Secondary Level Hospital Research Articles

Analysis on the distribution status and concentration degree of radiological diagnosis and treatment resources in Beijing

Objective To analyze the distribution status and agglomeration degree of radiological diagnosis and treatment resources in Beijing, and provide references for rationally coordinating the allocation of radiological diagnosis and treatment resources, formulating resource allocation policies, and promoting the stable development and efficient use of radiological diagnosis and treatment resources. Methods Based on the medical radiation protection monitoring data of Beijing medical and health institutions from 2019 to 2020, the current situation of radiological diagnosis and treatment resources is described by the number of radiological diagnosis and treatment resources, the average service volume, and the resource composition, and the distribution of radiological diagnosis and treatment resources in Beijing is evaluated with the aid of the agglomeration degree. Results The number of radiological diagnostic equipment, the number of service personnel, and the number of radiological workers engaged in third-level hospitals is the largest; for the number of service personnel for each type of single equipment, third-level hospitals account for a larger proportion, and radiotherapy and nuclear medicine services are concentrated in third-level hospitals. Human resource pressure and equipment service pressure are relatively high in third-level hospitals. First-level hospitals mainly undertake radiological diagnosis services. There is little difference in the amount of radiological diagnosis services per capita between second-level hospitals and third-level hospitals. Nuclear medicine and radiotherapy in third-level hospitals per capita service volume is significantly higher than that insecond-level hospitals. Radiological diagnosis and radiotherapy resources are concentrated in urban areas to a large extent. Conclusion There are obvious differences in the utilization of radiological diagnosis and treatment resources in different levels of hospitals. There is a significant concentration of radiological diagnosis and treatment resources in various districts. There is a certain degree of unbalanced distribution and inadequate utilization of radiological diagnosis and treatment resources in Beijing. 摘要： 目的 开展北京市放射诊疗资源分布现状与集聚度分析, 为合理统筹放射诊疗资源配置、制定政策、促进放射 诊疗资源稳定发展与高效利用提供参考。 方法 基于 2019—2020 年北京市医疗卫生机构医用辐射防护监测数据, 通 过放射诊疗资源数量、平均服务量、资源构成等指标描述放射诊疗资源现状, 借助集聚度指标评价北京市放射诊疗资 源分布均衡程度。 结果 三级医院放射诊断设备配备数量、服务人次及放射工作人员数最多；单台设备服务人次三级 医院占比较大, 且放射治疗、核医学服务集中于三级医院。三级医院的人力资源与设备服务压力均相对较大, 一级医 院主要承担放射诊断服务, 二级医院与三级医院人均放射诊断服务量差别不大, 三级医院核医学和放射治疗人均服务 量显著高于二级医院。放射诊疗资源在城区集聚程度较大。 结论 不同级别医院放射诊疗资源利用率存在明显差异, 各区放射诊疗资源存在显著集聚现象, 北京市放射诊疗资源存在一定程度的分布不均衡、利用不充分问题。

Accuracy of obstetric ultrasonography compared to fetal echocardiography in diagnosis of congenital heart disease at a secondary level hospital in Brazil: A pilot study

BackgroundCongenital heart diseases (CHD) are dynamic defects that originate in the embryo, evolving during gestation, and undergoing significant change throughout the entire course of extrauterine life. CHD represent a complex group of abnormalities related to high infant morbidity and mortality. Ultrasonography advances in Obstetrics and Fetal Medicine have contributed to the increased detection of these anomalies, with high screening potential during pregnancy. Despite studies pointing to high fetal echocardiography's sensitivity and specificity, this method is not homogeneously available worldwide yet, particularly in low and medium-income countries. ObjectivesHere we compared the accuracy of obstetric ultrasonography performed between 18 and 22 weeks of gestational age with Fetal Echocardiography. MethodsWe evaluated 44 pregnant women who underwent fetal echocardiography examination. This way, we can comprehend if the first method alone can diagnose fetal cardiac abnormalities or track those that need additional imaging by fetal echocardiography. ResultsIn our sample, Obstetric Ultrasonography reached 81.8% accuracy, 57.1% sensitivity, and 93.3% specificity, whereas Fetal Echocardiography's accuracy was estimated at 97.7%, 100% sensitivity, and 96.8% specificity. ConclusionsDespite the superior accuracy of Fetal Echocardiography, we believe that Obstetric Ultrasonography is enough to establish a probable diagnostic hypothesis when performed by experienced professionals, following the specific guidelines. This way, appropriate referral to tertiary centers can facilitate the care of these infants with complex heart disease that requires aggressive surgical intervention and Neonatal and Cardiac Intensive Care services.

Satisfaction on Nursing Care among Admitted Patients in Secondary Level Hospital

Background: Nurses are the vital for any health care setting and basic nursing cares is concerned with helping a patient and meet his or her basic needs. The main role of nursing today is to help the individual to attain or maintain the optimal level of health. -+In Bangladesh, health care service is mostly curative oriented and hospital based; where the quality of service is a major concern particularly care provided by nurses. Therefore, in the present study the researcher interested to measure the degree of patients’ satisfaction and its relationship with quality of nursing care, which is measured by three important aspects of nurses including nurse’s attitude, behavior and interpersonal relationship. Many previous researchers have studied patient satisfaction towards nursing services in healthcare setting using NCPSS with Likert scale. But in this study the researcher used Risser's patient's satisfaction scale. Materials and Methods: This cross sectional study was conducted from January to December 2015, purposively about 329 admitted patients of male, female and gyene & obstetrical ward at Adhunik Sadar Hospital, Nilphamary to find out the level of satisfaction on nursing care among admitted patients in secondary level Hospital. Data were collected by the researcher himself by face to face interview with a pretested semi-structured questionnaire. Results: Result reveals that regarding attitude 52.6% were satisfied, 33.4% and 14.0% were highly satisfied and dissatisfied respectively. Regarding nurses’ behavior 53.8% were satisfied, 32.5% and 13.7% were highly satisfied and dissatisfied respectively. Regarding nurses’ interpersonal relationship 44.4% were highly satisfied, 40.4% and 15.2% were satisfied and dissatisfied respectively. Conclusion: Nurses need to improve their attitude, behavior, and interpersonal relationship for patients’ satisfaction.

The impact of COVID-19 national lockdown on orthopaedic trauma admissions in the northern part of South Africa: A multicentre review of tertiary- and secondary-level hospital admissions.

COVID-19 national lockdown measures in South Africa (SA) have been under scrutiny since they were implemented in March 2020. Currently there are no studies showing the effect of the first lockdown on hospital admissions in the northern provinces of SA. To evaluate the impact of national lockdown restrictions on musculoskeletal injury admissions in three hospitals across three provinces (Gauteng, Limpopo and North West). In a retrospective review, we compared orthopaedic trauma admissions from 1 April 2020 to 30 June 2020 (during alert level 5 of the national lockdown) with cases admitted during the same period in 2019 (non-lockdown). We reviewed the number of admissions, demographic data and mechanisms of injury in the adult and paediatric population groups. A total of 449 patients were admitted with musculoskeletal injuries during the lockdown period compared with 664 patients in 2019, equating to a 32% reduction in total admissions. While there was an 8% increase in paediatric admissions during lockdown at Dr George Mukhari Academic Hospital, adult admissions decreased in all centres. More young males were admitted during both lockdown (mean age 39.8 years) and non-lockdown (mean age 41.2 years) periods than females (p=0.004). There were significant reductions in the number of injuries due to motor vehicle accidents (59%) and in the number of gunshot wounds (36%) during lockdown. However, we observed an 11% rise in injuries related to suicide attempts among adult admissions during the lockdown period. Lockdown restrictions resulted in a significant reduction in orthopaedic trauma admissions, and were effective in terms of allowing institutions to direct resources to the management of COVID-19 patients. In the light of the increased suicide attempts observed during lockdown, future lockdown regulations should include comprehensive measures to relieve socioeconomic stress.

The costing of operating theatre time in a secondary-level state sector hospital: A quantitative observational study.

There is no established costing model for operating theatres (OTs) in South Africa (SA), yet both health sectors have existing charges for OT time: in the state sector, Uniform Patient Fee Schedule (UPFS) rates, and in the private sector, rands per minute (ZAR/min) rates. Understanding the cost of providing the separate components of a health service is important for planning and funding purposes. To develop a costing model that would allow calculation of the ZAR/min cost of OT time. To determine the actual costs, in order to establish the comparable costs that would be included in the ZAR/min charges for OTs in the private health sector. The OTs in a secondary-level, state sector hospital in Cape Town were used in this quantitative observational study to develop a top-down costing model for OTs in SA. The inclusive costing model was developed in a consultative process with professionals, managers and experts from the state and private sectors. The model was then populated with costs for the month of August 2018. Costs were considered in the categories of full costs, shared costs, and capital or annualised costs. Owing to uncertainty in costing of OTs, two models - with different annualisation times assigned to the capital costs - were developed to demonstrate the difference. For shared costs, correction factors were determined using either an activity-based (workload) factor or a more generic estimation of workload using theatre nursing staff as a percentage of total hospital nursing staff.To determine a ZAR/min cost of creating a minute of available theatre time, all the annual costs were divided by minutes that the OTs are explicitly available, each year, to provide patient care. The model was then populated with costs using the appropriate correction factors. The longer annualisation model costed OT time at ZAR31.46 per minute, and the shorter annualisation model at ZAR33.77 per minute. In both the longer and shorter capital annualisation models, nursing was the largest contributor to costs at 36% and 33%, respectively, followed by construction costs at 9% and 11%, and then OT equipment at 8% and 11%. An inclusive, top-down costing model for OTs in SA was developed. This costing model will support work to develop costing for individual procedures and the appropriate charge for planned and emergency OT time, and to better determine budgeting for OT services. Meaningful critique of the model will improve its fidelity, and is likely to increase its utility, especially as SA moves towards universal health coverage.

A three year review of twin deliveries in a specialist hospital in North-Western Nigeria

Background: Although the frequency of twin pregnancies varies from one ethnic group to another, there has been a general trend toward an increase recently. Maternal and perinatal mortality are higher in twin than singleton pregnancies. Most studies on twinning had been done in university teaching hospitals where conditions are different from what is seen in secondary-care health institutions where this study was done Objectives: To determine the incidence, mode of delivery and maternal and perinatal outcomes of twin deliveries at a secondary-level hospital in North-Western Nigeria. Methodology: This was a descriptive study of 96 twin deliveries over a three-year period between May 2013 and April 2016 at a secondary-level hospital with access to specialist obstetricians and paediatricians. Result: There were 4,567 deliveries, with 101 twin deliveries, an incidence of 2.2% or 1 in 45 deliveries. The mean maternal age and parity were 26.4 years and 3.2 respectively. The mean gestational age at delivery was 35.9 weeks, with a mean birth weight of 2.18kg and 2.01kg for the first and second twins respectively. Male twins constituted 53.2% of twin births. The common presentations of the twins were cephalic–cephalic (64.6%), cephalic–breech (16.7%) and breech–breech (6.3%). Mode of deliveries were vertex vaginal (77.1%) and caesarean (14.6%). Breech presentation of the leading twin was the commonest indication for caesarean section (57.1%). Anaemia in pregnancy (16.7%) was the commonest maternal complication, while prematurity was the leading cause of perinatal mortality. Conclusion: Preterm delivery, malpresentation, operative delivery and maternal anaemia in pregnancy were commonly seen in association with twin pregnancy in this cohort of patients.

Induction of labour – a misused blessing: Prospective study of factors influencing the success of induction and comparison of fetomaternal outcomes with spontaneous labour

Background. Although most pregnant women experience spontaneous labour at term, induction of labour is indicated whenever continuation of pregnancy is detrimental to either the fetus or the mother. Objectives . To study the factors associated with the successful induction of labour and to compare the maternal and fetal outcomes between induced and spontaneous labour . Methods. We conducted a prospective observational and comparative study from September 2015 to December 2016 at Dr TMA Pai Hospital – a secondary level hospital at Manipal Academy of Higher Education (MAHE). Women with a singleton pregnancy, live fetus, vertex presentation and gestational age (GA) >36 weeks were included in the study, and those with antepartum haemorrhage, scarred uterus, anomalous fetus and intrauterine fetal demise were excluded. Results. Out of 1 575 deliveries during the study period, 550 were induced (34%). A total of 300 inductions fulfilled the inclusion criteria and formed the study group. Multiparity, body mass index (BMI) <25 and gestational age (GA) >38 weeks were factors associated with successful induction. Among the components of the Bishop score, dilatation was a better predictor of vaginal delivery ( p <0.001) and post-dated pregnancy was the most common indication (33.6%). The rates of caesarean section (CS) delivery (33% v. 12%) and neonatal intensive care unit (NICU) admissions (4% v. 1%) were more in the induced group compared with the spontaneous group. Conclusion. Multiparity, BMI <25 and advancing GA are predictors of successful induction. Induction is safe but carries a high risk of CS delivery and NICU admissions.

O36: DEVELOPING A TRAUMA REGISTRY IN A MIDDLE INCOME COUNTRY – BOTSWANA

Abstract Background Botswana has a large burden of disease from injury, but no trauma registry. This study sought to design and pilot test a trauma registry at two hospitals. Methods A cross sectional study was piloted at a tertiary hospital and a secondary level hospital in Botswana. The study consisted of two stages: stage 1 mainly involved stakeholder consultations on existing data collection tools. Stage 2 consisted of two phases: Phase I involved retrospective collection of existing data from existing data collection tools and Phase II collected data prospectively using the proposed trauma registry prototype. Results The pre-hospital road traffic accident data is collected using hard copy forms and some of this data is transferred to a stand-alone electronic registry. The hospital phase of road traffic accident data all goes into hard copy files then stored in institutional registry departments. The post-hospital data is also partially stored as hard copies and some data is stored in a stand-alone electronic registry. The demographics, pre-hospital, triage, diagnosis, management and disposition had a high percent variable completion rate with no significant difference between phases I and II. However, the primary survey variables in Phase I had a low percent variable completion rate which was significantly different from the high completion rates in phase II at both hospitals. A similar picture was observed for the secondary survey at both hospitals. Conclusion Electronic trauma registries are feasible and data completion rate is high when using the electronic data registry as opposed to data collected using the existing paper-based data collection tools. Keywords Trauma registry, Injury registry, Road Traffic Accident Trauma Registry, Road Traffic Crushes Registry, Road Accident Registry. SYSTEMATIC REVIEWS

Advanced Primary Abdominal Pregnancy – A Case Series Based on Single-Center Experience from a Rural Secondary Level Hospital in Northeast India

Five patients with advanced primary abdominal pregnancy presented to our center between 2010 and 2020. The clinical profile, presentation, and management of these patients are described with a discussion on this rare but important condition. Of the five, four women survived. There was preoperative fetal demise in four of them, and one patient had a healthy live term baby. Advanced primary abdominal pregnancy, although very rare, is a life-threatening variation of ectopic gestation. Correct diagnosis is often a serious obstetric dilemma and the condition is associated with a 90-fold increase in maternal mortality rate and fetal survival is exceedingly rare. The clinical symptoms by which patients present are similar to other ectopic pregnancies like tubal ectopics. However, in our subset of patients, all were in their third trimester and four out of five presented in shock. Hence, a high degree of clinical suspicion for abdominal pregnancy is required to clinch a correct diagnosis. Often, the diagnosis of abdominal pregnancy is made only during laparotomy. Preoperative ultrasound has 50% accuracy in diagnosing this condition. Magnetic resonance imaging is considered gold standard for the diagnosis of abdominal pregnancies. Medical management with methotrexate is opted when the site of abdominal pregnancy is in the liver and spleen where life-threatening hemorrhage is expected. Surgical management is considered in patients with severe intraperitoneal hemorrhage and in second- and third-trimester abdominal pregnancies. Early diagnosis and proper surgical management irrespective of the stage of gestation is important for achieving good outcome.

Does social health insurance prevent financial hardship in Mongolia? Inpatient care: A case in point.

BackgroundProtecting people from financial hardship and impoverishment due to health care costs is one of the fundamental purposes of the Mongolian health system. However, the inefficient, oversized hospital sector is considered one of the main shortcomings of the system. The aim of this study is to contribute to policy discussions by estimating the extent of catastrophic health expenditure and impoverishment due to inpatient care at secondary-level and tertiary-level public hospitals and private hospitals.MethodsData were derived from a nationally representative survey, the Household Socio-Economic Survey 2012, conducted by the National Statistical Office of Mongolia. A total of 12,685 households were involved in the study. “Catastrophic health expenditure” is defined as out-of-pocket payments for inpatient care that exceed a threshold of 40% of households’ non-discretionary expenditure. The “impoverishment” effect of out-of-pocket payments for inpatient care was estimated as the difference between the poverty level before health care payments and the poverty level after these payments.ResultsAt the threshold of 40% of capacity to pay, 0.31%, 0.07%, and 0.02% of Mongolian households suffered financially as a result of their member(s) staying in tertiary-level and secondary-level public hospitals and private hospitals respectively. About 0.13% of the total Mongolian population was impoverished owing to out-of-pocket payments for inpatient care at tertiary-level hospitals. Out-of-pocket payments for inpatient care at secondary-level hospitals and private hospitals were responsible for 0.10% and 0.09% respectively of the total population being pushed into poverty.ConclusionsAlthough most inpatient care at public hospitals is covered by the social health insurance benefit package, patients who utilized inpatient care at tertiary-level public hospitals were more likely to push their households into financial hardship and poverty than the inpatients at private hospitals. Improving the hospital sector’s efficiency and financial protection for inpatients would be a crucial means of attaining universal health coverage in Mongolia.

A comparative cost analysis between two quick diagnosis units of different levels of complexity.

Aim: To compare by micro-costing the costs incurred by quick diagnosis units of tertiary and second-level hospitals. Patients & methods: We included 407 patients from a tertiary and secondary hospital unit. A bottom-up approach was applied. Results: Cost per patient was €577.5±219.6 in the tertiary versus €394.7±92.58 in the secondary unit (p = 0.0559). Mean number of visits and ratio of successive/first visits were significantly higher in the former (3.098 and 2.07 vs 2.123 and 1.12, respectively). Personnel and indirect costs including their percent contribution to overall costs accounted for the main differences. Conclusion: A greater volume of appointments, number of staff and staff time and a greater complexity of patients from the tertiary hospital unit justified the differences in cost outcomes.

A quality improvement intervention to improve early initiation of breastfeeding among newborns delivered at a secondary level hospital in northern India

BackgroundEarly initiation of breastfeeding (EIBF) has been shown to be associated with reduced neonatal mortality, but many barriers exist that lead to the delay of EIBF. We aimed at improving EIBF among newborns delivered at a secondary care hospital using standard quality improvement methods of root-cause analysis and the Plan-Do-Study-Act (PDSA) cycle. MethodsThe study was conducted in the year 2016–17 at a 50-bedded secondary care hospital in northern India. A baseline assessment of the timing of breastfeeding initiation was done, and factors contributing to delayed initiation of breastfeeding were analysed. Interventions were planned and implemented in short sequential PDSA cycles. The rapid-cycle aspect of PDSA began with piloting a new process, followed by examining results and responding by problem-solving, after which the next PDSA cycle was initiated. The percentage of newborns receiving breastfeeding within 1 h of birth was assessed on a monthly basis. ResultsThe rate of early initiation of breastfeeding improved from 52% at baseline to 97% in the immediate post-training phase. After an initial fall due to the shortage of staff, the EIBF rate was sustained at 91% after six months. ConclusionEIBF can be achieved through the involvement of all stakeholders, team-building, and commitment from managerial staff using the QI (Quality Improvement) approach.

Assessment of Respiratory Function in Infants and Young Children Wearing Face Masks During the COVID-19 Pandemic

Face masks have been associated with effective prevention of diffusion of viruses via droplets. However, the use of face masks among children, especially those aged younger than 3 years, is debated, and the US Centers for Disease Control and American Academy of Physicians recommend the use of face mask only among individuals aged 3 years or older. To examine whether the use of surgical facial masks among children is associated with episodes of oxygen desaturation or respiratory distress. This cohort study was conducted from May through June 2020 in a secondary-level hospital pediatric unit in Italy. Included participants were 47 healthy children divided by age (ie, group A, aged ≤24 months, and group B, aged >24 months to ≤144 months). Data were analyzed from May through June 2020. All participants were monitored every 15 minutes for changes in respiratory parameters for the first 30 minutes while not wearing a surgical face mask and for the next 30 minutes while wearing a face mask. Children aged 24 months and older then participated in a walking test for 12 minutes. Changes in respiratory parameters during the use of surgical masks were evaluated. Among 47 children, 22 children (46.8%) were aged 24 months or younger (ie, group A), with 11 boys (50.0%) and median (interquartile range [IQR]) age 12.5 (10.0-17.5) months, and 25 children (53.2%) were aged older than 24 months to 144 months or younger, with 13 boys (52.0%) and median (IQR) age 100.0 (72.0-120.0) months. During the first 60 minutes of evaluation in the 2 groups, there was no significant change in group A in median (IQR) partial pressure of end-tidal carbon dioxide (Petco2; 33.0 [32.0-34.0] mm Hg; P for Kruskal Wallis = .59), oxygen saturation (Sao2; 98.0% [97.0%-99.0%]; P for Kruskal Wallis = .61), pulse rate (PR; 130.0 [115.0-140.0] pulsations/min; P for Kruskal Wallis = .99), or respiratory rate (RR; 30.0 [28.0-33.0] breaths/min; P for Kruskal Wallis = .69) or for group B in median (IQR) Petco2 (36.0 [34.0-38.0] mm Hg; P for Kruskal Wallis = .97), Sao2 (98.0% [97.0%-98.0%]; P for Kruskal Wallis = .52), PR (96.0 [84.0-104.5] pulsations/min; P for Kruskal Wallis test = .48), or RR (22.0 [20.0-25.0] breaths/min; P for Kruskal Wallis = .55). After the group B walking test, compared with before the walking test, there was a significant increase in median (IQR) PR (96.0 [84.0-104.5] pulsations/min vs 105.0 [100.0-115.0] pulsations/min; P < .02) and RR (22.0 [20.0-25.0] breaths/min vs 26.0 [24.0-29.0] breaths/min; P < .05). This cohort study among infants and young children in Italy found that the use of facial masks was not associated with significant changes in Sao2 or Petco2, including among children aged 24 months and younger.

Postpartum infection, pain and experiences with care among women treated for postpartum hemorrhage in three African countries: A cohort study of women managed with and without condom-catheter uterine balloon tamponade.

ObjectiveWe aimed to determine the risk of postpartum infection and increased pain associated with use of condom-catheter uterine balloon tamponade (UBT) among women diagnosed with postpartum hemorrhage (PPH) in three low- and middle-income countries (LMICs). We also sought women’s opinions on their overall experience of PPH care.MethodsThis prospective cohort study compared women diagnosed with PPH who received and did not receive UBT (UBT group and no-UBT group, respectively) at 18 secondary level hospitals in Uganda, Egypt, and Senegal that participated in a stepped wedge, cluster-randomized trial assessing UBT introduction. Key outcomes were reported pain (on a scale 0–10) in the immediate postpartum period and receipt of antibiotics within four weeks postpartum (a proxy for postpartum infection). Outcomes related to satisfaction with care and aspects women liked most and least about PPH care were also reported.ResultsAmong women diagnosed with PPH, 58 were in the UBT group and 2188 in the no-UBT group. Self-reported, post-discharge antibiotic use within four weeks postpartum was similar in the UBT (3/58, 5.6%) and no-UBT groups (100/2188, 4.6%, risk ratio = 1.22, 95% confidence interval [CI]: 0.45–3.35). A high postpartum pain score of 8–10 was more common among women in the UBT group (17/46, 37.0%) than in the no-UBT group (360/1805, 19.9%, relative risk ratio = 3.64, 95% CI:1.30–10.16). Most women were satisfied with their care (1935/2325, 83.2%). When asked what they liked least about care, the most common responses were that medications (580/1511, 38.4%) and medical supplies (503/1511, 33.3%) were unavailable.ConclusionUBT did not increase the risk of postpartum infection among this population. Women who receive UBT may experience higher degrees of pain compared to women who do not receive UBT. Women’s satisfaction with their care and stockouts of medications and other supplies deserve greater attention when introducing new technologies like UBT.

Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study

Inappropriate antibiotic use greatly accelerates antimicrobial resistance. The appropriateness of antibiotic prescriptions is well evaluated, using big observational data, in some high-income countries, whereas the evidence of this appropriateness is scarce in China. We aimed to assess the appropriateness of antibiotic prescriptions in ambulatory care settings in China to inform future antimicrobial stewardship. We used data from the Beijing Data Center for Rational Use of Drugs, which was a national database designed for monitoring rationality of drug use. 139 hospitals that uploaded diagnosis and prescription information were included from 28 provincial-level regions of mainland China. Outpatient prescriptions were classified as appropriate, potentially appropriate, inappropriate, or not linked to any diagnosis for antibiotic use by following a published classification scheme. Antibiotic prescription rates for various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Antibiotic prescribing patterns and proportions of individual antibiotics prescribed for different diagnosis categories were analysed and reported. Between Oct 1, 2014, and April 30, 2018, 18 848 864 (10·9%) of 172 704 117 outpatient visits ended with antibiotic prescriptions. For conditions for which antibiotic use was appropriate, potentially appropriate, and inappropriate, 42·2%, 30·6%, and 7·6% of visits were associated with antibiotic prescriptions, respectively. Of all 18 848 864 antibiotic prescriptions, 9 689 937 (51·4%) were inappropriate, 5 354 224 (28·4%) were potentially appropriate, 2 893 102 (15·3%) were appropriate, and 911 601 (4·8%) could not be linked to any diagnosis. A total of 23 266 494 individual antibiotics were prescribed, of which 18 620 086 (80·0%) were broad-spectrum and the top four most prescribed antibiotics were third-generation cephalosporins (5 056 058 [21·7%]), second-generation cephalosporins (3 823 410 [16·4%]), macrolides (3 554 348 [15·3%]), and fluoroquinolones (3 285 765 [14·1%]). Inappropriate antibiotic prescribing was highly prevalent nationwide in China. Over half of the antibiotic prescriptions were inappropriate in secondary-level and tertiary-level hospitals, suggesting an urgent need for outpatient antibiotic stewardship aimed at optimising antibiotic prescribing to achieve the goals set in China's 2016 national action plan to contain antimicrobial resistance. The National Natural Science Foundation of China.

Antibiotic stewardship challenges in an evolving health-care market in China

Overuse of antibiotics has attracted increasing concerns globally. Excessive use of antibiotics is believed to be associated with the development of antimicrobial resistance, which can seriously jeopardise health-care services and patient outcomes. 1 Zhang X Cui Y Liu C Zuo K Tang Y Antibiotic sales in primary care in Hubei province, China: An Analysis of 2012–2017 Procurement Records. Int J Environ Res Public Health. 2019; 163376 Crossref Scopus (12) Google Scholar An Article by Houyu Zhao and colleagues 2 Zhao H Wei L Li H et al. Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database study. Lancet Infect Dis. 2021; (published online Jan 27.)https://doi.org/10.1016/S1473-3099(20)30596-X Summary Full Text Full Text PDF Scopus (12) Google Scholar —one of the largest studies ever conducted in China—published by The Lancet Infectious Diseases, revealed a concerningly high proportion of inappropriate prescriptions of antibiotics. More than 51% of antibiotic prescriptions (almost 2 million per year) from 139 public hospitals for outpatient visits were found to be inappropriate, compared with 15·3% that were deemed appropriate. China has 12 436 secondary and tertiary hospitals. 3 National Health Commission of the People's Repubic of China2019 health development report. http://www.nhc.gov.cn/wjw/nianb/list.shtmlDate: 2020 Date accessed: July 15, 2020 Google Scholar The total volume of inappropriate antibiotic prescriptions from secondary and tertiary hospitals could have exceeded 173 millions per year on the basis of these data. Appropriateness of antibiotic prescriptions in ambulatory care in China: a nationwide descriptive database studyInappropriate antibiotic prescribing was highly prevalent nationwide in China. Over half of the antibiotic prescriptions were inappropriate in secondary-level and tertiary-level hospitals, suggesting an urgent need for outpatient antibiotic stewardship aimed at optimising antibiotic prescribing to achieve the goals set in China's 2016 national action plan to contain antimicrobial resistance. Full-Text PDF

Outcomes of newborn hearing screening at an academic secondary level hospital in Johannesburg, South Africa.

BackgroundThe Health Professions Council of South Africa (HPCSA) issued early hearing detection and intervention guidelines, which has universal newborn hearing screening (UNHS) as one of the important goals. Despite established evidence of the importance of UNHS globally, there has been no mandated formalised and standardised implementation as yet in South Africa.ObjectivesThe aim of this study was to describe the outcomes of newborn hearing screening (NHS) in an academic secondary level hospital in Johannesburg, South Africa.MethodsThis was a prospective non-experimental feasibility study over a 3-month period, involving conducting hearing screening of 121 neonates. Audiologists conducted a risk factor assessment, otoscopic examinations and distortion product otoacoustic emissions (DPOAEs) screening on each neonate, with follow-up appointments for re-screening and diagnostic audiological assessments for all neonates with refer findings. Data were analysed using STATA intercooled version 11©, through both descriptive and inferential statistics (Fisher’s exact test), with significance established where p-values less than 0.05 were considered statistically significant.ResultsOf the 121 neonates screened, the majority (75%) were screened in the first 24 h of life. A high refer rate (47%) of the total sample was found on DPOAE screening. No maternal or neonatal risk factors were found to be significantly associated with refer findings.ConclusionFindings contribute towards the existing evidence base that raises implications for successful implementation of NHS programmes in public healthcare in South Africa. Screening protocols need to consider the timing of screening, the measures and procedures adopted in the screening protocols, as well as the follow-up strategies.

Knowledge and practices regarding infection control among nurses in secondary level hospital

Infection control and standard precautions is evidence-based practices that can reduce the risk of transmission of microorganisms. Infection control education is a fundamental component of the Nursing curriculum. A cross-sectional study was conducted to assess the level of knowledge and practices regarding infection control among nurses in secondary level hospital at 250 beds Chittagong General Hospital and Fouzderhat TB Hospital, Chittagong. The study period was 1st January to 31st December 2018. Total 182 nurses were included in this study. The respondents were selected by purposive sampling technique and data were collected by face to face interview. The study was found that (78.0%) respondents had fair knowledge and (90.2%) had fair practices regarding infection control. The study also revealed that, 161 (88.5%) respondents awarded about hand washing, 179 (98.4%) respondents were concerned about waste management and 93 (51.1%) respondents agree and 85 (46.7%) respondents strongly agree about PPE use is important. Significant statistical difference was found between working experience and knowledge level. This study can be concluded that in spite of practice level regarding infection control, nurses had fair knowledge level. These finding suggest that nurse knowledge and practice regarding infection control need further improvement.&#x0D; Asian J. Med. Biol. Res. December 2020, 6(4): 731-737

Feasibility, uptake and real-life challenges of a rural cervical and breast cancer screening program in Vellore, Tamil Nadu, South India.

Early detection of breast and cervical cancer by organized screening has been found to reduce mortality rates in trials, but documentation of programme results and challenges is rarely done from non-trial settings. This study reports results of a population-based cancer control programme in a rural block in Vellore, Tamil Nadu, population size (116,085), targeting a population of 18,490 women aged 25-60 years, between November 2014 and March 2018. Village-based health education sessions were conducted by social workers, using trained volunteers and health workers to motivate eligible women. Screening was done at a secondary level hospital, by trained general physicians using visual inspection with acetic acid and clinical breast examination, followed by colposcopy, radiological imaging (breast) and biopsy as required. A total of 8 volunteers and 17 health workers motivated women for 93 health education and screening sessions, in 46 out of 82 villages. While 1,890/18,490 (10.2 per cent) were screened for breast cancer, 1,783 (9.6 per cent) were screened for cervical cancer, with a yield of 3.4/1,000 for cervical pre-cancer/cancer. The main challenges were creating time for screening activities in a busy secondary hospital and difficulty in ensuring treatment completion of screen-detected cases. Population-based cancer screening programs can be offered by secondary hospitals that also run primary care services, to increase screening rates. Clear referral systems need to be established, bearing in mind that social factors, especially poor family support, may pose a threat to treatment, in spite of easy availability of cure.

A Study of the Relationship Between Job Satisfaction and Work Engagement of Physicians in Public Hospitals

To understand the level of job satisfaction and work engagement of physicians in public hospitals, to analyze the interaction between job satisfaction and work engagement, and to discuss how each dimension of job satisfaction affects work engagement so as to provide information and reference for improving the level of work engagement of physicians in public hospitals. Covering 6 public hospitals in Sichuan (3 tertiary-level hospitals and 3 secondary-level hospitals), 638 questionnaires were obtained from physicians through convenient sampling for data description and analysis. Pearson correlation method was used to analyze the correlation between job satisfaction and work engagement, and multiple linear stepwise regression method was used to analyze work engagement and the influencing factors of each dimension. With regard to job satisfaction, physicians showed high levels of satisfaction in personal safety (3.77±0.87), leadership identification and support (3.59±0.77), and job pressure (3.51±0.81). The mean points of work engagement and each dimension were as follows: total mean points of work engagement (4.02±0.99), dedication (4.21±1.13), absorption (4.19±1.08) and vigor (3.63±1.04). In job satisfaction, salary and benefits, work environment, social recognition, organizational management, leadership identification and support are positively correlated to work engagement and all dimensions. In job satisfaction, 5 dimensions, including social recognition, leadership recognition and support, work achievement, personal safety and organizational management, had a significant influence on work engagement and all dimensions. Emphasis on the high-level needs for recognition and self-actualization of doctors, doctor-patient communication, and personal development of doctors may improve doctors' job satisfaction and work engagement.