Secondary Health Care Institutions Research Articles

Preoperative Anesthetic Clearance a Necessity in Secondary Healthcare Institutions

Preoperative Anesthetic Clearance a Necessity in Secondary Healthcare Institutions

HEALTHCARE FROM THE CLASSROOM TO CLINICAL PRACTICE

Background: Nurses work in the fields of health promotion, disease prevention, treatment, and rehabilitation. After finishing high school, the title of nurse-technician is obtained, and they can be employed in primary, secondary, or tertiary healthcare institutions in basic medical care jobs up to the complex requirements of progressive care. The ability to transfer theory from the classroom to clinical practice is a key skill in nursing education. This transfer refers to students' ability to adapt classroom knowledge to different clinical practice situations. In order to provide nursing care that meets the standards of professional care, medical school students must accurately and effectively transfer theoretical knowledge to address specific patient care situations. Nursing education programs prepare students through a variety of learning opportunities that include simulated situations in healthcare offices and real-world situations in clinical hospital settings. Education takes place in classrooms, laboratories, and clinics. While the classroom environment provides students with mostly theoretical information, the clinical environment provides opportunities to put theoretical information into practice. Aim: To show the importance of practical teaching in the education of nurses. Method: Literature review, synthesis, and extraction of key professional and contemporary literature. Conclusion: Medical school students can acquire quality skills for patient care to the extent that they are able to implement them through theoretical knowledge in the clinical environment.

Assessment of Polycystic Ovarian Syndrome Knowledge among Unmarried Women Seeking Care at Secondary Healthcare Facilities

OBJECTIVES This study aims to assess the level of awareness regarding polycystic ovarian syndrome (PCOS) among young, unmarried females attending secondary healthcare institutions. METHODOLOGY A cross-sectional study was conducted at a rural hospital between January 2022 and December 2022. Ethical clearance was obtained prior to data collection. A pre-designed proforma was employed to gather information from participants visiting the Out-patient Department (OPD). Data collection utilized a non-probability sampling technique, and subsequent analysis was performed using SPSS version 24. RESULTSThe study’s findings pertaining to knowledge levels, participants with no formal education constituted 24.03%, while 6.20% had completed high school and 3.87% held master’s degrees. Information on PCOS was relayed by sisters/cousins (13.17%) and mothers (20.25%), and 32.55% expressed hesitancy in seeking information due to shyness. Menstrual irregularities included polymenorrhagia (24%), oligomenorrhea (33%), amenorrhea (15%), and irregular periods (28%). Clinical deviations encompassed menstrual abnormalities (37%), abnormal male hair type distribution (12%), infertility (16%), mood disorder (7%), dyslipidemia (17%), and hypertension (11%). CONCLUSION The study underscores the need for well-structured educational initiatives to enhance comprehensive awareness of PCOS symptoms, facilitate early diagnosis and treatment, and ultimately improve overall well-being.

A Study to Assess the Extent of Burnout Among Nursing Professionals Working at Various Secondary and Tertiary Health Care Institutions of Jammu and Kashmir

The study (Burnout among nursing professionals of Jammu & Kashmir-cross sectional survey) was conducted to generate findings that burnout is affecting patients and staff and inculcate a realisation for action to alter unhealthy situations through interventions to mitigate work stress

Prevalence of Intestinal Parasites among Patients Accessing care in Secondary and Tertiary Healthcare Institutions in Edo State, Nigeria

Prevalence of Intestinal Parasites among Patients Accessing care in Secondary and Tertiary Healthcare Institutions in Edo State, Nigeria

LEVELS OF ACCESSIBILITY OF PRIMARY MEDICAL SERVICES IN THE CONDITIONS OF THE REFORM OF THE MEDICAL INDUSTRY: A MARKETING APPROACH

The reform of the primary medical care link of the health care system became an indicator of changes in the health care system of Ukraine. Considering the fact that the primary link of the medical system was reformed as a priority, the feedback of the population, its assessment of the availability of quality medical care, is important, which will allow determining the consequences and prospects of the reform. The marketing analysis conducted in the article of such three criteria (levels) of the availability of primary medical care services as quality, financial and territorial or temporal availability of medical services in their dynamics for 2018-2020 made it possible to find out positive and negative development trends based on surveys of respondents units of primary medical care. In particular, it was established that during the specified period there is a general tendency to improve the quality of medical services, combined at the same time with an insufficient level of ensuring their financial and territorial or temporal availability. The marketing analysis of the respondents' opinions regarding the main indicators of quality criteria, financial and territorial or time availability made it possible to more objectively assess the consequences of the reform of the primary medical care link. The increase in the quality of medical services, which respondents attributed mainly to the improvement of the attitude of medical staff doctors to patients and the material conditions for the provision of medical services, is actually explained by the socio-psychological factors of the establishment of the "doctor-patient" interaction and the positive effect of the financial independence of medical institutions. The positive trend of increasing the financial availability of medical services, expressed in the survey by indicators of the ability to purchase drugs and receive effective treatment, is due to the practical implementation of the "Affordable Medicines" program, the availability of a significant range of free medical services (under the contract with the National Health Service) and the optimal pricing policy for additional medical services. In the end, the criterion of territorial or temporal availability of medical services, having received a wide range of evaluations (from positive to negative among respondents, testifies, on the one hand, to the positive consequences of the increase in temporal availability and opportunities for patients to choose a doctor, and on the other hand, it demonstrates the unresolved issue of territorial convenience placement of primary care facilities, especially in the conditions of reduction of their network in rural areas. We consider the development of practical recommendations for primary and secondary specialized health care institutions to improve individual indicators of quality, financial and territorial or temporal availability of medical services as a perspective for the study of the problem.

The association between burnout of healthcare employees and quality of work-life in Northwestern Turkey.

The present study aimed to determine the factors that affect the working life quality (WLQ) of healthcare employees and to examine the association between burnout levels and WLQ. This cross-sectional study was conducted with 332 healthcare employees working in Kirklareli, Northwestern Turkey. The data were collected with the e-survey, which included the Personal Information Form, Working Life Quality Questionnaire (WLQQ), and Maslach Burnout Inventory-General Form (MBI-GF). A total of 54.2% of the participants, who had a mean age of 34.45±8.82, were midwives/nurses and 14.5% were physicians. It was determined that 71.1% of the participants had increased workloads, 81.6% were working outside their job descriptions during the pandemic period, and 57.8% wanted to quit their job. In the multivariate linear regression analysis, according to the adjusted models, a positive and significant association was determined between the WLQQ general dimension scores and having professional seniority of ≥10 years, and a negative association was detected with working in a secondary healthcare institution, increased workload, working outside the job description, and the desire to quit the job (p < 0.05). A positive association was detected between the WLQQ general dimension scores and the competence sub-dimension of the MBI-GF, and a significant and negative association was detected between burnout and desensitization (p < 0.05). WLQ scores increased as the burnout and desensitization decreased and the competence increased among the healthcare employees. In order to raise the WLQ, initiatives must be planned to improve the working conditions of healthcare employees and reduce psychosocial risks.

The Psychosocial Well-being of Frontline Nurses During the COVID-19 Pandemic in South Africa

Healthcare workers have been under tremendous psychosocial strain since the advent of the COVID-19 pandemic, particularly those on the frontlines such as nurses. This is especially true in low- and middle-income countries such as South Africa, where lack of resources and support exacerbate challenges. Five focus group discussions were conducted with frontline nurses at primary, secondary, and tertiary healthcare institutions in Cape Town, South Africa. Participants reported significant stress emanating from all spheres of their life, with the acute stressors of their work having largely adverse consequences on their lives in their homes and communities. A lack of organisational support was evident, with participants highlighting various ways in which the psychosocial strain they were under may be alleviated. Healthcare facilities should investigate both individual and organisational interventions aimed at better supporting their invaluable frontline teams. These include tailored psychological support services, sufficient time for rest, adequate staffing and medical supplies, effective leadership, COVID-19 specific training, and the promotion of teamwork. However, facilities should also extend their concern to the families of staff by reducing potential risk of exposure through a variety of measures including providing transport and voluntary isolation accommodation. Such interventions are important not only for the healthcare workers and their families, but also for the smooth functioning of healthcare institutions as the pandemic draws on into an uncertain future.&#x0D;

Faktori rizika za nastanak sindroma sagorevanja kod medicinskih sestara u sekundarnoj zdravstvenoj zaštiti

Introduction/Objective The burnout syndrome among the nursing staff occurs when the intensity of the stressor exceeds the realistic capabilities of the individual/employee. This article aims to identify burnout syndrome risk factors in the nurse/technician population in secondary healthcare institutions. Methods The research was conducted at the General Hospital in Loznica in May 2023, as a cross-sectional study on a sample of 58 nurses/technicians. The research instrument was a questionnaire specifically constructed for this study, which incorporated 14 questions related to the assessment of burnout syndrome. The results were scored, and the level of burnout was analyzed according to the Freudenberger scale. Results The majority of the respondents (66%) primarily identified stress in the workplace, as opposed to other studied stressors; 69% of the sample felt overworked, and 27% felt constant fatigue regardless of the amount of rest and sleep they got. By assessing the existence of burnout syndrome, which was carried out based on a point system and the original scale (derived from the semantic differential scale), it was determined that 4% of the respondents were professionally burned out, 15% were affected by the burnout syndrome, 32% were at risk, and that 40 % of the sample were candidates for its development. Conclusion Nurses/technicians are continuously exposed to stress in the workplace due to the very nature of the work they perform. Therefore, the activities of all relevant organizations and institutions should be focused on designing preventive strategies regarding burnout in the workplace. This research proved the existence of stress at work, work overload, fatigue, inadequate working conditions, and lack of self-maintenance strategies and culture of support at the workplace in the observed population.

Survey-Based Analysis of the Clinical Treatment Status of Irritable Bowel Syndrome in Korea.

The quality-of-life of patients with irritable bowel syndrome is low; incorrect diagnosis/treatment causes economic burden and inappropriate consumption of medical resources. This survey-based study aimed to analyze the current status of irritable bowel syndrome treatment to examine differences in doctors' perceptions of the disease, and treatment patterns. From October 2019 to February 2020, the irritable bowel syndrome and Intestinal Function Research Study Group of the Korean Society of Neurogastroenterology and Motility conducted a survey on doctors working in primary, secondary, and tertiary healthcare institutions. The questionnaire included 37 items and was completed anonymously using the NAVER platform (a web-based platform), e-mails, and written forms. A total of 272 doctors responded; respondents reported using the Rome IV diagnostic criteria (amended in 2016) for diagnosing and treating irritable bowel syndrome. Several differences were noted between the primary, secondary, and tertiary physicians' groups. The rate of colonoscopy was high in tertiary healthcare institutions. During a colonoscopy, the necessity of random biopsy was higher among physicians who worked at tertiary institutions. 'The patient did not adhere to the diet' as a reason for ineffectiveness using low-fermentable oligo-, di-, and mono-saccharides, and polyols diet treatment was higher among physicians in primary/secondary institutions, and 'There are individual differences in terms of effectiveness' was higher among physicians in tertiary institutions. In irritable bowel syndrome constipation predominant subtype, the use of serotonin type 3 receptor antagonist (ramosetron) and probiotics was higher in primary/secondary institutions, while serotonin type 4 receptor agonist was used more in tertiary institutions. In irritable bowel syndrome diarrhea predominant subtype, the use of antispasmodics was higher in primary/secondary institutions, while the use of serotonin type 3 receptor antagonist (ramosetron) was higher in tertiary institutions. Notable differences were observed between physicians in primary/secondary and tertiary institiutions regarding the rate of colonoscopy, necessity of random biopsy, the reason for the ineffectiveness of low-fermentable oligo-, di-, and mono-saccharides, and polyols diet, and use of drug therapy in irritable bowel syndrome. In South Korea, irritable bowel syndrome is diagnosed and treated according to the Rome IV diagnostic criteria, revised in 2016.

Improving health-care planning for fracture patients in Türkiye: insights from a nationwide study.

The distribution of fractures may vary according to age and gender. In a country like Türkiye, which has high population density and covers a large geographical area, it is important to understand the regional variations in fractures and identify the health institutions in which patients seek treatment to plan new health-care investments effectively. The objective of our study was to investigate the distribution of fractures across the seven regions of Türkiye considering age, gender, and the level of health institutions the patients visited. Between January 2021 and May 2023, the total number of fractures, locations of the fractures, patient age and gender, geographical regions, and levels of the health-care institutions to which the patients presented were examined through the e-Nabız personal health record system. Age groups were divided into pediatric (0-19 years), adult (20-64 years), and geriatric (≥65 years) categories. Geographical regions included the Marmara, Central Anatolia, Black Sea, Eastern Anatolia, Aegean, Mediterranean, and Southeastern Anatolia regions. A total of 2,135,701 patients with 2,214,213 fractures were analyzed. Upper extremity fractures were the most common among all considered fracture groups (1,154,819 fractures, 52.2%). There were 643,547 fractures in the pediatric group, 1,191,364 fractures in the adult group, and 379,302 fractures in the geriatric group. While the total number of fractures was higher among men with 1,256,884 fractures (58.9%), the rate among women was higher in the geriatric group (67.2%). Geographically, the highest number of fractures was observed in the Marmara region (714,146 fractures), and 67.92% of all patients presented to secondary health-care institutions (1,500,780 fractures). The most commonly diagnosed fracture in the study population was distal radius fractures. The most common fracture in the geriatric group was femur fractures while distal radius fractures were the most common fractures in the adult and the pediatric groups. By understanding the distribution of fractures in Türkiye based on fracture site, geographical region, age, and gender, it becomes possible to improve the planning of patient access to health-care services. In regions with limited health resources, a more successful resource distribution can be achieved by considering fracture distributions and age groups.

Evaluation of family physicians’ anxiety during the COVID-19 process: provincial example from Turkey

BackgroundIn the natural progression of COVID-19, recovery usually takes months in most cases. Comprehensive evaluation of underlying complications requires a holistic approach as in primary health care, which creates additional workload and stress for family physicians.MethodsThe descriptive-cross-sectional study was carried out in 226 family physicians in Samsun, Turkey. Ethical permissions were obtained to conduct the study. State-Trait Anxiety Inventory scale was used as data collection tool.Results214 physicians were included in the study. The majority of the participants in the study were female. Most of the family physicians were not specialist physicians. Most of them were married. The majority of family physicians do not smoke and did not have any chronic diseases. The trait anxiety score of the physicians was 43.40 ± 8.50, and the situational anxiety score was 48.09 ± 11.55. The correlation between trait anxiety and situational anxiety was positive and significant. Gender difference did not make a significant difference on anxiety. Anxiety was significantly higher in patients with chronic disease. Marital status, having a child, and a history of COVID disease do not have a significant effect on anxiety.ConclusionAt the beginning of the COVID pandemic, the greatest struggle was given in secondary and tertiary healthcare institutions. In the following process, this burden shifted to primary health care institutions. This situation has increased the workload and stress of family physicians working in primary care. Therefore, it also increased perceived anxiety. Individuals with high trait anxiety scores have higher state anxiety scores.

Complementary Approaches in Fetal Genetic Diagnosis: Decision-Making Process and Alternative Choices for Clinicians in a Secondary Health Care Institution

Objectives The aim of this study was to determine indications of invasive, genetic results of conventional karyotyping and chromosomal microarray analysis and culture failure rates to discuss possible solution options and guide our clinical choices. Materials and methods Fetal samples were analyzed by conventional karyotyping, array comparative genomic hybridization, fluorescence in situ hybridization. Results Failure rates of chorionic villus sampling (CVS) and amniocentesis were as follows, respectively: 4.5% and 0.4%. The rates of abnormal genetic results in fetuses with only thickened nuchal translucency and thickened nuchal translucency + USG abnormality were %4.2 and %40, respectively. Conclusions Abnormal genetic results showed a significant increase in cases of thickened nuchal translucency accompanied by USG abnormalities. Although culture failure rates in the CVS were higher, none of the cases remained inconclusive. Centers with prenatal invasive genetic diagnosis should offer a wide spectrum of genetic tests by medical genetics specialists.

Core competencies of healthcare professionals in Oman: Research and evidence-based practice needs attention.

The aim of the study was to examine (1) the perceptions on core competencies of healthcare professionals working at clinical settings in Oman and (2) which demographic characteristics explain the overall core competency. A cross-sectional design. Healthcare Professional Core Competency Instrument, consisting of 11 sub-scales with 81 items, was distributed to healthcare professionals (n= 1,543; 826 nurses and 717 physicians) who worked at primary, secondary and tertiary healthcare institutions. Descriptive statistics, t-test, ANOVA and linear regression were used for data analysis. Altogether 1,078 healthcare professionals (628 nurses and 450 physicians) responded representing 70% overall response rate. Healthcare professionals perceived their overall core competence as excellent, safety being the highest, and research and evidence-based practice was the lowest. The multiple linear regression analysis revealed that ethnicity, gender and years of working experience were the characters that explained the overall core competence, where expatriate senior professionals reported higher competency levels compared with counterparts.

Effectiveness of antepartum breathing exercises on the outcome of labour: A randomized controlled trial

Abstract Background Childbirth is a life-transforming intense event to a woman and her family. Even though a variety of non-pharmacological techniques are readily available to alleviate the distress of women in labour, the majority of women are unaware of its benefits. The objective of the study was to explore the impact of a simple non-pharmacological technique i.e., antepartum breathing exercises on maternal outcomes of labour among primigravid women. Methods A single centre prospective, single-blinded, randomized controlled trial was conducted at the antenatal outpatient clinic of a secondary healthcare institution. Eligible primigravid women were randomized into intervention and standard care groups. Both groups received standard obstetrical care. In addition, the intervention group were taught antepartum breathing exercises and were advised to practise daily and also during the active stage of labour. The primary outcome of the trial was the maternal outcome of labour measured in terms of onset of labour, nature of delivery, duration of labour, and need for augmentation of labour. Data was collected using World Health Organization (WHO) partograph, structured observational record on the outcome of labour. Results A total of 98 (70%) primigravid women who practised antepartum breathing exercises had spontaneous onset of labour. The odds of spontaneous onset of labour after randomization in the intervention group was 2.192 times more when compared to standard care at a (95% confidence interval 1.31–3.36, p&lt;.001). Also, the requirement for augmentation of labour was minimal and there was a reduction in the rate of caesarean deliveries (p &lt;.05) based on the χ2 test. The overall mean duration of labour was less compared to standard care group F(1)= 133.800, p &lt;.001. Conclusion Antepartum breathing exercises during labour can facilitate spontaneous vaginal birth, shorten the duration of labour, and reduce the need for operative interference.

Conservative Treatment Of Puerpera With Severe Hemorrhagic Shock And Secondary Coagulopathy

Abstract Aim: The main aim is to show that the life of a patient depends on the decisions the doctor makes as well as the proper assessment of the case. The decision to avoid a surgical procedure and continuewith the conservative treatment following the vital parameters, was beneficial for the patient who was later discharged recovered. Case report:The case is about a patient who was in labor for the fifth time with the delivery complicated by severe postpartum hemorrhage in the secondary health care institution. Despite all conservative measures taken, the hemorrhage hasn’t stopped, therefore, the subtotal hysterectomy was performed, after which the patient was directed to the Clinical Centre Kragujevac. Regarding the fact that the postpartum hemorrhage hasn’t stopped and abdominal hematoma as well as intracranial hemorrhagewere diagnosed, the main dilemma was if the surgical procedure should be redone or if the conservative treatment should be continued. By applying the conservative treatment andcontinued consultations of the multidisciplinary team, the patient was discharged from the Clinical Centre Kragujevac. Conclusion: The main issue with severe cases like this one, is to define and direct the treatment towards the lower risk rate – repeated surgery could be fatal with the current state of the patient. The estimation was correct, at the end, the patient was released after thelengthy treatment, recovered.

Factors affecting women's access to antenatal care services

The aim of this study was to quantitatively investigate the antenatal care provided by healthcare physicians in a rural area of North East Anatolia, Turkey, and the effective factors. Patients who applied to a Second-tier health institution for delivery were asked how many times they went for a check-up during their pregnancy. In addition, the sociodemographic characteristics of the responding patients were recorded. In this study, the rate of pregnant women who received inadequate antenatal care was 41.0%. Examining the risk factors for inadequate antenatal care in pregnant women who attended fewer than four antenatal care visits revealed that the risk was 2,115 (confidence interval [CI] = 1.328–3.368) times higher for those receiving spousal education for &lt;5. Longer years than those with ≥6 years of partner training. Pregnant women who received inadequate antenatal care in the North East Anatolia region preferred to visit Secondary and Tertiary healthcare institutions instead of visiting primary care physicians. In conclusion, it is necessary to establish a referral chain through health plans and expand Primary antenatal care services to reduce both maternal and neonatal mortality and morbidity.

A Comparative Study on Cultural Competence of Healthcare Professionals in Primary and Secondary Healthcare Institutions: A Cross Sectional Study

A Comparative Study on Cultural Competence of Healthcare Professionals in Primary and Secondary Healthcare Institutions: A Cross Sectional Study

Hypertension control in Kerala, India: A prescription-based study at primary and secondary level health care institutions

ObjectiveWe undertook a prescription-based study to identify the provider and institution-level factors related to achieving guideline-recommended control of hypertension and diabetes mellitus in Kerala, India. MethodsThis cross-sectional study in primary and secondary care hospitals in Kerala included both public and private institutions. One practitioner was selected from each institution. Data on institutional and provider factors were collected using a structured questionnaire. Prescriptions were photographically captured and data on disease status and drugs prescribed were recorded. Factors associated with disease control were identified using binary logistic regression. ResultsTotally 4679 prescriptions were included for analysis. For hypertension-only patients, control levels were 31.5% and was significantly higher in public hospitals (Adjusted odds ratio (AOR) 1.96, 95% confidence intervals (CI) 1.50–2.57). Among patients with diabetes only, diabetes control was seen in 36.6%. When both conditions were present, control was achieved in only 17.0% patients. Being prescribed two or more drugs indicated lower control, whatever the respective condition. Among antihypertensive prescriptions rationality of 26.7% were questioned, such as lack of Renin Angiotensin System (RAS) inhibitor in diabetic hypertensives, dual RAS blockage, and indication for beta-blocker monotherapy. ConclusionsIn this prescription-based study in Kerala, India, a majority of hypertensive patients did not have controlled blood pressure levels, particularly if diabetes coexisted. This has serious implications as Kerala is the state with the highest burden of hypertension in India. Several prescription patterns were of questionable rationality. Further research and actions on rationality of anti-hypertensive prescriptions and barriers to treatment intensification is warranted.

Acute pancreatitis following thiocolchicoside use: a case report

Acute pancreatitis (AP) is an inflammatory disease with high mortality and morbidity, characterized by elevated amylase and lipase, accompanied by typical abdominal pain. In this case, we present a case of acute pancreatitis developed after the use of thiocolchicoside in a 52-year-old patient with a history of cholecystectomy. There was no history of intrahepatic and choledochal stones or enlargement, hyperlipidemia, and alcohol use on MRCP. After excluding the possible cause, a diagnosis of AP caused by thiocolchicoside, a rare side effect of this drug, was made. There are case reports about the development of AP secondary to drugs in the literature, but the development of AP after thiocolchicoid is extremely rare. It is important to determine the etiology in AP cases. It is aimed to raise awareness on this issue with this case, which shows that thiocolchicoid, which is frequently prescribed in primary and secondary health care institutions, may rarely cause AP.