Tertiary Health Care Institution Research Articles

Gauging the Motivation Level of Health Personnel of a Tertiary Care Hospital in District Dehradun

Background- Healthcare providers serve as the backbone of the healthcare delivery system, and motivating them is crucial for its enhancement, which is often a challenging task. Understanding the motivational factors that keep employees engaged is a pressing concern for leaders and senior personnel. Aims & Objectives: This study aimed to assess the motivation levels of healthcare personnel working in a tertiary healthcare institution in Dehradun, Uttarakhand. It sought to explore the various factors influencing employee motivation in the healthcare sector. Methodology: A cross-sectional study involved 150 healthcare personnel, and data analysis was conducted using Statistical Package for Social Sciences (SPSS) software and Microsoft Excel. Frequency percentages and mean standard deviations were used for categorical and continuous data, respectively. The Chi-Square test and Fischer Exact test were employed to assess relationships between categorical variables. Results: Among the study groups, technicians displayed the highest motivation levels, while doctors exhibited lower motivational indices. Across doctors, nurses, and technicians, "rewards" ranked as the top motivating factor. Health personnel identified monetary support, incentives, promotion, resource improvement, appreciation, feedback, communication, job security, training, teamwork, and effective management as significant motivational factors. Conclusion: Satisfied healthcare workers not only inspire their colleagues but also foster a positive work environment, enhancing the overall functioning of the institution. Employee motivation directly impacts the performance of healthcare organizations. Recognizing non-financial motivators, such as appreciation, teamwork, professional growth, and training, alongside financial incentives, is essential to maintaining a motivated and efficient healthcare workforce.

Assessment of Clinical Profile in Patients Suffering from Non-radiographic Axial Spondyloarthropathy

Objectives Axial Spondyloarthritis is an inflammatory, immune-mediated condition comprising clinically dif- ferentiated ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). Clinically, as the name suggests, nr-axSpA lacks definitive plain X-ray evidence of structural damage to the sacroiliac (SI) joint. This study was undertaken to assess the patients with newly diagnosed nr-axSpA clinically and compare the same with those with radiographic AS. The laboratory profile of patients suffering from nr-axSpA and their outcomes over three months were also studied. Material and Method This study was conducted in the Department of Medicine over 18 months in a tertiary health care institution, being a prospective observational type done with 43 subjects. Results We observed a major improvement as per ankylosing spondylitis disease activity score (ASDAS) criteria present among 53.49% of subjects, followed by clinically significant improvement among 27.91% of subjects. 18.60% of subjects did not show any improvement. 9.3 % of subjects showed radiological progression. Out of 8 cases that did not show improvement, all presented with lower back pain (LBP) and morning stiffness. 62.5% had peripheral arthritis. 87.5% had Schober’s test positive, flexion, abduction and external rotation (FABER) test (62.50%), and SI joint tenderness was found among 7.5% of subjects. A total of 4 (9.3%) patients showed radiological progression. They all have low back aches and morning stiffness, and three have peripheral arthritis at presentation. We found that patients who showed progression had higher mean erythrocyte sedimentation rate (ESR) and C-Reactive protein (CRP) levels (45 and 36.5, respectively) values and very high disease activity as per ASDAS and bath ankylosing spondylitis disease activity index (BASDAI) criteria. Conclusion There is a great scope and need for research to differentiate the magnetic resonance imaging (MRI) changes in the normal population against the patients with spinal diseases to be able to use MRI with precision in patients with non-radiographic axial spondyloarthropathy (nr-axSpA). As assessed, physiotherapy and Non-steroidal anti-inflammatory drugs (NSAIDS) are currently first-line therapy for patients suffering from nr-axSpA.

'Been there, experienced that': A qualitative study on the experiences and perceptions of online peer volunteers in supporting Singaporean mothers at risk of depression.

Online peer support is a useful source of support for parents during the perinatal period, associated with improved psychological outcomes. Past research has found that peer support providers themselves gain from providing peer support as well, making it mutually beneficial. As current maternity care services are insufficient to meet the support needs of parents, the Supportive Parenting App (SPA) intervention was developed to offer them informational, appraisal and emotional support during the perinatal period. It consists of mobile health application-based educational support and online peer support provided by trained peer volunteers, to prevent the development of postnatal depression. To explore the experiences of peer volunteers with providing online peer support to parents during the perinatal period, as well as to identify areas of improvement for the SPA intervention. A qualitative descriptive design was adopted. This study took place from October 2020 to August 2021 in two tertiary public healthcare institutions in Singapore. A total of 18 peer volunteers were invited for individual semi-structured interviews. The interviews were audio recorded and transcribed verbatim, and thematic analysis was used to analyse the data. Four themes were emerged as follows: (1) 'Being there': Reminiscing about and healing of own postnatal depression experience; (2) Building rapport with parents; (3) Parents in mind: Mutual sharing of knowledge and how to support new parents better; (4) Ensuring good quality peer support. The peer volunteers felt that their experience was fulfilling and healing. Frequent contact, sharing of SPA resources and self-disclosure were found to help engage the new parents and build rapport between peer volunteers and parents. Challenges described by the peer volunteers have identified possible areas in which the SPA intervention can be improved. Communication between peer program facilitators, managers and peer volunteers can be enhanced to ensure that peer volunteers are more sensitive and precise when providing support or information. This can improve rapport building between parents and peer volunteers, which will in turn maximize the benefits that parents can reap through online peer-to-peer support. This study explored the perceptions of peer volunteers who provided online peer support to parents across the perinatal period. Peer volunteers felt that the SPA intervention was meaningful and that providing peer support was a healing experience. They were able to learn about the experiences of other mothers with postpartum depression while sharing their own past experiences. Thus, both parents and peer volunteers can benefit from engaging in online peer support programs. Technology-based interventions like the Supportive Parenting App (SPA) can be a suitable complement to maternity care services by providing parents access to medically accurate information and social support. Additionally, more experienced mothers can engage in fulfilling experiences through volunteering for new mothers who may benefit from informational, appraisal and emotional support. This study follows the reporting guidelines as stated by the Consolidated criteria for reporting qualitative research (COREQ) checklist. Parents and peer volunteers contributed ideas that aided with the design of the mobile app. Many topics added to the educational materials were suggested by these parents as well. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: This study showed that sufficient training can be provided to lay peer volunteers to help them support other parents, buffering the pressure exerted on the healthcare industry due to the rising demand for healthcare services. The provision of such support is also beneficial for the peer volunteers themselves, as they find it meaningful and educational. Program developers of parenting and peer volunteering interventions can draw on the findings of this study to improve the effectiveness of these programs.

Evolving Patterns of Infective Endocarditis: Insights from a Tertiary Healthcare Institute in Western India

Abstract Context: Infective endocarditis (IE) is a dynamic disease with high morbidity and mortality despite advancements in diagnostics, antimicrobial therapy, and surgery. India faces a complex situation due to changing factors such as host characteristics, diagnostic techniques, antibiotics, and aggressive surgical approaches. Monitoring local epidemiology is crucial for prompt recognition and treatment. However, studies on IE trends in India are scarce and outdated. Aims: To investigate the clinical, microbiological, predisposing conditions, echocardiographic characteristics, and treatment outcomes of IE patients admitted to a Tertiary Care Academic Institute in Western India. Settings and Design: This retrospective observational study was done in a 2011-bedded tertiary care referral hospital in Western Maharashtra, between June 2019 and May 2023. The records of all adult patients (age >14 years) admitted during the study period with a definite diagnosis of IE, both native valve endocarditis and prosthetic valve endocarditis according to the modified Duke criteria, were included in the study. Baseline demographic data on age, sex, underlying heart disease, and predisposing conditions for bacteremia (infections, central venous catheters, surgeries, and invasive procedures) were collected. Subjects and Methods: The echocardiographic and microbiological findings, complications, treatment, and outcomes were noted. All blood cultures done for the diagnosis of IE were processed using standard methods to identify bacterial and fungal species and antimicrobial susceptibility profiles. For all the patients in this study, blood (5–8 mL per bottle) was collected in adult blood culture bottles using standard precautions and processed by a semiautomated blood culture system (BioMérieux, Marcyl̕ Etoile). Identification of causative organisms was performed by standard microbiological methods. Transthoracic and transesophageal echocardiography were performed to determine the location of vegetation, type of valve infected, and cardiac complications. Sample Size Calculation: Considering the Indian prevalence of IE to be 14.5% as observed by Gupta et al.,margin of error as 9%, and 95% of confidence level, the minimum required sample size calculated using WinPepi software (version: 11.65) for conducting the study was 59 patients. Statistical Analysis: Data was collected and entered into a database using Microsoft Excel. Data was represented as the frequency with percentage and Chi-square test (two-sample proportionality test) were applied for comparison of categorical variables. Quantitative data was summarized using mean and standard deviation and a two-sample t-test was applied to compare differences. P < 0.05 was considered statistically significant. Results: The mean age in the study was 44.1 ± 10.6 years with a female preponderance (male:female – 0.85:1). Rheumatic heart disease (RHD) (44.3%) was the most common underlying heart disease etiology, whereas 33% of patients did not have any cardiac disease. Blood culture was positive in 34.9% of episodes, with the most common organisms being Gram-positive Staphylococci (38%). Medical complications such as congestive heart failure (CHF) and acute kidney injury were seen in 41.2% of patients, followed by cerebrovascular accident and stroke in 20.6%. The majority of patients, 61.9%, had received antibiotics before referral to our center. Thirty-seven (58.7%) patients underwent definitive surgery for IE. The total in-hospital mortality rate was 12 (19.1%). In the univariate analysis, younger patients (<50 years) with CHF, diabetes mellitus, and Staphylococcus culture-positive IE were independent predictors of mortality. Conclusions: Over the past four decades, the landscape of IE in India has experienced noteworthy transformations. The disease profile of patients has shifted from predominantly older individuals with RHD to a rising number of younger patients with prosthetic valves or those without identified valvular conditions. Moreover, the yield of blood cultures has declined due to the increased utilization of antibiotics over the last two decades, although Staphylococcus species continue to be the most common organisms detected. Despite significant advancements in medical technology, the mortality rate remains unchanged. Our study provides compelling evidence to advocate for early surgical intervention, which holds the potential for improved outcomes.

Predictors of Outcome in Management of Paediatric Head Trauma in a Tertiary Healthcare Institution in North-Central Nigeria.

Trauma is a leading causes of death and disability in all ages. The aim of this study was to describe the demography and characteristics of paediatric head trauma in our institution and examine the predictors of outcome and incidence of injury related mortality. We examined our institutional Trauma Registry over a 2 year period. A total of 1100 trauma patients were seen over the study period. Of the 579 patients who had head injury 99 were in the paediatric age group. Of the paediatric head trauma patients 79 had documented Glasgow coma score (GCS), 38 (48.1%), 17 (21.5%) and 24 (30.4%) had mild, moderate and severe head injury respectively. The percentage mortality of head injury in the paediatric age group was 6.06% (6/99). There is an association between mortality and GCS (p=0.008), necessity for intensive care unit (ICU) admission (p=0.0001), associated burns (p=0.0001) and complications such as aspiration pneumonia (p=0.0001). The significant predictors of outcome are aspiration (p=0.004), the need for ICU admission (p=0.0001) and associated burns (p=0.005) using logistic binary regression. During the study period 46 children underwent surgical intervention with extradural haematoma 16 (34.8%), depressed skull fracture 14 (30.4%) and chronic subdural haematoma five (10.9%) being the commonest indication for surgeries. Paediatric head injury accounted for 9.0% (99/1100) of all trauma admissions. Majority of patients had mild or moderate injuries. Burns, aspiration pneumonitis and the need for ICU admission were important predictors of outcome in children with traumatic brain injury.

Temporal tendency, seasonality and relationship with climatic factors of Crimean-Congo Hemorrhagic Fever cases (East of Turkey: 2012–2021)

Crimean-Congo Hemorrhagic Fever continues to be an important public health problem by expanding its borders. To evaluate the temporal trend, seasonality, and relationship with the climatic factors of Crimean-Congo Hemorrhagic Fever. Study data included cases treated in two different tertiary healthcare institutions between 2012 and 2021. The demographic characteristics of the cases and the dates of admission to the hospital were determined, and they were matched with the average of the measurements (temperature, cumulative precipitation, relative humidity, wind speed) of two different meteorology stations in the study area. By calculating the crude incidence rates, the trend in years was investigated. Estimates were created by removing the incidence rates, seasonality, and trend components using the additive decomposition technique. The temporal relationship between incidence rates and climatic factors was evaluated with the help of the Autoregressive Distributed Lag Bound Test. Toda Yamamoto test was used for causality verification. The mean age of the cases (n = 974) included in the study was 47.6 ± 17.7 years, and the majority (57.3%) were in the group above 45 years of age. 56.6% of the cases were male and there was a male predominance in all age groups. Incidence rates ranged from 5.5 to 23.1/100,000 over the ten-year period and there was a significant upward trend (R2 = 0.691, p = 0.003). Cases of Crimean-Congo Hemorrhagic Fever that started in March, peaked in July and ended in October, showed a clear seasonality. A cointegration relationship was observed between case incidence rates and air temperature, cumulative precipitation, and relative humidity (p < 0.05 for all). Climatic factors can only indirectly affect the occurrence of Crimean-Congo Hemorrhagic Fever cases. However, climatic conditions that become progressively more favorable for vector ticks lead to the spread of the disease. The control measures to be taken should be prepared by considering the changing climatic conditions and prioritizing the risk groups. There is a need for information and awareness-raising studies about climate change and the growing dangers associated with it, also outside of endemic regions.

Impact of the COVID-19 pandemic on Clostridioides difficile infection in a tertiary healthcare institution in Belgium

ABSTRACT Objectives Clostridioides difficile infection (CDI) causes the greatest number of healthcare-associated infectious diarrhoea. CDIs are transmitted by direct and indirect patient-to-patient contact and risk increases with the use of antibiotics. Since early 2020, the COVID-19 pandemic has affected healthcare systems in many ways including substantial changes in hygiene behaviour. The aim of this study was to assess whether CDI incidence differed during the COVID-19 pandemic compared to a year before. Methods All tests for suspected CDI cases were recorded for a hospital in Brussels, Belgium. The percentage of CDI-positive results and incidences (total and healthcare-associated (HA)-CDI)) for years 2019, 2020, 2021, and 2022 were calculated. Antibiotic consumption was analysed for years 2019 and 2020. Results Since the COVID-19 pandemic struck, a significant reduction of up to 39% was observed in the number of Clostridioides difficile stool tests in our hospital. A significant decrease in the percentage of positive tests and a 50% decrease in the incidence of CDI (total and HA-CDI) was found for 2020 compared with 2019 and confirmed for years 2021 and 2022. The decrease in CDI incidence was mostly marked in haematology, nephrology, and gastroenterology units. No significant change in the use of antibiotics was found. Conclusion The global decrease in CDI incidence observed in our hospital was not associated with a change in the use of antibiotics. The control measures implemented to prevent COVID-19 transmission may explain a reduction in CDI incidence. An underdiagnosis of CDI cannot be excluded.

Effect of a Tabletop Program for Training Emerging Infectious Disease Responses in Nurses at Small- to Medium-Sized Hospitals in Areas with Poor Healthcare Access.

This study developed and evaluated a tabletop program for training nurses working in small- to medium-sized hospitals in areas with poor healthcare access for emerging a tabletop program for training emerging infectious disease responses in nurses working at small- to medium-sized hospitals in areas with poor healthcare access and evaluated infectious disease responses. A tabletop program for training responses to emerging infectious diseases was provided to 29 nurses at a general hospital with <300 beds in a region without a tertiary general hospital or healthcare institution with nationally designated inpatient wards for patients with infectious diseases. The 180 min program consisted of an online theoretical lecture (Phase 1), one-on-one drills (Phase 2), and a scenario-based tabletop exercise (Phase 3). To evaluate the program's effect, pre- and post-knowledge, awareness, and competencies related to responses to emerging infectious diseases were assessed. The mean knowledge score significantly improved from 11.41 ± 2.33 before the training to 16.69 ± 2.48 after the training (z = -4.529, p < 0.001). The mean awareness score significantly improved from 80.83 ± 11.94 before the training to 85.45 ± 7.08 after the training (z = -2.335, p = 0.020). The mean competence score significantly increased from 67.31 ± 14.75 before the training to 79.38 ± 10.39 after the training (t = -6.187, p < 0.001). The tabletop exercise program effectively enhanced the nurses' competencies in responding to emerging infectious diseases. The training program developed in this study may be utilized in addition to a simplified theoretical lecture to train nurses to improve their competency in responding to emerging infectious diseases.

Direct medical cost of COVID-19 in children hospitalized at a tertiary referral healthcare center in Mexico City.

Despite the end of the COVID-19 pandemic being declared by the WHO, the economic consequences are far from over. One of these implications was the cost of inpatient care for health institutions. To date, some studies have examined the economic burden of COVID-19 in the adult population but only a few have focused on child populations. To estimate the direct medical costs of COVID-19, focusing on children in Mexico. Data about resources consumed during hospital stays were extracted from the medical records of patients hospitalized at a Mexican tertiary healthcare institution. Other sources of information were the unit prices of inputs and the salaries of health personnel. A micro-costing methodology was used to obtain cost results by age group over different hospital areas. Data analysis was performed with descriptive statistics and regression models to evaluate the predictors of total cost. One hundred and ten medical records were reviewed of which 57.3% corresponded to male patients and the mean age was 7.2 years old. The estimated average cost per patient was US$5,943 (95% CI: US$4,249-7,637). When the costs of the three clinical areas were summed, only the 5-10 years old group showed a maximum cost of US$14,000. The regression analysis revealed the following factors as significant: sex, age, staying at an emergency room, having a positive bacterial culture, and having comorbidities. The cost results were somewhat similar to those reported in children from the USA, but only regarding low severity COVID-19 cases. However, comparability between these types of studies should be done with caution due to the huge differences between the healthcare systems of countries. The study cost results may help public decision-makers in budget planning and as inputs for future cost-effectiveness studies about interventions regarding COVID-19.

Antimicrobial susceptibility and molecular characteristics of beta-lactam- and fluoroquinolone-resistant E. coli from human clinical samples in Nigeria

This study determined the antimicrobial resistance profiles and molecularly characterized beta-lactam- and fluoroquinolone-resistant E. coli recovered from human clinical samples. Three hundred (300) clinical samples collected from two major tertiary healthcare institutions were analyzed using standard microbiological techniques. Antimicrobial susceptibility testing and phenotypic detection of extended-spectrum beta-lactamase (ESBL) were done by disc diffusion and Double Disk Synergy Test. Molecular characterization for ESBL and fluoroquinolone-resistant genes were done by PCR with specific primers. In total, 44 (14.7%) ESBL-producing E. coli were recovered from human clinical specimens. The recovered isolates were multidrug-resistant with multiple antibiotics resistance index values ranging from 0.5–0.8. Isolates exhibited resistance to sulfamethoxazole/trimethoprim 44 (100%), cefoxitin 42 (95.5%), tetracycline 42 (95.5 %), cefuroxime 41 (93.2%), ciprofloxacin 40 (90.9%), cefotaxime 37 (84.1%), amoxicillin 37 (84.1%), amoxicillin/clavulanic acid 37 (84.1), and ceftazidime 35 (79.5%). BlaTEM 41 (93.2%) ESBL gene was the most predominant gene among the isolates, followed by blaCTX-M 9 (20.5%), and blaSHV 1 (2.3%) genes. Co-existence of blaTEM +blaSHV, blaTEM + blaCTX-M, and blaTEM +blaSHV + blaCTX-M genes was observed in 1 (2.3%), 7 (15.9%), and 4 (9.1%) isolates, respectively. All the fluoroquinolone-resistant isolates harbored aac-lb-6-cr gene while Qnr gene was absent. Association of fluoroquinolone resistance- and β-lactam resistance genes; aac-lb-6-cr + blaTEM + blaSHV + blaCTM was observed in 5 (11.4%) isolates. Our study showed high frequency of ESBL-producing E. coli harboring ESBL and fluoroquinolone resistance genes from human clinical samples in Ebonyi State, Nigeria. The high frequency of multidrug-resistant E. coli in our study is very worrisome and could have significant public health impact such as treatment failures, and possibly death, if not properly managed. It is therefore imperative to establish strong regulative measures and guidelines that would help in curtailing the increasing dissemination of these superbugs in healthcare institutions in Nigeria.

The Role of the Bile Microbiome in Common Bile Duct Stone Development.

Common bile duct (CBD) stones are a health concern for 10-20% of individuals with symptomatic gallstones, leading to health complications and placing a burden on healthcare systems. This study was initiated to investigate the changes in microbiome compositions and the metabolic signature associated with CBD stones. The research approach integrated taxonomic and functional data with metabolomics data, complemented by in vivo experiments. In a single tertiary healthcare institution, a total of 25 patients were enrolled who had undergone endoscopic retrograde cholangiopancreatography (ERCP) between February 2019 and January 2021. We harvested DNA from bile samples acquired from these individuals. The amplification of the bacterial 16S rRNA gene V3-V4 region was conducted through polymerase chain reaction (PCR), followed by sequencing. We utilized QIIME2 for a comprehensive data analysis. Furthermore, we performed a metabolomic analysis of the bile samples using nuclear magnetic resonance (NMR) spectroscopy. For the assessment of functional gene enrichment, we employed MetaboAnalyst 5.0. Lastly, we executed in vivo experiments on C57BL/6 mice and undertook histological examinations of tissue samples. Out of the 25 study subjects, 17 underwent ERCP due to CBD stones (the CBD stone group), while the remaining 8 had the procedure for different reasons (the non-CBD stone group). An alpha diversity analysis showed a significantly greater microbial diversity in the bile samples of the non-CBD stone group (p < 0.01), and a beta diversity analysis confirmed the greater microbial compositional abundance in the gut microbiomes in this group (p = 0.01). A taxonomic analysis revealed that the abundances of Enterococcaceae and Enterococcus were higher in the bile microbiomes of the CBD stone group. A metabolic profile analysis showed that the acetate, formate, and asparagine levels were higher in the CBD stone group. A pathway enrichment analysis showed the metabolic pathways (Arginine and Proline Metabolism, Aspartate Metabolism, Glycine, and Serine Metabolism, and Ammonia Recycling pathways) that were associated with these differences. Preclinical experiments demonstrated systemic inflammation and extracellular trap formation in the CBD stone group. Our study highlights the importance of biliary dysbiosis and bile metabolites, specifically acetate and formate, in CBD stone development and progression. These findings have implications for the development of diagnostic and therapeutic strategies using microbiomes for CBD stones.

Effect of Immune Plasma Therapy on Mortality and Morbidity in Patients with Covid-19: A Retrospective Study

Objective: Immune plasma therapy, a method employed for passive immunization, has been utilized as a treatment modality based on historical precedents during the Covid-19 pandemic, a global crisis resulting in the unfortunate demise of countless individuals. The objective of this study is to investigate the impact of immune plasma therapy on laboratory parameters and the overall survival rate in patients with Covid-19 pneumonia. Material and Methods: Our study was designed as a retrospective analysis, conducted at a tertiary healthcare institution from April 1, 2020, to December 31, 2020. The study population comprised individuals aged 18 and above, presenting with pulmonary involvement, and diagnosed with Covid-19 using the polymerase chain reaction (PCR) method at our hospital. The inclusion criteria encompassed patients who received immune plasma therapy, as well as a control group matched for age, gender, and admission date, who did not undergo immune plasma therapy. Exclusion criteria involved patients with low serum IgA levels, those who did not provide consent for immune plasma therapy, and individuals below the age of 18. Results: The study comprised a total of 72 patients who received immune plasma therapy and 72 patients in the control group, matched for age and gender, all diagnosed with Covid-19. The median age of the patients was 70 years, ranging from 19 to 91, and 56.9% (41) of them were female. When comparing the immune plasma group with the control group, several significant differences were observed (p&lt;0.05). These included elevated levels of leukocytes, neutrophils, neutrophil-lymphocyte ratio (NLR), glucose, aspartate aminotransferase (AST), sedimentation rate, C-reactive protein (CRP), ferritin, fibrinogen, d-dimer, and low levels of platelets and lymphocytes in the control group. Furthermore, in the immune plasma therapy group, significant associations were found between mortality and lymphocyte count, NLR, AST, CRP, and d-dimer elevation after treatment (p&lt;0.05). Additionally, pre- and post-treatment measurements of troponin, procalcitonin, and ferritin were significantly correlated with mortality (p&lt;0.05). Conclusion: The administration of immune plasma therapy, involving the transfer of neutralizing antibodies, has demonstrated a favorable impact on laboratory parameters and overall survival in severe cases of Covid-19 pneumonia, particularly during the early stages of the disease.

Plurihormonal Pituitary Neuroendocrine Tumours - A Single Centre Experience.

Introduction. Plurihormonal pituitary neuroendocrine tumours (PitNET)/adenomas are pituitary neuroendocrine tumours composed of monomorphous cell populations expressing anterior pituitary transcription factors and/or hormones belonging to more than one cell lineage. Studies dedicated to plurihormonal tumours are rare and quite heterogenous with their results, bearing in mind changes in diagnostic criteria and inconsistent use of antibodies for anterior pituitary transcription factors in the diagnostic immunohistochemical panel. Material and Methods. We retrospectively analysed all patients surgically treated for PitNETs from 2016 to July 2022 in a tertiary healthcare institution. All tumours previously diagnosed PitNETs with the word "plurihormonal" were re-examined and potentially re-classified, according to 2022 WHO classification of endocrine tumours. Results. Among 721 patients surgically treated for PitNET in 5.5 years period, the diagnosis of plurihormonal PitNET was established in 11 tumours (1.3%). All tumours showed diffuse and intensive positivity for anterior pituitary transcription factors PIT1 and SF1. Clinically, all patients presented with acromegaly. Conclusions. Retrospective studies related to newly defined plurihormonal PitNETs with a reassessment of diagnoses are necessary due to their rarity and ambition to investigate their origin and biological behaviour. The fact that the majority of plurihormonal PitNETs are clinically presented with acromegaly and show simultaneous positivity to PIT1 and SF1 transcription factors deserve special attention and need for further research in larger cohorts of these exceptional tumours.

Moderating role of meaning in life in the relationship of death anxiety, experiential avoidance and health-related quality of life among type 2 diabetes patients

Individuals diagnosed with type 2 diabetes mellitus may experience death anxiety and experiential avoidance, which may impact negatively on health-related quality of life. Meaning in life is a positive psychological resource that protects against negative psychosocial outcomes. Although a direct relationship between these variables exists, to our knowledge, previous research has not explored their interaction effect. The present study examined whether meaning in life moderates the relationship between (1) multidimensional death anxiety and health-related quality of life, and (2) experiential avoidance and health-related quality of life among type 2 diabetes mellitus patients. The pool of participants consisted of 311 type 2 diabetes outpatients drawn from a tertiary health care institution in South-East Nigeria. The participants completed several self-report measures, such as the short form of the Diabetes Quality of Life Questionnaire, Death Anxiety Inventory–Revised, Acceptance and Action Questionnaire, and the Presence of Meaning in life subscale of Meaning in Life Questionnaire. The results of a regression analysis showed that death anxiety in terms of death acceptance, death finality, and thoughts about death were independently associated with poor health-related quality of life at low, but not at average and high levels of meaning in life. Externally generated death anxiety was associated with poor health-related quality of life at low and average, but not at high levels of meaning in life. Finally, experiential avoidance was associated with poor health-related quality of life at low and average, but not at high levels of meaning in life. We concluded that psychological interventions geared towards promoting health-related quality of life of type 2 diabetes mellitus patients should consider integrating meaning in life for its protective nature in improving positive health outcomes and recovery.

Utilization Rate of Primary Health Services in the Diagnosis, Treatment, and Follow-Up of Patients Diagnosed with Rheumatic Disease

In this study, we aimed to investigate the utilization of primary health care in the diagnosis, treatment and follow-up of patients diagnosed with rheumatic disease. For this purpose, 350 patients with rheumatic disease were included in the survey and 26-question about the demographic information of the patients, utilization of primary health care during and afterwards the diagnosis process of the disease. The mean age of the participants was 48.67±13.26, and 73.7% (n=258) of them were female. The patients were diagnosed with rheumatic disease an average of 6.74±6.07 years ago. Joint pain was the most common complaint with a rate of 79.7%. 22% (n=77) of the patients were referred to first internal medicine outpatient department. First admission rate to a family physician was 12.3% (n=43) and 55.8% (n=24) of these patients were referred to higher care for diagnosis. 69.1% (n=242) of the patients were diagnosed in a tertiary healthcare institution. According to the analysis results, 47.7% of the patients had a prescription from their family physician for their rheumatic diseases, but only 6% (n=21) went to their primary care physician for check-ups for their rheumatic diseases. In our study, the rate of use of primary care services was high when patients' rheumatic disease symptoms first begin and were only prescribed prescription drugs after diagnosis. The tendency to prefer primary care for follow-up was low. Contributing to all processes of the rheumatic disease will reduce the workload of hospitals and contribute to a cost-effective approach. For this, the factors that will eliminate the negative perceptions of patients towards primary care can be reviewed and the rate of patients' preference for primary care can be increased.

Study of Psychiatric Morbidity among Patients with Chronic Obstructive Pulmonary Disease in a Tertiary Health Care Institute

Study of Psychiatric Morbidity among Patients with Chronic Obstructive Pulmonary Disease in a Tertiary Health Care Institute

Effect of Emotional Intelligence on Employee Caring Behaviour: a Study of Professional Nurses in Tertiary Health Care Institutions in Benue State, Nigeria

This study examined the effect of emotional intelligence on caring behaviour of professional nurses in tertiary health care institutions in Benue State, Nigeria. Specifically the study sought to examine the effects of self-awareness, self-management, social awareness and relationship management on caring behaviour of professional nurses in tertiary health care institutions in Benue State. Anchored on Jean Watson’s Theory of Human Caring, the study adopted the survey design. Population of the study consisted of 586 professional nurses working in the two tertiary healthcare facilities in Benue State (312 from the Federal Medical Centre and 274 from the Benue State University Teaching Hospital). A sample size of 245 was arrived at with the aid of Taro Yamene’s sampling formula. Primary data were gathered through questionnaire. The data were coded and analysed with the aid of SPSS. Hypotheses of the study were tested using regression analysis at 5% level of significance. Findings revealed that self-awareness, self-management, social awareness and relationship management all have significant effect on caring behaviour of professional nurses in tertiary health care institutions in Benue State, Nigeria. The study concludes that there is a significant relationship between emotional intelligence and caring behaviour of professional nurses in tertiary health care institution in Benue State. The study recommends that in order to ensure quality care to patients, management of tertiary healthcare organisations in Benue State should recognize and develop EI abilities in nurses who constantly struggle to show care since EI can be taught and learnt.

Effect of Coronavirus Disease 2019 Pandemic on Spinal Surgery Patients: Our Experience at a Tertiary Care Center.

In December 2019, a cluster of atypical cases of pneumonia was reported in Wuhan, China, which was later designated as Coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO) on Feb 11, 2020. We all are facing a global pandemic, and it is very important to be clear that there is no correct roadmap to navigate this difficult situation. It is imperative to state that this global pandemic impacted the spine care services of our institute. In the present study, we have assessed the spine surgeries performed by orthopedic surgeons in terms of volume and etiologies during the COVID-19 pandemic and compared the data with a pre-COVID period. We retrospectively collected data from all patients who underwent spinal surgeries at our institute under the department of orthopedics from August 20, 2019 to August 20, 2020 (a total of 12 months duration). The data was then divided into two groups-pre-COVID period (August 20, 2019-February 19, 2020-6 months) and during the COVID pandemic (February 20, 2020-August 20, 2021-6 months). A total of 140 patients underwent surgery at our institute from August 20, 2019 to August 20, 2020. Of these, 91 patients underwent surgery during the pre-COVID period, and 49 patients underwent surgery during the COVID pandemic. In this devastating phase of the pandemic, our department's total number of surgeries significantly declined to 46.15%. The routine surgeries performed during the pandemic phase show a steep fall from 59.34% in the pre-COVID period to 10.20%. This paper is meant to focus attention on the exorbitant reduction in the operative workflow of the spine patients during the COVID-19 pandemic at a tertiary healthcare institute. It is the need of the hour that orthopedic surgeons maintain equilibrium while providing the best possible treatment to their patients and limiting the spread of the COVID-19 pandemic.

Association of immune status with haematology and inflammatory markers in treatment naïve HIV positive patients from a tertiary health care institute e HIV Positive Patients from a Tertiary Health Care Institute

Association of immune status with haematology and inflammatory markers in treatment naïve HIV positive patients from a tertiary health care institute e HIV Positive Patients from a Tertiary Health Care Institute

Relationship between the prostate cancer screening attitudes, beliefs, and knowledge levels of men working in a healthcare institution

Objective: The attitudes and knowledge level of individuals toward prostate cancer screening are important factors affecting participation in screening. This study aimed to determine the relationship between prostate cancer screening attitudes, beliefs, and knowledge levels of men working in a tertiary healthcare institution. Material and Methods: A total of 236 healthcare personnel working in a tertiary education and research hospital were included in the study. In the collection of data, an information form, the Health Beliefs Model Scale for Prostate Cancer Screenings (HBM-PCS), and the Knowledge About Prostate Cancer Screening Questionnaire (KPCSQ) were used. Results: The mean age of the men participating in the study was 46.7±5.9 years. Of the participants, 16.1% had previously undergone a prostate-specific antigen test, and 67.4% had a low level of knowledge. When the subscales of HBM-PCS were examined, the participants had a mean score of 12.6±3.8 on susceptibility perception, 11.9±3.6 on seriousness perception, 32.9±7.6 on health motivation perception, 38.5±10.3 on barrier perception, and 24.8±5.7 on benefit perception. There was no significant difference in the participants’ HBM-PCS scores according to their KPCSQ scores. Conclusion: It was determined that the men participating in this study had a low level of knowledge, moderate levels of susceptibility, seriousness, and barrier perceptions, and high levels of health motivation and benefit perceptions concerning prostate cancer screening. It is important to raise the awareness of healthcare workers about the benefits of screening and early diagnosis of prostate cancer through training programs. Keywords: prostate cancer, screening, attitude, belief, knowledge level