Outpatient Department Services Research Articles

Perceived Social Support and its Relation with Mental Adjustment among Women Diagnosed with Breast Cancer

Women with breast cancer experienced many problems in various aspects of their lives, thatthey use active approaches which can result in improving their psychosocial adaptation to thedisease. Social support buffers the harmful impacts of cancer. Aim of the study: was to evaluateperceived social support and its relation with mental adjustment among women diagnosed withbreast cancer Subject: 85 women with breast cancer as a convenient sample from both inpatientand outpatient services of oncology Department of Tanta University Hospital was included.Study design: a descriptive correlation research design was utilized. Tools of the Study: Tool 1:Perceived Social support scale, include 2 parts: Part one: Socio-demographic Characteristicsand Clinical Information. Part two: Perceived Social support scale. Tool 2: Mental Adjustmentto Cancer Scale. Results: majority 74.1% women had moderate social support while one third25.9% of them had high social support. The majority 78.8% of women had adapted in fightingspirit subscale of positive adaptation. But two thirds 68.2% of them had not adapted in anxiouspreoccupation, hopelessness /helplessness, and avoidance subscales of negative adaptationsubscales while 31.8% of them had adapted. Conclusion: perceived social support dimensionswere not statistically significant correlated with mental adjustment to cancer dimensions. Alsoperceived social support dimensions with positive & negative mental adjustment to cancerdimensions. While breast cancer severity & degree was statistically significant related withpositive mental adjustment dimensions. Recommendations: women showing negativepsychological responses to cancer need to psychiatric intervention during cancer treatment.

The antecedents of patient satisfaction: Evidence from super-specialty hospitals in Tiruchirappalli in India

ABSTRACT This study explores the determinants of patient satisfaction in the healthcare industry in a developing country. The effect of healthcare services, supportive services, and auxiliary services were conceptualized in three models. After checking the measurement properties of the survey instrument, the hypotheses were tested using the data collected from 748 in-patients from five super specialty hospitals in Tiruchirappalli in southern India. The physicians’ services, intensive care unit (ICU) services, operation theatre (OT) services, and outpatient department (OPD) services had a significant positive influence on patient satisfaction. The results also suggest supportive services, including nurse, technical, and administrative services, played an essential role in increasing patient satisfaction. Finally, patients were satisfied with the registration process, transportation, and housekeeping services, including cleanliness in the hospitals. The results did not find support for pharmacy services, emergency services, and hospital security impacting patient satisfaction. The findings provide recommendations for the administrators of healthcare units to improve patient satisfaction.

Challenges Faced by Cancer Patients in Receiving Health Services During the COVID-19 Pandemic in a Tertiary Care Hospital in Rajasthan.

Amidst the COVID-19 pandemic, cancer patients may have faced difficulty accessing health care. This study explored the challenges experienced by cancer patients in availing of healthcare during the pandemic, as well as the vaccination status and prevalence of COVID-19 infection among cancer patients in the year 2021. A cross-sectional study was conducted in a tertiary care hospital in Jodhpur, Rajasthan, to interview 150 patients from the oncology department using convenience sampling. Face-to-face interviews lasted for 20-30 minutes. The first segment of the pretested semi-structured questionnaire was directed at obtaining the patient's socio-demographic characteristics, while the second segment focused on the problems that patients encountered during the pandemic in receiving cancer care. The data were analyzed using Statistical Packages for Social Sciences (SPSS) software (IBM Corp., Armonk, NY). Several constraints, such as a lack of transportation services, difficulty in availing outpatient department (OPD) and teleconsultation services, long waiting times, and deferred surgeries and therapies, have hampered cancer care. COVID-19 mitigation measures further imposed additional stress and financial burden on cancer patients. Moreover, there was low vaccination coverage among cancer patients, which increases their probability of acquiring an infection. Policy reforms must prioritize cancer care in India to maintain a continuum of care by ensuring medication, teleconsultation, uninterrupted treatment, and complete vaccination to decrease the risk of COVID-19 infection and facilitate patient compliance with the healthcare delivery system.

Impact of COVID 19 pandemic lockdown in pediatric ophthalmology service in Kedia eye hospital, Nepal

Purpose: The Objective of the study is to know and record the effect of lockdown in the outpatient and emergency services of pediatric ophthalmology department of Kedia Eye Hospital.Method: Comparison of the children attending the Pediatric Eye Department of Kedia Eye Hospital during and before lockdown. Data of February 16 2021 to April 15 2021 was compared with April 16 2021 to June 15 2021. Collection of data was done from the Kedia Eye Hospital Outpatients and Emergency Eye Register.Results: Children below 15 years of age were enrolled in this study. Number of patients recorded from February 16 to April 15 2021 were 2030 and from April 16 to June 15 2021 were 318. Male patients attending hospital before lockdown was 51.62% and 55.47% during lockdown. Before lockdown female patient in the hospital was 55.47% and during lockdown was 44.02%. Total surgeries performed before lockdown was 94 and during lockdown was 11. Before lockdown Refractive error (43.15%) was the most common problem followed by Dry eye (16.55), vernal keratoconjunctivitis (15.41%). During lockdown Refractive Error (32.38%) was common followed by viral conjunctivitis (17.92%), Nasolacrimal duct obstruction (13.83%) and Trauma (11.63%).Conclusion: COVID -19 Lockdown reduced the number of patients and surgeries in the hospital. Trauma related eye disease, ocular infections and nasolacrimal duct obstruction increased in children during the lockdown.

Burden of Hepatocellular Carcinoma and Pattern of Hepatitis B and C Presentation among HCC Patients: A Retrospective Study from a Tertiary Care Hospital in Karachi, Pakistan

Background: Hepatocellular carcinoma (HCC) is the most commonly occurring cancer of the liver. HCC ranks fifth from the top among the most prevailing cancers in men globally. It stands second among the major causes of mortality associated with cancer in the world. The majority of the cases of hepatocellular carcinoma (HCC) are due to cirrhosis developed after infection with the chronic hepatitis B virus (HBV) or hepatitis C virus (HCV). Objective: To assess the burden of hepatocellular carcinoma and to study the pattern of hepatitis B and C in HCC patients who visited oncology outpatient department (opd) services in a tertiary care hospital in Karachi. Materials and Methods: This is a retrospective study. The total number of patients visiting the Oncology OutPatient Department from July 2019 to June 2021 was recorded. Patients who had HCC of these were included in the study. The age, viral markers, and TNM staging of the patients were recorded. Both male and female patients belonging to any age group were included in the study. Results: During two years, a total of 2,102 patients visited oncology outpatient services for different cancers. Out of these, 50 patients had a diagnosis of HCC and were included in the study. The mean age of the patients was 59.76±10.16 years. 70% of the patients were male and 30% were female. 60% of the patients were positive for Hepatitis C, while 36% of the patients had all viral markers negative. Conclusion HCC is a fairly common malignancy but screening programs across the world are hampered by low rates of utilization. Infection with hepatitis B and C is frequently associated with the development of HCC. If proper and adequate screening measurements are taken in time for patients who are at greater risk for hepatocellular carcinoma, better survival rates could be seen in Pakistan.

Evaluation of Bacterial Contaminants on N95 FFRS after Reuse in Hospital Personnels: A Prospective Study in the Era of COVID-19 Pandemic

Introduction: N95 Filtering Face-piece Respirators (FFRs) prevent the spread of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection and protect medical personnel. It is considered as one of the essential protective equipment. An increased demand for N95 FFRs during the Coronavirus Disease 2019 (COVID-19) pandemic has resulted in shortage crisis for the care of cases arising in hospitals. Therefore, this situation generated the need to implement alternatives like four mask policy that allows reuse of N95 FFRs in settings with limited resources. Aim: To find out the burden of bacterial isolates on N95 FFRs after reuse. Materials and Methods: The present study was a prospective study conducted at Govt. R.D.B.P. Jaipuria hospital, Jaipur, Rajasthan, India, from May 2021 to October 2021 on 526 used N95 FFRs after multiple or extended use by 96 hospital personnel who attended Outpatient Department (OPD) services. Swab samples were collected from both external as well as internal surface of the mask after each use and further subcultured to identify any microorganism present on them. Results: Growth of Gram positive bacilli, and micrococci were found on 499 samples out of total 526 samples. Other bacteria like Pseudomonas spp. and other gram negative were also observed in 19 samples. Furthermore, it was also observed that bacterial load on reused N95 FFRs was mainly commensal flora. Conclusion: Mainly commensal floras were found over internal and external surface of used N95 FFRs. This proves that four mask policy is optimum for judicious use of N95 FFRs and resulted in saving of funds for other more emergency works mainly in OPD settings.

Estimation of Waiting Time and Consultation Duration for Patients in the Outpatient Department of Radiation Oncology at a Tertiary Care Teaching Hospital in Uttarakhand, India: A Cross-sectional Study

Introduction: The Outpatient Department (OPD) holds significant relevance in modern medical care and serves as the “Shop Window” of the hospital. Waiting time serves as a crucial indicator of the quality of OPD services provided by the hospital, as it greatly affects patient satisfaction. Radiation oncology is a clinical specialty that focuses on administering radiation therapy to cancer patients, who seek consultation in the radiation oncology OPD. Aim: To estimate the waiting time and consultation duration for patients in the OPD of radiation oncology at a tertiary care teaching hospital. Materials and Methods: This cross-sectional study was conducted from August 1 to August 31, 2022, at the Cancer Research Institute of Himalayan Hospital, which is the affiliated hospital of the Himalayan Institute of Medical Sciences under the aegis of Swami Rama Himalayan University, Dehradun, Uttarakhand, India. A total sample size of 300 patients was selected using the simple random sampling technique. Data was collected through direct observation using a data collection sheet. Statistical analysis was performed using the data analysis tool in Microsoft Excel and Statistical Package for Social Sciences version 23.0. Pearson coefficient of correlation (r) and p-value were calculated. Results: The results were analysed based on demographic details, days of the week, patients seen per consultation room, new and follow-up patients, and patient arrival time in the OPD. The majority of patients attending the OPD were in the age group of 50-69 years (60.6%). A total of 256 patients (85%) were follow-up patients. Analysis of the patient arrival pattern revealed that the highest number of patients, 200 (66.7%), arrived between 8:30 AM and 10:30 AM. The overall mean waiting time was estimated to be 50.43±0.030 minutes, and the mean consultation time was estimated to be 9.53±0.004 minutes. The Pearson coefficient of correlation between the two variables was calculated, revealing a positive correlation with ‘r’ value=0.14 and a statistically significant p-value=0.014 (<0.05). Conclusion: This study provides valuable insights for waiting time and consultation duration in the radiation oncology department's OPD. On average, patients spend approximately 59.96 minutes in the OPD premises. Out of this time, 84.1% is spent waiting, while 15.9% is spent with the consultant. The primary reason for delays in the waiting area is the delayed availability of consultants due to ongoing ward rounds or other academic activities.

Outpatient department service quality: An empirical investigation in the hospitals of Delhi-NCR during pandemic

Purpose – The present study aims at explaining the patients’ opinion towards the Outpatient Department (OPD) facility of tertiary care hospitals in Delhi-NCR region during Covid pandemic. The research focuses on the quality of healthcare services provided by the OPD and examines the comparative importance of quality measurements in finding out the patients’ satisfaction. Design – A total 408 respondents took part in a questionnaire survey from the Delhi- NCR region who has visited OPD facilities of either private or Government hospital on one pretext or other. Data was analyzed through descriptive statistics, reliability study, correlation and multivariate regression on SPSS to examine customer perceptions of service quality and how the quality of services stimulates an overall satisfaction index towards OPD facilities in healthcare sectors. Findings – As per the findings of this paper, the maximum number of respondents had a good overall experience in the outpatient departments of the tertiary hospitals and therefore assessed the services on a positive scale. Doctors’ knowledge and communication, waiting time, and online consultation in the era of pandemic emerged as the most vital factors of outpatient satisfaction. Originality – The service quality factors in healthcare, i.e., physical facilities, responsiveness, and communication were assessed and new dimension of service quality, online consultation, was added, which is believed to be an important parameter for measuring patients’ satisfaction in the current situation, where physical communications have been limited to emergencies only. Practical Implications – The outcomes will enable hospital managers to formulate effective strategies to enhance service quality of healthcare, especially in OPD, which is the most frequented area of healthcare service systems.

Determinants of ambulatory patients’ satisfaction with encounter at core service stations in a tertiary hospital of a developing country

Patients may have different and complex convictions of what their idea of satisfaction is, which may not be addressed regarding what they perceive as satisfaction. Therefore, using the patients’ demographic and clinical characteristics could tailor the individual needs of these patients, hence, providing feedback and recommendations on improvement in services provided. This study examined the determinants of patients’ satisfaction with general outpatient department (GOPD) services of a tertiary hospital in Rivers State, Nigeria. A descriptive cross-sectional study was carried out among new and repeat patients attending the GOPD of the University of Port-Harcourt Teaching Hospital, Rivers State, Nigeria. A structured questionnaire was used to obtain information from 332 patients recruited into the study using a multi-stage sampling method. Patients were more satisfied with consultations and nursing services than they were with services received at the medical records department. Patients’ socio-demographic and clinical characteristics that influence that satisfaction included age, marital status, visit status, insurance status, and level of schooling. This study provides insights on factors that determine the satisfaction of ambulatory patients with the record, nursing, and consultation services. Modifiable factors will form the basis for a future intervention to improve patient experiences in this facility. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

Epidemiological factors affecting outpatient department service utilization and hospitalization in patients with diabetes: A time-series analysis from an Ethiopian hospital between 2018 and 2021.

BackgroundThe burden of diabetes-related deaths reached two million in 2019 globally. Accessibility to health care services and adherence to follow-up and therapy are key to improving outcomes for diabetic patients. We aimed to assess outpatient department (OPD) service utilization and diabetes-related hospitalizations over a period of 44 months.MethodsA retrospective cohort study was conducted on OPD visits and hospitalizations recorded between January 1, 2018, and August 31, 2021, at the St Luke Catholic Hospital (Ethiopia). All diabetic patients were included in the analysis. A linear regression model was used for univariate analysis of OPD visits and hospitalizations and their association with potential predictors. The autoregressive integrated moving average (ARIMA) method was applied to both the time series of OPD visits and hospitalizations. Potential predictors were sociodemographic factors, COVID-19 cases, mean monthly temperature and precipitations.ResultsIn the time series analysis, OPD visits increased over time (P < 0.01) while hospitalizations were stable. The time series model was ARIMA (0,1,1) for OPD visits and ARIMA (0,0,0) for hospitalizations. There were 1685 diabetes OPD patients (F = 732, 43%). Females had an average of 16% fewer OPD accesses per month (P < 0.01) and a lower number of hospitalizations per month (P = 0.03). There were 801 patients missing follow-up (48%). The time between follow-up increased with age (P < 0.01). OPD visits decreased differently by geographic area as COVID-19 cases increased (P < 0.01). There were 57 fewer forecast OPD visits per month on average using COVID-19 cases as ARIMA regressor. The odds ratio (OR) of new diagnosis at hospitalization was lower in patients with type 2 diabetes (OR = 0.26, 95% CI = 0.14-0.49, P = 0.02).ConclusionsDespite an increase in OPD visits for diabetic patients over the study period, the number of losses at follow-up and diagnoses at hospitalization remains high. Female sex, older age, and COVID-19 were associated with impaired OPD service accessibility. Primary health care should be implemented to achieve better health coverage and improve diabetes management.

Therapeutic drug monitoring of levetiracetam: Method validation using high-performance liquid chromatography-ultraviolet detector technique and usefulness in patient care setting.

To develop and validate a modified HPLC-UV method for the estimation of serum levetiracetam levels and to assess the usefulness of serum levetiracetam estimation in epileptic patients. Modification of a previously existing HPLC-UV method was performed using liquid- liquid phase extraction and processing using reverse phase analytic HPLC-UV detector technique followed by method validation. Serum samples of patients attending our hospital's Therapeutic Drug Monitoring Outpatient Department services were analyzed for levetiracetam levels using the study method. Data of the past 6 years (2015-2020) were descriptively analyzed. The modified HPLC-UV method was validated as per ICH Q2 (R1) 2005 guidelines. Usefulness of levetiracetam estimation was assessed in 1383 patients (635 children, 683 adults, 40 elderly, and 25 pregnant women). Levetiracetam levels were within the therapeutic range (TR) in 520 children, 543 young adults, 35 elderly patients, and nine pregnant women. In 112 of 232 patients with low levetiracetam levels, poor compliance was elicited. Of 641 patients on polytherapy, 446 patients had levetiracetam values within TR, whereas 29 had values above and 166 patients had values less than TR. Sodium valproate, phenytoin sodium, and carbamazepine affected levetiracetam levels when given concomitantly. Levetiracetam dose was adjusted in 61 patients with abnormal levels for better clinical response. Good seizure control was noted in 913 (82.47%) patients whose levels were within TR, whereas 136 (58.62%) patients with low levels reported an increase in seizure frequency. The modified HPLC-UV method is simple, rapid, efficient, and reliable for assaying serum levetiracetam.

Utilization of 18s ribosomal RNA LAMP for detecting Plasmodium falciparum in microscopy and rapid diagnostic test negative patients.

In this study, Plasmodium falciparum was detected in patients that were declared negative for malaria microscopy and rapid diagnostic test kit (mRDT), using Plasmodium 18s rRNA loop-mediated isothermal amplification (LAMP) technique. The main aim of this study was to assess the usefulness of LAMP assay for detecting pre-clinical malaria, when microscopy and mRDT were less sensitive. DNA was obtained from 100 μL of whole blood using the boil and spin method. Subsequently, the Plasmodium 18s rRNA LAMP assay was performed to amplify the specific Plasmodium 18s rRNA gene. Microscopy and mRDT negative samples [697/2223 (31.2%)] were used for this study. Compared to frequencies obtained for the other demographic variables, most of the patients were < 6 years (37.7%), females (59.0%), peri-urban dwellers (39.0%) and patients that sought outpatient department services (39.3%). Overall, the prevalence of Plasmodium 18s rRNA was 17.5%. when stratified by study variables, Plasmodium 18s rRNA LAMP positivity was higher in patients over 30 years [58/122 (54.2%)], males [69/122 (56.5%)], rural dwellers [69/122 (56.5%)] and patients that sought OPD services [68/122 (55.7%)]. The risk of being infected with Plasmodium when routine tests were negative was higher in 15–30-year group (OR = 3.03, 95% CI: 1.6–5.8, p = 0.0007), patients > 30 years (OR = 15.2, 95% CI: 8.3–27.7, p<0.001), males (OR = 2.1, 95% CI: 1.4–3.2, p = 0.0002) and rural dwellers (OR = 2.2, 95% CI:1.4–3.6, p = 0.0009). However, risk was lower in post-natal children (OR = 0.3, 95% CI: 0.18–0.51, p<0.001). Majority (81.5%) of the infected patients presented with headache, herpes labialis, diarrhea and vomiting. We demonstrated the lack of sensitivities of microscopy and mRDT for one-time diagnosis of malaria. Therefore, it is essential to utilize a sensitive technique such as Plasmodium 18s rRNA LAMP to increase the detection rate of Plasmodium infection.

Level of Clients’ Satisfaction and Associated Factors with the Service of Out-Patient Department in Dilla University Referral Hospital, Southern Ethiopia, 2021

Background. Client satisfaction with seeking healthcare is generally regarded as one of the core outcomes of the health system. Various efforts are underway to provide hospitals with the necessary manpower, medical equipment, and other services to suit the demands of their patients. The goal of this study was to determine the level of client satisfaction with outpatient department services and the factors that influence it at Dilla Referral Hospital in Ethiopia. Methodology. A cross-sectional investigation was undertaken in a hospital setting. An interviewer-administered quantitative data were collected on socio demographic characteristics of respondents and their satisfaction level with the different components of the outpatient services. SPSS version 20 was used to conduct the analysis. The connection between independent and dependent variables was evaluated using bivariate analysis ( p &lt; 0.25 ). To discover the determinants of client satisfaction and control cofounding, multivariate logistic regression was performed ( p ≤ 0.05 ). Result. The study enrolled a total of 419 individuals, with a response rate of 98.3%. Overall, 52.2 percent of clients were satisfied with the health services provided by the hospitals’ outpatient departments. Client satisfaction was significantly predicted by the cleanliness of the consultation room (AOR = 2.05, 95% CI: 1.06–3.95), payment status (AOD = 1.68, 95% CI: 1.08–2.63), and telling clients about the etiology of sickness (AOR = 0.55, 95% CI: 0.34–0.87). Conclusion. The general satisfaction of outpatients with Dilla referral hospital’s OPD clinics healthcare services was low. The cleanliness of the consultation room, payment status, and readiness to suggest the service to others were all linked to a positive outcome.

Patient Satisfaction With Outpatient Department (OPD) Services At Bahawal Victoria Hospital, Bahawalpur

Objective: To determine the patient's satisfaction with outpatient department (OPD) services at BahawaI Victoria Hospital, BahawalpurPlace of Study: Out Patient Department of BahawaI Victoria Hospital, Bahawalpur.Study Design: Hospital-based descriptive cross-sectional study.Duration of Study: January 2022 to March 2022.Methodology: A sample size of 326 was calculated for the study for 68.7% anticipated population proportion (Satisfaction level). The sample was selected using a nonprobability consecutive sampling technique. A closed-ended questionnaire was used to gather the appropriate information. A total of 16 questions were asked to measure the satisfaction of the respondents with the services. Response to each question was measured on a 5 points Likert Scale. The composite score of each respondent ranged from 16-80. The level of satisfaction on the basis of the composite score was divided into three categories, the score ≥ 65 was categorized as very good, the score in the range 50-64 was categorized as good, the score between 35-50 was satisfactory and score ≤ 35 was taken as poor. Data were analyzed by using the statistical package for social sciences (SPSS) version 21. The chi-square test was used considering p ≤ 0.05 as significant.Results: The proportion of patients having a very good level of satisfaction was 27.3% while 17.2% had a satisfactory level of satisfaction. Satisfaction of the respondents was not significantly associated with the age of the respondents (p= 0.383) Variables including respondent's education (p = 0.008), gender of the respondents (p= 0.000), and monthly family income (p = 0.021) were significantly associated with patient's satisfaction.Conclusion: Education, gender, and monthly family income are key determinants of patient satisfaction with healthcare services.

Evaluation of patient satisfaction in outpatient departments of selected eye care hospitals in the Hyderabad City, Telangana State

The degree of agreement between a patient's expectations of optimal treatment and their evaluation of the actual care they got has been defined as the level of patient satisfaction. Medical service quality and cost-effectiveness, doctor conduct and attitude, the cost of services, hospital infrastructural facilities, physical comfort and psychological care, as well as empathy for clients' testimonies all go towards a patient's satisfaction with their healthcare facility experience. To determine how satisfied patients are with the out-patient department (OPD) services at five different eye care facilities in Hyderabad, Telangana, and the variables influencing patient satisfaction. To conduct the study, the out-patient department of LV Prasad Eye Institute: Banjara Hills, Vasavi Eye Care &amp; Diabetic Center: Chandanagar, Aravind Eye Hospital &amp; Institute: Mehdipatnam, Sri Madhavi Eye Care Hospital: Habsiguda, Dr. Agarwal Eye Hospital: Panjagutta in Hyderabad city, Telangana state was visited by researchers from 01.04.2021 to 30.06.2021. To choose patients for the out-patient section of the hospital, a systematic random technique was adopted.

What Impact Have SARS-CoV-2/Covid-19 Pandemic induced lockdown on the number of OPD patients of Diabetes, Hypertension, Stroke (CVA), Acute Heart Disease, Mental Illness, Epilepsy, Ophthalmic, Dental and oncology in India during the lockdown months (April-May-2020)–Observational Research Analysis?

The First human case of the covid-19 global pandemic was reported from Wuhan city of China in December 2019. On 27th January 2020, India found a suspected case of covid-19 in Kerala with a recent travel history of Wuhan; china. The suspected case was reported as positive by the National Institute of Virology located at Pune in Maharashtra, India on January 30, 2020 as positive for COVID-19 infection. This was the first documented COVID-19 case in India. The government of India responded to this novel disease by enforcing nationwide lockdown starting on 25/03/2020 and ending on 31/05/2020. In this retrospective observational quantitative and qualitative study I have done assessment of the impact of covid-19 lockdown measures on OPD health services for some important non communicable diseases. The data is collected, observed, analyzed for the years 2020 and 2019 and the lockdown period of April-May 2020 is compared with the same duration of 2019 (excluding period of 7 days of lockdown in march) . The OPD (outpatient Department) services for the patients of Diabetes, Hypertension, Stroke (CVA), Acute Heart Disease, Mental Illness, Epilepsy, Ophthalmic, Dental and oncology were selected for this observational retrospective study-analysis. In version 2 time series analysis (longer period) will be applied to test the significance of difference between pre and post intervention (lockdown). The study found as compared to 2019 when lockdown and pandemic was not in existence, 2020 lockdown period have notable reduction in various OPD health services. The study have derived conclusion that lockdown reduced number of OPD patients and hence reduced access to the health services for non-communicable disease which is the major burden of disease in India as well as at global levels. In the final conclusion the author feel the need of more emphasis and priority for NCDs care in any situations of emergency like pandemic and natural calamities, lockdowns etc which usually disrupt routine healthcare. Routine healthcare is very essential in context of chronic diseases which can be converted to acute emergency conditions like CVA.

Site-based payment differentials for ambulatory services among individuals with commercial insurance.

To compare prices paid by commercial insurers for ambulatory services in physician office and hospital outpatient settings. MarketScan Commercial Claims and Encounters database obtained from Truven Health Analytics. We examined ambulatory service claims for a sample of privately insured individuals who were continuously enrolled in a health maintenance organization plan, preferred provider organization plan, high-deductible/consumer-driven health plan, or exclusive provider organization plan in 2018. We categorized services into five categories: Evaluation & Management, Medical Services & Procedures, Pathology/Lab, Radiology, and Surgical. We identified services commonly provided in both outpatient and office settings and computed the price differential between outpatient and office services overall and for each service category, controlling for observable patient characteristics and geography. We examined 89 services (defined by Current Procedural Terminology [CPT] code) that were provided in both office and outpatient settings in our sample (102.7 million claims, 8.3 million individuals). Adjusting for patient and geographic characteristics and across all services, total payment for an ambulatory service was, on average, 145% higher in a hospital outpatient department than the same service in a physician office. Out-of-pocket spending was 109% higher. Price differences between outpatient and office services were highest for pathology/laboratory services. Patients receiving services in outpatient departments had higher mean risk scores and received more services on the date of their visit (in addition to the index CPT being studied) than patients receiving the same index CPT in a physician's office. Payments in hospital outpatient departments were significantly higher than payments for the same services in physician offices among commercially insured patients. Policies such as site-neutral payment would lower costs and could reduce incentives for further consolidation in health care markets. Care must be given to adjusting for patient severity across settings.

Impact of Covid-19 Induced Lockdown on The opd Patients of Diabetes, Hypertension, Stroke (cva), Acute Heart Disease, Mental Illness, Epilepsy, Ophthalmic, Dental and Oncology in India- A Cross-Sectional Research Study

Impact of COVID-19 on the number of OPD patients: The First global covid-19 patient was reported from Wuhan city in China (Hubei Province) during December 2019. India’s first suspected patient of SARS-CoV-2 infection was reported on 27th of January 2020, from Kerala state, which had a travel history of Wuhan city in china. This suspected case was tested and reported as the first covid-19 positive case by the (NIV) National Institute of Virology, Pune, on January 30, 2020. The government of India like other global countries responded to this novel disease by enforcing complete nationwide lockdown starting on 25/03/2020 and ending on 31/05/2020. In this cross-sectional research study, I had done assessment of the impact of covid-19 induced lockdown on OPD patients of few non communicable diseases (NCD). The data for different quantitative variables were collected for 12 months before and after lockdown, observed, analyzed for the years 2019, 2020, 2021. The complete lockdown period of April-May 2020 is compared with the previous 12 months of lockdown (including period of March 2020 which had only last 7 days of complete lockdown) as well as later 12 months. Also the lockdown months (April-May-2020) were compared to previous (April-May-2019) as well as next (April-May-2021) year same months. Here the researcher would like to emphasize that different months of years may have different numbers of patients due to seasonal and geographical variations in prevalence of diseases. The researcher had included the month of March 2020 in order to show the trends of OPD numbers to closest timeline before the lockdown. The OPD (outpatient Department) services for the patients of significant NCD burden such as Diabetes, Hypertension, Stroke (CVA), Acute Heart Disease, Mental Illness, Epilepsy, Ophthalmic, Dental and oncology were selected for this studyanalysis to assess the difference between pre and post intervention (lockdown). The author previous preprints on this research study are mentioned in note and acknowledgement. This research study revealed that COVID-19 induced lockdown period have negative impact on NCD (non-communicable disease) - OPD health services utilization. Non-communicable diseases are the major burden of disease in India as well as at global levels. The researcher had done this study to draw the attention of policy makers and governments to give more attention on emphasis and priority for NCDs care in any situations of emergency like pandemic and natural calamities, lockdowns etc which usually disrupt routine healthcare. Routine healthcare is very essential and significant in context of chronic diseases which can be converted to acute emergency conditions like CVA due to lack of care and proper-timely treatments.

Inflammation markers in moderate and severe obstructive sleep apnea: the influence of sex.

Obstructive sleep apnea (OSA) is the most prevalent sleep-related breathing disorder, with a negative impact on cardiovascular health. Different OSA symptoms and treatment response in males and females have been reported. The aim of this study was to investigate inflammatory markers inpatients with OSA and the relationshipof those markers to disease severity in male and female subjects. We considered consecutive subjects referred to the outpatient Sleep Disorder Service of the Respiratory Medicine Department, San Marino Hospital. We included patients with a diagnosis of moderate or severe OSAS and an age range of 45-80years. Concomitant inflammatory conditions were an exclusion criterion. A polygraphic study and a blood draw for inflammatory markers were performed for each subject. Of 110 subjects, 59 weremales. Severe OSA affected 72 subjects. We analyzed data through a 4-level categorical variable according to sex and OSA severity (moderate OSA, males; severe OSA, males; moderate OSA, females; severe OSA, females), which showed significant differences for interleukin-6 (IL-6) and C-reactive protein (CRP) levels. A significant difference in IL-6 levels with a significant ascending trend (p = 0.045) from females with moderate OSAS to males with severe OSAS emerged in our pairwise comparison for estimated marginal means. Also, a significant trend (p = 0.0001) for CRP levels from males with moderate OSAS to females with severe OSAS was shown. OSA and inflammation are interconnected, and both are associated with vascular diseases. Sex-related differences in OSA phenotypes may help the clinicians aim for a more personalized approach.

Impact of the COVID-19 pandemic on the otolaryngology residency training program in a university-based hospital in Bangkok, Thailand.

This study aimed to evaluate the impact of the COVID-19 pandemic on the otolaryngology residency training program in Vajira Hospital, Navamindradhiraj University. Conducted from October 2021 to January 2022, this cross-sectional survey included all residents, residents who graduated in 2021, and the attending staff. One form was sent to both resident groups for self-assessment and another form to the attending staff for resident assessment. The survey questions were about attitude toward COVID-19 service, knowledge, outpatient department service, surgical skills, and burnout assessment using the Maslach Burnout Inventory. This study included 17 residents and 9 attending staff members. COVID-19 indeed had affected the clinical and surgical training. Regarding the attitude toward COVID-19 services, the residents were moderately satisfied. They were concerned about work suspension resulting from infection and also death from COVID-19. N95 masks and other protective gears were scarce. Compared with those during the prepandemic era, residents had fewer academic activities, and they preferred hybrid teaching. The inpatient department, outpatient department, and surgical training opportunities, as well as elective and urgent surgeries, were also reduced. The attending staff considered 1-year extension of the training program, but the residents disapproved. The residents became less confident both in outpatient department service and surgical skill, and they felt emotional exhaustion, depersonalization, and decreased sense of personal accomplishment. COVID-19 pandemic had significant impact on otolaryngology residency training programs. It did not only affect burnout among residents but also caused a perception of skill and knowledge reduction.