also research in the field of preventive medicine (19.4%).The reason for them not being involved in research before was that (i) they had no opportunity to do research (43.7%) and (ii) they were not interested in research (27.4%). Only 19.9% of the respondents had received additional training in statistics, 14.9% of them had previously used a statistical package for analyzing data, and 3.4% of them had a prior experience of publishing research articles in scientific journals. They also reported that they did not read journals regularly (58.1%) and were not confident in interpreting medical literature (69.0%). Conclusion: Our findings in this study had shown that both the proportion of Malaysian nurses who were interested in clinical research (40.3%) and also those with prior experience in conducting clinical research (31.5%) remained very low. Results of this study also showed that these Malaysian nurses might have encountered various barriers in their quest for their involvement in clinical research and utilizing these findings in their daily nursing practice. Two of the most important barriers identified by this study are (i) the lack of having undergone appropriate training in research methodology and also (ii) the lack of the necessary statistical expertise for analyzing research findings. Hence, this study provides valuable information for formulating strategies to increase nurses’ participation in research activities at Hospital Putrajaya by providing more research training opportunities, and enhancing the level of awareness and increasing the accessibility to these resources by the nurses. It is our sincere hope that the results obtained from this study can be aptly utilized for promoting quality and ethical research among the nurses at Hospital Putrajaya by providing adequate support to and facilitating their future research endeavours.

Challenges in providing surgical procedures during the COVID-19 pandemic: Qualitative study among Operating Department Practitioners in Pakistan.

The surgical theatre is associated with the highest mortality rates since the onslaught of the COVID-19 pandemic. However, Operating Department Practitioners (ODPs) are neglected human resources for health in regards to both professional development and research for patient safety; even though they are key practitioners with respect to infection control during surgeries. Therefore, this study aims to describe challenges faced by ODPs during the pandemic. The secondary aim is to use empirical evidence to inform the public health sector management about both ODP professional development and improvement in surgical procedures, with a specific focus on pandemics. A qualitative study has been conducted. Data collection was based on an interview guide with open-ended questions. Interviews with 39 ODPs in public sector teaching hospitals of Pakistan who have been working during the COVID-19 pandemic were part of the analysis. Content analysis was used to generate themes. Ten themes related to challenges faced by ODPs in delivering services during the pandemic for securing patient safety were identified: (i) Disparity in training for prevention of COVID-19; (ii) Shortcomings in COVID-19 testing; (iii) Supply shortages of personal protective equipment; (iv) Challenges in maintaining physical distance and prevention protocols; (v) Human resource shortages and role burden; (vi) Problems with hospital administration; (vii) Exclusion and hierarchy; (viii) Teamwork limitations and other communication issues; (ix) Error Management; and (x) Anxiety and fear. The public health sector, in Pakistan and other developing regions, needs to invest in the professional development of ODPs and improve resources and structures for surgical procedures, during pandemics and otherwise.

ANALYZING PATIENT SATISFACTION WITH REGARDS TO PROVISION OF FREE MEDICINES IN KHYBER PAKHTUNKHWA PAKISTAN

Objective: To measure the association between provision of free medicines and patient satisfaction with regard to new health policy.
 Materials and methods: A total of 384 sampled respondents (admitted patients, Male/Female) who visited the OPD for surgical and medical components were selected through random sampling technique from three public teaching hospitals namely, Khyber Teaching Hospital, Hayatabad Medical Complex and Lady Reading Hospital in district Peshawar Khyber Pakhtunkhwa respectively. A conceptual framework consisted of independent variable namely provision of free medicines and a dependent variable patient satisfaction was tabulated and analyzed through chi-square test statistics. The multi-variate analysis of the study intimated a non –significant association between patient satisfaction and provision of free medicines controlling family type and it was found a non-spurious relationship while comparing at bi-variate level.
 Results: The findings revealed that any health policy with provision of special attention to patients by taking along the relevant stakeholders does yield the desired results. All these provisions may include the services with a strong mechanism of monitoring, evaluation based on reward and punishment.

Functional and Cost Audit of Primary Total Knee Arthroplasty in Public vs Private Hospitals: A Retrospective Cohort Study.

Government funded hospitals are believed to be stigmatised with 'substandard care' and constant fear of infection. The aim of this study is to compare the results and direct expenditure incurred for total knee arthroplasty (TKA) done at a government funded public teaching hospital with an economy packaged private hospital in India. A review of electronic and physical records of the patients operated by the senior author for primary TKA at a government funded hospital and a private hospital spanning 2007 to 2019 was done. A retrospective cohort study was designed matching the implant design and the ASA grade of the patients. Knee injury and Osteoarthritis Outcome Score (KOOS), Hospital for Special Surgery score (HSS), Knee Society Score (KSS) at 2years follow-up were the primary outcome parameters. The retrieved data describing the cost of surgery and perioperative complications were analyzed. The confounders were minimized by including only the surgeries performed by the author, using the same instruments and implants in similar operating theatre environments. This study involved two cohorts comprising 280 patients each, with no differences in gender, ASA grade and primary diagnosis. There was no significant difference in the 2-year HSS, KSS and KOOS score between the two groups. The 2-year cumulative incidence of major and minor complications in both the study cohorts showed no significant difference. The mean cost of an uncomplicated primary TKA (2019) in government hospital was INR. 85,927; 39.476% of that required in a private setup (INR. 2,17,667). Affordable TKA package in a government funded hospital can produce results comparable to that in a private hospital setup at a reasonably lower cost without increasing the complication rates.

Abstract P45: A global snapshot of the impact of the COVID-19 pandemic on cancer research: Report from a Global Cancer and COVID-19 Task Force

Abstract Introduction: The COVID-19 pandemic has had profound effects on healthcare systems worldwide. It has also had global economic impacts that will continue to be felt for years. The effects have implications for how cancer research is conducted and funded. The REPRISE project aims to learn from the COVID-19 pandemic to provide opportunities to redefine cancer research priorities in low- to middle-income countries (LMICs). We aim to characterize the nature of these practical and economic impacts and use this information to redefine research priorities in a changed world moving forward. Methods: As a first step, we conducted a snapshot survey of members of the ‘Cancer and COVID-19 Global Task Force’, which consists of experienced cancer researchers across the world. We asked about the extent to which the COVID-19 outbreak and resulting public health measures had affected cancer research in their centers. Results: We received 57 responses to our questionnaire. The respondents worked in 22 countries, representing all Word Health Organization (WHO) regions. 67% of respondents worked in either an academic/university setting, or in a public teaching hospital. The specialities of medical oncology, radiation oncology, surgery, and epidemiology were each represented by >25% of all respondents, which also included those with backgrounds in nursing, palliative care, survivorship, psychology, pathology, and prevention. Respondents in 17/22 countries reported that some (n=10) or all (n=7) cancer research studies were suspended at their center following the outbreak of COVID-19. Respondents in 5 countries reported that suspension of these studies had lasted >6 months. Respondents in 8/22 countries reported that staff redeployment, furlough, or restriction from clinical areas had had a ‘large impact’ on the conduct of research they were involved with. Respondents in 4 further countries reported that these factors had had a ‘moderate impact’. Respondents also reported local impacts on cancer research from in-center outbreaks of COVID-19 (14 countries); government-imposed ‘lockdowns’ (20 countries); compliance with COVID-19 safety (18 countries); decreases in participant accrual (11 countries); and decreased patient access to diagnostics or treatment (19 countries). Nine countries yielded reports of funding cuts in their center. Twenty countries yielded reports of concerns about future funding cuts. Fifteen countries yielded reports of issues from delays to postgraduate education. Additionally, respondents were concerned about future impacts on cancer research from COVID-19 safety measures, funding cuts, and decreased patient access to diagnostics or treatments. Conclusion: The COVID-19 pandemic has profoundly impacted on the conduct of cancer research in many different countries and in several different ways. The process of redefining cancer research priorities throughout the REPRISE project will ensure that the impacts we have documented here are mitigated as far as possible and that moving forward, we can begin to address global disparities in cancer research. Citation Format: Louis Fox, Verna Vanderpuye, Richard Sullivan, Mieke Van Hemelrijck, Deborah Mukherji. A global snapshot of the impact of the COVID-19 pandemic on cancer research: Report from a Global Cancer and COVID-19 Task Force [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P45.

Neuroradiologic Features Associated With Severe Restriction of Functional Mobility in Children With Cerebral Palsy in North India.

Few studies have focused on magnetic resonance imaging (MRI) brain findings associated with functional mobility in cerebral palsy. To determine association between MRI findings and Gross Motor Functional Classification System (GMFCS) levels in cerebral palsy. Prospective-observational study conducted in Pediatric Neurology Clinic at a public teaching hospital, Northern India. First 3 new cases of cerebral palsy were enrolled on particular neuro-clinic day per week for 1 year. Functional mobility was classified according to GMFCS. Association between MRI findings, cerebral palsy type, and GMFCS levels were evaluated using χ2 test. A total of 138 cases (mean age 2.71 [SD = 1.91] years; male [64.5%]) were enrolled. Reported types of cerebral palsy were as follows: spastic quadriplegia (47.8%), spastic diplegia (28.35%), spastic hemiplegia (11.6%), extrapyramidal (6.5%), and ataxic/hypotonic (5.8%). GMFCS were classified into level 1 (13%), level 2 (7.2%), level 3 (4.3%), level 4 (10.9%), and level 5 (64.5%). Spastic quadriplegia and extrapyramidal cerebral palsy were significantly associated with higher (severe) levels (IV and V), whereas spastic diplegia and hemiplegia were significantly associated with lower (mild) levels (I-III) of GMFCS. MRI features of periventricular white matter injury, deep gray matter injury, basal ganglia and thalamic changes, and superficial gray matter injury were significantly associated with severe levels of GMFCS (V and IV). MRI was normal in 8 children (5 = mild category, 3 = severe category). Severe cerebral palsy is most often associated with spastic quadriplegia, extrapyramidal cerebral palsy, superficial gray matter lesions, deep gray matter lesions, and periventricular white matter injury. This information is useful for anticipating and addressing the needs of children with cerebral palsy and for prognostication.

The inappropriateness of brain MRI prescriptions: a study from Iran

BackgroundInappropriate prescriptions can lead to adverse consequences for patients. It also imposes excessive cost on the patients, payers and health systems. The current study aimed at estimating the rate of inappropriate brain Magnetic Resonance Imaging (MRI) prescriptions and their financial burden in Iran.MethodsUsing systematic stratified sampling method, this cross-sectional study recruited 385 participants from three public teaching hospitals in Shiraz, Iran. Demographic information, questions related to brain MRI prescription and its indications checklist were collected using study-specific data collection tools. The completed indications checklist was compared to the appropriateness status table of indications and scenarios to detect the percent of the appropriateness of prescriptions.ResultsAbout 21 percentage of total brain MRI prescriptions are inappropriate. Previous treatment, number of referrals to physician, having other diagnostic tests and the applicant of MRI (P < 0.01) had significant relationships with prescription appropriateness. The estimated financial burden of inappropriate brain MRIs in Shiraz teaching hospitals was 99,988 US dollar in 2017.ConclusionsMore than one-fifth of brains MRIs were inappropriate (i.e. prescriptions without medical indications). It caused 99,988 United States Dollar (USD) financial burden which is 17 times that of Iran's Gross Domestic Product (GDP) per capita. To better allocate resources for the provision of MRI services to health system, rationing policies for controlling moral hazard and reducing provider induced demand can be helpful.

Adjustment in women treated for rheumatoid arthritis

The favourable or unfavourable process of a patient's adaptation to a challenging medical condition may indicate that certain adjustment reactions, which can be either constructive or undesirable, tend to prevail.The aim of the study was to examine the adjustment reactions of patients, and to define the correlation between the reactions and socio-demographic factors, health self-assessment, satisfaction with medical care, duration of treatment, and limitations in women treated for rheumatoid arthritis.The study was conducted at the Department of Rheumatology and Connective Tissue Diseases and the Specialist Outpatient Clinic of the Independent Public Teaching Hospital No. 4 in Lublin, Poland. The Polish adaptation of the Reactions to Impairment and Disability Inventory RIDI (H. Livneh, R. Antonak, 1990) was used in the study, together with an Original Questionnaire. A p-value of <0.05 was set to define statistical differences. Analysis was performed using commercial SPSS Statistics software (IBM Corp., Armonk, NY).Adjustment reactions, adaptive reactions, i.e. adjustment (3±0.5) and acknowledgement (2.6±0.4) were found to markedly prevail, while the lowest mean value was observed for denial (1.9±0.4), which was considered a negative reaction. Longer duration of the disease was associated with a lower level of external hostility. Low health self-assessment and significant limitations impairing everyday activities, caused by pain, deformity and impaired joint mobility, were mostly related to unfavourable early and intermediate non-adaptive reactions.Knowledge of the adjustment reactions and their moderating factors appears to be crucial in the planning of measures aimed at the rehabilitation of RA patients.

Facial pressure injuries and the COVID-19 pandemic: skin protection care to enhance staff safety in an acute hospital setting.

The aim of this study was to determine the impact of a specially designed care bundle on the development of facial pressure injuries (PI) among frontline healthcare workers wearing personal protective equipment (PPE) during the COVID-19 pandemic. The primary outcome of interest was the incidence of facial PIs. The secondary outcomes of interest were facial pain while wearing PPE and ease of use of the care bundle. This study used a voluntary survey by questionnaire, supplemented by a qualitative analysis of interviews from a small purposive sample that took place in one large Irish hospital over a two-month period in 2020. The hospital was a city-based public university teaching hospital with 800 inpatient beds. The intervention was a care bundle consisting of skin protection, face mask selection, material use, skin inspection, cleansing and hydration developed in line with international best practice guidelines. All staff working in COVID-19 wards, intensive care units and the emergency department in the hospital were given a kitbag containing the elements of the care bundle plus an information pamphlet. Data were collected via a survey and interviews. A total of 114 staff provided feedback on the use of the care bundle. Before using the care bundle 29% (n=33) of the respondents reported developing a facial PI, whereas after using the care bundle only 8% (n=9) of the respondents reported developing a facial PI. The odds ratio (OR) of skin injury development was 4.75 (95% confidence interval (CI): 2.15-10.49; p=0.0001), suggesting that after the care bundle was issued, those who responded to the survey were almost five times less likely to develop a skin injury. Interviews with 14 staff determined that the bundle was easy to use and safe. Among those who responded to the survey, the use of the bundle was associated with a reduction in the incidence of skin injury from 29% to 8%, and respondents found the bundle easy to use, safe and effective. As with evidence from the international literature, this study has identified that when skincare is prioritised, and a systematic preventative care bundle approach is adopted, there are clear benefits for the individuals involved.

Perspectives of physicians who work in public hospitals about ethical problems in medical practice

The recognition of ethical problems in medical practice and the potential harmful effects that they may have on patients, underscores the importance of the ethical training of professionals as well as the development of Ethics Committees in Healthcare institutions. However, there is a paucity of national studies about the type of problems faced by professionals and the role of Ethics Committees in hospitals. To explore the perception about ethical problems in clinical practice of Chilean physicians of different specialties of two public teaching hospitals. Physicians of both sexes and different specialties working in two teaching hospitals of Metropolitan Santiago, were invited to participate in focus groups of seven to eight participants. They discussed the ethical problems faced during their clinical practice. A content analysis based on the Grounded Theory was performed with the obtained information. Different types of ethical problems could be distinguished according to their content and the actors involved. The data obtained shows that the ethical dimension is present in the daily work of physicians. The evolution of the narrative throughout the interviews corroborated the importance of installing ethical issues and culture in the working routine of health care professionals. Human resources and an adequate institutional environment are required to promote the discussion about ethical issues such as the relationship between physicians and patient, the role of teaching in health care and institutional decisions.

Vigilância em saúde na pandemia da COVID-19: retomada das atividades eletivas em rede de hospitais de ensino

Introdução: A retomada das atividades durante a pandemia da COVID-19 tem sido tema de discussão em diferentes países para que não afete a continuidade do atendimento às urgências e às emergências atualmente em andamento. Objetivo: Descrever as estratégias para a retomada das atividades eletivas em uma rede de hospitais públicos de ensino no Brasil durante a pandemia da COVID-19. Método: Trata-se de um estudo descritivo no formato de relato de experiência que inclui um processo de vigilância em saúde hospitalar realizado a partir da observação e discussão em uma perspectiva de rede. Resultados: O guia para retomada das atividades eletivas foi estruturado em quatro tópicos, sendo o segundo tópico dividido em outros 11 para detalhamento das recomendações a serem seguidas. As estratégias e ações apresentadas neste guia foram categorizadas em etapas da gestão de projetos para melhor visualização do caminho a ser percorrido: organização, planejamento, implantação e monitoramento. O material foi publicado em setembro de 2020 pela administração central da rede e está em fase de implantação pelos hospitais. Conclusões: O relato de experiência poderá auxiliar outras organizações na definição de estratégias para a retomada segura de suas atividades.

Cost analysis of pediatric intensive care: a low-middle income country perspective

BackgroundGlobally, Pediatric Intensive Care Unit (PICU) admissions are amongst the most expensive. In low middle-income countries, out of pocket expenditure (OOP) constitutes a major portion of the total expenditure. This makes it important to gain insights into the cost of pediatric intensive care. We undertook this study to calculate the health system cost and out of pocket expenditure incurred per patient during PICU stay.MethodsProspective study conducted in a state of the art tertiary level PICU of a teaching and referral hospital. Bottom-up micro costing methods were used to assess the health system cost. Annual data regarding hospital resources used for PICU care was collected from January to December 2018. Data regarding OOP was collected from 299 patients admitted from July 2017 to December 2018. The latter period was divided into four intervals, each of four and a half months duration and data was collected for 1 month in each interval. Per patient and per bed day costs for treatment were estimated both from health system and patient’s perspective.ResultsThe median (inter-quartile range, IQR) length of PICU stay was 5(3–8) days. Mean ± SD Pediatric Risk of Mortality Score (PRISM III) score of the study cohort was 22.23 ± 7.3. Of the total patients, 55.9% (167) were ventilated. Mean cost per patient treated was US$ 2078(₹ 144,566). Of this, health system cost and OOP expenditure per patient were US$ 1731 (₹ 120,425) and 352 (₹ 24,535) respectively. OOP expenditure of a ventilated child was twice that of a non- ventilated child.ConclusionsThe fixed cost of PICU care was 3.8 times more than variable costs. Major portion of cost was borne by the hospital. Severe illness, longer ICU stay and ventilation were associated with increased costs. This study can be used to set the reimbursement package rates under Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Tertiary level intensive care in a public sector teaching hospital in India is far less expensive than developed countries.

Waiting time for outpatient specialist care in Lombardy Region: evaluating accessibility and quality of information on websites of public health agencies and healthcare structures.

Waiting time for outpatient specialist care is an ever-present problem for all Countries with a universal healthcare system. In Italy, information about waiting times must be available on all websites belonging to public health agencies and healthcare structures. The aim of the present descriptive study is to evaluate the accessibility and quality of such information on websites of all public health agencies and healthcare structures in Lombardy Region. All websites belonging to 8 health agencies (ATS), 27 public hospitals (ASST), 4 research and teaching hospitals (IRCCS) were analyzed using a newly designed 30-item checklist. The items were scored 0/1 and grouped in five categories: Accessibility, Architecture, Content, Interactivity, Utility. In all, 76.3% of websites reported their waiting times directly, but three did not update data at least monthly as required by current legislation. Less than half of websites provided information aimed at raising awareness and tackling no-shows, and only 10.5% explained the role of private practice in public structures when maximum waiting times are exceeded. The lack of exposition of waiting times on some websites belonging to ATS, ASST and IRCCS appears to be a relevant issue. There is also little empowering information that may help tackle waiting times themselves. These results warrant further efforts to improve accessibility, quality and transparency of information for all citizens.

200 Homelessness in pregnancy is associated with adverse maternal and neonatal outcomes

The objective of this study was to evaluate the effects of homelessness in pregnancy on obstetrical, neonatal and postpartum outcomes. We conducted a retrospective cohort analysis of all deliveries at a large urban public teaching hospital between January 1st, 2017 and December 31st, 2017. Homeless women who delivered during this period were compared to age-matched controls. Data was collected on demographics, prenatal care, and obstetrical, neonatal and postpartum outcomes. There were 1425 total deliveries at our institution between January 1st, 2017 and December 31st, 2017. Ultimately 67 patients (4.7%) were identified as homeless; the majority, 39 (58.2%) were shelter-housed. Our final cohort included 67 homeless patients and 67 domiciled controls (4.9% of total domiciled patients). Homeless patients were less likely to have a vaginal delivery (61.2% vs 77.6%, p=0.017). Their neonates had longer NICU stays (27.3 days vs 7.5 days, p=0.008). The mean birthweight for neonates born to homeless patients was 2864g as compared to 3174g for controls (p= 0.006). Homeless patients were more likely to be evaluated by the Administration for Children’s Services (ACS) (15% vs 2%, p = 0.016). Homeless women were also less likely to exclusively breastfeed in the 6 weeks following delivery (28.3% vs 53.7%, p=0.005). Homeless women are less likely to have a vaginal delivery and to exclusively breastfeed during the immediate postpartum period, and more likely to be referred for evaluation by the Administration for Children’s Services. Their neonates have longer NICU stays and a lower average birthweight than that of their non-homeless counterparts. Homelessness should be considered as a social determinant of health that may have an unrecognized and severe impact on maternal and neonatal health, and warrants further exploration. We plan to evaluate our findings more in-depth to explore these associations.

Patient Experiences of the Emergency Laparotomy Pathway: A Qualitative Study.

Emergency laparotomy (EL) is a commonly performed operation with high rates of morbidity and mortality. Despite a growing body of literature on outcomes from EL, there is sparse literature on the patient experience. The aim of this study is to capture the perspective of patients on their EL experience. Qualitative methodology is used as a platform to allow patients to express their personal experiences and ideas around the EL process. Participants were consented as a part of a large observational study, established across the three public teaching hospitals in Auckland, New Zealand. Patients who had an EL within the past 4months were recruited. A recorded interview was conducted either face-to-face or over the telephone, using questions formulated from a previous systematic review on EL outcomes. Transcripts were transported to NVivo and thematically analysed by two reviewers. Fifteen participants were interviewed. The majority of participants were female, New Zealand European and 65 or older. Five important themes were identified. Overall, participants expressed satisfaction with their interactions with hospital staff. However, they wanted more information about their condition, operation and what outcomes might occur. Participants also described post-operative priorities in the acute setting, as well as long-standing physical and emotional impacts. This study provides a better understanding of what is important to patients during the EL process. This information is important when considering ways to improve care and communication with patients undergoing EL.

Challenges in Establishing a New Clubfoot Clinic at a Public Hospital: an Appraisal of the Initial 384 Cases

The Ponseti method of clubfoot treatment has revolutionized the clubfoot treatment. Participation of non-government organizations (NGOs) has helped expand the reach of clubfoot treatment and improve the outcomes. Establishing new clubfoot clinics may have their teething problems, which need to be anticipated and addressed for their efficient functioning. This retrospective observational study was performed using records of children enrolled in the initial 4 years of an NGO supported clubfoot clinic at a teaching public hospital. Patient details were analyzed to act as surrogate indicators of the challenges faced in the efficient delivery of care at this new clubfoot clinic. Furthermore, the authors’ suggestions would help other clinicians in starting a clubfoot clinic more effectively. Three hundred eighty-four children were enrolled in the initial 4 years. Two hundred ninety-seven children completed their cast treatment. Two hundred four (53.12%), which was more than half of all the enrolled children, had received some prior treatment. Only 86 (22.4%) children followed up for 4 years or more. A high dropout rate at different stages of treatment and follow-up was also noticed. The high dropout rate with the knowledge that most of the enrolled children had some prior treatment points to the clinicians’ and counselors’ failure to educate the parents. Electronic instead of manual data entry would play a role in tracing children in the setting of a new clubfoot clinic. A dedicated team of clinicians and counselors right from the beginning would help in gaining parental trust. Field visits by volunteers might be a useful additional strategy in improving the follow-up and the overall results.