Tertiary Care Teaching Hospital Research Articles

KNOWLEDGE ATTITUDE AND AWARENESS REGARDING ZNO SUNSCREEN PROTECTION AMONG UNDERGRADUATE DENTAL STUDENTS

Background:Zincoxidenanorods were employed as the primary ultra- violet protection agent in the formulation of sunscreens. Examination of ZnO powder through FESEM and TEM micrographs revealed the predominant presence of rod-like structures with a width range between 61-70 nm. Notably, sunscreens containing 20-40% (by weight) of ZnOnanorods exhibited significantly improved UV absorbance across both UVA and UVB spectra (280-400 nm). This study mainly aims to assess the Knowledge Attitude and Awareness Regarding ZnOnanorodsinSunscreenProtectionAmongUndergraduateDentalStudents. Aim: Knowledge Attitude and Awareness Regarding ZnO Sunscreen Protection Among Undergraduate Dental Students. Objective: Analyzing and determining the Knowledge Attitude and Awareness Regarding ZnO Sunscreen Protection Among Undergraduate Dental Students. Method: A cross sectional study was conducted among the dental students (II,III, IV, interns) in a tertiary care teaching hospital,Khammam, using a web basedtool called forms pro, a semi-structural online questionnaire was designed and distributed to the students in order to fill.Descriptive statistics were calculated using SPSS verson-29..A p- value <0.05 was used to evaluate statistical significance. Result: A total of 209 students took part with females (70.8%) and males (29.2%). Age of participants ranges from 19-25 years. In this study female students have more knowledge and awareness regarding ZnO Sunscreen Protection compared to males. Among all the students Interns have more knowledge, followed by IV-BDS, III-BDS and II-BDS. Conclusion: The study result suggests that knowledge and awareness level of ZnO Sunscreen Protection is adequate.

Impact of Smoking in Postoperative Outcomes after Elective Surgery

Abstract Introduction: The hazard of smoking is not only limited to the general health risks but also makes the smokers more vulnerable to various perioperative complications ranging from pulmonary complications to delayed wound healing to cardiovascular events. Methodology: This is an observational study in the department of general surgery of a tertiary care teaching hospital over a period of 24 months (May 2019–April 2021). Patients between 18- and 60-year age undergoing noncardiac elective surgical procedures were included in the study. Results: A total of 240 patients, meeting the inclusion criteria, posted for elective, noncardiac surgery were enrolled in this prospective observational study. In smoker patients’ group (n = 138) undergoing surgery, 42 (30.4%) patients developed postoperative complications as compared to 12 (11.8%) patients in nonsmoker group (n = 102). The risk of postoperative complications among smokers was 3.2 times (odds ratio [OR], 95% confidence interval [CI]: 1.62–6.63) (P ≤ 0.0009). Smokers with pack-years > 11 had 3.8 times increased risk of postoperative complications as compared to nonsmokers (OR, 95% CI: 1.85–8.098) (P ≤ 0.0003). Conclusion: Our study aims to add to existing evidence and improve our understanding of delayed wound healing and major complications in smoker patients as surgical cases. Nonsmokers are at a lesser risk than smokers in postoperative complications. Awareness regarding the harmful effects of smoking and its influence on postoperative wound healing, motivation for quitting, and abstinence from smoking will help in reducing postoperative complications and better treatment outcomes.

Knowledge, attitudes and practices of Materiovigilance among physicians in a rural tertiary care teaching hospital in Puducherry- a cross sectional study

Background: In India, medical devices are considered as drugs. A medical device may lead to problems either due to a defect during manufacture or transport, improper handling by health care professionals or patients, or failure to comply with recommendations. Aim & Objective: To evaluate the knowledge, attitude, and practice of Materiovigilance among health professionals at the Tertiary Care Hospital. Methods: This was a Cross-Sectional Questionnaire Based study. The questionnaires were circulated among 100 medical professionals. The structured survey tool comprised of two parts. The first part contains demographic data, and the second part consists of 15 questions, with 5 each pertaining to the awareness, attitude, and practice domains. All the data were entered into a Microsoft Excel sheet and analyzed using GraphPad Instat software version 5.0. Results: Medical professionals with above-average knowledge scores were 57 %, and the practice percentage of Materiovigilance was 60%, but there is a positive attitude (72%) towards Materiovigilance. A significant difference was noted Between the knowledge scores of professors and residents (p-value - 0.0491). There was no significant difference in knowledge scores between medical, surgical, and pre/para specialties. However, there was a positive correlation between the knowledge and attitude scores of the medical professionals. Conclusion: We conclude that the Knowledge aspect and also the practice of Materiovigilance among Physicians in our tertiary care hospital is lacking. However, their positive attitude to reporting adverse events is reassuring.

Regional Anaesthesia Techniques for Orthopaedic Surgery at Tertiary Care Teaching Hospital

Background: Regional anaesthesia has found its uses in many aspects of orthopaedic surgery including more recently, spine surgery. Neuraxial or regional anaesthesia are often the preferred techniques for surgical anaesthesia in patients with multiple comorbidities. For instance, osteoporosis-related complications such as hip fractures are common in the growing geriatric population. Orthopaedic surgery aims to recover functional capacity in patients but it carries a specific morbidity and mortality. Orthopaedic surgery conveys several challenges for the anaesthesiologist, including prevention of thromboembolic complications, reduction of peri- and postoperative bleeding and management of autologus blood transfusion and postoperative pain. Material and Methods: This is a prospective study was conducted in the Department of orthopaedic and Anaesthesia at Shadan Institute of Medical Sciences, Teaching Hospital and Research Center. Three hundred and ten consecutive cases posted for orthopaedic surgeries were taken up for study. Anaesthesia technique was decided based on the nature of surgery, willingness and medical status of the patient and experience of the anaesthesiologists. RA was planned whenever possible. In the morning of operation the RA technique was explained to the patients and intravenous (IV) access established. Preoperative medication was given using IV fentanyl and midazolam in titrated doses. Ketamine was used in children and appropriate block given using standard technique. Nerve stimulator was used wherever applicable Results: Age of the patients ranged from three months to 92 years. Maximum number of patients belonged to the age group of 21- 50 years (63.2%). As per the demographic data. In our study, Knee arthroscopy and repair was 28.38%, Femoral was 17.41%, Radius and ulna was 15.16% and least were Ankle and foot, Wrist and hand surgery was 1.93%. In our study Subarachnoid block was 40.96% followed by Combined spinalepidural 17.09%, General anaesthesia 12.90%. Conclusion: In a conclusion, the use of regional anesthesia techniques for postoperative outcomes in orthopedic surgeries has been investigated in lots of clinical studies and case reports. Most of the authors proposed that regional anesthesia in orthopedic patients may be associated with better postoperative pain control and a reduction in intraoperative blood loss when compared with general anesthesia. In the future regional anesthesia techniques will be more preferable anesthetic technique in orthopedic surgeries

Skin Grafting in Post burn contractures of Groin and perineum in patients

Background: Groin and perineal burn contracture is a rare postburn sequel. Such postburn contractures causes distressing symptoms to the patients and in the management of these contractures, both functional and cosmetic appearance should be the primary concern. Material and Methods: This is prospective and descriptive study conducted in the Department of Plastic Surgery at Tertiary Care Teaching Hospital over a period of 1 Year. First dressing was seen on third or fourth postoperative day and percentage of graft take/loss was noted. Complications, if any, were recorded. Indwelling urinary catheter drainage was instituted for 3 to 4 days postoperatively. Once the graft stabilized, patients were discharged and advised to wear compression garments. Results: In our study, 77.1% of the patients, post burn contractures of the groin and perineum were because of Open chulla. Other less common causes were hot water (14.3%) and flame burn (8.6%). Majority of the patients were brought with complaints of difficulty in squatting (80.0%) followed by limitation of movements of hip joints (71.4%) and (44.3%) impairment of walking. In our series of 70 patients two types of operative procedures were performed: (1) release of contracture with split thickness skin grafting; (2) release of contracture and closure by multiple Zplasties. Moreover, 30 (42.9%) patients having bilateral groin contractures underwent release of contracture with split thickness skin grafting. 29 (41.4%) patients underwent release of unilateral groin contracture with split thickness skin grafting and 4 (5.7%) patients underwent release of unilateral groin contracture and closure by multiple Zplasties.Conclusion: To conclude, recuperation from perineal burns, both in acute period and chronic phase in case contracture occurs, is a difficult challenge physically and mentally. The agony that a burn patientendures during treatment is evident even to an onlooker.

A comparative study of morphological and Immunohistochemical expression of P40 and P63 immunomarkers in squamous cell carcinoma and adenocarcinoma lung

Background: Lung cancer is the leading cause of cancer related death worldwide and accounts for 28% of all cancer mortality and around 1.8 million new cases were diagnosed in 2012. The morphological distinction between pulmonary adenocarcinoma (ADC) and squamous cell carcinomas (SCC) is sometimes difficult, mainly in cases of poorly differentiated tumors or when degenerative changes, necrosis and crushing may obscure the cell characteristics. p63 is a homologue of the p53 tumour suppressor gene that is responsible for proliferation and differentiation of epithelial progenitor cells. p40 is consistently the predominant isoform expressed in squamous cell carcinoma; thus, it offers improved specificity for diagnosing squamous cell carcinoma. Material and Methods: This is a prospective and observational study conducted in the Department of Pathology, Tertiary care Teaching Hospital over a period of 1 year. Primary lung carcinoma cases included with unequivocal morphological diagnosis irrespective of age, gender and nature of biopsy material (endoscopic biopsy/ needle core biopsy / resected specimen). Cases diagnosed as Small cell carcinoma of lung, as metastatic lung cancers, poorly differentiated NSCLC-NOS and with inadequate material for IHC study were excluded from present study. Results: In the present study, a total of 150 patients were included out of which 112 (74.6%) were males and 38 (25.4%) were females. In our study, most of the patients were >61 years i.e., 63 out of 150 (42%), followed by 51-60 years, i.e., 40 out of 150 (26.7%). All 8 cases of well differentiated Adenocarcinoma were positive for P40 and 5 cases showed P63 expression. Out of 13 cases of moderately differentiated Adenocarcinoma, 3 cases were positive for P40 and 10 cases were positive for p63 marker. Out of 30 cases of well differentiated Squamous cell carcinoma 15 cases were P40 positive and 15 cases were P63 positive. All 53 cases of moderately differentiated Squamous cell carcinoma showed positive P40 and P63 expression.

A study to Monitor Adverse drug reactions in a patients of Chronic Obstructive pulmonary Disease

Background: Inappropriate drug usage may preclude ideal benefit due to increased medical cost, adverse effects and mortality. Therefore drug utilization studies have become a plausible means in evaluating the healthcare systems. COPD management usually involves more than one drug which may escalate the risk of ADEs (adverse drug events). The present study aimed at assessing the current drug practice and ADEs in COPD management in ICU. Material and Methods: A prospective, single centered, observational and open labeled study was carried out in Department of Pulmonary Medicine and Pharmacology, Tertiary Care Teaching Hospital. The patient population was broadly divided into four categories based on diagnosis ‑ chronic obstructive pulmonary disease, Infections, Asthma and Others. Suspected ADRs were reported, analyzed, and causality assessment was carried out using Naranjo’s algorithm scal0065. Results: In our study, most important causative drug was Budesonide (11.1%). Causality assessment of ADR by Naranjo’s algorithm showed 11.9% probable and 88.1% possible reactions. According to WHO-UMC scale, 85.9% reactions are possible, 11.1% are probable, and 3% are unlikely. Among the 270 ADR reported, the most common ADR was oral thrush which accounted for 11.1% (n = 30) of the reported cases, followed by palpitation 11.1% (n = 30), sore throat 20 (7.4%), dizziness 17 (6.3%) cases, and headache 20 (7.4%) of reported ADR cases. Conclusion: Many research have been conducted separately on various respiratory diseases such as COPD, tuberculosis, asthma, respiratory tract infections (upper/lower), and so on. However, this study included some of the most common diseases in this field, such as COPD, tuberculosis, and respiratory tract infections. A routine patient follow-up is needed for the early detection and prevention of ADRs in order to improve patient adherence to drug therapy and provide improved drug therapy by avoiding associated morbidity and mortality.

Impact of recurrent pregnancy loss on depression, anxiety and fertility related stress in Omani women: A cross sectional survey.

Pregnancy is a state of happiness and hope not only for a woman but for her family as well as near and dear ones. However, this phase of happiness comes shattering down for some couple who are not able to successfully complete pregnancy and end up losing a baby in the early stages of pregnancy. Recurrent pregnancy loss (RPL) is prevalent among Omani women and the psychosocial impact of RPL is heavy upon these young women devastating their overall quality of life. Researchers conducted a cross sectional survey among 184 Omani women who had a history of recurrent pregnancy loss in a pioneering teaching tertiary care hospital. Data collection done from using a self-reported questionnaire to assess the depression, anxiety and RPL associated stress of women with history of RPL The mean age of women with RPL was 34.05 and 81% reported 2-3 pregnancy loss. Participants reported higher mean scores of depression (9.94), Anxiety (10.32) and fertility related stress (30.28). Women with multiple pregnancy losses (above 3) reported higher level of anxiety which was significant at (p<0.05%) The findings from current study also indicated that women with RPL experience higher levels of depression, anxiety, and fertility related stress.

Microbial Spectrum of Keratitis at a Rural Tertiary Care Teaching Hospital.

Microbial keratitis poses a significant threat to vision and is a common ocular infection. Its causative agents encompass a wide spectrum, including bacteria, fungi, viruses, and parasites. The microbiological profile of microbial keratitis is influenced by factors such as patient demographics, geographical location, climate, and occupational hazardsand evolves over time. Corneal scrapings were collected from 75 patients with a provisional diagnosis of microbial keratitis.The samples were processed in the microbiology laboratory, and the bacterial and fungal growth isolated in the study were identified according to standard procedures. Among the 75 patients, 48 (64%) were maleand 27 (36%) were female.Corneal ulceration was found in individuals of all age groups, with the highest prevalence of 77.33% (58/75) observed in the 21-60 age range. Farmers exhibited a higher susceptibility, constituting 66.67% (50/75) of the cases.The study noted a higher occurrence of keratitis from November to February, accounting for 69.33% (52/75). Microbial etiology was identified in 25.33% (19/75) of scrapings, with fungi accounting for 68.42% (13/19) and bacteria for 31.57% (6/19). The prevalent fungal species included Fusarium (7/13, 53.84%),Aspergillus(3/13, 23.07%),Colletotrichum(2/13, 15.38%), andCurvularia​​​​​​​(1/13, 7.69%). Bacterial isolates featuredStreptococcus pneumoniae(5/6, 83.33%) and Klebsiella pneumoniae (1/6, 16.66%). This study underscores the importance of regularly updating local microbial profiles and understanding antimicrobial resistance patterns. Such updates are critical for informed decision-making in selecting optimal topical treatments for microbial keratitis.

Knowledge, attitude and practice of pharmacovigilance among medical students

Background: Spontaneous voluntary adverse drug reaction (ADR) reporting is the backbone for the successful functioning of the Pharmacovigilance Programme of India. The aim of pharmacovigilance is to ensure safe and rational use of medicines, once they are released for general use in the society. Targeting the younger doctor for sensitization toward pharmacovigilance is the key to ensure practice of adverse drug reactions (ADR) reporting in clinical practice. The objectives of this study are to evaluate the knowledge, attitude, and practice (KAP) of pharmacovigilance among medical students at LLRM Medical College, Meerut, a tertiary care teaching hospital. Methods: A cross-sectional study was carried out using a pretested questionnaire. The questionnaire was designed to assess the KAP regarding pharmacovigilance. The medical students (2nd year, final year, and interns) were included in the study. Only the participants who gave their consent were included in the study. Results were calculated by proper statistical analysis. Results: The current study was conducted in a LLRM Medical College, Meerut, which included a total of 250 medical students of which 40% 2nd year, 40% final year students, and 20% interns. Most of them (83%) accepted that reporting ADR is necessary, and pharmacovigilance should be taught in detail to health-care professionals. Conclusions: This study demonstrated that knowledge of pharmacovigilance among medical students is improving gradually and pharmacovigilance and ADR reporting needs to be made compulsory, have better, interesting ways to learn and understand it, so that the students can practice it with confidence in their clinical practice.

Questionnaire-based assessment on knowledge, attitude and practice of fixed-dose combination in medical undergraduates of a tertiary care teaching hospital, Kanpur

Background: Aim was to assess knowledge, attitude and practice of second-year medical undergraduates towards FDC. Methods: A cross-sectional questionnaire-based study was conducted among second-year medical undergraduates of GSVM, medical college, Kanpur in the form of a pre-test, and after sensitizing the students about FDC, the same questionnaire was given as a post-test. Results: A total of 251 students, 157 students participated in the pre-test and 140 participated in the post-test. The percentage of male students in pre and post-test were more (58% and 61.4%) compared to female students (42% and 38.6%). After conducting a post-test survey, there is a significant improvement in knowledge and attitude toward FDC. Conclusions: The inclusion of FDC in the undergraduate curriculum is a good initiative by NMC but there is a need to conduct more CME, symposiums, and workshops in medical colleges to update the knowledge regarding FDC among medical undergraduates.

A Study to Establish the Relationship between Hand Hygiene Compliance and Hospital Associated Infections in an ICU Setup of a Tertiary Care Teaching Hospital

Proper hand hygiene is especially important in a hospital setting where patients may have weakened immune systems and are more susceptible to infections. It is essential for healthcare professionals to follow strict hand hygiene protocols to ensure the safety and well-being of both patients and staff. Hand hygiene audits should be conducted regularly to assess compliance with these protocols and identify areas for improvement. These audits can help identify any gaps in hand hygiene practices and provide opportunities for additional training or education for healthcare professionals. By consistently monitoring and reinforcing proper hand hygiene, hospitals can minimize the spread of infections and create a safer environment for everyone involved in patient care. The present study provides an overview of the hand hygiene audits conducted at a tertiary care hospital in Pune, India, and highlights the areas for improvement and implementation of best practices.

Correlation Between Depression and Quality of Life Among Patients With Parkinson's Disease: An Analytical Cross-Sectional Study.

Introduction Parkinson's disease (PD) is a progressive complex degenerative disorder characterised by several motor and non-motor symptoms that result in disability and deterioration of the patient's quality of life (QOL). Depression is the most common non-motor symptom that may severely alter the QOL. The objective of this study was to examine the correlationbetween depression and QOL among patients with PD who received treatment from a movement disorder clinic of a tertiary care teaching hospital in South India. Methods This was an analytical cross-sectional study conducted among 220 PD patients who received treatment from a movement disorder clinic of a tertiary care teaching hospital inSouth India. The participants aged between 40 and 80 years, who can comprehend Malayalam or English and were clinically diagnosed with PD according to United Kingdom PD Society Brain Bank criteria were included in the study. Depression was assessed using the Hospital Anxiety and Depression Scale, motor function using the Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III, and the quality of life was assessed using the Parkinson's Disease Questionnaire 39. Results The results of this study showed that there was a significant positive correlation between depression andQOL (r=0.699, p<0.01) among patients with PD who received treatment from a tertiary care teaching hospital.The correlation with domains of QOL also identified that depression was significantly correlated with all domains of QOL and more to the emotional domainof QOL (r=0.799, p<0.01). Conclusion Depression is the most common neuropsychiatric condition in PD and the most important determinant of QOL.Depression mayoccur at any stage of PD and can significantly impact the QOL of patients and their caregivers.Hence it should be recognized early and managed by pharmacological and nonpharmacological measures to improve the QOL.

Impact of an Educational Measure on the Quality of Medical Certificate of Cause of Death at a Tertiary Care Teaching Hospital: A Pre-post Interventional Study.

Background A death certificate is an important document that serves as a tool for gathering epidemiological data and as an essential legal document. Although it is a mandatory document to be given for all deaths, the quality of its filling is often an ignored aspect and errors are frequently encountered. This documentation process can be mastered with minimal educational efforts. This study aimed to determine the utility of an educational measurein improving the accuracy of death certificate documentation. Methods and materials This pre- and post-interventional study was conducted at Maharaja Agrasen Medical College, Agroha, a tertiary care teaching hospital in Hisar, Haryana, India, wherein an audit of death certificates was done before and after an educational intervention on doctors responsible for filling death certificates. Errors in the death certificates were classified into major and minor errors and compared in the pre- and post-intervention groups. Results A total of 184 pre-intervention and 136 post-intervention death certificates were audited. In the pre-intervention certificates, at least one major and one minor error were present in 88% and 92.93% of the certificates, respectively, which was reduced to 33% (p < 0.01; relative risk (RR) = 3.62; 95% confidence interval (CI) = 2.69-4.91) and 38% (p < 0.01; RR = 3.33; 95% CI = 2.53-4.37), respectively, post-intervention. Reduction in all types of major and minor errors was statistically significant (p < 0.05). Conclusions Errors in death certification are a common but frequently ignored problem that can have a negative impact on epidemiological data and can be drastically reduced with simple educational measures, which need to be carried out regularly.

On-Arrival Lumbar Epidural Analgesia for Lower Limb Trauma Pain in Emergency Care: A Superiority Randomized Controlled Trial.

Lower limb trauma in emergency settings often leads to pain management challenges. Traditional methods, primarily non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, have limitations. This study explores the efficacy of epidural analgesia in emergency for lower limb trauma patients (ELETRA) as an alternative for managing pain in lower limb trauma patients upon arrival in emergency care. This study primarily focuses on determining ELETRA's effectiveness in reducing pain for patients with lower limb trauma upon arrival. It also aims to evaluate ELETRA's influence on decreasing stress and shortening hospital stays compared to traditional pain management approaches. This study was executed as a prospective, parallel-design, randomized controlled trial in the emergency department of a tertiary care teaching hospital. The interventions were performed in a dedicated induction room adjacent to the emergency operating theater. The trial was registered in the Clinical Trial Registry of India with registration number CTRI/2022/08/044699 dated 16/08/2022.Participants were 18- to 50-year-old patients with lower limb injuries, classified under American Society of Anesthesiologists (ASA) class 1 or 2. Participants were randomized into two groups: one receiving ELETRA and the other standard pain control treatment. The effectiveness of pain relief was measured through a visual analogscale (VAS), and hemodynamic parameters, adverse effects, levels of acute phase reactants, and stress hormones were also measured along with patient satisfaction. The study enrolled 356 participants with lower limb injuries. After excluding participants lost following the intervention, data from 157 individuals in Group A and 160 in Group B were analyzed. Group A's success rate for analgesia (VAS < 2) was 92.35% (n = 145), significantly higher than Group B's 75.62% (n = 121) (p < 0.001). The commonest side effect was hypotension (5.73%) inGroup Aand nauseainGroup B (7.5%). C-reactive protein (CRP) levels rose to 104.71 ± 8.99 mg/dL in Group A and 192.58 ± 9.23 mg/dL in Group B; the difference was statistically significant. Serum cortisol levels were also higher in Group B (67.18 ± 9.21) compared to Group A (44.72 ± 6.14) at one week. Group B had a longer hospital stay, averaging 12.24 ± 4.81 days, against Group A's 10.19 ± 4.91 days. ELETRA is a safe and effective alternative for pain management in lower limb trauma patients in emergency settings. It reduces pain, improves patient satisfaction, and has a favorable impact on stress responses.

Suicide Ideation and Patterns among Suicide Survivors Admitted in Teaching Tertiary Care Hospital Multan, South Punjab Pakistan

Suicide Ideation and Patterns among Suicide Survivors Admitted in Teaching Tertiary Care Hospital Multan, South Punjab Pakistan

The Combined Effect of Robot-assisted Therapy and Activities of Daily Living Training on Upper Limb Recovery in Persons With Subacute Stroke: A Randomized Controlled Trial

ObjectivesTo evaluate the effectiveness of robot-assisted therapy (RAT) followed by activities of daily living (ADL) training in comparison with conventional rehabilitation therapy (CRT) and ADL training in individuals with subacute stroke. DesignA single-blind, 2-arm, parallel-group, open-level, randomized controlled trial. SettingA tertiary care teaching hospital in India. ParticipantsForty-four persons (n=44) with first-ever stroke (in subacute stage) were enrolled from August 2021 to July 2023. InterventionParticipants in the RAT group (n=22) received RAT for 30 minutes, followed by ADL training for 30 minutes. In contrast, participants in the CRT group (n=22) received CRT (30 minutes) followed by ADL training (30 minutes). Both groups received allocated interventions for 15 days over 3 weeks (5 days/week, 3 weeks). Main Outcome MeasuresPrimary outcome: Motor domain score of the Fugl-Meyer Assessment scale for upper extremity (FMA-UE). Secondary outcomes: the other domains scores of FMA-UE (UL -sensation, -joint motions, -joint pain); Modified Ashworth Scale (MAS) (spasticity); hand-function (HF) and ADL-domain scores of the stroke impact scale (SIS); WHOQQL-BREF questionnaires (QOL). Participants were assessed at enrolment and follow-up at 3, 6, and 12 weeks. ResultsPersons who received RAT and ADL training reported significant improvement (P<.05) in UL motor function (mean difference [MD]=3.54;(95% confidence interval [CI]: 1.28 to 5.79]), UL passive joint motions (MD=2.54; [95% CI: 1.56 to 3.52]), SIS-HF (MD=6.37;[95% CI: 4.75 to 7.99]), SIS-ADL (MD=7.13 [95% CI: 3.52 to 8.74]), and in all domains of WHOQOL-BREF (except environmental domain) compared with persons who received CRT and ADL training at 12 weeks. ConclusionsThe findings indicate that RAT followed by ADL training is more effective than CRT followed by ADL training in motor improvement, SIS-HF, SIS-ADL, and QOL at 12 weeks.

An In-Depth Investigation of Liver Diseases at a Tertiary Care Teaching Hospital

An In-Depth Investigation of Liver Diseases at a Tertiary Care Teaching Hospital

Healthcare provider perspectives on emergency department-initiated buprenorphine/naloxone: a qualitative study

BackgroundTake-home buprenorphine/naloxone is an effective method of initiating opioid agonist therapy in the Emergency Department (ED) that requires ED healthcare worker buy-in for large-scale implementation. We aimed to investigate healthcare workers perceptions of ED take-home buprenorphine/naloxone, as well as barriers and facilitators from an ED healthcare worker perspective.MethodsIn the context of a take-home buprenorphine/naloxone feasibility study at a tertiary care teaching hospital we conducted a descriptive qualitative study. We conducted one-on-one in person or telephone interviews and focus groups with ED healthcare workers who cared for patients given take-home buprenorphine/naloxone in the feasibility study at Vancouver General Hospital from July 2019 to March 2020. We conducted 37 healthcare worker interviews from December 2019 to July 2020. We audio recorded interviews and focus groups and transcribed them verbatim. We completed interviews until we reached thematic saturation.Data analysisWe inductively coded a sample of transcripts to generate a provisional coding structure and to identify emerging themes, which were reviewed by our multidisciplinary team. We then used the final coding structure to analyze the transcripts. We present our findings descriptively.ResultsParticipants identified a number of context-specific facilitators and barriers to take-home buprenorphine/naloxone provision in the ED. Participants highlighted ED conditions having either facilitative or prohibitive effects: provision of buprenorphine/naloxone was feasible when ED volume was low and space was available but became less so as ED volume increased and space decreased. Similarly, participants noted that patient-related factors could have a facilitative or prohibitive effect, such as willingness to wait (willing to stay in the ED for study-related activities and buprenorphine/naloxone initiation activities), receptiveness to buprenorphine/naloxone, and comprehension of the instructions. As for staff-related factors, time was identified as a consistent barrier. Time included time available and time required to initiate buprenorphine/naloxone (including time building rapport). Healthcare worker familiarity with buprenorphine/naloxone was noted as either a facilitating factor or a barrier, and healthcare workers indicated that ongoing training would have been advantageous. Many healthcare workers identified that the ED is an important first point of contact for the target patient population.ConclusionIntegrating a buprenorphine/naloxone program into ED care requires organizational supports (e.g., for managing buprenorphine/naloxone within limitations of ED volume, space, and time), and ongoing education of healthcare workers to minimize identified barriers.

Role of Transcranial Ultrasound and Doppler Studies to Evaluate Intracranial Pathologies in Preterm and High-risk Term Neonates

Abstract Background: Transcranial grayscale neurosonography (NSG) and Doppler studies have major role in diagnosing neonate intracranial pathologies. The aim of the study is to evaluate the role of NSG and Doppler studies in correlation with clinical hypotonia and seizures in preterm neonates and high-risk term neonates. The prevalence of intracranial pathology is the second aim of this study. Methods: The present cross-sectional study was done in a tertiary care teaching hospital for 2 years. The study population of 120 cases comprised two groups: one group of 60 preterm neonates and the other of 60 high-risk term neonates with a history of well-defined episode of fetal distress. The NSG and Doppler findings (resistance index ≤0.62 is the optimum cutoff point for diagnosing perinatal asphyxia) are recorded. The sensitivity and specificity values for the NSG study alone, the Doppler study alone, and the combined NSG and Doppler studies are calculated. Results: The majority (46%) of preterm neonates had presented with germinal matrix hemorrhage, whereas a majority (46%) of high-risk term neonates had presented with periventricular and subcortical cysts. Comparison of the sensitivity of NSG versus Doppler versus combined NSG and Doppler in evaluating hypotonia and seizures in preterm (P = 0.0442) and high-risk term neonates (P = 0.0399) was significant. Conclusion: NSG combined with the Doppler study has significantly higher sensitivity than NSG alone in both groups. The specificity of the Doppler study is also high in both groups. Thus, it is strongly recommended to include Doppler during every NSG study to increase the detection rate.