Tertiary Care Government Hospital Research Articles

Burnout among Nurses and Doctors Working at a Tertiary Care Government Hospital: A Descriptive Cross-sectional Study

Introduction: Work environment related feelings of dissatisfaction, exhaustion, decreased interest and isolation is common. Burnout among health professionals has been on rise at every stage of professional growth affecting wellness of service providers, patient care and health care organizational efficiency. Assessment of burnout among health care workers from government setup in the current context in this post COVID era in our socio-geographical context has become essential. The aim of this study was to find the prevalence of burnout among nurses and doctors working at a tertiary care government hospital in Nepal. Methods: This descriptive cross sectional study was conducted among nurses and doctors working at a tertiary level government hospital from May 2022 to Nov 2022 after approval from Institutional Review Committee of the same institute. Nurses and doctors available on duty, from all ages were included. Trainees and students, those unable to participate due to their illness, on leave, known cases of mental illness were excluded. The point estimate was calculated at 95% Confidence Interval. Results: Among 180 participants, the prevalence of moderate burnout was 94 (52.22%) (44.92-59.51, 95% Confidence Interval). Among nurses 72 (50%), while in doctors 22 (61.11%) had moderate burnout. Out of those with moderate levels of burnout, the majority of 66 (52.80%) were in the age group 26-50 years. Conclusions: The prevalence of burnout among nurses and doctors is high, similar to other studies done in similar settings.

Dengue Hemorrhagic Fever Presenting with Acute Abdomen in a Non- Government Tertiary Care Hospital in Bangladesh

A 60-year-old diabetic and hypertensive post-menopausal lady, presented at a tertiary care Hospital in Dhaka, Bangladesh with severe abdominal pain in the right middle and lower abdomen, associated with oliguria for 1 day. She also gave history of having high grade fever and headache for 3 days, which subsided 2 days ago. On examination, she was afebrile, mildly dehydrated, tachycardic (PR- 110/min), hypotensive (BP- 90/60 mm Hg), Tourniquet Test was positive. Her abdomen was tense and diffusely tender, especially in the right middle and lower parts, bowel sound was present, no organomegaly or lump was found. S. Lipase was normal, Anti-dengue Antibody IgM and IgG were positive, CBC revealed Hemoglobin – 8.6 gm/dL, Hematocrit was raised- 52%, Platelet count was 16000/ microliter, Stool for OBT was negative, RBS- 16 mmol/L and Urine RME and ketone bodies was negative. A provisional diagnosis of Dengue Hemorrhagic fever with suspected intra- abdominal bleeding was made and she was shifted to ICU.

IJCM_240A: A cross sectional study to assess the health literacy among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore.

Background: WHO defines health literacy as cognitive and social skills that determine the motivation and ability of people to understand, gain access and use the information to obtain good health. Inadequate health literacy has been linked to increased hospital admissions, poorer physical and mental health, lower use of preventive health services like vaccinations and screening tests. These ultimately lead to higher healthcare costs. This study was conducted to assess health literacy among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore. Objectives: To estimate proportion of inadequate health literacy and its associated factors among adults attending outpatient clinics at a government tertiary care hospital in urban Bangalore. Methodology: A cross-sectional study was conducted among adult attendees (i.e., patients and companions) of outpatient clinics of a government tertiary care hospital in urban Bangalore. Based on a study done by Almaleh. R et al. (P = 34.3%) with 7% absolute precision, the sample size was calculated as 200. A total of 200 adults attending outpatient clinics at the government tertiary care hospital were selected using simple random sampling. Data was collected using a pre-tested, semi-structured questionnaire for sociodemographic factors and HLS-EU-Q16 (European Health Literacy Survey Questionnaire short version) for assessing health literacy. The data collected was entered in MS Excel and analysed using SPSS 21.0. Results: The proportion of inadequate health literacy among study participants was observed to be 38%. Factors like educational status, age, and gender were found to have an association with it. Health literacy was found to be least in lower-educated individuals. Conclusion: From the present study, it was found that a large part of adult population had limited health literacy. It should be addressed through proper interventions, like ensuring basic education and health awareness programmes.

IJCM_76A: Assessment of quality of life after normal vaginal delivery and caesarean section among mothers at a government tertiary care hospital, Bengaluru - A cross sectional study.

Background: Quality of life comprises multifaceted dimensions encompassing physical, emotional, social, and psychological aspects. Assessing quality of life is essential not only for mothers but also for their children, family members, and the community. Understanding the impact of different modes of delivery on women’s well-being is crucial for healthcare providers to offer appropriate support and interventions. Objective: To assess and compare the quality of life after normal vaginal delivery and caesarean section among mothers at a government tertiary care hospital, Bengaluru. Methodology: A cross-sectional study was conducted among mothers at a tertiary care hospital in Bengaluru. A pilot study was conducted and sample size was calculated as 200, with 100 participants in each group. Samples were selected using a simple random sampling method, and data were collected using a pre-tested, semi-structured questionnaire. The Short Form Health Survey (SF-36) was used to assess the quality of life. The collected data was entered into MS Excel and analyzed using SPSS 21.0 Results: Out of 200 participants, the mean age of the study population was 24.32 ± 5.58 years. Comparison between the vaginal and cesarean groups revealed that the vaginal birth group had higher mean scores in the physical health domain. Factors such as physical functioning, emotional well-being, socioeconomic status, and comorbidities were found to be significantly associated with modes of delivery. Conclusion: Different modes of delivery have their own unique challenges and benefits, this study illuminated distinct differences in quality of life. Normal vaginal delivery was associated with a quicker physical recuperation compared to caesarean section, while caesarean sections demanded a longer recovery period and potential physical limitations.

Hepatic Decompensation in Patients with Chronic Liver Disease: Exploring the Role of Vitamin D Deficiency as a Prognostic Marker.

Although the function of vitamin D as a regulator of calcium and bone metabolism is well recognized, its role as an immunomodulator, regulator of cellular differentiation, and anti-inflammatory and antifibrotic actions is being increasingly noted. It is estimated that one-third of liver cirrhosis patients are vitamin D deficient. It has been reported that as liver disease progresses, the incidence of vitamin D deficiency rises. Several clinical implications of vitamin D levels have been proposed, including as a prognostic marker for the assessment of mortality in liver cirrhosis. To analyze the link between levels of vitamin D and decompensation of liver cirrhosis. This observational, cross-sectional study was conducted on 100 patients with liver cirrhosis admitted at Goa Medical College, a tertiary care government hospital in Goa, from March 2020 to February 2022. Demographic profile, history, and examination findings were recorded, and biochemical analysis included vitamin D levels. Child-Pugh (CP) and Model for End-Stage Liver Disease (MELD) scores were calculated, and based on these, patients were grouped into classes of disease severity. Data was interpreted using Statistical Package for the Social Sciences (SPSS) version 22. Mean age of the study population was 50 ± 9 years, with a 96% male predominance. Mean levels of vitamin D were 12.13, with a standard deviation (SD) of 7.38. Significant differences were noted between different classes of CP score (CPS). A vitamin D deficient state was noted in 93.3% CP class C group and 0% of class A group. A statistically significant association was demonstrated between low levels of vitamin D and CP class severity of liver dysfunction as well as MELD scores. This study confirms a high prevalence of vitamin D deficiency among patients with liver cirrhosis concurrent with the results of similar studies done earlier. More importantly, with increasing severity of hepatic decompensation as measured by CPS and MELD, vitamin D concentrations reduce.

Mobility as an Effective Nonpharmacological Method for Parturition: A Pilot Study

Background: Childbirth is a transformative process. Modern healthcare offers pharmacological and non-pharmacological interventions for safe and improved childbirth experience. Studies have found that maternal mobility during the first stage of labour has a significant effect on maternal and child outcomes. A pilot study was done to find the effect of mobility during the first stage of labour on maternal satisfaction and foetal outcome. Method: An experimental study was done with 60 primigravida women with uncomplicated antenatal history reporting to the labour room of a tertiary care government hospital in Delhi chosen as study participants. Validated and reliable tools were used to measure labour, maternal and neonatal outcomes within 24 h post-delivery. Results: The results showed that there was an impact on mobility intervention during the first stage of labour on parturition ( p = .03) and significant maternal satisfaction ( p = .001). However, the neonatal outcome of both groups was not significant. Conclusion: Mobility was an effective non-pharmacological intervention for enhancing parturition and maternal satisfaction. Mobility during the first stage of labour can be recommended for practice guidelines for all midwives in the labour room as a protocol.

Emergent Endoscopic Services for Acute Upper Gastrointestinal Bleeds: A Critical Need in Government Tertiary Care Hospitals.

Upper gastrointestinal bleeding (UGIB), defined as blood loss originating from above the ligament of Treitz in the gastrointestinal tract, is the most common gastroenterological emergency.1 Acute forms of UGIB have an approximate in-patient mortality rate of 2-10 percent, despite advances in management options over the last three decades. Urgent endoscopy within 12 hours is the standard management for all patients presenting with UGIB, both as a diagnostic and therapeutic tool.1 Worldwide, most cases of UGIB are due to peptic ulcers, however, this trend differs in Pakistan, where variceal haemorrhage is the predominant cause most likely due to the high disease burden of hepatitis C in the country2. According to the national health survey conducted in 2009, there is limited data on the exact prevalence and incidence, but trends have shown a frequency of 4.7% (CI 4.6-4.8), and around 8 million affected people.3 The major viral epidemic continues to impact the country’s healthcare system, primarily due to resource constraints, overburdened government setups, and lack of public awareness.2 As such, there is an urgent need to cater to this healthcare detriment, especially the decompensated forms of the disease which contribute to most mortalities.4 Like other low-income countries, Pakistan does not have the luxury of emergent endoscopic services and facilities in the well-developed world as a primary care modality. No national data on mortality from UGIB in Pakistan, or numbers on acute cases managed without emergent endoscopy exist. A study by Rajan et al 5 demonstrates that a lack of emergent endoscopy is an independent predictor of mortality among patients with UGIB in similar low-income setups, with numbers rising up to 30%. Such trends indicate a significant gap in our literature that needs to be addressed, with more studies oriented around this health concern. We also require a higher number of emergent endoscopic services to be made readily available, especially at large government tertiary care centers which cater to most of these patients, especially given the epidemic of Hepatitis C.

Patient’s satisfaction and service quality of clinical laboratory: A questionnaire based analysis in accredited tertiary care government hospital

The Phlebotomy is the first phase of interaction of the patient to the laboratory. It is therefore considered as an important step of good clinical laboratory practice and is referred to as "pre-analytic phase”. Patient’s satisfaction is one of the key quality indicators in the laboratory. : To assess the patient's satisfaction , to investigate, monitor, and analyse the non-conformities in order to remove the root cause by performing corrective and preventive action in order to improve the quality of laboratory services.: A cross-sectional study conducted in a NABH/NABL accredited government super-speciality hospital on 1500 patients over a period of three months. Data were collected in a self administered predesigned, pretested, structured questionaired feedback form in both Hindi and English, further reviewed by Senior Pathologist in a quality assurance meet and CAPA.A statistical analysis performed by using SPSS version 16.0 software and Likert Scale.Overall patient satisfaction with phlebotomy services found to be high, i.e 88%. Highest mean rating of satisfaction was 99.2% for parameter -Whether the seats during phlebotomy was comfortable. The parameter for washroom facility accounted for 75 % dissatisfaction followed by 63.4% overall dissatisfaction noted for ambulatory services. Phlebotomy services needs improvements: 12%.The study enlighten to understand patient preferences through a patient satisfaction questionnaire known as a "feedback form." Knowing how our patients feel about our laboratory services is vital and to identify all problems (non-conformities) found in the analysis and take appropriate CAPA.

Seroprevalence of COVID antibodies in health-care population of tertiary care government hospital in South India

Background: The pandemic coronavirus disease 2019 (COVID-19) caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a worldwide abrupt and significant rise in admissions for pneumonia with multiorgan diseases. Aims and Objective: To determine the positive prevalence of SARS-CoV-2 antibodies in health-care professionals over 6 months. In addition, to make a subgroup analysis and estimate the age, gender, and workforce-based prevalence of SARS-CoV-2. Materials and Methods: An observational cross-sectional study was conducted on 200 healthcare professionals during 6 months. After taking proper informed consent, the study was started. We included subjects aged ≥18 years in this study. Not receiving any other vaccine during the study, suspected or confirmed immunosuppressive condition, imaging confirmed COVID-19 or recent blood transfusions were excluded from the study. Results: Most patients were 26–30 years old. Out of 200 patients, 116 (58%) were males, and 84 (42%) were females. The total positivity of the titers amounts was 57%. In addition, the males had higher mean titers than the females, with 24.186 versus 13.304. Of the 116 males, 68 were positive (58.6%), and of the 84 females, 46 were positive (54.7%). The age-wise positivity of the titers was high among the 26–30 years of age group, of which, in the 53 people, 33 were seropositive, which is 62.2% of this age group and lowest in the 51–55 years age group, of which in the 23 participants 9 were positive (39.31%), and 14 were negative (60.85%). Conclusion: We concluded that male doctors and adults had a greater seroprevalence of SARS-CoV-2 infection, suggesting that they are more susceptible to contracting COVID-19 through patient contact or surgical procedures.

Drug susceptibility, Prevalence and effect of Pseudomonas aeruginosa on wound healing of burn patients.

To determine the prevalence, antibiotic susceptibility and effect of Pseudomonas aeruginosa in relation to burn patients. The cross-sectional study was conducted at the Centre for Advanced Studies in Vaccinology and Biotechnology, University of Balochistan, Quetta, Pakistan, from March 2018 to May 2021, and comprised pus swab cultures were isolated from inpatients with 2nd and 3rd degree burns aged up to 60 years at Bolan Medical Complex Hospital and Sandeman Provinical Hospital, the two main government tertiary care hospitals in Quetta. The samples were immediately cultured, and evaluated using biochemical tests, antibiotic susceptibility and molecular identification using polymerase chain reaction. Data was analysed using SPSS 20. Of the 720 burn wound samples, 424(58.9%) were positive for Pseudomonas aeruginosa; 304(42%) males and 120(16%) females (p<0.02). The overall mean age of the patients was 27.7±6.2 years (range: 1-60 years). The mean total burn surface area was not significantly different in positive 29.6±6.2% and negative 30.3±6.2% cases (p>0.05). The time leading to skin grafts in positive patients was 29.5±6.5 days compared to 22.3±6.3 days for negative patients (p< 0.007), and the time required for wound healing was 25.0±4.7 days and 16.7±5.2 days, respectively (p<0.001). Length of hospital stay of Pseudomonas aeruginosa positive patients was 38.0±7.8 days compared to 32.1±6.8 days for negative patients (p<0.001). Nosocomial infections and multidrug resistance species were observed frequently at the burn wound site. P. aeruginosa.

Prevalence of co-morbidities and referral patterns in routine preoperative evaluation: A retrospective observational analysis in a tertiary care government hospital

The initial interaction between patients and anaesthesiologists during pre-anaesthesia check-ups (PAC) is a crucial opportunity to diagnose and pre-optimize co-morbidities that might go unnoticed. This proactive approach contributes to safe anaesthesia administration, uneventful intra-operative experiences, and smooth post-operative recovery. Our study assesses the prevalence of diverse co-morbidities within a tertiary care centre's PAC. After analysing data from 3 months involving 905 patients, 624 individuals exhibited co-morbidities, with 217 cases being newly identified within the PAC clinic. Among female patients, anaemia emerged as the most prevalent anomaly (219 cases), while hypertension dominated among male patients (171 cases). Overall, anaemia constituted the most common co-morbidity (362 cases). A comprehensive clinical assessment during the Pre-Anaesthetic Clinic empowers formulation strategies for pre-optimization and treatment of co-morbidities. Timely intervention is pivotal, not only to prevent surgery delays but also to avert potentially catastrophic outcomes arising from untreated conditions. This approach translates into expedited patient recovery, minimizing anaesthesia-related complications. The Pre-Anaesthetic Clinic plays a pivotal role in diagnosing and intervening in patient co-morbidities. Beyond diagnosis, it is a crucial early intervention and treatment platform, significantly enhancing the overall surgical recovery process.

Pattern of Violence Among Healthcare Workers in a Tertiary Care Government Hospital and a Multi-Specialty Private Hospital in Sagar, India: A Cross-Sectional Study.

Background Workplace violence in hospitals is an occupational hazard that affects healthcare workers (HCWs) negatively in many aspects and causes deterioration of the doctor-patient relationship, resulting in providence of substandard healthcare. This study was conducted to compare the pattern of violence in a tertiary care government teaching hospital and a multi-specialty private trust hospital in Sagar district, Madhya Pradesh, India. Methodology After ethical clearance of this cross-sectional, observational study, participants (frontline healthcare workers, including doctors and nurses) were asked about the type, frequency, department, and place of violence, etc., along with its perceived causes, solutions, and arrangements made by hospitals for dealing with it using a pretested, semi-structured questionnaire. Data analysis was performed using IBM SPSS Version 26.0 (IBM Corp., Armonk, NY). Categorical variables were described using frequency and percentages, and inferential analysis was conducted using the chi-square/Fisher's exact test. A P-value of <0.05 was considered statistically significant. Results Among the 113 participants, 67 (59.3%) were female, 53 (46.9%) were doctors, and 60 (53.1%) were nurses. The mean age of participants was 30.9±7.3 years. Predominantly verbal, emotional, and physical violence were present in 96.5%, 43.4%, and 6.2% of participants, respectively. Violent incidents against healthcare workers were more frequent in government hospitals as compared to private hospitals. Most healthcare workers (87.6%) tried to resolve violent incidents peacefully, and 1.8% tried to fight back. The most perceived cause of violence in both setups was a lack of morality and literacy among patients and their relatives (i.e., 83.2%), followed by a lack of proper facilities and a lack of trust in healthcare workers. Conclusion Both setups faced a substantial amount of violence. The loopholes in both setups, considering resources, security, and other facilities, are clearly visible, and specific steps must be adopted to protect both systems from violence.

Prevalence of Pressure Ulcer in Orthopaedic Bedridden Patients With a Higher Braden Pressure Ulcer Score in a Tertiary Care Government Hospital in Jammu

In this research, our primary objective was to determine the prevalence of pressure ulcers (PU) in bedridden patients with risk of higher Braden Pressure Ulcer scores who were admitted to the orthopaedic wards at the tertiary care government hospital in Jammu. Methodology To achieve this, we conducted a cross-sectional point prevalence study utilising the Braden Pressure Ulcer Risk Assessment Scale and the European Pressure Ulcer Advisory Panel (EPUAP) grading scale and data form. Our research sample consisted of 180 bedridden patients with higher Braden scores admitted to the orthopaedic ward of the selected facility. We monitored these patients using an observational checklist based on the established EPUAP minimal dataset form and grading scale. We conveniently selected patients who had moderate to severe Braden Pressure Ulcer Risk scores. Result Our findings revealed that 22.8% of the bedridden patients with moderate to high-risk Braden pressure ulcer scores developed pressure ulcers. Among the respondents, the majority (67.78%) were categorised as high risk, followed by severe risk (18.89%) and moderate risk (13.33%). Of those who developed pressure ulcers, 28 had Grade 1 ulcers and 12 had Grade 2 ulcers. The most common locations for these ulcers were the sacrum (40%), followed by the iliac region (35%), and the buttocks (25%). We did not observe any significant association between clinical variables and the incidence of pressure ulcers, except for skin turgor.

A randomised controlled trial of clinical and cost-effectiveness of the PASS Plus intervention for young children with autism spectrum disorder in New Delhi, India: study protocol for the COMPASS trial

BackgroundAutism Spectrum Disorder (ASD) is a neurodevelopmental disability affecting at least 5 million children in South Asia. Majority of these children are without access to evidence-based care. The UK Pre-school Autism Communication Therapy (PACT) is the only intervention to have shown sustained impact on autism symptoms. It was systematically adapted for non-specialist community delivery in South Asia, as the ‘Parent-mediated Autism Social Communication Intervention for non-Specialists (PASS)’ and extended ‘PASS Plus’ interventions. RCTs of both showed feasibility, acceptability and positive effect on parent and child dyadic outcomes.MethodsThe Communication-centred Parent-mediated treatment for Autism Spectrum Disorder in South Asia (COMPASS) trial is now a scale-up two-centre, two-arm single (rater) blinded random allocation parallel group study of the PASS Plus intervention in addition to treatment as usual (TAU) compared to TAU alone, plus health economic evaluation embedded in the India health system. Two hundred forty children (approximately 120 intervention/120 TAU) with ASD aged 2–9 years will be recruited from two tertiary care government hospitals in New Delhi, India. Accredited Social Health Activists will be one of the intervention delivery agents. Families will undertake up to 12 communication sessions over 8 months and will be offered the Plus modules which address coexisting problems. The trial’s primary endpoint is at 9 months from randomisation, with follow-up at 15 months. The primary outcome is autism symptom severity; secondary outcomes include parent–child communication, child adaptation, quality of life and parental wellbeing. Primary analysis will follow intention-to-treat principles using linear mixed model regressions with group allocation and repeated measures as random effects. The cost-effectiveness analysis will use a societal perspective over the 15-month period of intervention and follow-up.DiscussionIf clinically and cost-effective, this programme will fill an important gap of scalable interventions delivered by non-specialist health workers within the current care pathways for autistic children and their families in low-resource contexts. The programme has been implemented through the COVID-19 pandemic when restrictions were in place; intervention delivery and evaluation processes have been adapted to address these conditions.Trial registrationISRCTN; ISRCTN21454676; Registered 22 June 2018.

Vaccine Breakthrough Infections Among Healthcare Workers in a COVID-19-Designated Tertiary Care Government Hospital in Sikkim.

Introduction Since the emergence of the coronavirus disease 2019 (COVID-19) virus at the beginning of 2020, the world has gone through various waves of pandemics. The health care workers (HCWs) or the COVID warriors as they were termed were the first line of defense against the virus. They were armed with personal protective equipment and prophylactic doses of the COVID-19 vaccine. Despite these precautions, some of the HCWs still contracted the disease and a few others succumbed to it. The objective of this study was to estimate the prevalence of COVID-19 infections and vaccine breakthrough infections (BTIs) in HCWs after receiving the COVID-19 vaccine during the second wave of the pandemic. Methods This was a cross-sectional, hospital-based study conducted over a period of four months from September 2021 to December 2021 on HCWs aged 18 years and above working at the COVID-19-designated tertiary care government hospital in Sikkim. A structured coded questionnaire with no patient identifiers was used to gather details on demographics, vaccination history, breakthrough infection, and other social details. HCWs who had received at least one dose of the COVID-19 vaccine at the time of initiation of the study and were >18 years of agewere included in this study. Results A total of 678 HCWs were screened, out of which 229 (33%) participants tested positive for COVID-19 and the rest of the participants(455; 67%) tested negative. COVID-19 infections and vaccine BTIs (COVID-19 infection >14 days after the second vaccination) were recorded and 137 (20%) respondents had a post-vaccination COVID-19 infection out of which 115 (18.5%) were BTI. The majority of the participants were females and of the age group of 26-35 years. The correlation of COVID-19 infections with the dose gap between vaccination, gender, age, profession, department, area posted during COVID duty, cycles of duty performed, hospitalization due to infection, influenza vaccination, and comorbidity was analyzed. Conclusion COVID-19 vaccines are disease-modifying and they decreasethe severity ofBTIs in HCWs. Pandemics and outbreaks cannot be predicted; therefore, it becomes very important to have healthy frontline workers who are constantly exposed to infectious agents. Monitoring of health and surveillance of infectious diseases among the HCWs should be encouraged.

Mortality by Admission Diagnosis in Children 1-60 Months of Age Admitted to a Tertiary Care Government Hospital in Malawi.

Diagnosis-specific mortality is a measure of pediatric healthcare quality that has been incompletely studied in sub-Saharan African hospitals. Identifying the mortality rates of multiple conditions at the same hospital may allow leaders to better target areas for intervention. In this secondary analysis of routinely collected data, we investigated hospital mortality by admission diagnosis in children aged 1-60 months admitted to a tertiary care government referral hospital in Malawi between October 2017 and June 2020. The mortality rate by diagnosis was calculated as the number of deaths among children admitted with a diagnosis divided by the number of children admitted with the same diagnosis. There were 24,452 admitted children eligible for analysis. Discharge disposition was recorded in 94.2% of patients, and 4.0% (N = 977) died in the hospital. The most frequent diagnoses among admissions and deaths were pneumonia/bronchiolitis, malaria, and sepsis. The highest mortality rates by diagnosis were found in surgical conditions (16.1%; 95% CI: 12.0-20.3), malnutrition (15.8%; 95% CI: 13.6-18.0), and congenital heart disease (14.5%; 95% CI: 9.9-19.2). Diagnoses with the highest mortality rates were alike in their need for significant human and material resources for medical care. Improving mortality in this population will require sustained capacity building in conjunction with targeted quality improvement initiatives against both common and deadly diseases.

Caregiver burden assessment of children with neurodevelopmental disorders in a tertiary care centre

Families of children with neurodevelopmental disorders have significant financial and social stressors and difficulties with coordinating medical care. Caregivers play a central role in the rehabilitation of these children. This was a hospital based cross sectional study in the Department of Pediatrics in the year 2021-22 in a tertiary care government hospital in Kerala.Caregiver burden was assessed using Zarit Burden Interview and the clinical profile was assessed using a self made proforma. This was done for 86 children and their caregivers.A total of 86 children and caregivers were included in the study and the Zarit burden scores were compared between the categories. 55.8% of the caregivers fell into the category of severe burden. Amongst these, in caregivers of children with cerebral palsy, 68% had a burden score of &amp;#62;60 or categorized as severe burden. In cerebral palsy, the burden score of those caregivers of children with spastic quadriparesis showed 81% falling into the category of severe burden.Caregiver burden continues to be a big concern in our setting where the families are plagued not only by factors affecting the health of their child but also with social and financial burden. Burnout of the caregivers can in turn affect the well being of their children and families.

Job Satisfaction Among Healthcare Providers in a Tertiary Care Government Medical College and Hospital in Chhattisgarh.

Background The job satisfaction of healthcare providers is particularly relevant in service management because employees' level of job satisfaction impacts healthcare service users. A positive association is observed between the job satisfaction of healthcare providers and patient satisfaction. This study was conducted to determine the job satisfaction levels and their determinants among healthcare providers (doctors, nurses, and support staff) in a tertiary care hospital. Methodology A cross-sectional study was conducted among 400 healthcare providers of a tertiary care medical college and hospital. The questionnaire method was employed to collect demographic data. Job satisfaction level was assessed using the Job Satisfaction Survey Scale (JSS Scale). Results The mean overall satisfaction score among doctors was 123.05 ± 17.06, for nurses 127.4 ± 14.58, and for the support staff 138.46 ± 22.09. Among all three groups, employees' support staff were found to be more satisfied (40%), followed by doctors (15%) and nurses (6.67%), while the proportion of dissatisfied employees was highest among doctors (20%) than nurses (6.67%) and the support staff (6.67%). Satisfaction was significantly higher among the support staff compared to doctors and nurses. The level of satisfaction was found to be more in the younger staff (38.14%), regular job holders (33.33%), and fresh recruits (37.5%). Overall, satisfaction levels were found to be positively associated with factors such as the type and nature of work (64%) and relationships with co-workers (40%) and supervisors (36%) while more dissatisfied with factors such as interpersonal communication (70%), salary (54%), and promotional opportunities (42%). Conclusion The overall satisfaction among employees was only 20%. Factors such as job security, young age, and work experience were strongly associated with job satisfaction. Employees were more satisfied with the type and nature of work and relationships with co-workers while more dissatisfied with salary, promotional opportunities, and interpersonal communication.

Assessment of blood culture and tube agglutination serology test for the diagnosis of typhoid fever amongst malaria-negative patients: a one-year hospital-based study

Salmonella serotypes, including Salmonella Typhi, S. Paratyphi A, S. Paratyphi B, and S. Paratyphi C, are responsible for the systemic, protracted febrile sickness known as typhoid fever. Various antibody-based tests are being used for diagnosing typhoid fever. This study was carried out to assess the performance of the widal test and blood culture for the diagnosis of typhoid fever among malaria-negative patients in a tertiary care hospital in east Delhi, India. The study was conducted from July 2021 to June 2022 in the Department of Microbiology of a tertiary care hospital in Delhi. Patients, including the adult and pediatric population, were evaluated for typhoid fever and participated in an observational, prospective study on febrile patients that was malaria-negative. Venous blood samples were obtained under strict aseptic conditions and further processed for widal serology and blood culture tests for typhoid fever. In our study, the prevalence of blood culture-positive Salmonella species was 0.3% (30/10,000 = 0.3%) Among antimicrobial susceptibility patterns, S. Typhi revealed the highest resistance rates for Ciprofloxacin (43.33%), Azithromycin (36.66%), and third-generation cephalosporins. Out of 30 blood culture-positive Salmonella Typhi of typhoid fever patients, 5 (17%) samples were negative for the Widal test. Among 30 samples, all were blood culture positive, but only 25 samples show Widal titer above the baseline i.e. &gt;1:64. Although blood culture is the gold standard for the diagnosis of typhoid fever, the Widal test does play a role in the diagnosis and management of typhoid fever, especially in suspected cases when blood culture is negative, especially in government tertiary care hospitals.

Perception of Health Care Provider Regarding Covid-19 Vaccination: A Qualitative Study in Peshawar Khyber Pakhtunkhwa

OBJECTIVES To explore the perception of health care providers regarding covid-19 vaccination. METHODOLOGY A phenomenological qualitative study was carried out in tertiary care government hospitals of Peshawar. Data from 15 health care providers were collected via interviews. Permission from the university ethical review board and hospital administration was granted. Consent forms were granted from the participants before data collection. RESULTS The mean age of the participants was 34.31 years. Overall, 117 codes were identified after the initial analysis. A total of 15 codes were identified after omitting the unnecessary codes. These 15 codes were arranged into 4 themes as “Information”, “Potential Benefits”, “Responsibility”, and “Hesitancy”. CONCLUSION The findings of the study concluded that health care providers need information regarding the protentional benefits and they accept that it’s the responsibility of them to smoothly proceed the process of vaccination. The study highlighted that information regarding covid-19 vaccination is very important for health care workers. Similarly, potential benefits of vaccination are highlighted and vaccination hesitancy was also described in this study. KEYWORDS: Perception, Covid-19, Vaccination, Health Care Workers, Tertiary Care Hospital