Teaching Hospital Research Articles

The challenges of installing Picture Archiving and Communication Systems (PACS) in a low- or poor-income resource nation: Our experience in a teaching hospital in Sub-Saharan Africa

The practice of radiology as a subspecialty of medicine has undergone remarkable advancement as a result of picture archiving and communication Systems(PACS) technology. This technology allows for storage and retrieval of radiographic images and reports at any time, and possible transfer to other locations for secondary viewing and opinions. PACS enables healthcare professionals to access and review medical images quickly, allowing for faster and more accurate diagnosis and treatment planning. However, there are challenges involved in its installation and operations in our health facility, a teaching hospital in Sub-Saharan Africa. These challenges range from lack of huge financial resources required to acquire PACS equipment and accessories to lack of steady and regular electric power supply. Other challenges include inadequate dedicated space for its installation, inadequate functional cooling systems for its sensitive components, inadequate internet services for end users and paucity of qualified and trained personnel. There is, therefore, need for increased government and private sector funding in order to surmount these challenges, thereby enhancing health promotion in Sub-Saharan Africa.

Relationship between Level of Knowledge and 5 moment Hand Hygiene Practice among Assistant Healthcare in Malaysia Teaching Hospital.

Hand hygiene is a handwashing method that significantly lowers the likelihood of pathogens (dangerous germs) on the hands. While assistant healthcare workers are part of the healthcare team, they always deal with patients' care but did not get proper training like nurses or doctors before becoming assistant healthcare This study is to assess the relationship between level of knowledge and five moments hand hygiene practice among assistants healthcare in one of the teaching hospitals in Malaysia. A cross-sectional research methodology was used; 154 Assistants healthcarewere chosen using random number generators after the sample size was calculated. The Knowledge, Attitude, and Practice on Hand Hygiene questionnaire used was adopted from WHO publications. The ANOVA revealed a significant effect of Level of Knowledge on Level of Practice (F(1, 152) = 3.416, p = 0.006). Specifically, for each unit increase in Level of Knowledge, Level of Practice increased by 57.725 units (β = 57.725, p = 0.006). These findings emphasise the need for targeted interventions and training programmes aimed at bridging the knowledge-practice divide and eventually raising hand hygiene compliance in the medical setting

Level of medication adherence and its determinants of cardiovascular disease patients attending at specialized teaching hospitals of Amhara regional state, Ethiopia: a multicenter cross-sectional study

BackgroundNon-adherence to medication in patients with cardiovascular disease continues to be a main cause of suboptimal management, increased morbidity and mortality, and increased healthcare expenses. The present study assessed the level of medication adherence and its determinants of cardiovascular disease patients.MethodsAn institutional-based multicenter cross-sectional study was conducted with patients with cardiovascular disease in Northwest Ethiopian teaching hospitals. The level of medication adherence was evaluated using a standardized questionnaire of the Adherence in Chronic Disease Scale (ACDS). To find determinants of the level of medication adherence, an ordinal logistic regression model was employed. Statistics were significant when P ≤ 0.05 at a 95% confidence interval (CI).ResultsIn the end, 336 participants were included in the research. According to this study, one-third of patients had low medication adherence, half had medium adherence, and one-fifth had high medication adherence. Elderly patients [adjusted odds ratio (AOR) = 2.691; 95% confidence interval (CI), 1.704–4.251; P < 0.000], marital status (AOR = 1.921; 95% CI, 1.214–3.039; P = 0.005), alcoholic patients (AOR = 2.782; 95% CI, 1.745–4.435; P < 0.000), Patients without physical activity (AOR = 1.987; 95% CI 1.251–3.156; P = 0.004), non health insurances (AOR = 1.593; 95% CI 1.003–2.529; P = 0.049), sever Charles comorbidity index (AOR = 2.486; 95% CI 1.103–5.604; P = 0.028), patients with polypharmacy (AOR = 2.998 (1.817–4.947) P < 0.000) and, manypolypharmacy (AOR = 3.031 (1.331–6.898) P = 0.008) were more likely to have low medication adherence.ConclusionThe current study concluded that one-third of study participants had low medication adherence. Older age, marital status, drinker, physical inactivity, drug source, comorbidity, and polypharmacy all contributed to the low level of medication adherence. To improve patients with cardiovascular disease’s adherence to their medications, intervention is necessary.

Iraqi patients with a single-nucleotide polymorphism of interleukin-10 -1082G/A and interleukin-6 -174G/C susceptibility to asthma

The effects of genetic variations in the IL-10 -1082G/A gene and IL-6 -174G/C gene, as well as the genotypes and alleles linked to the prevalence of asthma disease, were investigated using a molecular and immunological study. Between October 2018 and the end of July 2020, 40 healthy individuals (20 females and 20 males) served as a control group for the study, which involved 50 asthmatic patients (31 females and 19 males) at the Allergy Centre, Al-Anbar Teaching Hospital, in Al-Anbar City. The study used the Single Specific Primer-Polymerase Chain Reaction (SSP-PCR) technique to show that the single nucleotide polymorphisms IL-10 -1082G/A and IL-6 -174G/C had a considerably high prevalence rate (P<0.05) among asthma case and that there was an association between the polymorphism and the asthma risk. The findings indicate that asthma patients had considerably higher (P<0.05) IL-10 A alleles and heterozygous GA genotypes (1082G/A) compared to the control group. Genetic variations affecting IL-10 production and the genotypes affecting IL-10 serum levels are associated with the occurrence of asthma and are attributed to the IL-10 -1082G/A promoter gene polymorphism. There was a strong correlation between cytokine levels, of disease development, and the genotypes of the AA and AG genes, indicating that IL-10 -1082A/G predisposition to asthma may be influenced by the gene promoter polymorphism. Asthma development and immunological markers (IL-10) are substantially correlated. One theory links allergic rhinitis to both the development of asthma and its risk. Inducing long-term immunological and clinical tolerance in patients was a good use of HDM immunotherapy. The current study's findings indicate a substantial difference between the asthma patients and the control group in terms of gene type and allele frequency of the IL-6 -174G/C polymorphism. The patients exhibited a higher prevalence of the G allele and the GG homozygous genotype than the control group. Therefore, it was shown that those with GG genotypes had a 2-fold increased probability of having asthma, indicating that patients were more prone to the condition.

Comparison of the functional outcome of Philos Plate Vs. external fixator in the management of proximal humerus fracture

Background: Proximal humerus fractures, are a major medical issue that are relatively prevalent. 4-5% of all fractures are proximal humeral fractures, most of which involve older and osteoporotic individuals. Objectives: To compare the functional outcome of philos plate vs. external fixator in the management of proximal humerus fracture. Material and Methods: A retrospective comparative study was conducted at the Department of Orthopaedic Surgery, Ghurki Trust Teaching Hospital, Lahore. From November 23, 2022, to May 23, 2023. After approval from the hospital's ethical board, 112(56 per group) patients were included in the study through an emergency. Informed consent was taken from parents. We stratified patients into two groups. Group A received the treatment of Philos, while Group B received the external fixator treatment. Functional outcome was assessed at the end of 3 months postoperatively using constant shoulder score. The collected data were entered and analyzed accordingly using SPSS version 27. Results: In the current study, a total of 112 patients included underwent two surgical interventions, among these, 56 patients underwent Philos plating while an equal number of patients underwent external fixation. In Group A and B, the majority were males (37:47) out of 112. The mean age of patients was equal in both groups (Group A=44.36±11.71), and the mean age of patients was (Group A=44.88±10.05), ranging from 20 to 80 years. In Group A, the average BMI was less than 24.29±4.23, ranging from 18-35 kg/m2, compared to Group B, 28.89±3.77, ranging from 22-35 kg/m2. 38(67.9%) were effected from right side as in Group A while 41(73.2%) were effected from right side in Group B. Majoruty 28(50.0%) had history of RTA in Group A while patients 24(42.9%) were observed with history of RTA in Group B25(44.6%) cases reported excellent outcome, 6(10.7%) reported very good outcome, 16(21.4%) good, 7(12.5%) fair and 2(3.6%) poor outcome in Group A. In Group B, 36(64.3%) excellent, 7(12.5%) very good, 12(21.4%) cases reported Good and 1(1%) reported fair outcome. So it is concluded that 25(44.6%) cases reported excellent outcome in Group A, comparatively low as compared to Group B 36(64.3%). Only age was significantly associated with excellent outcomes as p<.05. Conclusion: It is concluded that External fixation demonstrated a better outcome as compared to Philos Plating, so in Orthopaedic practice, External fixation should be preferred for patients diagnosed with proximal humerus fracture to get better results and reduce the complications.

Antiretroviral adverse drug events reported among adult HIV patients in a Nigerian tertiary hospital: A retrospective study

Background: The use of Highly Active Antiretroviral Therapy (HAART) has changed HIV/AIDS from a near-certainly fatal illness to one that can be managed chronically. A significant constraint of HAART is the high prevalence of adverse drug events (ADE) among HIV patients taking them. Objectives: The study determined the frequency and severity of reported antiretroviral adverse events among HIV-infected adults (≥16 years) at the Institute of Human Virology (IHV) Clinic of Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, Nigeria, within five years. Antiretroviral therapies implicated in the reported adverse drug events were also determined. Method: Information on reported ADEs was extracted from the NAFDAC Pharmacovigilance forms in the Pharmacovigilance section of the IHV Clinic Pharmacy. The severity of ADEs was classified using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index for categorizing errors. Results: A hundred and nineteen (119) patients reported 161 ADEs within the 5-year study period (2017-2021). Most ADE reports came from females (74.53%) and patients 36-55 years old. Dizziness (31.1%), Rashes (14.3%), and Fatigue (13.0%) were prominent among all the ADE reports documented. TDF/3TC/EFV (57.8%) and AZT/3TC/NVP (11.8 %) combinations were the frequently implicated antiretroviral regimen. All the ADEs reported were mild (Category ‘E’). ADE reports appreciated in the second year and progressively declined afterwards. Conclusion: There is a need to improve the system for antiretroviral ADE reporting through sensitization and developing a specific tool that enhances ADE reports from patients and healthcare providers.

The prevalence of facial canal dehiscence: first cross-sectional study in Iraq

BackgroundThe facial nerve is considered a crucial structure and is vulnerable to injury during middle ear and mastoid surgery. The facial canal could be dehiscent in certain populations; therefore, identifying it and avoiding injury to the nerve is an important step during otological surgeries. In this study, we assessed the rate of facial canal dehiscence (FCD) among patients undergoing surgery due to the presence of chronic suppurative otitis media (CSOM).MethodsA cross-sectional study was performed between June 2019 and May 2023. We included 102 patients (aged 8–70 years), admitted for primary tympanomastoid exploration due to the presence of CSOM with and without cholesteatoma at Azadi Teaching Hospital in Duhok/Iraq. Cases with a history of trauma or craniofacial abnormalities were excluded from the study. Also, none of the selected patients complained of facial nerve disorders.ResultsAmong the 102 patients who were admitted, 11.76% (n = 12) had FCD; they were between the ages of 11 and 58 (average: 30.9) years (18.8% ≤ 18 years vs. 10.5% > 18 years, p = 0.396). The dehiscence was more common in males than females (14.3% vs. 10.0%, p = 0.545) and was also more common on the left side than the right side (13.8% vs. 9.1%, p = 0.547). Of those with the dehiscent facial nerve, 83% (n = 10) had the dehiscence on the tympanic segment. The dehiscence was statistically more common in patients with cholesteatoma than those without (25.9% vs. 6.7%, p = 0.014).ConclusionDehiscence in the facial nerve can be encountered in patients with CSOM, particularly those with cholesteatoma. In such patients, the dehiscence is most commonly found on the tympanic segment of the facial nerve, so care should be taken during surgery for such cases to avoid injury of the nerve.

Failure of ceftazidime/avibactam experimental therapy in the treatment of Klebsiella pneumoniae ST11 co-producing NDM-1 and OXA-48 carbapenemases infection.

Carbapenem-resistant organisms (CRO) represent a significant threat because of their widespread in hospital settings, difficult-to-treat, and association with high morbidity and mortality rates. Data on the efficacy of ceftazidime/avibactam (CAZ-AVI) among patients infected with CRO in Iran are lacking. Herein, we report a case of a 91-year-old man with infection caused by extensively drug-resistant ST11 co-harbouring blaNDM and blaOXA-48-like strain from seven isolates. During ICU hospitalization, 10 different antibiotics were prescribed to the patient, and CAZ-AVI was experimentally prescribed in combination with tobramycin and tigecycline to the patient for the first time in the teaching hospitals of Isfahan City. The patient died on the 56th day of hospitalization. The present study revealed that the use of CAZ-AVI should be limited to targeted therapy after susceptibility results and minimum inhibitory concentration values are available to the treating clinicians and not be used for empirical therapy of patients with an infection caused by CRO, underscoring the urgent need for stringent policies for antibiotic stewardship to preserve the activity of novel β-lactam/β-lactamase inhibitors.

A retrospective study of predisposing factors and management of incisional hernia in a tertiary care hospital

Background: An incisional hernia is characterized as any defect in the abdominal wall, with or without a noticeable bulge, in the region of a postoperative scar, identifiable through clinical examination or imaging. This condition can be detected through clinical examination or imaging and affects approximately 10-20% of patients who undergo abdominal operations. Aims and objectives of the study was to evaluate various precipitating factors, clinical presentations, management and post-operative complications in patients with incisional hernia. Methods: A retrospective study of 150 patients conducted at a tertiary care teaching hospital. Results: In this study, incisional hernia was more common in obese, elderly, and female patients. The incidence was higher with Pfannenstiel incision followed by lower midline incisions. Incisional hernia was common between 1-5 years of index surgery and it was observed that more the risk factors and complications associated with index surgery, earlier was the onset of incisional hernia. Patients had a defect of size <4x4 cm were 58.66%. Open onlay mesh repair was done in 36.66% patients, preperitoneal mesh repair in 13.33%, retro rectus mesh repair in 13.33%, laparoscopic mesh repair in 28.66% and anatomical repair alone in 7.99% patients. Duration of laparoscopic surgery was longer compared to open. Most common post- operative complication was seroma (4.66%) followed by wound infection (2.66%). Conclusions: Incisional hernias occur more in females as they commonly undergo lower abdominal surgeries. Subcutaneous suction drain decreased the incidence of post-operative wound complications.

Learning from a crisis: a qualitative study on how nurses reshaped their work environment during the COVID-19 pandemic

BackgroundThe global nursing shortages exacerbated by the COVID-19 pandemic necessitated a drastic reorganization in nursing practices. Work routines, the composition of teams and subsequently mundane nursing practices were all altered to sustain the accessibility and quality of care. These dramatic changes demanded a reshaping of the nurses’ work environment. The aim of this study was to explore how nurses reshaped their work environment in the early stages of the COVID-19 pandemic.MethodsA descriptive study comprising 26 semi-structured interviews conducted in a large Dutch teaching hospital between June and September 2020. Participants were nurses (including intensive care unit nurses), outpatient clinic assistants, nurse managers, and management (including one member of the Nurse Practice Council). The interviews were analysed with open, axial, and selective coding.ResultsWe identified five themes: 1) the Nursing Staff Deployment Plan created new micro-teams with complementary roles to meet the care needs of COVID-19 infected patients; 2) nurse-led adaptations effectively managed the increased workload, thereby ensuring the quality of care; 3) continuous professional development ensured adequate competence levels for all roles; 4) interprofessional collaboration resulted in experienced solidarity, a positive atmosphere, and increased autonomy for nurses; and, 5) supportive managers reduced nurses’ stress and improved work conditions.ConclusionsThis study showed that nurses positively reshaped their work environment during the COVID-19 pandemic. They contributed to innovative solutions in an environment of equal interprofessional collaboration, which led to greater respect for their knowledge and competencies, enhanced their autonomy and improved management support.

Evaluation of serum ferritin level and hepatitis b and hepatitis c viral infection in chronic hemodialysis patients.

The most popular treatment for end-stage renal illness is hemodialysis (HD). The study aimed to assess serum ferritin levels and their connection to Epoetin alfa resistance, along with exploring the link between hepatitis C virus, iron overload, and the prevalence of hepatitis C and B infections in chronic HD patients. This was a descriptive-analytical study conducted on 50 Patients with chronic kidney disease (CKD) who were on regular HD in the dialysis unit of Ibin Sina Teaching Hospital in Mosul City, Iraq. Out of 50 patients, 26 (52%) tested positive for Hepatitis C Virus (HCV) Antibody, 10 (20%) for Hepatitis B surface Antigen (HBsAg), and 14 (28%) tested negative for both. Higher serum iron and ferritin levels were found in HCV antibody-positive patients (p < 0.05). Despite Epoetin alfa treatment, patients with elevated ferritin levels exhibited lower Hemoglobin (HB) and Packed Cell Volume (p < 0.05). Non-diabetics exhibited significantly higher serum ferritin, Hemoglobin, Blood urea, and serum creatinine than diabetics (p < 0.05). A noteworthy association was seen between the quantity of blood transfusions and elevated levels of serum ferritin and total serum iron (p < 0.05). Most HD patients were anemic, with Hepatitis B and C prevalent. The main CKD causes were diabetes and hypertension. HCV-positive patients often showed mild to moderate iron overload, and high serum ferritin was linked to poor Epoetin alfa response. Dialysis can elevate blood urea, ferritin, and creatinine, worsening anemia. High ferritin levels may hinder response to Epoetin alfa and iron replacement. Excessive blood transfusions can lead to iron overload and inhibit erythropoiesis. Maintaining HB at 110-120 g/l improves quality of life and reduces anemia-related risks.

Safety Outcomes After Sacubitril/Valsartan Initiation in a Community Teaching Hospital: A Retrospective Observational Study

Safety Outcomes After Sacubitril/Valsartan Initiation in a Community Teaching Hospital: A Retrospective Observational Study

Clinical characteristics and outcome of critically ill children referred to a tertiary hospital in Indonesia: a prospective observational study

BackgroundThe clinical characteristics of pediatric critically ill patients who need referral to a tertiary hospital is often unknown in resource limited settings where constraints in diagnosis capacity, resources, and infrastructures are common. There is a need to increase insight in the characteristics of these patients for capacity building strengthening and appropriate resource allocation. The aim of this study was to describe the clinical characteristics and outcomes of critically ill children who are referred to a tertiary referral teaching hospital in Yogyakarta.MethodsA prospective observasional study was carried out from July 1st, 2022 -January 31st, 2023 which included all critically ill pediatric patients who were referred through the Integrated Referral System (SISRUTE) to the Pediatric Intensive Care Unit (PICU) of dr. Sardjito hospital. We excluded patients who were referred with a request for admission to the PICU, but were not admitted to the PICU due to their stable condition and lack of the need for intensive care.ResultDuring the study period, we received 1046 emergency referral requests for pediatric patients via SISRUTE, of those, 562 (53.7%) patients were critically ill. The reasons of PICU referral request were the need of solely intensive care 504 (89.7%), the need of multidisciplinary team care, including intensive care 57 (10.1%) and parents request 1 (0.3%). The pre-referral emergency diagnosis was shock 226 (40.3%), respiratory distress/failure 151 (26.7%), central nervous system (CNS) dysfunction 135 (24.1%), trauma 33 (5.9%) and sepsis 17 (3%). Of the 562 critically ill PICU referral requests, 473 (84.2%) requests were accepted. One hundred and eighty-one (58.7%) patients were finally admitted to the PICU, 125 (40.3%) admitted to our regular ward due to stable condition, 4 (1.3%) patients died in Emergency Departement (ED). The remaining accepted patients on request did not arrive in our facility due to various reasons. The mean (SD) response time was 9.1 (27.6) minutes. The mean (SD) transfer time was 6.45 (4.73) hours. Mean (SD) PICU and hospital length of stay was 6.7 (8.3) days and 10.2 (9.2) days respectively. PICU and hospital mortality was 24.3% and 29.7%, respectively.ConclusionThe mortality rate for critically ill pediatric patients referred to a tertiary PICU still high, with shock being the most common pre-referral emergency diagnosis. There is a discrepancy between the referring hospital’s and the referral hospital’s indication for PICU admission. The time required to reach the referral hospital is quite lengthy.

Evaluation of case based simulation teaching to improve the Family Medicine residents urgent care management skills at a teaching hospital

ABSTRACT Context: Simulation based teaching is effective strategy to allow trainees to acquire skills, develop clinical judgment and to become competent in order to manage the patients in a safe environment. The Case-based simulation improves the assessment and management skills of the trainees to prepare them as a competent physician. Aim: Evaluation of case based simulation teaching to improve the Family Medicine residents urgent care management skills at a teaching hospital. Setting and Design: An Interventional study (Pre and post design) was conducted on the residents of the Family Medicine department of the Aga Khan University hospital Karachi. Methodology: After getting their consent, pre intervention Objectively structured clinical examination (OSCE) was conducted at the Center for Innovation in medical education, AKUH. The scenarios were based on urgent care problems presenting in the Family Medicine setting. It was followed by the case based simulation teaching intervention by the facilitators and debriefing. The post intervention OSCE was conducted in order to assess the resident’s performance. Statistical Analysis: The data was analyzed in Stata version15 software in two stages; descriptive and inferential. In descriptive analysis frequency and proportion were calculated for categorical variables. Median and inter quartile range were reported for continuous variable. Paired T-tests were applied to compare the pre and post test results. Results: The resident’s scores significantly improved after case based simulation in majority of the post intervention OSCE stations proving the effectiveness of the intervention. Conclusion: Case based simulation is an effective teaching strategy for the learning process of the Family Medicine residents regarding the urgent care management skills. It is advised to use this strategy in the teaching and learning process of other Family medicine residency programs.

Adverse pregnancy outcomes with respect to treatment modalities in women with gestational diabetes mellitus at a rural tertiary care teaching hospital

ABSTRACT Objectives: To estimate the prevalence of gestational diabetes mellitus (GDM) and compare adverse pregnancy outcomes with respect to treatment modalities in a peri-urban teaching hospital in Telangana. Methods: A prospective study was conducted on GDM cases delivered from January 2019 to March 2020. GDM was diagnosed using a two-step procedure of screening using IADPSG criteria. Women diagnosed with GDM were divided into four groups – diet group, metformin group, metformin plus insulin group and insulin group based on the treatment modalities. Adverse pregnancy outcomes of the women managed with different treatment modalities were recorded. Results: Good glycaemic control (FBS, P = 0.04, 2 hrs PLBS, P = 0.01) was achieved in diet and metformin groups. Incidence of Gestational hypertension (P = 0.01) and preeclampsia (P = 0.01) were found to be higher in the insulin group when compared to the metformin and insulin group, metformin group and diet group. No difference was noted with respect to polyhydramnios, preterm birth, premature rupture of membranes, induction labour and caesarean delivery rates between the treatment groups. Apgar score at 5 min of &lt;7 (P = 0.02), neonatal intensive care unit admissions for &gt;24 hrs (P = 0.03) and neonatal hypoglycaemia (P = 0.01) were found to be higher in insulin-required groups. Rates of shoulder dystocia, stillbirth, early neonatal death within 1 week and respiratory distress did not vary significantly between the treatment groups. Conclusion: Universal screening of women for GDM and multidisciplinary management of women once diagnosed tend to lessen maternal and fetal complications. Metformin can be an effective, cheaper and non-invasive alternative to insulin in the management of GDM.

Five-year trends in antimicrobial susceptibility of uropathogens isolated from paediatric patients attending a tertiary care teaching hospital

Five-year trends in antimicrobial susceptibility of uropathogens isolated from paediatric patients attending a tertiary care teaching hospital

Evaluation of health records management systems of Lagos State University Teaching Hospital, Nigeria

Evaluation of health records management systems of Lagos State University Teaching Hospital, Nigeria

Frequency and potential causes of non-beneficial Code Blue activations at a metropolitan teaching hospital.

Code Blue activations in patients who are not for resuscitation (NFR) may be regarded as non-beneficial and may cause harm to patients, relatives and hospital staff. To estimate the prevalence of non-beneficial Code Blue calls in a metropolitan teaching hospital and identify modifiable factors that could be utilised to reduce these events. The study consisted of two parts: (i) a retrospective analysis of all Code Blue activations over a 12-month period using prospectively collected data. Non-beneficial activations were defined as calls made in patients with a NFR order in either the current or any previous hospital admissions and (ii) an anonymous voluntary survey of staff who were present at a Code Blue activation. There were 186 Code Blue activations over the study period, with 48 (25.8%) defined as non-beneficial. Such patients had more comorbidities, previous hospitalisations and greater levels of frailty. Most non-beneficial calls occurred on general wards and more than three-quarters of patients had been reviewed by a consultant prior to the call. The survey determined that despite ward staff having a considerable degree of resuscitation experience, there were deficiencies in understanding of Code Blue criteria, the resuscitation status of patients under their care and the interpretation of goals of care. Over a quarter of Code Blue calls were deemed non-beneficial. Improving the visibility of NFR status and staff understanding of patient goals of care are needed, along with timely, proactive documentation of NFR status by experienced clinicians.

Evaluation of a short-structured learner-centric training program on rational drug prescribing for medical interns: A quasi-experimental study

ABSTRACT Introduction: Rational drug prescribing skills of interns remain bleak despite clinical pharmacology training during their second year, warranting the need for further training. This study was designed to evaluate the effectiveness of a short-structured learner-centric training program using the World Health Organization (WHO) guide to good prescribing in improving interns’ knowledge of rational drug use and their rational drug prescribing skills. Methods: This quasi-experimental study was implemented at a tertiary care teaching hospital in South India. We conducted a short-structured learner-centric training program on rational drug prescribing for interns in September 2022, using the WHO guide to good prescribing. The medical interns who consented to participate were included in the study. A pre-test was administered at the start of the training, followed by a post-test and feedback questions at the end of the program. Statistical tests used for quantitative data were the Wilcoxon signed-ranks test and McNemar’s Chi-square test. Qualitative data were analyzed using manual content analysis. Results: Of the 77 interns who attended the training program, 73 provided consent and completed both the pre-test and the post-test. Their mean age was 22 years, with a slight preponderance of female participants (53.4%). Overall, there was a statistically significant increase in the median (interquartile range) total scores from 52 (44.6 – 60) to 84 (70 – 88) after the training (P = 0.001), out of a maximum score of 93. Also, a significantly greater number of them wrote legible prescriptions (grade 4/excellent – 44 in pre-test vs 52 in post-test; P = 0.001) after the training. Conclusion: The short-structured learner-centric training program based on the WHO guide to good prescribing significantly improved the knowledge of rational drug use and rational drug prescribing skills among medical interns.

A postmortem study of demographics and severity of thoracoabdominal injuries among patients attending a teaching hospital in northeast India

ABSTRACT Introduction: The global estimate reflects 4.4 million injury-related deaths every year and the thoracoabdominal region is frequently injured since it is a wide area. Methods: An autopsy-based cross-sectional study was conducted using a convenient sampling technique for three years. A Chi-square test was conducted for categorical variables. A P value of less than 0.01 was considered statistically significant. Results: Out of 80 cadavers, the male:female ratio was 1:0.31. The commonest age group was 20–29 years. Victims of road traffic accidents were 54 (67.5%) followed by falls from height 10 (12.5%). External thoracic injuries were commoner than internal and vice versa in abdominal injuries. Liver injuries were major in number. Combined thoracic-abdominal and associated injuries were observed in 67 (83.75%) victims. The commonest cause of death was craniocerebral injury combined with hemorrhagic shock (36.25%). Eighteen (22.5%) victims died on the spot having an Injury Severity Score (ISS) of 73.37 followed by a survival time of 1–7 days in 17 (21.25%) cases. A significant correlation was found between ISS and survival period. Conclusion: All thoracic and abdominal injuries represent a possible increase in morbidity and mortality; hence, working toward their prevention and timely intervention is necessary.