Teaching Hospital Research Articles

Prevalence and associated factors of hypertension among people living with HIV/AIDS on antiretroviral therapy in Benin’s National Teaching Hospital

Antiretroviral therapy (ART) has extended the lifespan of people living with HIV/AIDS (PLHIV), exposing them to a higher risk of cardiovascular diseases (CVD). Hypertension (HTN), the primary contributor to CVD burden, is increasingly concerning for PLHIV. This study aimed to assess the prevalence and associated factors of hypertension in PLHIV on ART at the National Teaching Hospital Hubert Koutoukou Maga (HKM) of Benin using a prospective cross-sectional study conducted between October and December 2021. Patients who had a systolic blood pressure ≥ 140 mmHg or/and diastolic blood pressure ≥ 90 mmHg or/and current use of antihypertensive medication from medical records were considered to have HTN. A total of 352 patients, including 260 women with a sex ratio of 0.3 were included. The mean age was 42.9 ± 11.9 years. Most patients were educated and did not use tobacco. 42.0% were current alcohol drinkers. The duration of ART treatment ranged from 0 to 22 years, with a median duration of 5.0 years. 14.2% were hypertensives with 3.1% newly diagnosed and 11.1% known with hypertension. Age above 40 years, living with a partner, alcohol consumption and body mass index greater than 25 were significantly associated with HTN. HTN in PLHIV is associated with numerous factors. Reducing the burden of the disease in target people in Benin requires a wide range of actions that need to be implemented.

A retrospective analysis of the pharmacovigilance data registry in a tertiary teaching hospital in Jordan

A retrospective analysis of the pharmacovigilance data registry in a tertiary teaching hospital in Jordan

Management of a dentigerous cyst; a ten-year clinicopathological study

BackgroundDentigerous cysts, deemed of developmental origin, are benign odontogenic cysts characterized by a gradual growth rate. Their occurrence is twice as prevalent in men compared to women. These cysts are recognized as the most frequent developmental cysts affecting the jaws, with a typical manifestation in individuals aged 20 to 40, while infrequently identified in young children. Notably, dentigerous cysts have the potential to attain significant dimensions, resulting in painless enlargement of the jaw and subsequent deformation.ObjectivesTo assess the clinicopathological features and management of ten years of experience with dentigerous cysts.MethodsA challenging cases were reported from reviewed records of the patients who were treated by the surgical intervention of various dentigerous cysts throughout the period of ten years, 2012–2022 and only histologically confirmed cases were selected, at Ramadi Teaching Hospital in addition to Rashid, Razi, Zuhur Private Hospitals and private clinics in Iraq.Results76 patients were included in this clinicopathological research. The highest age group affected was ≤ 18 years (68.4%), 54% were male, the mandible was more affected (63.1%) than the maxilla (36.9%). Marsupialization was applied to 30.3% of the cases, while enucleation was carried out in 69.7%.ConclusionsThe significance of meticulous examination of radiographs and the consequences associated with undetected and untreated ailments is affirmed by this case study. A comprehensive understanding of oral pathology serves as a valuable resource for dentists, facilitating accurate diagnosis, appropriate referrals, and the provision of anticipatory guidance to patients striving to achieve optimal oral health across various age groups.

Examination of ethical intelligence and cognitive flexibility of nurses and their role in predicting the level of patient privacy protection

IntroductionPossessing ethical intelligence and cognitive flexibility can play a significant role in the acceptable performance of nurses. Furthermore, respecting the privacy of patients should always be a primary ethical principle that nurses focus on. This study aimed to investigate the ethical intelligence and cognitive flexibility of nurses and their role in predicting the level of patients’ privacy observance. Also, determining the overall status of patient privacy protection and its two domains, namely human dignity domain and maintaining personal privacy, were specific objectives of this study.MethodsThis cross-sectional descriptive-analytical study was conducted in 2022. A sample of 340 nurses and 1067 patients from teaching hospitals affiliated with Shiraz University of Medical Sciences in southern Iran were selected. Standard questionnaires of ethical intelligence and cognitive flexibility were used for nurses, and a privacy observance questionnaire was used for patients. Data were analyzed using t-tests, ANOVA, Pearson correlation coefficient, and multiple linear regression with the SPSS23 software.ResultsThe mean score of ethical intelligence and cognitive flexibility for nurses was 98.33 ± 18.06 (out of 200) and 74.56 ± 16.76 (out of 140), respectively. The mean score of patients’ privacy observance was 79.74 ± 14.53 (out of 150). The results of multiple linear regression showed that the dimensions of perseverance and assertiveness towards rights (β = 0.540, p < 0.001), action based on principles, values, and beliefs (β = 0.454, p < 0.001), responsibility towards personal decisions (β = 0.410, p < 0.001), accepting responsibility for serving others (β = 0.393, p < 0.001), ability to forgive one’s mistakes (β = 0.301, p = 0.001), ability to forgive others’ mistakes (β = 0.287, p = 0.002), honesty (β = 0.275, p = 0.004), acknowledgment of mistakes and failures (β = 0.263, p = 0.005), commitment to promises (β = 0.242, p = 0.005), and interest in others (β = 0.237, p = 0.01) from the dimensions of ethical intelligence, as well as the dimensions of perceived control (β = 0.580, p < 0.001), perception of multiple solutions (β = 0.511, p < 0.001), and perception of justifications (β = 0.373, p < 0.001) from the dimensions of cognitive flexibility had a positive and significant effect on the level of patients’ privacy observance.ConclusionEthical intelligence and cognitive flexibility of nurses and the level of patient privacy protection were estimated to be at a moderate level. Also, the level of ethical intelligence and cognitive flexibility of nurses played a predictive role in the level of patients’ privacy observance. It is suggested that hospital managers and policymakers enhance nurses’ ethical intelligence and cognitive flexibility through educational, welfare, managerial, motivational, and job-related programs, thereby improving the status of patient privacy protection.

Perceived compassionate care and preoperative anxiety in hospitalized patients.

Quality nursing care and ethical responses to patient pain and suffering are very important in the preoperative period. However, few studies have addressed these variables. This study aimed to examine the relationship between compassionate care and preoperative anxiety from the perspective of hospitalized patients. The current study was a cross-sectional descriptive one. The participants were selected using convenience sampling. The data were collected using a demographic questionnaire, Burnell Compassionate Care Tool, and Amsterdam Preoperative Anxiety and Information Scale (APAIS). The collected data were analyzed with SPSS software (version 22) through descriptive and inferential statistics at a significance level of 0.05 (p < .05). This study was conducted on 704 candidates for surgery in the internal and surgical wards of a large teaching hospital located in the south of Iran from December 2022 to March 2023. The protocol for this study was reviewed and approved by the University Ethics Committee. The patients' average age was 36.61 ± 13.07. The average preoperative anxiety and need for information scores were 13.80 ± 2.66 and 7.44 ± 1.47, respectively. The average score of importance was 3.03 ± 0.19, and the average score of the extent of compassionate care provision was 1.22 ± 0.15. There was a significant relationship between preoperative anxiety with importance and the extent of compassionate care provision (r = 0.68, p < .001), r = -0.72, p < .001, respectively). A comparison of the demographic characteristics, need for information, importance, and provision of compassionate care showed that the extent of compassionate care provision had the greatest contribution in explaining preoperative anxiety (β = 0.50; p < .001). Even though patients' preoperative anxiety was high and providing compassionate care in the preoperative period had a great role in relieving their anxiety, many participants appear to have received little compassionate care. To this end, nursing managers should pay attention to the quality of compassionate care in the preoperative stage. Besides, healthcare staff should receive the necessary training in compassionate nursing care.

Implementation and Evaluation of Clinical Decision Support for Apixaban Dosing in a Community Teaching Hospital.

This study aimed to describe and evaluate the transition from a specialty service-based prospective order approval system to a computerized clinical decision support (CCDS) tool for apixaban dosing at a community teaching hospital. The primary objective was to assess the impact of the transition on the appropriateness of apixaban prescribing. A CCDS tool for apixaban dosing was developed and implemented using interprofessional collaboration. A retrospective chart review was conducted for apixaban orders placed before (preimplementation) and after (postimplementation) the CCDS transition. The primary outcome was the percent change in inappropriate apixaban orders, with secondary outcomes exploring percent change of apixaban orders with inappropriate dosing in different patient groups and indications per package insert. Fifty orders were assessed in both arms, with 8% of orders preimplementation and 10% postimplementation deemed inappropriate. After accounting for questionable orders, overall appropriateness of prescribing was 88% preimplementation and 84% postimplementation (P = 0.7). Challenges with implementation of CCDS included working with available information technology resources and facilitating acceptance of a new ordering process. The implementation of a CCDS tool for apixaban dosing at a community teaching hospital demonstrated comparable rates of appropriateness to the previous specialty service-based approval process. While the transition streamlined resources and improved efficiency, ongoing efforts are needed to address specific dosing challenges. Future research should explore the sustainability and generalizability of CCDS tools in diverse healthcare settings.

Maternal micronutrient biomarkers and risk of non-syndromic cleft lip/palate: A case-control study.

This case-control study investigated the associations between maternal plasma vitamin B12, homocysteine, and red blood cell (RBC) folate levels and the risk of cleft lip with or without cleft palate (CL/P) in offspring. The study compared 94 mothers and children with non-syndromic CL/P from a teaching hospital in Thailand to 94 mother-infant controls from local well-baby clinics, frequency-matched by birth date and mother's education. Data included anthropometric measurements, blood sample analyses, and a questionnaire. Odds ratios (ORs) and 95% confidence intervals (CIs) estimated the associations through multiple logistic regression, adjusting for confounders. Mothers with higher plasma vitamin B12 levels had a lower risk of having a child with CL/P compared to those in the lowest quartile. This association was more pronounced among mothers without a family history of orofacial clefts and those who were not underweight. Conversely, elevated homocysteine levels, a marker of impaired B vitamin metabolism, increased the risk of CL/P. No association was found between RBC folate and CL/P. Higher maternal vitamin B12 levels are associated with a reduced risk of CL/P, while elevated homocysteine levels may increase the risk.

Assessment of knowledge, attitude and practice of biomedical waste management among nursing staff in a tertiary care teaching hospital

Assessment of knowledge, attitude and practice of biomedical waste management among nursing staff in a tertiary care teaching hospital

A study on patients’ perception of signage system in a tertiary care teaching hospital

A study on patients’ perception of signage system in a tertiary care teaching hospital

Transforming Hospital Housekeeping: The Kayakalp Journey

Introduction The Kayakalp guidelines for public healthcare facilities under the Swachh Bharat Abhiyan (Clean India Mission) focus on improving sanitation, cleanliness, and infection control at public hospitals in India. This study was conducted in a 960-bed tertiary-level teaching hospital in eastern India. Housekeeping has been a challenge in public institutions, with factors like overcrowding and resource constraints. Tobacco and betel nut chewing, spitting, poor sanitation practices, and open urination are major challenges in ensuring sanitation at the hospital. The research objective was to study the implementation of the Kayakalp guidelines for quality improvement in housekeeping services at the institution. Methods A pre- and post-interventional study was conducted using the Plan-Do-Check-Act (PDCA) quality tool. Plan phases included the gap assessment using the Kayakalp checklist with numerical scoring. Necessary interventions were done under three headings: structure, processes, and outcomes in the “Do” phase. The “Check” phase included monitoring of the activities followed by the “Act” phase, which included a review of the action plan. External experts nominated by the government conducted the final assessments and recommended it as one of the cleanest hospitals. Results A 360-degree improvement was observed in hospital services, with assessment score improvement from 73.68% to 95.0%. The institution received the first prize in 2020 and 2021 and runners-up Kayakalp National Award under category “B” (Institute of National Importance) Hospitals in 2019. Conclusion The implementation of Kayakalp guidelines of the Government of India proved to be efficient in the improvement of housekeeping and infection control practices in the institution.

Outcomes of Acute Kidney Injury among Hospitalized Patients with Infective Endocarditis: A National Inpatient Sample Analysis

Background/Objectives: Patients with infective endocarditis (IE) are more susceptible to acute kidney injury (AKI). The presence of AKI increases in-hospital complications in these patients. Methods: The 2016–2020 National Inpatient Sample (NIS) database consisting of adult admissions with IE and AKI was utilized. The primary outcome was all-cause inpatient mortality. Secondary outcomes included fluid and electrolyte disorders, stroke, septic arterial embolism, septic shock, cardiogenic shock, valve surgery, vasopressor support, mechanical ventilation, length of stay (LOS), and total hospital charges. Results: Out of a total of 63,725 adult admissions with IE, 16,295 (25.5%) admissions had AKI. Patients with AKI were more likely to be males (63% vs. 57.6%, p &lt; 0.001) and older (55.8 vs. 50.4, p &lt; 0.001). A higher proportion of these patients were admitted to large hospitals (60.6 vs. 55.3%, p &lt; 0.001) and urban teaching hospitals (81.9 vs. 75%, p &lt; 0.001). Patients with AKI had higher LOS (17 ± 16.1 vs. 11.32 ± 11.7, p &lt; 0.001) and hospital charges (USD 239,046.8 ± 303,977.3 vs. USD 124,857.6 ± 192,883.5, p &lt; 0.001). Multivariable analysis showed higher odds of all-cause inpatient mortality (aOR: 2.22, 95% CI: 1.81–2.73, p &lt; 0.001). They also had higher risk for fluid and electrolyte disorder (aOR: 2.31, 95% CI: 2.10–2.53, p &lt; 0.001), septic arterial embolism (aOR: 1.61, 95% CI: 1.42–1.84, p &lt; 0.001), septic shock (aOR: 3.78, 95% CI: 2.97–4.82, p &lt; 0.001), cardiogenic shock (OR: 3.37, 95% CI: 2.65–4.28, p &lt; 0.001), valve surgery (aOR: 1.52, 95% CI: 1.35–1.71, p &lt; 0.001), vasopressor requirement (aOR: 1.99, 95% CI: 1.52–2.60, p &lt; 0.001), and mechanical ventilation (aOR: 2.75, 95% CI: 2.33–3.24, p &lt; 0.001). The association with stroke was elevated but not statistically significant. Conclusions: This large retrospective analysis demonstrated that patients with AKI and infective endocarditis had increased mortality, adverse hospital outcomes, increased LOS, and hospital costs.

Assessing the nutritional status and impact of a series of nutritional interventions on elderly inpatients using bioelectrical impedance analysis: A service evaluation.

The aim of the study was to use bioelectrical impedance analysis (BIA) to assess nutritional status of elderly patients admitted to hospital and quantitatively measure the impact of the Cardiff and Vale University Health Board (CAVUHB) model ward. Secondary objectives were to assess the feasibility of using BIA in this patient population and compare nutrition risk screening tools against fat-free mass index (FFMI). A prospective, comparative, single-centre, service evaluation of a 'model ward for nutrition and hydration' undertaken in medical and rehabilitation beds in a large UK teaching hospital. A total of 450 BIA measurements were taken using a Bodystat Multiscan 5000 on 162 patients; several patients had repeated measurements during their hospital stay. Patients tolerated the procedure well, but lack of accurate weight, implanted medical devices and tissue viability precluded some participants. BIA is quick, non-invasive, simple to complete and can elicit huge data about an individual's body composition. In a larger cohort of medical admissions, BIA could assist in identifying the sensitivity and specificity of the nutrition screening tools. The collective benefit of a series of nutritional interventions preserved nutritional status better in this elderly inpatient population than usual models of care. Although results were not statistically significant, there is an opportunity with the new model of care to better support frail patients and prevent deconditioning.

Normal M-mode, Pulsed Wave and Tissue Doppler Echocardiographic Studies in Healthy Working Police Dogs

Background: Physical activity alters the cardiovascular system of dogs depending on the exercise characteristics and the animal’s physical conditioning. Little is known about the cardiovascular changes in working police dogs. This study evaluated the cardiovascular responses of working Labradors to regular exercise and various workload. Methods: Twelve working Labradors of Tamil Nadu police department that were regularly trained and exercised 30 minutes morning and evening and twelve normal household pet Labradors brought for regular checkup to Madras Veterinary College Teaching hospital were taken for the study. All the animals were subjected to physical, clinical, hematobiochemical, electrocardiographic examinations and cardiac auscultation before performing echocardiography. Those animals which showed normal recordings in all the above tests were further subjected to M-mode, Pulsed wave and Tissue Doppler echocardiography. In this study, the resting heart rate values of working groups were lesser than that of normal pet dogs. Result: The results of echocardiography showed significant increase in Interventricular septal diameter during diastole, left atrial diameter, aortic artery diameter and the left atrium to aortic diameter ratio without impairing systolic and diastolic cardiac functions in working dogs. The present study indicated that there were few changes in the echocardiographic parameters which might be a response to physiological adaptation and regular exercise.

Knowledge, Attitude, and Practice of Materiovigilance Among Healthcare Professionals at a Tertiary Care Teaching Hospital

Knowledge, Attitude, and Practice of Materiovigilance Among Healthcare Professionals at a Tertiary Care Teaching Hospital

Exploring the viability of Virtual Reality as a teaching method for knee aspiration

Knee arthrocentesis is a simple procedure commonly performed by general practitioners and junior doctors. As such, doctors should be competent and comfortable in performing the technique by themselves; however, they need to be adequately trained. The best method to ensure practitioner proficiency is by optimizing teaching at an institutional level, thus, educating all future doctors in the procedure. However, the Coronavirus Disease 19 (COVID-19) pandemic caused significant disruption to hospital teaching for medical students which necessitated investigating the effectiveness of virtual reality (VR) as a platform to emulate hospital teaching of knee arthrocentesis. A workshop was conducted with 100 fourth year medical students divided into three Groups: A, B and C, each receiving a pre-reading online lecture. Group A was placed in an Objective Structured Clinical Examination (OSCE) station where they were assessed by a blinded orthopaedic surgeon using the OSCE assessment rubric. Group B undertook a hands-on practice station prior to assessment, while Group C received a VR video (courtesy of the University of Adelaide’s Health Simulation) in the form of VR headset or 360° surround immersion room and hands-on station followed by the OSCE. Upon completion of the workshop, students completed a questionnaire on their confidence with the procedure and the practicality of the VR station. OSCE scores were compared between Groups B and C to investigate the educational value of VR teaching. On average, students with VR headsets reported higher confidence with the procedure and were more inclined to undertake it on their own. Students in Group C who used the VR station prior to assessment scored higher than the non-VR Groups (Group A, 56%; Group B, 67%; Group C 83%). Students in Group A had statistically significant results on average compared to those in Group B (t(69) = 3.003, p = 0.003), as do students in Group B compared to Group C (t(62) = 5.400, p < 0.001). Within Group C students who were given VR headsets scored higher than immersion room students. The VR headset was beneficial in providing students with a representation of how knee arthrocentesis may be conducted in the hospital setting. While VR will not replace conventional in-hospital teaching, given current technological limitations, it serves as an effective teaching aid for arthrocentesis and has many other potential applications for a wide scope of medicine and surgical training.

Advancing Research Through Clinical Trials: Insights from Dr. Akbar Niazi Teaching Hospital, Islamabad

Advancing Research Through Clinical Trials: Insights from Dr. Akbar Niazi Teaching Hospital, Islamabad

Study on Drug Utilisation in Medicine Department Under National Health Scheme of Ayushman Bharath Arogya Karnataka in Tertiary Care Teaching Hospital

Study on Drug Utilisation in Medicine Department Under National Health Scheme of Ayushman Bharath Arogya Karnataka in Tertiary Care Teaching Hospital

Preference of Objective Based Learning among Medical Students in a Teaching Hospital

Preference of Objective Based Learning among Medical Students in a Teaching Hospital

Clinical profile and associated comorbidities of cerebral palsy in children visiting Orotta National Referral Hospital, Eritrea: a cross-sectional study

BackgroundCerebral Palsy (CP) is one of the most common physical disabilities in children. This study aimed to explore the clinical spectrum of CP at Orotta National Referral and Teaching Hospital, including CP subtypes, gross motor function, patterns of associated comorbidities, and possible risk factors in children aged 2 to 12 years.MethodsA hospital-based cross-sectional study was conducted from January to April 2022 in 153 children with suspected motor symptoms. The Surveillance of CP in Europe (SCPE) decision tree was used as an inclusion criteria guideline and the evaluation of the participants was done using a standardized questionnaire and clinical examination. Descriptive statistics, chi-square test, and logistic regression were employed to statistically analyze the data.ResultsEighty-four children who fulfilled the clinical criteria were included in the study. The median age was 5-years [IQR: 3.8] with an equal distribution of males and females. Quadriplegic CP was the most common subtype (51.2%) followed by unilateral (hemiplegic) CP (22.6%), and dyskinetic CP (14.3%). Most children had severe gross motor impairment GMFCS level IV-V and females were almost three times more likely to have GMFCS level IV/V than males (AOR: 2.70; CI: 1.08–6.72; p-value = 0.033.) More than half (52.4%) of the neonates either did not cry within five minutes and/or needed breathing resuscitation, 55.3% had to be admitted to the NICU with a median of 5 days’ hospital stay. Between the first week of birth and the first year of life, 28.6% had trouble feeding, 26.2% had an infection, 10.7% had difficulty breathing, 20.2% had seizures and 6% had jaundice. Feeding problems (64.3%), speech problems of some sort (91.7%), and epilepsy (46.4%) were the most commonly associated comorbidities with CP.ConclusionsThe clinical profile of the CP patients was found to be dominated by the spastic subtype and moderate to severe disability. Since perinatal risk factors were found to be dominant, strengthening maternal and child healthcare systems is recommended to minimize incidents of preventable risk factors and the burden of the disability.

Challenges and solutions to implementing cardiac rehabilitation in a low- and middle-income country

ABSTRACT Background Cardiac rehabilitation (CR) remains greatly underutilized, especially in low- and middle-income countries (LMIC). It is therefore important to explore factors that contribute to this, as perceived by health-care professionals (HCPs). Research design and methods This was a qualitative study using in-depth interviews that enrolled 18 HCPs (i.e. six each of physicians, physiotherapists, and nurses; mean experience in CR: 17.9 ± 11.8 yrs) working in cardiovascular care, and CR across private and government hospitals (both teaching and non-teaching) in India. Results The main challenges were related to lack of referrals, perceived lack of benefit from CR, poor infrastructure within hospitals and health systems, and differences in practice. The perceived inadequacies were lack of competencies in CR, limited task sharing strategies, and ineffective utilization of existing human resources. Devising strategies to improve awareness and competencies, facilitating task sharing, and remodeling holistic care with an active CR component may be beneficial to facilitate greater implementation of CR in India. Conclusions Challenges, inadequacies, and solutions to implementing CR have been explored by involving various HCPs commonly involved in delivering CR across different health systems in a LMIC. Trial registration www.ctri.nic.in with identifier CTRI/2020/07/026807.