Teaching Hospital In Delhi Research Articles

Knowledge, Attitude, and Practice Regarding Dyslipidemia among Adult Patients Visiting Medicine Outpatient Department of a Tertiary Care Teaching Hospital in Delhi

Abstract Background: Dyslipidemia, a key risk factor for atherosclerosis, affects 25%–30% of urban and 15%–20% of rural individuals in India, as per the Indian Heart Watch study. Despite its association with cardiovascular diseases, there is insufficient understanding among the public. Given the scarcity of studies on knowledge, attitudes, and practices of dyslipidemia among the Indian population, this study aims to fill that gap. Materials and Methods: A cross-sectional observational study was conducted from September 2022 to February 2024. A total of 288 adult patients visiting the medicine outpatient department were included in the study through convenience sampling. A structured questionnaire consisting of 42 questions was designed, pretested, and administered to the participants to assess their knowledge, attitude, and practices regarding dyslipidemia. Data regarding lipid profile tests (total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein) were collected, and medication adherence was also asked from the patients. Results: The study revealed a lack of knowledge, negative attitudes, and poor practices regarding dyslipidemia among the participants. The study included 288 participants with an average age of 40 years, predominantly males (53.1%). The majority of participants lacked knowledge about dyslipidemia (81.9%), with a prevalent misconception identified, with many participants incorrectly associating dyslipidemia exclusively with obesity. Among dyslipidemic patients, medication adherence was suboptimal, with a significant proportion discontinuing medication over time (87.3%). Factors associated with better knowledge of dyslipidemia included younger age, male gender, higher education level, professional occupation, higher income, unmarried status (who tend to be younger), urban residence, absence of comorbidities, and lower body mass index. Conclusion: The findings reveal significant gaps in awareness, negative attitudes, and suboptimal practices related to dyslipidemia and its management among the study participants. The majority of participants lacked knowledge about dyslipidemia, with a prevalent misconception associating it primarily with obesity.

Experiences from a COVID-19 vaccination center at a tertiary care teaching hospital in Delhi, India: Challenges and solutions.

India began its nationwide coronavirus disease 2019 (COVID-19) vaccination program on January 16, 2021, in a phased manner. In this paper, we have discussed our experience at one of the COVID-19 vaccination centers in the country and have identified a few of the major challenges and their implications. The guidelines for COVID-19 vaccination in the country were changing frequently, leading to ambiguity among the beneficiaries. Co-WIN software, used for program implementation, had some glitches, which caused dissatisfaction among the service providers and beneficiaries. Vaccine hesitancy and eagerness caused low vaccine uptake initially and overcrowding at vaccination centers later. Some of the vaccination centers had the potential to become hot spots for further spread of the virus due to insufficient infrastructure. The disparity in access to vaccines for the homeless and other vulnerable groups was another hurdle for adequate vaccination coverage. These challenges could have been addressed by pretesting the information technology platform, long-term planning with a vision for handling vaccine hesitancy and eagerness, strong communication systems, removing disparities in vaccine access, and maintaining uniformity in messages for frequently updating guidelines.

Knowledge, attitude, and practices about disaster preparedness among resident doctors in a tertiary care teaching hospital in Delhi, India: A cross-sectional study.

Disasters pose various challenges to hospitals' functioning during calamities. Resilient health system is the need of the hour. To work as a safe hospital even during disasters, it is important to sensitize, orient, and train doctors and other medical professionals towards disaster preparedness. This study was conducted to study the knowledge, attitudes, and practices about disaster preparedness among resident doctors. It was a cross-sectional study conducted amongst 363 resident doctors of a tertiary care teaching hospital in Delhi, India. A pretested self-administered semistructured questionnaire was used to gather information. Analysis was done using the SPSS version 21.0 and employing descriptive -statistics. Mean age of the participants was 28.1 ± 2.8 years. Ninety-four (25.9 percent) study participants were found to have good/excellent knowledge about disaster preparedness, only 16.5 percent (60) had good awareness about the hospital's disaster preparedness, and 306 (84.3 percent) study participants had a favorable attitude towards disaster preparedness. Age and educational qualification were found to be significantly associated with knowledge about disaster preparedness. Only 11.6 percent (42) resident doctors attended any mock drill for disaster preparedness in the past 1 year and less than one-fifth (68, 18.7 percent) received training in disaster preparedness. A majority of study participants had a favorable attitude in spite of inadequate knowledge and aware-ness about disaster preparedness. There is a need to address this mismatch between knowledge and attitude through regular sensitization and retrainings along with frequent practical drills and simulation exercise.

Pre-morbid frailty is associated with poor outcome after thrombolysis in older patients with ST-elevation Myocardial Infarction

Introduction: In recent years, the association of frailty has been established with a poor outcome after percutaneous intervention following an acute cardiovascular event. However, a larger proportion of the world population is unable to access the prohibitively expensive tertiary cardiac care and receives the more readily available, affordable and acceptable thrombolytic therapy in emergency situations. The current study was designed to explore the association of pre-morbid frailty with immediate and short-term outcome of thrombolysis in older subjects presenting with ST-elevation myocardial infarction to our hospital. Methods: This was an observational prospective cohort study completed between 2015 and 2017 at a tertiary care teaching hospital in Delhi. Patients older than 60 years who presented to the hospital with ST-elevation myocardial infarction and underwent successful thrombolysis were included for the study. Complications such as bleeding, reperfusion reactions and allergic reactions were recorded whenever these were observed. In addition, complications such as re-infarction, stroke, cardiac arrest, cardiogenic shock and death were also recorded. In addition, a short-term outcome in terms of discharge, death, recovery was noted. A pre-morbid frailty score was historically computed with inputs from the patients and their primary caretakers using a deficit count approach on a pre-defined list of fifty self-reported deficits. The descriptive statistical analysis comprised of calculating means (standard deviations) and proportions (frequencies and percentages). The association of premorbid deficit score with thrombolysis success and other variables was tested by calculating mean ranks, and Mann Whitney U test was used as a statistical test of significance. Spearman correlation coefficient was used to determine the association between frailty and complications and morbidity and mortality indicators. Univariable logistic regression models were used to evaluate independent variables associated with outcome of thrombolysis to further explore the association between frailty and outcome. Independent variables found significantly associated with poor outcome were entered into a multivariable logistic regression model (forward) in addition to those considered scientifically relevant. Results: In the present study, we found a significant association between a higher pre-morbid frailty status assessed by an interview-based deficit count score and poorer outcome of thrombolysis. Every unit increment in the frailty deficit count score on a scale of 50 points increased the odds of failed thrombolysis by 1.14 times. Frailty was also associated with an increased risk of reperfusion arrhythmias and cardiac arrest following thrombolysis. Additionally, we noted that higher the deficit score, lesser the resolution of ST segment on ECG, 90 minutes following thrombolysis. Conclusions: Our study indicates that frailty determined by a premorbid count of health deficits is associated with the outcome of thrombolysis following myocardial infarction in older patients. The patients with greater count of deficits have a higher chance of failure. Our findings will help informed decision-making while managing older patients presenting with myocardial infarction and in-turn improve morbidity and mortality.

Gender differences in quality of life and psychiatric comorbidities among persons with juvenile myoclonic epilepsy: A single-center cross-sectional study.

Juvenile myoclonic epilepsy (JME) is the most common idiopathic generalized/genetic epilepsy syndrome. Gender differences are known in clinical presentation, with a well-identified female predilection. We aimed to study gender-based differences in quality of life (QoL) and psychiatric comorbidities among persons with JME. This was a cross-sectional study conducted at a teaching hospital in Delhi, India. Persons above 11 years of age with JME diagnosed according to the International League Against Epilepsy criteria established in 2001 were enrolled. QoL assessment was made using Quality of Life in Epilepsy Inventory-Adolescents-48 (QOLIE-AD-48) and Patient-Weighted Quality of Life in Epilepsy Inventory 31 (QOLIE-31-P) for adolescent and adult patients, respectively. For the assessment of psychiatric comorbidities, participants were administered the Mini-International Neuropsychiatric Interview (M.I.N.I). Participants who tested positive for psychiatric comorbidities on M.I.N.I subsequently underwent the Diagnostic and Statistical Manual-5 categorization. We enrolled 50 patients with JME. Eighteen (36%) were male and 32 (64%) were female patients. The median age of males at study enrollment was 23.5 (range 15-38) years. The median age of females was 22 (16-48) years. The median QOLIE-31-P score among males was 68.31 (37.13-91.82) and for females was 66.9 (31.7-99.1). The median overall QoL score for males was 65 (25-87.5), which qualified as "fair" QoL. For females, the median overall QoL score was 62.5 (10-87.5) which also qualified as "fair" QoL. No significant difference was noted between genders in QoL (P = 0.723). Among males, 55.5% had psychiatric comorbidity. Of these, two had mild depression and eight had anxiety. Among female patients, 34.4% had comorbid psychiatric issues; 6 had anxiety and 5 had depression. No significant difference was noted between genders (P = 0.9136). Persons with JME do not have gender-stratified differences in terms of psychiatric comorbidities and QoL despite differences in exposure to antiseizure medications and other gender-related factors. All persons with JME should be screened for psychiatric comorbidities, specifically anxiety, and depression.

VITAMIN D DEFICIENCY IN PREGNANCY AND ITS ASSOCIATION WITH MATERNAL COMPLICATIONS.

Introduction: Vitamin D deciency and insufciency have been associated with a variety of adverse maternal and fetal outcomes, ranging from Gestational hypertension, preeclampsia, gestational diabetes, preterm delivery, intrauterine growth restriction, and cesarean section. The study was done to determine whether vitamin D deciency in pregnant women was associated with complications. Methods: In this prospective observational study, vitamin D levels were estimated in 100 pregnant women from gestational age 32 to 40 weeks in a teaching hospital in Delhi, India. All the subjects were further followed up for the appearance of pregnancy associated complications mostly focusing on the appearance of Gestational Hypertension, Pre-eclampsia, Gestational Diabetes, IUGR, Preterm labour or landing up in Caesarean section. Results: 84% had suboptimal vitamin D level i.e serum vitamin D < 30ng/ml. Common complications were gestational hypertension (47%), caesarean section (47%) and gestational diabetes (41%). Signicantly low vitamin D levels were found in women with obstetric complications as compared to controls with no complications. Also, signicant association was found between suboptimal vitamin D levels and complications. Conclusion: The routine measurement of vitamin D in pregnancy can be of great help in identifying patients at risk for development of these complications, early intervention and prevention of occurrence of these complications. Cost effective and timely treatment can prevent the complications in expecting mothers

Creation of Neovagina Using Complete Laparoscopic Dissection

Study Objective Exclusive laparoscopic dissection for creation of neovagina in MRKH Design Video with step-by-step description of technique Setting Department of Gynaecology at BLK Max Superspeciality Hospital, a tertiary care teaching hospital in Delhi, India Patients or Participants 27-year-old patient with MRKH syndrome, married for 6 months came for creation of neo-vagina Interventions Neovagina was created using complete laparoscopic dissection. Measurements and Main Results The surgery required lesser time than combined laparoscopic-perineal approach. The operation duration was 25 minutes. Blood loss was 20 ml. The vaginal lumen accommodated the vaginal mould well and patient could very comfortably change the vaginal mould herself from 4th day onwards. Conclusion For creation of neovagina, MacIndoe's method had been gold standard for many years. Combined laparoscopic and perineal technique with peritoneal pull through has become popular due to minimal morbidity. In this video, we show the technique of complete laparoscopic dissection right up to skin at vaginal dimple. As this dissection is completely under vision, it minimises the risk of damage to the bladder and rectum, which is not uncommon with perineal dissection. In addition, few medial fibers of levator ani can be divided under vision with this technique which avoids cicatrisation of vagina in future. Exclusive laparoscopic dissection for creation of neovagina in MRKH Video with step-by-step description of technique Department of Gynaecology at BLK Max Superspeciality Hospital, a tertiary care teaching hospital in Delhi, India 27-year-old patient with MRKH syndrome, married for 6 months came for creation of neo-vagina Neovagina was created using complete laparoscopic dissection. The surgery required lesser time than combined laparoscopic-perineal approach. The operation duration was 25 minutes. Blood loss was 20 ml. The vaginal lumen accommodated the vaginal mould well and patient could very comfortably change the vaginal mould herself from 4th day onwards. For creation of neovagina, MacIndoe's method had been gold standard for many years. Combined laparoscopic and perineal technique with peritoneal pull through has become popular due to minimal morbidity. In this video, we show the technique of complete laparoscopic dissection right up to skin at vaginal dimple. As this dissection is completely under vision, it minimises the risk of damage to the bladder and rectum, which is not uncommon with perineal dissection. In addition, few medial fibers of levator ani can be divided under vision with this technique which avoids cicatrisation of vagina in future.

Pubertal Development and its Determinants in Adolescents With Transfusion-Dependent Thalassemia

To assess pubertal development and its determinants in adolescents with transfusion-dependent thalassemia (TDT). In this cross-sectional study from a tertiary teaching hospital in Delhi, records of adolescents aged 17-19 years with TDT on regular transfusion at thalassemia day-care centre were reviewed. Pubertal development and its determinants were assessed. Records of 58 (33 male) adolescents with TDT were reviewed. Among them, 42 (72.4%) had normal/delayed onset with spontaneous progression of puberty, while 16 (27.6%) had pubertal arrest/failure and received hormonal replacement therapy (HRT). Short stature was observed in all adolescents on HRT. Amongst other endocrinopathies, only hypoparathyroidism was found to be significantly higher in the HRT group. On multivariate analysis, serum ferritin (OR-1.005, 95% CI 1.002, 1.009) was observed to be the only significant determinant of pubertal arrest/failure. A significant proportion of adolescents with TDT continue to have pubertal arrest/failure. High systemic iron load is the key determinant for this.

Epidemiological surveillance of Chikungunya cases – Findings from a tertiary care hospital in New Delhi

Background: Chikungunya epidemic is a major public health problem in metro cities in India especially during rainy season. There was an epidemic of chikungunyain the year 2016 in New Delhi. Therefore, this present study was planned to understand epidemiological and clinical profile of Chikungunya cases attending fever clinic in a tertiary care teaching hospital in Delhi. Methods & Materials: A total of 200 patients with fever of up to 7 days duration who reported at fever clinic of a tertiary care hospital in New Delhi were studied over a period of 6 months. A total of 47,874 fever cases were reported in fever clinic in same duration. Serum specimens were screened for chikungunya infection by serology (IgM). Chikungunya infection was detected in 16.5% patients by anti-CHIKV IgM antibodies by ELISA. A preformed semi-structured, interviewer administered questionnaire was used for the purpose of data collection. Results: Among these 200 suspected cases of chikungunya, fever (96.0%), joint pain (81.0%), myalgia (77.5%) and lower backache (57.5%) were the major clinical features. Major joints involved were knee joint (45.5%), wrist (32.5%), hand (phalanges) (34.5%) and ankle joints (31.0%). Myalgia, rashes, joint pain and joint swelling was frequently observed among chikungunya confirmed cases (p < 0.05). All group of ages, both gender and all class of socioeconomic scale were equally susceptible to chikungunya infection. Conclusion: Chikungunya virus had a wide spectrum of clinical features and all age groups, gender and socioeconomic status people were equally susceptible to Chikungunya infection. All acute febrile illness patients with joint pain should be screened in the laboratory for both Chikungunya IgM antibodies. Predictability of chikungunya is more in presence of joint pain and swelling, myalgia and rashes. This study emphasizes the need for a continuous surveillance on the disease burden.

E-Waste awareness among Medical Undergraduates’ in a Tertiary Care Teaching Hospital in Delhi, India: A Cross-Sectional Study

Background:Globally, around 44.7 million metric tonnes of e-waste was generated in 2016. India, being the second most populous country in world, generated 2 million metric tonnes of e-waste in 2016. About 5000 metric tonnes of e-waste is imported to India every year. This highlights the need to study awareness about e-waste among the consumers generating it. So, this study was planned with primary objective to assess the knowledge regarding e-waste among medical undergraduate students as they are also the consumers of electronic equipment which constitutes e-waste. Methodology: The present study was a cross-sectional one, done among 300 medical undergraduate students of a tertiary care hospital and teaching institution in Delhi, India. A pre-tested, semi-structured, self-administered questionnaire was used to gather information from study participants. Descriptive statistical analysis was performed. Result: More than two-thirds of the (77.3%, 232) study participants were aware about concept of e-waste. Out of these 232 students, only about half had adequate knowledge about equipment contributing to e-waste and constituents of e-waste. Most common reason for purchase of new electronics was desire for new technology. Conclusion: A significant percentage of students (22.7%) have not even heard of concept of e-waste. Their practices related to e-waste handling were hazardous from both health and environmental aspect. This is an area of concern in this era of growing environmental deterioration. There is a need to study general public awareness also so that appropriate measures can be undertaken.

Profile of acute childhood poisoning at a tertiary care teaching hospital in North India

Objective: The objective of the study was to determine the profile and outcome of children under the age of 12 years admitted with acute poisoning at a tertiary care teaching hospital in Delhi. Materials and Methods: We retrospectively reviewed case files of all patients &lt;12 years of age admitted with poisoning at pediatric emergency from January 2016 to December 2016. All cases with definite history of poisoning were included in the study. Exclusion criteria included chronic poisonings such as lead poisoning, food poisoning, foreign body ingestion, and homeopathic drug ingestion. Baseline characteristics of patients, type of poison, signs and symptoms of poisoning, investigations, treatment, and outcome were recorded from the case files and analyzed. Results: A total of 91 patients were presented with poisoning during the study period. Almost all cases (n=89, 97.8%) were accidental, only 2.2% (n=2) cases were suicidal, and none was homicidal. The mean age of presentation of these patients was 4.08±3.11 years with males outnumbering females (M: F=1.6:1). Corrosives (n=20, 21.9%), kerosene (n=17, 18.7%), prallethrin (n=11, 12.1%), and drugs (n=7, 7.7%) were the most frequently implicated agents. 11 patients (12.1%) were completely asymptomatic, while 30.7% (n=28) patients developed serious symptoms such as breathing difficulty, altered sensorium, seizures, abnormal speech, hematemesis, nasal bleeding, and hypotonia. Gastric lavage was done in 15 cases, three patients received activated charcoal, and three patients required intubation, and one patient required an emergency tracheostomy. One patient expired and rest all survived. Conclusion: The trends of pediatric poisoning noted in our center were different from those observed in other hospital based studies. Corrosives (particularly acids) being the most common agents. Prallethrin, kerosene, and drugs were other common agents.

Prevalence and Risk Factors of Subclinical Vertebral Fractures Among Women with Rheumatoid Arthritis

Introduction: Patients of rheumatoid arthritis (RA) are prone to osteoporosis and overt fractures. Subclinical vertebral fractures (SVFs) precede overt vertebral fractures. We studied prevalence and risk factors of SVFs among women with RA. Aim: To determine the prevalence of SVFs in women with RA and to study the various risk factors associated with presence of SVFs. Settings and design: Adult patients of RA attending the rheumatology clinic of medicine department at a tertiary teaching hospital in Delhi. One hundred eleven adult women with RA were included. Clinical assessment included anthropometry, Body Mass Index (BMI), duration of RA, disease activity using Clinical Disease Activity Index (CDAI), disease disability using Health Assessment Questionnaire (HAQ), and details of glucocorticoid (GC) use. Thoracic and lumbar vertebrae were graded for presence of VFs using the semi-quantitative method of Genant by two radiologists. Statistical analysis used: Simple descriptive statistics were used to describe prevalence of SVFs. Risk factors for SVFs were tested for significance using the Studentʼs t-test for quantitative variables and chi-square test for qualitative variables. Kappa statistics were calculated for assessment performed by the two radiologists. Two-sided alpha was set at 3 SVFs. Women with any SVF were significantly older as compared to women with no SVF. Fifty five percent of women using GCs had any SVF, while 44%, not using GC, had any SVF (P = ns). GC use, duration of RA, CDAI score, HAQ score, BMI, presence of RF, and anti-CCP were not different between women with and without SVFs. Kappa for inter-reader variability among the two radiologists was 0.98. Conclusions: This study provides evidence of very high prevalence of SVFs among women with RA. Traditional risk factors do not fully account for this enhanced risk.

Prevalence and Determinants of Domestic Violence among Attendees of an Antenatal Clinic in a Tertiary Care Teaching Hospital in Delhi, India

Prevalence and Determinants of Domestic Violence among Attendees of an Antenatal Clinic in a Tertiary Care Teaching Hospital in Delhi, India

Health Literacy Levels among Outpatients at a Tertiary Hospital in Delhi, India

Background: Health literacy is defined as the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information in ways which promote and maintain good health. This study was conducted to determine health literacy levels and the associated factors among patients attending the outpatient departments of a tertiary care hospital in Delhi. Methods: A hospital-based cross-sectional study was carried out in a tertiary care teaching hospital in Delhi over a period of four months. A total of 150 patients were included in the study. Fifty patients from the Diabetes Clinics, 50 patients from Hypertension Clinics, and 50 patients with anemia from the Antenatal Outpatient Department (OPD) were selected using a convenience sampling method. Data was analyzed using Epi Info software. Statistical analysis was conducted with the chi-square test and the Fisher’s exact test. P values less than 0.05 were considered significant. Results: Out of 50 diabetic subjects, 37 (74%) understood the information about their blood sugar levels as explained to them by the doctor. Similar results were found among hypertensive subjects as well. Furthermore, education status was significantly associated with health literacy. In terms of understanding the regimen of medications, significant association was seen with age, sex, and education. Conclusion: Education status, age, and gender are important determinants of health literacy. Our results support that innovative strategies of communication should be used to improve health literacy among patients.

Clinical Profile of Early Diagnosed Dengue Fever in Hospitalized Children in South Delhi

To the Editor: Dengue fever (DF), an acute febrile illness caused by dengue viruses belonging to the family Flaviviridae, remains a major cause of morbidity and mortality among children in South East Asia [1]. Since the clinical presentation and severity of dengue infection has been changing with every outbreak, we aimed to study the clinical and laboratory parameters of children admitted with dengue fever during the latest outbreak. In this prospective study conducted in a multi-speciality teaching hospital in Delhi, hospitalized children testing positive for NS1 antigen were enrolled. Cases were classified into three groups: Dengue (D), Dengue with warning signs (DW) and Severe Dengue (SD), according to WHO Classification [2]. Among 60 patients of dengue fever 11.7 % were classified as D, 83.3 % as DW and 5 % as SD group. Seventy-eight percent had thrombocytopenia and 15 % had total platelet count (TPC) below 50,000. All the nine cases with platelet count ≤50,000/cu mm had leucopenia, and 33.3 % had skin bleeds/epistaxis. Transiently elevated transaminase levels, which returned to normal after 4 wk were seen in 9 out of 31 cases tested. Ascites was observed in 23 % cases but shock in 5 % only. Increase in the hematocrit >45 %was observed in none. Mean hospital stay was 3.6 d. The unique observation during this outbreak of DFwas that it was milder and life threatening manifestations of DF like shock, plasma leak and severe hemorrhage were uncommon. Even though laboratory parameters like thrombocytopenia and elevated transaminases were comparable to previous studies, the course of the disease was milder in most of the cases [3, 4]. Reason being early detection of cases and timely hospitalization, which was facilitated by availability of a quick and early diagnostic test like NS1 antigen detection, augmented by increased awareness among the public and general practitioners during this outbreak. This view is supported by the fact that 12% cases were admitted with only complaints of fever and myalgia, the sole reason for hospitalization being low platelet counts and/or positive dengue NS1 antigen. Similar observation has been made from Thanjavur [5]. Despite low platelet counts bleeding manifestations were relatively uncommon. Although the limitation of this study was a small sample size, we conclude that increase in awareness, change in health seeking behavior, early diagnosis and identification of danger signs are positive public health approaches to prevent complications and death following dengue infection.

Variation in Bowel Habits of Healthy Indian Children Aged up to Two Years

To study the normal bowel habits of healthy Indian children up to 2y of age. This cross sectional study was conducted in medical college associated teaching hospital in Delhi. Ethical clearance was obtained from Institutional Ethical Committee. A total of 500 infants and toddlers up to 2y of age were recruited for the study. Data were collected by interviewing parents of the eligible children who came for immunisation using pre designed Performa. There was steady decline in stool frequency with increasing age. Maximum decline in stool frequency was noted after 1mo of age. Variation in stool frequency between children was maximum in 0-3mo of age and decreased with increasing age. Stools at 4wk were usually semiliquid, watery and semisolid. By 6mo of age 55% infants were passing semisolid stools and 40% were passing formed stools. At 24mo of age, 89.2% children usually passed formed stools. This is the first study in India to date documenting the frequency and consistency of the stools of young children. These results make an important contribution to defining normal stool patterns in young Indian children.

P138 Knowledge, awareness & acceptance of HIV testing amongst pregnant women in a teaching hospital in Delhi a five year study

P138 Knowledge, awareness & acceptance of HIV testing amongst pregnant women in a teaching hospital in Delhi a five year study

A study of job satisfaction and work environment perception among doctors in a tertiary hospital in Delhi

Many doctors are dissatisfied with their jobs, which is due to long working hours and overwork. This can affect patient care and reduce quality of care. To study job satisfaction among doctors in a tertiary hospital in Delhi and the various factors related with it. Data collection was done among 250 doctors on tenure-based job, selected by stratified random sampling, in a teaching hospital in Delhi, by using a self-administered questionnaire. Proportions and Chi-square tests. The mean number of work-hours among doctors was 9.7 +/- 2.7 hours per day, and the mean number of night shifts was 5.6 per month. About half (49.6%) of the doctors were dissatisfied with the average number of work-hours per day. Dissatisfaction was significantly more in those who had an average of> 8 work-hours per day and who had > or =8 night shifts per month. About half (45.6%) of the doctors considered their salary as 'bad,' and this was significantly more among unmarried doctors, interns and those who had > or =8 night shifts per month. More than half (55.2%) of the doctors were dissatisfied with their choice of profession, i.e., being a doctor, as compared to other professions. A significant proportion of doctors were found to be dissatisfied with the average number of their work-hours and salary. Factors like the average number of work-hours per day and the number of night shifts per month were found to have a significant relation with dissatisfaction. Further studies are needed to explore how best the work-hours of doctors could be adjusted to improve their job satisfaction.

Medical errors and consequent adverse events in critically ill surgical patients in a tertiary care teaching hospital in Delhi.

Background:Medical errors and adverse events (AE), though common worldwide, have never been studied in India. We believe that though common these are under reported. Aim: The aim of this study was to study medical errors and consequent AE in patients presenting with trauma and bowel perforation peritonitis.Methods:Five hundred and eighty-six consecutive patients with trauma or peritonitis, presenting to surgery emergency of UCMS-GTBH, were prospectively studied using review form (RF) 1 and 2. AE was defined as an outcome not expected to be part of the illness. RF 1 was filled for all and indicated if AE was present or not. RF2 was filled when RF 1 indicated presence of AE; it further confirmed the occurrence of AE and pointed to the type of medical error and resultant disability. All results were expressed as percentage.Results:There were 500 (85%) males. Mean age of the patients was 31 years. There were 332 patients with peritonitis and 254 with trauma. AE and its consequences were present in 185 (31.5%) and 183 (31.2%) patients, respectively. Consequences were as follows: disability – 157 (85%), increased hospital stay and/or increased visits in the OPD – 28 (15.3%) and both-101 (55.2%) patients. Disabilities were: death – 62 (40%), temporary disability – 90 (58%) and permanent disability – 05 (3.1%) patients. AE in 133 (71.8%) patients was definitely (level of confidence 6) due to error in healthcare management. All AE were considered preventable. Error of omission accounted for AE in 122 (65.9%) patients. System and operative errors were the commonest, 84.3% and 82.7%, respectively. One hundred and sixty-seven (90%) patients had multiple errors.Conclusions:The study proves that medical errors and AE are a serious problem in our set-up and calls for immediate system improvement.

Evaluation of awareness and utilization of an autologous blood transfusion programme.

Autologous blood transfusion (ABT) has an important role in transfusion practice in the developing world due to increasing incidence of HIV and hepatitis C virus infection. Our study was done to evaluate the level of awareness and utilization of an autologous blood transfusion programme in a teaching hospital in Delhi. We assessed the level of awareness of preoperative ABT amongst treating physicians from different specialties in a teaching hospital through an anonymous questionnaire. The utilization of this methodology in transfusion practice was estimated from records of the Blood Transfusion Service. Of the 150 doctors contacted 96 (64%) responded. Although 67.7% of them were aware of the technique and its advantages, only 21.8% used it for the patients under their care. In the preceding 24 months 133 (1.1%) of 12,090 blood collections in the transfusion service were from autologous donor-patients. Only one unit of blood was collected from each patient, although 41.8% of them received > or = 2 units of blood. Of the 11,123 patients transfused, 55 (0.49%) received the ABT. Thus only 55 (41.3%) of 133 total ABT collections were utilized. The study highlights that there is a general lack of awareness about ABT amongst physicians. This transfusion practice is rarely and inadequately used. The study was repeated the following year after an intensive intervention strategy was adopted. The results show a trend towards improvement in the practice of ABT. This study emphasizes the need for proper organization, planning and communication between clinicians and blood transfusion personnel for effective implementation of an ABT programme, especially in countries with a high incidence of transfusion-transmitted infections and acute shortages of blood for transfusion.