Tertiary Health Care Institution Research Articles

Assessment of the ROX index as a predictor of invasive ventilation in patients with community-acquired pneumonia

Aims: Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality worldwide, particularly among elderly patients and those with comorbid conditions. CAP can lead to severe respiratory failure, often necessitating invasive mechanical ventilation (IMV). Early identification of patients at high risk for intubation is crucial for optimizing management and improving outcomes. The ROX index, which incorporates respiratory rate, oxygen saturation, and fraction of inspired oxygen, has emerged as a potential tool for predicting the need for IMV in patients with respiratory distress. This study aims to evaluate the effectiveness of the ROX index in predicting IMV in patients hospitalized with CAP. Methods: This retrospective cohort study included patients diagnosed with CAP who were admitted to a tertiary healthcare institution between January 1, 2019, and January 1, 2024. The ROX index was calculated at hospital admission using respiratory rate, oxygen saturation (SpO₂), and fraction of inspired oxygen (FiO₂). Severe pneumonia was defined as pneumonia severity index (PSI) class IV or V, and subgroup analyses were conducted for these patients to evaluate the diagnostic performance of the ROX index. The primary outcome was the requirement for IMV, and the predictive ability of the ROX index was evaluated. Results: A total of 416 patients were included, with 30 (7.2%) requiring invasive mechanical ventilation. The mean ROX index was significantly lower in the intubation group (14.4±4.5) compared to the non-intubation group (23.8±5.4) (p

Sleep quality and risk of obstructive sleep apnea in psoriasis and hidradenitis suppurativa patients.

Psoriasis and Hidradenitis Suppurativa (HS) are chronic inflammatory skin conditions that significantly impact quality of life, sleep, and increase morbidity. This study aims to compare sleep quality and the risk of obstructive sleep apnea (OSA) in patients with these conditions. Additionally, it explores the relationships between sleep disorders, demographic factors, disease severity, and inflammatory markers. The study included 25 HS and 50 psoriasis patients diagnosed and followed in the Dermatology Department of a tertiary healthcare institution. Disease severity was assessed using the HURLEY score for HS patients and the Psoriasis Area and Severity Index (PASI) for psoriasis patients. Sleep quality and OSA risk were evaluated using the Pittsburgh Sleep Quality Index (PSQI), Berlin, and STOP-Bang questionnaires. A total of 75 patients participated, with 50 in the psoriasis group and 25 in the HS group. Of the participants, %41 were female, with a mean age of 36.4 ± 12.7 years. HS patients had significantly higher PSQI and STOP-Bang scores compared to psoriasis patients (p = 0.001 and p = 0.003, respectively). No significant associations were found between disease severity and questionnaire scores in either condition. However, the rate of high-risk OSA was higher in males (p = 0.004) and more prevalent in HS patients than in psoriasis patients (%64 vs. %26, p = 0.002). HS patients face a significantly higher risk for OSA due to factors like obesity, smoking, increased neck and waist circumference, and elevated inflammation. Routine assessment of OSA risk using tools like the PSQI, Berlin, and STOP-Bang questionnaires is recommended for these patients.

Effectiveness of a Knowledge Level of Hypertension on Blood Pressure Control, Treatment Adherence, and Physical Activity of Hypertensive Individuals.

Individuals' knowledge and attitudes about hypertension are important in controlling blood pressure (BP) and reducing hypertension-related mortality and morbidity. The current study aimed to investigate the effect of hypertension knowledge level on treatment adherence, BP control, and physical activity of hypertensive individuals. This prospective and cross-sectional study was conducted in the Family Medicine clinic of a tertiary healthcare institution between October 2023 and April 2024. The study included 218 patients with essential hypertension. The BP of all patients was measured with a calibrated mercury sphygmomanometer, and the patients were divided into two groups: uncontrolled BP and controlled BP. The Hypertension Knowledge Level Scale (HK-LS), General Practice Physical Activity Questionnaire (GPPAQ), and Modified Morisky Medication Adherence Scale (MMMAS-6) were administered to all participants. Although 40.8% (n = 89) of the patients had their BP under control, 59.2% (n = 129) did not. The median weight of the participants whose BP was not under control was higher than those whose BP was under control (p < 0.05). A significant positive correlation was found between the hypertension knowledge score and the Morisky total score, Morisky motivation, and Morisky knowledge scores. There was a significant negative correlation between the GPPAQ score and both systolic and diastolic BP, as well as a significant positive correlation with hypertension knowledge levels. Assessing the knowledge level of hypertensive patients about their disease, recognizing their lifestyles, and questioning their habits is crucial for recommending individualized health interventions tailored to the needs and characteristics of this population.

HIV Patients' Mindfulness Moderates How Death Anxiety and Depression Impact Life Quality.

Many people living with HIV (PLWH) experience death anxiety and depression, which may impact negatively on their health-related quality of life (HRQoL). Mindfulness is a psychological resource that protects against death anxiety and depression and promotes HRQoL. Although a direct association among these variables exist, little is known about their interactive effect. This study examined the role of PLWH mindfulness in the relationship between (a) death anxiety and HRQoL, and (b) depression and HRQoL. Participants included 311 HIV patients (199 women, 122 men, mean age = 30.52) selected from a tertiary healthcare institution in Nigeria. They completed relevant measures. Results showed that mindfulness moderated the effect of death anxiety on HRQoL. Mindfulness also buffered the effect of depression on HRQoL. Clinical efforts to improve HRQoL of PLWH should consider mindfulness-based training program due to its potentials in mitigating the effects of death anxiety and depression on health and recovery.

Anatomical predispositions for silent cerebral infarction postcarotid artery stenting: a retrospective cohort.

Silent cerebral infarction (SCI) that manifests following carotid artery stenting (CAS) has been postulated to correlate with cognitive decline, the onset of dementia, and an increased risk of subsequent cerebrovascular events. This investigation aimed to thoroughly examine the potential anatomical predispositions that are linked to the occurrence of SCI post-CAS, and further develop a predictive nomogram that could accurately forecast the risk of SCI post-CAS. The present investigation conducted a retrospective examination of datasets from 250 individuals presenting with carotid artery stenosis who had been subjected to CAS within a tertiary healthcare institution from June 2020 to November 2021. Stratified by the procedural date, participants were allocated into a training cohort and a validation cohort. A nomogram was constructed predicated on salient prognostic determinants discerned via a multivariate logistic regression analysis. An aggregate of 184 patients were incorporated into the study, of which 60 (32.6%) manifested SCI, whereas 124 (67.4%) did not. Within the training cohort ( n =123), age (OR 1.08, 95% CI: 1.01-1.16; P =0.034), aortic arch type (Type III vs. I: OR 10.79, 95% CI: 2.12-54.81; P =0.005), aortic arch variant (OR 47.71, 95% CI: 6.05-376.09; P <0.001), common carotid artery (CCA) ostium lesions (OR 6.93, 95% CI: 1.49-32.32; P =0.014), and proximal tortuosity index (TI) (OR 1.01, 95% CI: 1.00-1.02; P =0.029) were demarcated as standalone risk predispositions for SCI subsequent to CAS. The concordance index (C-index) for the training cohort's nomogram stood at 0.89 (95% CI: 0.84-0.95). Moreover, the said nomogram exhibited commendable efficacy within the validation cohort (C-index=0.94) as well as the entire participant base (C-index=0.90). Furthermore, the decision curve analysis illustrated the exemplary clinical applicability of the nomogram. The findings of this inquiry underscore that age, aortic arch type, aortic arch variant, CCA ostium lesions, and proximal TI serve as independent determinants linked with SCI post-CAS. The formulated nomogram, predicated on these risk factors, possesses robust prognostic significance, and might serve as a valuable adjunct to inform clinical decision-making.

Exploring the Effect of Leadership Styles on Financial Management Practices in Tertiary Healthcare Institutions in South-South Nigeria

Leadership in healthcare institutions has a significant effect on financial management practices, which are crucial for ensuring the sustainability and efficiency of service delivery. This study explores the effect of various leadership styles—autocratic, democratic, laissez-faire, bureaucratic, transformational, and transactional—on financial management practices, specifically financial accountability and budgeting, in two tertiary healthcare institutions in South-South Nigeria: University of Port Harcourt Teaching Hospital (UPTH) and Rivers State University Teaching Hospital (RSUTH). Using a cross-sectional design approach, quantitative data were collected through structured questionnaires administered to 195 participants from UPTH and 115 from RSUTH. The data were analyzed using Descriptive statistics and Spearman’s rank-order correlation. The results revealed that at RSUTH, transformational and autocratic leadership styles positively influenced financial accountability, with transformational leaders fostering transparency and ethical practices, while autocratic leaders ensured compliance with financial standards. In terms of budgeting, democratic and transactional leadership styles were positively associated with budgeting practices at RSUTH, supporting inclusive and structured financial planning. At UPTH, laissez-faire and bureaucratic leadership styles unexpectedly showed positive correlations with budgeting, suggesting that decentralized decision-making and procedural rigor may encourage employee engagement in financial planning. These findings highlight the importance of adaptable leadership that balances compliance with collaborative and innovative approaches to financial management. The study concludes that healthcare institutions should prioritize transformational and democratic leadership styles, which promote transparency, accountability, and participatory decision-making. Implementing leadership development programs to equip leaders with adaptable skills based on situational needs is recommended. Future research should investigate the long-term effects of leadership styles on financial sustainability across diverse healthcare contexts.

A Comparative Study of Fetal and Maternal Outcomes in Booked and Unbooked Mothers Delivering at a Tertiary Health Care Institute in Lagos- Retrospective Cohort Study

A Comparative Study of Fetal and Maternal Outcomes in Booked and Unbooked Mothers Delivering at a Tertiary Health Care Institute in Lagos- Retrospective Cohort Study

Validation and efficacy of a tele-yoga intervention for improving psychological stress, mental health and sleep difficulties of stressed adults diagnosed with long COVID: a prospective, multi-center, open-label single-arm study.

The objective of this study was to validate and test the efficacy of a 16-week tele-yoga intervention for perceived stress, anxiety, depression, and insomnia in individuals who had had COVID-19 infection in the previous year, and had reported moderately high levels of psychological stress (PSS ≥14). 25 and 50-min versions of the program were developed. They were then validated using Lawshe's content validity ratio after obtaining feedback from 20 yoga therapy experts. The safety and efficacy of the two programs were subsequently tested in a prospective, multicenter, open-label single-arm study. Eighty-six adults (18 male, 68 female) were recruited from two tertiary mental healthcare institutions, 48 in NIMHANS, Bengaluru; and 38 in SCARF, Chennai. Participants were assessed at weeks zero, 4, and 16 using validated tools. Data were analyzed using a Mixed Model, Intention to Treat approach. After week 16, 31 subjects remained in the trial and continued to practice yoga without any side effects. Subjects who adhered in the trial had significantly higher levels of baseline anxiety and depression as compared to subjects who dropped out. Results at week 4 included significant reductions in levels of perceived stress, anxiety, and insomnia; improvements were maintained at week 16. Correlations between number of yoga sessions and post-intervention PSS scores were negative (r = -0.49), and significant (p< 0.05). Both tele-yoga programs proved safe, useful tools to counteract perceived stress, anxiety and insomnia. Future trials should explore the utility of tele-yoga as a tool to enhance well-being and manage stress.

Adherence to antihypertensive medications in Omani patients: a comparison of drug biochemical analysis and the Morisky Medication Adherence Scale.

Medication nonadherence is a major risk factor for suboptimal or failed hypertension pharmacologic therapy. To determine the nonadherence rate to antihypertensive medications using high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) and the self-reported Morisky Medication Adherence Scale (MMAS). This study used a prospective cross-sectional cohort design. Patients with hypertension aged ≥18 years and prescribed at least one antihypertensive medication were recruited from an outpatient hypertensive clinic at a tertiary healthcare institution in Oman. Adherence was assessed using LC-MS/MS urine analysis and the MMAS. In total, 162 patients completed the MMAS questionnaire and provided urine samples for LC-MS/MS analysis. The overall mean age of the cohort was 55 ± 13 years, and 57% of the patients were men. The mean systolic and diastolic blood pressures were 146 ± 18 mmHg and 79 ± 10 mmHg, respectively. Using the MMAS method, 65% of the patients reported nonadherence. However, LC-MS/MS analysis revealed that only 27% of the patients were nonadherent. The adherent group by LC-MS/MS had significantly lower systolic (P = 0.026) and diastolic blood pressures (P < 0.001) than the nonadherent group, whereas no differences were observed using the MMAS method. There was weak or no agreement between the MMAS and LC-MS/MS results (P = 0.142). Almost one-fourth of our patients with hypertension were nonadherent to their medications. There was a weak concordance between the MMAS and LC-MS/MS methods in detecting medication nonadherence. Further research into noninvasive convenient adherence scales or methods and their correlations with LC-MS/MS analysis is warranted.

Challenges and barriers toward conducting research at a tertiary hospital in Saudi Arabia

Background: In healthcare, research is essential for improving disease diagnosis and treatment, patient outcomes, and resource management, while fostering evidence-based practice. However, conducting research in this sector can be challenging, and healthcare workers may face various obstacles while engaging in research activities. Therefore, understanding healthcare workers’ attitudes toward research participation is essential for overcoming barriers and increasing research engagement. In this study, these aspects are examined through the analysis of survey data from a tertiary healthcare institution in Saudi Arabia. Method: Data obtained via a survey conducted between April and November 2022 among the healthcare workers and employees at a tertiary care hospital in Saudi Arabia were analyzed using descriptive and bivariate statistics. Results: The study sample comprised 713 respondents, 61.71% of whom were female, 58.06% were 26–41 years old, and 72.93% had not undertaken any research as employees or affiliates. A significant association was noted between age group and time constraints (p = 0.004) and lack of opportunity for research (p = 0.00), which were among the identified barriers to research participation. A significant association was also found between gender and barriers to pursuing research (p = 0.012). When the 193 (27.07%) participants who conducted research were asked about the challenges they encountered during this process, gender was significantly associated with difficulties in allocating time for conducting research (p = 0.042) and challenges in accessing journals and references (p = 0.016). Conclusion: The study findings highlight the importance of addressing the barriers and challenges in promoting positive attitudes toward research participation among healthcare workers considering their gender and age. In this manner, healthcare institutions can adopt an environment conducive for professional research engagement.

How are different traditional Chinese medicine modalities deployed by clinical practitioners in China? Findings from a national survey

ObjectiveTraditional Chinese medicine (TCM) incorporates traditional diagnostic methods and several major treatment modalities including Chinese herbal medicine, Chinese patent medicine, and non-pharmacological methods such as acupuncture and tuina. Even though TCM is used daily by more than 70,000 healthcare facilities and over 700,000 clinical practitioners in China, there is a poor understanding of the extent to which TCM diagnostic methods are used, how different treatment modalities are deployed in general, and what major factors may affect the integration of TCM and Western medicine. This study aimed to fill this void in the literature. MethodsIn the 2021 National Healthcare Improvement Evaluation Survey, we included three questions gauging the perception and practices of TCM amongst physicians working in TCM-related facilities, investigating the frequency of their deployment of TCM diagnostic methods, and predominant TCM treatment methods. Our empirical analysis included descriptive statistics, intergroup chi-square analysis, and binary logistic regression to examine the association between different types of facilities and individual characteristics and TCM utilization patterns. ResultsA total of 7618 clinical physicians comprised our study sample. Among them, 84.27% have integrated TCM and Western medicine in their clinical practice, and 80.77% of TCM practitioners used the 4 diagnostic methods as a tool in their clinical practice. Chinese herbal medicine was the most widely utilized modality by Chinese TCM physicians (used by 88.49% of respondents), compared with the Chinese patent medicine and non-pharmacological TCM methods, which were used by 73.14%, and 69.39%, respectively. Herbal tea as an out-of-pocket health-maintenance intervention is also a notable practice, recommended by 29.43% of physicians. Significant variations exist across certain institutions, departments, and individual practitioners. ConclusionGiven that most of the surveyed physicians integrated TCM with Western medicine in their clinical practices, the practice of “pure TCM” appears to be obsolete in China’s tertiary healthcare institutions. Notably, remarkable variation exists in the use of different TCM modalities across institutions and among individuals, which might be related to and thus limited by the practitioners’ experience. Future research focusing on the efficacy and safety of TCM interventions for specific diseases, the development of standardized clinical guidelines, and the enhancement of TCM education and training are called for to optimize TCM-Western medicine integration.

The pivotal role of neurosurgeons in transitional care: A comprehensive tertiary healthcare institution's experience.

Transitional care (TC) is increasingly crucial, particularly in neurosurgery, where optimal follow-through of patients' care is paramount. Challenges of transition are exacerbated by the complexity of neurosurgical conditions, with pediatric and adult neurosurgery often managed separately by different attending neurosurgeons or in different institutions. While numerous models for transitioning have been proposed, several barriers persist, impeding successful transfer from pediatric to adult settings. Our review focuses on important roles neurosurgeons can play in facilitating successful transition, exploring some existing TC models, with emphasis on the benefits of maintaining a single provider. Clinic visits data between 2019 to 2023 of patients between the ages of 16 to 26 was compiled retrospectively. Successful transition was defined as continued follow-up moving from pediatric to adulthood with lost to follow-up being that of unsuccessful transition. Age, diagnosis and whether patients were successfully transitioned or lost to follow-up were documented. 1829 neurosurgical patients between the ages of 16 to 26 were identified over 5 years. A snapshot review identified 78 adolescent patients deemed to require follow-up into adulthood. 13 patients had epilepsy, 32 central nervous system (CNS) tumors, 17 congenital conditions, 14 neurovascular, and 2 patients had idiopathic intracranial hypertension. All 78 were noted to have successfully transited into their adulthood (age 21 and beyond). Having the same providers; having pediatric and adult neurosurgery within the same institution, was the single most important factor in facilitating successful transition. Neurosurgeons in institutions, particularly those with experience and competencies in both pediatric and adult care, can serve as crucial anchors during the transitional period. At our institution, the implementation of this continuity of care model has demonstrated remarkable success. Institutions with both pediatric and adult services would be uniquely positioned to develop and implement effective transitional care.

Awareness and Preferences about Packaged Food Labelling amongst Healthcare Personnel of a Tertiary Healthcare Institution in Eastern India

Abstract Introduction: This study was conducted to assess the awareness and preferences of healthcare personnel (HCP) in making healthy dietary choices leading to a reduction in the risk of developing non-communicable diseases (NCDs). Materials and Methods: This descriptive hospital-based study was conducted amongst 506 HCP. A pre-tested questionnaire was used to collect the information from participants. Descriptive analysis was conducted and proportions with percentages were reported. Results: Around 93.3% of the participants reported reading the labelling of packaged food items before purchasing. About 80% looked for the information present on both sides of packaged food items. The most common information checked by the respondent was the expiry date and manufacturing date. Respondents reported the most common nutrient content they looked for was protein (31%) followed by fat (29%). Conclusion: The practice of checking nutrition information was low amongst the study population even though there was high awareness regarding FOPL. There is a need to educate people on nutrition information on packed food items to enable them to make healthier choices.

Outcomes of Microscopic vs. Endoscopic Tympanoplasty at a Tertiary Healthcare Institution in Western Maharashtra.

Introduction Chronic suppurative otitis media (CSOM) involves tympanic membrane perforation and is traditionally treated with microscopic tympanoplasty. Recent advancements in endoscopic techniques offer enhanced visibility and outcomes. This retrospective study compares endoscopic and microscopic tympanoplasty outcomes in CSOM patients between 2023 and 2024. Aim This study aims to evaluate outcomes of endoscopic vs. microscopic tympanoplasty in patients suffering from CSOM who are presenting at our tertiary care center. Methodology A retrospective study of 100 patients of CSOM undergoing tympanoplasty. Sixty patients underwent microscopic tympanoplasty and 40 endoscopic tympanoplasty. Postoperative successful uptake of graft and resultant hearing were compared between the two groups. Results Ninety-seven out of 100 patients had a successful graft uptake at three months. Fifty-eight patients in the microscopic tympanoplasty group (96.67%) and 39 in the endoscopic group (97.5%) had healed the tympanic membrane at three months of follow-up (p = 0.864). At postoperative three months, no statistically significant difference was found in the improvements in air conduction levels of the two groups (p = 0.995). No significant difference in the air-bone gap between the two groups (p = 0.095). The average air-bone gap at three months postoperative was 7.95 ± 4.20 decibel (dB) in the microscopic tympanoplasty group and 7.80 ± 4.10 dB in the endoscopic tympanoplasty group (p = 0.680). The incidence of postoperative wound area pain, numbness, and ear discharge was significantly higher in patients undergoing microscopic tympanoplasty (p < 0.05). Conclusion The two methods did not significantly differ in terms of the outcome of the hearing test or the rate of graft uptake. However, a better result was noted in endoscopic tympanoplasty compared to the microscopic tympanoplasty group. Postoperative complications encountered were less in the endoscopic tympanoplasty group.

Effect of National Accreditation Board for Hospital-Recommended Trainings on Patient Care Standards: A Comparative Study Based on the National Quality Assurance Standards Guidelines in a Tertiary Health-care Institute.

The National Quality Assurance Standards (NQAS) have been developed keeping in specific requirements for public health facilities as well global best practices. Standards are primarily meant for providers to assess their quality for improvement through predefined standards and to bring up their facilities for certification. To study the effect of National Accreditation Board for Hospitals (NABH)-recommended training on patient care standards based on NQAS guidelines. The research was conducted at a tertiary-level teaching institute and medical care center in North India. The institute has multiple blocks, few have undergone training for NABH standards, and few have not due to administrative reasons. Only the NABH-trained blocks underwent accreditation process through NABH and provided an opportunity to study whether there is a difference in patient care standards between NABH-trained staff and nontrained staff. It was a checklist-based observational study. The evaluation covered seven key areas in intensive care unit (ICU) and wards in both NABH-trained and nontrained hospital blocks: patient rights, inputs, support services, clinical services, infection control, quality management, and outcome. The compliance percentage of ICU and wards was measured for NABH-trained and nontrained hospital blocks. NABH-trained blocks in both areas showed better compliance adhering to standards as compared to nontrained blocks for all seven key areas. The study findings indicate that NABH-recommended training showed positive impact on patient care standards as per the NQAS guidelines. The NABH-trained hospital block exhibited superior compliance with various domains including patient rights, inputs, support services, clinical services, infection control, and quality management.

A Comparative Study on Videonystagmography in Patients with Vertigo between Open-Loop and Closed-Loop Irrigation Technique

Abstract Background and Aims: Patients with balance disorders are evaluated by a battery of vestibular function tests including videonystagmography (VNG). However, the caloric test component of VNG is risky to be performed in patients with ear infections. In order to perform the test in such patients, closed-loop technique has been performed. This study aimed to compare the efficacies of closed- and open-loop techniques of the caloric test using VNG in patients with vertigo so that it can be applied to patients with ear infections also. Setting and Design: A prospective study was conducted at the neurotology clinic in our tertiary health-care Institution between May 2019 and April 2020. Subjects and Methods: The study involved 83 patients aged between 20 and 60 years with complaints of giddiness patients who were evaluated using videonystagmography with open-loop and closed-loop method and the results were compared. Results: By comparing the outcome of caloric responses in both ears using both these techniques, it is evident that both techniques’ outcome is similar in detecting the caloric response of the ear as there was no statistically significant differences among both irrigation techniques. Conclusions: Closed-loop irrigation technique is equally as effective as open-loop technique in the evaluation of vertigo so that it can be used for the evaluation of vestibular system for patients in whom the open-loop technique is contraindicated.

Diabetes Distress and Health-Related Quality of Life among Patients with Type 2 Diabetes-Mediating Role of Experiential Avoidance and Moderating Role of Post-Traumatic Growth.

Many people living with type 2 diabetes experience diabetes distress which impacts negatively on their health-related quality of life (HRQoL). However, little is known about the modifiable factors or psychological processes that make this happen. The current study examines the role of experiential avoidance and post-traumatic growth (PTG) in association with diabetes distress and the HRQoL. Participants included 303 patients with type 2 diabetes conveniently selected from two tertiary healthcare institutions in Nigeria. They completed relevant self-report measures. The Hayes PROCESS macro for SPSS was used for data analysis. The results showed that experiential avoidance mediated the association between diabetes distress and the HRQoL [95% CI: -0.15, -0.07]. PTG significantly moderated the association between diabetes distress and the HRQoL [95% CI: 0.01, 0.02]. Specifically, diabetes distress was associated with a poor HRQoL only among patients with low levels of PTG but not among those with average and high levels of PTG. These findings underscore the importance of Acceptance and Commitment Therapy as it can potentially decrease the experiential avoidance behaviour of patients. Moreover, intervention should also target the facilitation of PTG due to its beneficial effects in reducing the negative effects of diabetes distress on health and recovery.

Perceived outcomes of medical teaching institute reforms: insights from management, faculty, and administration in Pakistani tertiary health care

ObjectiveThe study aims to explore the perceived outcomes of Medical Teaching Institution (MTI) reforms on autonomy and overall performance within tertiary healthcare institutions in Khyber Pakhtunkhwa (KP) province, Pakistan.MethodologyA cross-sectional study was carried out from September 2023 to March 2024, involving interviews with frontline staff, administrative personnel, and senior management within MTI-affiliated institutions. The methodology employed, using both qualitative and quantitative data analysis techniques.ResultsThe study showed that institutional staff members’ knowledge and understanding of the MTI changes differed. Some observed very minor adjustments, while others saw advances in hospital operations and service delivery. Administrative complexity, political meddling, and resource allocation problems were noted as challenges. Positive results were also observed, though, and they included improved infrastructure, possibilities for staff training, and decision-making procedures.ConclusionDespite significant improved, there are still challenges, such as inconsistent staff comprehension, mixed impacts on service delivery, resource allocation issues, and political meddling. Addressing these issues necessitates improved communication, continuous evaluation, and coordinated efforts to improve administrative systems and obtain consistent funding.

Clinical Profile of Leg Symptoms and Reflux in the Legs From Varicose Veins Disease Reported at a Tertiary Healthcare Institute in Jharkhand, India.

Background Varicose veins, affecting 8-10% of the population, are categorized as primary or secondary, depending on the etiology. The aim of thestudy is to assess the clinical profile of leg symptoms and reflux in the legs of varicose veins disease among patients reported in a tertiary hospital. Patients and methods An institution-based cross-sectional exploratory study comprising 56 patients with reflux in legs of varicose veins disease selected through purposive sampling, conducted in the OPD (outpatient department), general surgery, AIIMS (All India Institute of Medical Sciences) Deoghar. The standardized study instrument includes the Aberdeen varicose veins questionnaire, and patients' symptoms and concerns questionnaire, followed by a brief clinical examination based on CEAP (clinical, etiological, anatomical, and pathophysiological)classification and VCSS (venous clinical severity score) for C5/6 and color-flow duplex imaging of both lower limbs. Descriptive and inferential statistics were used for data analysis using IBM SPSS Statistics for Windows, Version 23 (IBM Corp.,Armonk, NY). Results Bilateral presentation of the disease had been seen in 57.1% (n=32) participants, and the common history of present illness reported by participants included swelling along the veins (n=55, 98.2%), pain (n=51, 91.1%), and discoloration (n=33, 58.9%). The clinical grading revealed that most participants, i.e., 87.5% (n=49) had C2 and 75% (n=42) had C3 disease. The majority of participants 96.4% (n=54) suffered from primary varicose veins. Furthermore, all subjects exhibited superficial vein involvement, alongwith one individual having deep vein involvement and a few participants (n=35, 62.5%)having perforators. With this, the majority of participants (n=55, 98.2%) showed reflux pathology. Conclusion Varicose veins typically afflict men in their 40s and 50s who work in positions of extended standing. Limited awareness in the Santhal Pargana division, Jharkhand state, India may result in poor healthcare outcomes. Improving public awareness may help lessen disease-related consequences.

Medication prescribing trends and its associated adverse drug reactions among hospitalized stroke patients from a main stroke center in Penang, Malaysia: A retrospective 5-year study

Adverse drug reactions (ADRs) are one of the major threats in our healthcare system, which profusely affects health, transience, and quality of life, especially among hospitalized patients. This 5-year study was conducted to determine the incidence and analyze the pattern of ADRs among stroke patients at Hospital Seberang Jaya (HSJ), Malaysia which is the main stroke center for all tertiary healthcare institutions in Penang, Malaysia. A total of 1,993 patients were hospitalized for stroke during the study period of 5 years out of which only 30 of them were reported to experience ADRs during hospitalization. The study patients had a mean (SD) of 61 (±11.8) years, Modified Rankin Score (mRS) score of 1.8 (±1.6), NIH Stroke Scale (NIHSS) score of 3.0 (4.0) with median (IQR) duration of adverse drug reaction of 3.0 (7.0) days. The majority of the patients were Malay (66.7%); female (50.0%); experienced ischemic stroke (90.0%); with first episode of stroke (93.3%); with comorbidity dyslipidemia (60.0%); and mostly recovered post ADRs (80.0%). The major drug classes that contributed to ADRs were vaccines, anti-infective, anti-epileptic, anti-platelets, and others. Evaluation of the causality of ADRs indicated majority were possible (50.0%) ADRs based on the Naranjo scale. The evaluated incidence of ADRs among stroke patients is low in this study. This low incidence rate could be possibly due to active clinical interventions by healthcare professionals during hospitalization. ADR monitoring is highly warranted among the sub-population of stroke patients due to the existence of multiple risk factors and their state of vulnerability.