Tertiary Health Care Institution Research Articles

Characteristics and outcomes of people living with HIV hospitalised at tertiary healthcare institutions during the COVID-19 pandemic in Mexico City

BackgroundWhile existing research on people living with HIV (PWH) during the COVID-19 pandemic primarily focused on their clinical outcomes, a critical gap remains in understanding the implications of COVID-19 delivery of in-hospital care services to PWH. Our study aimed to describe the characteristics and outcomes of PWH hospitalised during 2020 in Mexico City, comparing patients admitted due to COVID-19 vs. patients admitted due to other causes.MethodsAll PWH hospitalised for ≥ 24 h at four institutions in Mexico City from January 1st to December 31st, 2020 were included. Patients were classified into two groups according to the leading cause of their first hospitalisation: COVID-19 or non-COVID-19. Characteristics among groups were compared using chi-square and Kruskal tests. A Cox model was used to describe the risk of death after hospitalisation and the characteristics associated with this outcome. Mortality and hospitalisation events were compared to data from 2019.ResultsOverall, we included 238 PWH hospitalised in 2020. Among them, 42 (18%) were hospitalised due to COVID-19 and 196 (82%) due to non-COVID-19 causes, mainly AIDS-defining events (ADE). PWH hospitalised due to COVID-19 had higher CD4 + cell counts (380 cells/mm3 [IQR: 184–580] vs. 97 cells/mm3 [IQR: 34–272], p < 0.01) and a higher proportion of virologic suppression (VS) compared to those hospitalised due to non-COVID-19 causes (92% vs. 55%, p < 0.01). The adjusted hazard ratio (aHR) for AIDS was 3.1 (95%CI: 1.3–7.2). COVID-19 was not associated with death (aHR 0.9 [95%CI: 0.3–2.9]). Compared to 2019, mortality was significantly higher in 2020 (19% vs. 9%, p < 0.01), while hospitalisations decreased by 57%.ConclusionsPWH with COVID-19 had higher VS and CD4 + cell counts and lower mortality compared to those hospitalised due to non-COVID-19-related causes, who more often were recently diagnosed with HIV and had ADEs. Most hospitalisations and deaths in 2020 in PWH were related to advanced HIV disease. The increased mortality and decreased hospitalisations of PWH during 2020 evidence the impact of the interruption of health services delivery for PWH with advanced disease due to the pandemic. Our findings highlight the challenges faced by PWH during 2020 in a country where advanced HIV remains a concern.

Contract Employment and Service Delivery in Tertiary Healthcare Institutions in Enugu State Nigeria

The study examinede Contract Employment and Service Delivery in Tertiary Healthcare Institutions in Enugu State. Specifically, the study sought to: determine the contribution of contract employment to healthcare delivery in tertiary healthcare institutions, examine the extent to which contract employment has assisted healthcare delivery in regard to emergency response in the tertiary healthcare institutions and ascertain the effect of contract employment on Equipment maintenance for special procedure in tertiary healthcare institutions in Enugu State Nigeria. The study adopted descriptive research design. The population of the study was 3694. Freund and Williams formular was adopted in determining the sample size of 3342. Tables, frequency distribution and Mean Scores were adopted in the analysis of data while z-test analysis was used in testing the hypotheses. The findings revealed that Contract employment has significantly contributed to healthcare delivery in tertiary healthcare institutions in Enugu State, Nigeria (where Z- value = 5.215 and the critical Zvalue= 1.96), that contract employment had assisted in healthcare delivery in regard to emergency response time in tertiary healthcare institutions in Enugu State, Nigeria ((whereZ- value = 4.096 and the critical Z-value= 1.96) and that Contract employment had significant positive effect on Equipment maintenance for special procedure in tertiary healthcare institutions in Enugu State Nigeria (where Z- value = 5.983 and the critical Zvalue= 1.96). The study concluded that judicious use of contract employment can enhance service delivery in these institutions by providing specialized expertise, promoting efficiency, and managing costs effectively. The study recommended.

Cutaneous findings in patients with acromegaly and its relationship with concomitant endocrinopathies.

Skin changes in acromegaly are often the first sign of the disease. The aim of this study was to describe the cutaneous findings in patients with acromegaly. In addition, a secondary aim was to investigate the possible association of these findings with remission status and concomitant endocrinopathies. In this prospective multicenter study, 278 patients over the age of 18 years with acromegaly who were followed up in 14 different tertiary healthcare institutions were included. These patients, who were followed up by the Endocrinology Department, were then referred to a dermatologist for dermatological examination. The frequency of skin lesions was investigated by detailed dermatologic examination. Dermatological diagnosis is reached by clinical, dermatological and/or dermoscopic examination, and rarely skin punch biopsy examinations in suspicious cases. The possible association of the skin findings between remitted and nonremitted patients and with concomitant endocrinopathies were evaluated. The most common skin findings in patients with acromegaly in our study were skin tags (52.5%), cherry angiomas (47.4%), seborrhoea (37%), varicose veins (33%), acneiform lesions (28.8%), hyperhidrosis (26.9%) and hypertrichosis (18.3%). Hypertrichosis was significantly more prevalent in patients nonremitted (p: .001), while xerosis cutis was significantly more prevalent in patients remitted (p: .001). The frequency of diabetes mellitus and hypothyroidism was significantly higher in patients with varicose veins and seborrhoeic keratosis than those without. Additionally, the coexistence of hypothyroidism, hyperthyroidismand galactorrhea was significantly higher in patients with Cherry angioma than in those without Cherry angioma (p-values: .024, .034and .027, respectively). The frequency of hypogonadism in those with xerosis cutis was significantly higher than in those without (p: .035). Cutaneous androgenization findings such as skin tag, seborrhoea, acneand acanthosis nigricans are common in patients with acromegaly. Clinicians should be aware that skin findings associated with insulin resistance may develop in these patients. It can be said that the remission state in acromegaly has no curative effect on cutaneous findings. Only patients in remission were less likely to have hypertrichosis. This may allow earlier review of the follow-up and treatment of acromegaly patients presenting with complaints of hypertrichosis. Additionally, it can be said that patients with skin findings such as cherry angioma may be predisposed to a second endocrinopathy, especially hypothyroidism. Including dermatology in a multidisciplinary perspective in acromegaly patient management would be beneficial to detect cutaneous findings earlier.

Antifungal Susceptibility Pattern of Fungi Isolated from Patients with Otomycosis Attending a Tertiary Health Care Institution in Sokoto, Nigeria

Antifungal Susceptibility Pattern of Fungi Isolated from Patients with Otomycosis Attending a Tertiary Health Care Institution in Sokoto, Nigeria

How Moral Distress Contributes to Depression Varies by Gender in a Sample of Sub-Saharan African Nurses

Although research has shown that moral distress harms mental health in diverse populations, information on potential moderators of such associations is scarce. In a sample of sub-Saharan African nurses, we examined the link between moral distress and depressive symptoms. We explored for whom and when such relationships may hold with regard to gender, age, and work experience. Participants consisted of 398 nurses drawn from a tertiary healthcare institution in southeastern Nigeria. Data were collected using the Moral Distress Questionnaire (MDQ) for clinical nurses, and the Center for Epidemiological Studies Depression Scale Revised (CEDS-R). Hayes regression-based macro results for the moderation effects indicated that the association of high moral distress with increased depressive symptoms was robust for women but not significant for men. Although older age and higher years of nursing experience were associated with reduced symptoms of depression, nurses’ age and years of work experience did not moderate the relationship between moral distress and depressive symptoms. To promote mental well-being and preserve the integrity of nurses, gender-based differentials in how morals contribute depressive symptoms should be considered in policy and practice.

Evaluating the hepato-renal function of preeclampsia pregnant women undergoing treatment at tertiary healthcare institutions in Enugu metropolis: A cross sectional study

Evaluating the hepato-renal function of preeclampsia pregnant women undergoing treatment at tertiary healthcare institutions in Enugu metropolis: A cross sectional study

Assessing good clinical practices in a clinical laboratory of a tertiary healthcare institute by evaluating key performance indicators of pre-analytical phase

Assessing good clinical practices in a clinical laboratory of a tertiary healthcare institute by evaluating key performance indicators of pre-analytical phase

IJCM_293A: A Reflective study about knowledge assessment and feedback of medical officers involved in the training programme for management of Animal bite as per NRCP guidelines &amp; Snakebite in Tertiary HealthCare Centre in Central India

Background: A training program for Management of Animal-bite as per NRCP (National Rabies Control Program) guidelines &amp; Snakebite of Medical Officer was conducted in the Tertiary Healthcare Centre. Evaluation of such training has been rarely reported. Objective: The objective of this study was to reflect on the quality of this training program regarding knowledge assessment and feedback. Methodology: A pre-test and post-test cross-sectional assessment of knowledge of medical officers working at health facilities of Bhopal district of Madhya Pradesh government, who attended one-day training program at AIIMS Bhopal in 2023, were conducted through the same questionnaire having 18 single-answer multiple choice questions. Anonymous feedback was also taken through a semi-structured questionnaire. Data were analyzed using R statistical software. The Chi-square test and Wilcoxon signed-rank test was used to compare the pre-and post-test proportions of correct responses and scores, respectively. Results: Out of a total of 54 participants, 64.8% were males. The median (IQR) age was 41 (31,52) years. The majority of the participants (68.5%) had the qualification of MBBS, 14.8% had PG degree, and the rest, 16.6%, had BAMS degree. Median (IQR) pre and post-test scores were9.0 (9.0, 12.0) and 15 (12, 16.0) respectively. All participants agreed that the training was very useful for the patient care and gave positive feedback related to the management of training. Conclusion: This training was very useful in terms of improvement of knowledge is concerned. More Tertiary Healthcare institutions should take the initiative to conduct such training programs for capacity building of Medical Officers working at community level.

IJCM_118A: Pathway of healthcare for breast cancer: A mixed method study among women with breast cancer attending a tertiary healthcare institute in Bihar

Background: Breast cancer is the most common cancer among women; however, the majority of them visit hospitals at an advanced stage. Knowledge of pathway of care will aid in timely intervention and better prognosis. Objectives: To find the pathway of health care for breast cancer and its correlates among the patients who have attended AIIMS Patna. To identify the reasons for seeking delayed definitive care. Methodology: A mixed-method cross-sectional design with quantitative and qualitative parts was conducted at AIIMS Patna between March 2021 and December 2022 among breast cancer patients. A total of 171 breast cancer patients were enrolled in this study. Piloted study tools were used. Descriptive analysis for quantitative part and manual thematic analysis for qualitative part were performed. Results: Out of total 171 participants, 88.9% (83.3–92.77%) had visited AIIMS Patna indirectly. About 60 (20.6%) visited informal providers or quacks, and 60 (39.5%) of the study participants visited more than one hospital before arriving at AIIMS Patna. The place of residence, treatment delay, and stage of cancer were found to be independent predictors of the pathway of healthcare for breast cancer. The reasons behind seeking delayed definitive care were identified under two major themes: presentation delay (misunderstanding or difficulty in identifying symptom, neglect of disease, lack of awareness about the disease, family support, financial constraints) and treatment delay (misdiagnosis, multiple referrals, dissatisfaction with the treatment, COVID-19 lockdown, informal providers/quacks) Conclusion: 9 out of 10 breast cancer patients had not come directly for definitive care, and among them, 3 out of 5 had visited multiple healthcare providers. So, it is important to educate the public on breast cancer, make systematized referral pathways, orient the private sector, and have trained manpower for screening purposes.

IJCM_135A: Tobacco Burden, Legal Awareness, and Attitudes toward Control Measures among Healthcare Students, Professionals, and Staffs: Insights of an Online Survey in Bihar &amp; Jharkhand, India

Background: Healthcare professionals, students, and workers are vital change agents in the global battle against tobacco. Yet, it’s important to note a concerning trend: there’s a high prevalence of tobacco use among them in India, although data on this is limited. Objective: This study aimed to assess tobacco use prevalence, awareness of related laws, and attitudes among healthcare professionals, students, and staff in Bihar and Jharkhand, India. Methodology: In July and August 2023, we conducted an extensive cross sectional, online survey across 24 tertiary healthcare institutions. Participants included a diverse group of medical, dental, and nursing students, faculty, resident physicians, nursing professionals, and support staff. The survey covered sociodemographic factors, tobacco use, awareness of laws (26 items) [a: 0.924), compliance practices (9 items) (a: 0.929), and perceptions of tobacco control (10 items) (a: 0.728). Results: Our research revealed a significant prevalence of tobacco use: 15.9% reported current use, with 9.6% as daily users. Notably, awareness levels differed noticeably between users and non-users, with non-users displaying deeper knowledge of tobacco-related laws in 61.5% of cases. Our multifactor logistic regression models for current (R2: 0.184, PAR: 84.1%) and daily tobacco use (R2: 0.203, PAR: 90.4%) highlighted various associated factors, including age, gender, marital status, occupation, family income, and native state. Importantly, insufficient awareness emerged as a key factor, correlating with higher chances of current and daily tobacco use. Regional differences were evident, with lower prevalence in southern states. A majority of faculty (90.0%) and students (93.6%) expressed the need for increased emphasis on tobacco control in healthcare curricula. Conclusion: Our research highlights disparities in healthcare tobacco use, influenced by age, gender, marital status, occupation, income, and location. Awareness plays a crucial role, emphasizing the need for integrating tobacco education into curricula and sustaining awareness campaigns to address this issue effectively

Blood Transfusion Procedure: Assessment of Serbian Intensive Care Nurses' Knowledge.

Many patients require administering one or more blood components during hospitalisation in the Intensive Care Unit (ICU). Therefore, nurses' knowledge of who is responsible for immediately administering blood transfusions, monitoring patients, and identifying and managing transfusion reactions is crucial. This cross-sectional descriptive-analytical study aimed to assess the knowledge of ICU nurses in tertiary healthcare institutions about blood transfusion procedures. The questionnaire about the transfusion procedure was designed and reviewed by experts. The questionnaire consisted of 29 items divided into three domains. The scores on the knowledge test ranged from 10 to 27. Generally, 57.7% of nurses had moderate, 23.4% low, and 18.9% high levels of knowledge about the transfusion procedure. Most nurses answered correctly about refreezing fresh frozen plasma, verifying the transfusion product, and identifying the patient. Of the nurses, 91.0% would recognise mild allergic reactions, and 98.2% knew about the supervision of sedated patients. Nurses showed poor knowledge of the length of usage of the same transfusion system for red blood cells, labelling, and transfusion administration in febrile patients. Nurses with higher education and longer working experience had significantly better outcomes (p = 0.000) on the knowledge test. Continuous education of ICU nurses on safe transfusion usage is recommended.

Perception of Undergraduate Medical Students in the Online OG Learning During COVID-19 Pandemic- A Cross Sectional Study at a Tertiary Care Medical College

Objectives: The COVID-19 pandemic has become a great teacher, and online teaching-learning has become the need of the hour during this crisis. In order to improve online medical education and include innovative methods to increase the cognitive, affective, and psychomotor domains of teaching-learning, it is essential to understand students' perceptions of this online teaching method. Methodology: A cross-sectional study was conducted among medical undergraduates at a tertiary healthcare institution involving students of third, sixth, and eighth semesters. All the students who were willing to participate were included in the study. Data was collected using a predesigned, self-administered validated questionnaire consisting of socio-demographic variables, perceptions about course content, teachers and online assessments, their rating of traditional classes compared to online classes, and their experiences with online learning. Results: A total of 295 Undergraduate medical students belonging to the third, sixth, and eighth semesters of the MBBS course were included in the study. 85% of the students felt that the online OG classes during the COVID pandemic were enjoyable. A statistically significant association was found between student's course content and gender. The ease of staying at home, studying at one's own pace, and saving the transport cost were more acceptable to the students. Lack of communication between the patients and teachers and network issues were identified as problem areas. Conclusions: Hence, online teaching may replace traditional medical teaching during the COVID-19 pandemic.

Economic Factors influencing Brain Flight Intention among Medical Doctors in Federal Tertiary Healthcare Institutions, South-South, Nigeria

This study was conducted to assess the influence of economic factors on brain flight intention of medical doctors in federal tertiary healthcare institutions, south-south, Nigeria.

Impact of acute silent ischemic lesions on clinical outcomes of carotid revascularization.

Previous literature has established an association between acute silent ischemic lesions (ASILs) and elevated susceptibility to future adverse clinical outcomes. The present study endeavors to scrutinize the prognostic significance of preprocedural ASILs, as detected through diffusion-weighted imaging and apparent diffusion coefficient metrics, in relation to subsequent adverse events-namely, stroke, myocardial infarction, and all-cause death-following carotid revascularization in a cohort of patients with symptomatic carotid stenosis. Subjects were extracted from a comprehensive retrospective dataset involving symptomatic carotid stenosis cases that underwent carotid revascularization at a tertiary healthcare institution in China, spanning January 2019 to March 2022. Of the 2663 initially screened patients (symptomatic carotid stenosis=1600; asymptomatic carotid stenosis=1063), a total of 1172 individuals with symptomatic carotid stenosis were retained for subsequent analysis. Stratification was implemented based on the presence or absence of ASILs. The primary endpoint constituted a composite measure of in-hospital stroke, myocardial infarction, or all-cause death. Both carotid endarterectomy (CEA) and carotid artery stenting (CAS) treatment modalities were individually subjected to propensity score-matched analyses. Among the 584 subjects who underwent CEA, 91 ASIL-positive and 91 ASIL-negative (NASIL) cases were propensity score-matched. Notably, the ASIL cohort demonstrated a statistically significant augmentation in the risk of primary outcomes relative to the NASIL group [10.99 vs. 1.10%; absolute risk difference, 9.89% (95% CI: 3.12-16.66%); RR, 10.00 (95% CI: 1.31-76.52); P =0.01]. Similarly, within the 588 CAS-treated patients, 107 ASIL-positive and 107 NASIL cases were matched, revealing a correspondingly elevated risk of primary outcomes in the ASIL group [9.35 vs. 1.87%; absolute risk difference, 7.48% (95% CI: 1.39-13.56%); RR, 5.00 (95% CI: 1.12-22.28); P =0.02]. ASILs portend an elevated risk for grave adverse events postcarotid revascularization, irrespective of the specific revascularization technique employed-be it CEA or CAS. Thus, ASILs may serve as a potent biomarker for procedural risk stratification in the context of carotid revascularization.

ChatGPT for Academic Purposes: Survey Among Undergraduate Healthcare Students in Malaysia.

The impact of generative artificial intelligence-based Chatbotson medical education, particularly in Southeast Asia, is understudied regarding healthcare students' perceptions of its academic utility. Sociodemographic profiles and educational strategies influence prospective healthcare practitioners' attitudes toward AI tools. This study aimed to assess healthcare university students' knowledge, attitude, and practice regarding ChatGPT for academic purposes. It explored chatbot usage frequency, purposes, satisfaction levels, and associations between age, gender, and ChatGPT variables. Four hundred forty-three undergraduate students at a Malaysian tertiary healthcare institute participated, revealing varying awareness levels of ChatGPT's academic utility. Despite concerns about accuracy, ethics, and dependency, participants generally held positive attitudes toward ChatGPT in academics. Multiple logistic regression highlighted associations between demographics, knowledge, attitude, and academic ChatGPT use. MBBS students were significantly more likely to use ChatGPT for academics than BDS and FIS students. Final-year students exhibited the highest likelihood of academic ChatGPT use. Higher knowledge and positive attitudes correlated with increased academic usage. Most users (45.8%) employed ChatGPT to aid specific assignment sections while completing most work independently. Some did not use it (41.1%), while others heavily relied on it (9.3%). Users also employed it for various purposes, from generating questions to understanding concepts. Thematic analysis of responses showed students' concerns about data accuracy, plagiarism, ethical issues, and dependency on ChatGPT for academic tasks. This study aids in creating guidelines for implementing GAI chatbots in healthcare education, emphasizing benefits, and risks, and informing AI developers and educators about ChatGPT's potential in academia.

A Longitudinal Analysis of Weight Changes before and after Total Knee Arthroplasty: Weight Trends, Patterns, and Predictors.

Longitudinal data on patient trends in body mass index (BMI) and the proportion that gains or loses significant weight before and after total knee arthroplasty (TKA) are scarce. This study aimed to observe patients longitudinally for a 2-year period and determine (1) clinically significant BMI changes during the 1 year before and 1 year after TKA and (2) identify factors associated with clinically significant weight changes.A prospective cohort of 5,388 patients who underwent primary TKA at a tertiary health care institution between January 2016 and December 2019 was analyzed. The outcome of interests was clinically significant weight changes, defined as a ≥5% change in BMI, during the 1-year preoperative and postoperative periods, respectively. Patient-specific variables and demographics were assessed as potential predictors of weight change using multinomial logistic regression.Overall, 47% had a stable weight throughout the study period (preoperative: 17% gained, 15% lost weight; postoperative: 19% gained, 16% lost weight). Patients who were older (odds ratio [OR] = 0.95), men (OR = 0.47), overweight (OR = 0.36), and Obese Class III (OR = 0.06) were less likely to gain weight preoperatively. Preoperative weight loss was associated with postoperative weight gain 1 year after TKA (OR = 3.03). Preoperative weight gain was associated with postoperative weight loss 1 year after TKA (OR = 3.16).Most patients maintained a stable weight before and after TKA. Weight changes during the 1 year before TKA were strongly associated with reciprocal rebounds in BMI postoperatively, emphasizing the importance of ongoing weight management during TKA and the recognition of patients at higher risk for weight gain.Level of evidence II (prospective cohort study).

Trends in Incidence and Drug Prescriptions for Croup in Children Under 5 Years of Age: A 2002-2019 Population-Based Study.

Tracking national croup trends can provide important insights for childhood health management. This study aimed to analyze the incidence and drug prescription trends in Korean children over a two-decade period. This population-based study encompassed 479,783 children aged < 5 years from 2002-2019, utilizing the National Health Insurance Service-National Sample Cohort. We identified participants with a primary croup diagnosis who were admitted to or visited the emergency room. Age-specific and age-adjusted incidence rates/10,000 person-years were calculated. We assessed using orthogonal polynomial contrasts and stratified by various factors (sex, age, residential area, economic status, comorbidities, and healthcare facility types). We observed changes in the use of five medications: inhaled steroids, systemic steroids, inhaled epinephrine, antibiotics, and short-acting bronchodilators. Generalized binomial logistic regression was used to analyze factors influencing prescription strategies. In 2002, the croup-related visits were 16.1/10,000 person-years, increasing to 98.3 in 2019 (P for trend < 0.001). This trend persisted, regardless of age, sex, region, and economic status. Children with comorbid atopic dermatitis or asthma maintained consistent croup rates, while those without comorbidities increased. Treatment trends showed decreasing antibiotic (73-47%) and oxygen use (21.3-3.4%), with increasing nebulized epinephrine (9.3-41.5%) and multiple drug prescriptions (67.8-80.3%). Primary care centers exhibited a greater increase in prescription usage and hospitalization duration than did tertiary healthcare institutions. Over the past two decades, croup incidence has risen, accompanied by increased epinephrine use and decreased antibiotic prescriptions. Longer hospitalization and higher medication use were mainly observed in primary care facilities.

Uticaj liderskih osobina menadžera na ključne pokazatelje aktivnosti hirurških klinika

Human resources reform is the main driver of improvement and change in healthcare organizations and the healthcare system in general. Thorough transformation of management and improvements in the structure and quality of employee performance are necessary for progress in the healthcare sector. This need for change stems from an increasing awareness of the importance of strategic human resources planning in healthcare, as well as the necessity of providing better quality services despite limited financial resources. Leadership skills are recognized as key to success in healthcare and can be adopted through targeted work and development, which benefits not only institutions but also individuals on a personal level. The World Health Organization (WHO) emphasizes the importance of capacity building in leadership and management, proposing a model that balances between four interconnected segments. This model should be adapted to local specificities, so that it would be as efficient as possible. The specific objective of this research was to analyse the leadership qualities of heads of surgical clinics of the University Clinical Centre in Niš (UCC Niš), based on employee ratings, and to explore how these qualities affect the key indicators of success of these clinics. The research consisted of two parts: qualitative, which included an analysis of the tertiary level healthcare institution during the period from June 2010 to March 2017, and quantitative, in which data on the activities and the quality of operation of surgical clinics were collected and analysed. Research results indicate a generally high leadership abilities rating among surgical clinic managers, noting that building trust among employees has been identified as an area with room for improvement. The highest ratings were assigned to managers' qualities related to goal-orientation and perseverance in their achievement, regardless of the circumstances. The study also shows that leadership qualities have a significant impact on key performance indicators of surgical clinics, confirming the importance of developing effective leadership in the healthcare sector.

Clinical profile and laboratory parameters of confirmed pediatric scrub typhus cases in a tertiary health care institute

Background: Scrub typhus is one of the vector borne tropical infectious disease, caused by O. Tsutsugamushi. Because of nonspecific signs and symptoms and variable prevalence of pathognomic sign (eschar), diagnosis is very difficult in early stage. The purpose of present research was to differentiate that whether case presenting at our institution are different from previously conducted research in various regions. Methods: Hospital record of all reported cases of scrub typhus admitted to department of pediatrics at tertiary health care institute in North India over last two years (2018-2019) was retrieved and reviewed. Results: More cases were reported in male. Maximum number of cases were in 5-10 years i.e. 32 (50.0%) and only one case in less than 12 months. Maximum number cases were reported in August to October 53 (82.8%) as shown. Most common presenting complaint was fever. Most of cases reported with fever of duration of 7-14 days in (51.6%). Rash was present in 7 (10.5%) and eschar in 1 (1.5%). In lab parameters reported abnormalities severe hypoalbuminemia, hyperbilirubinemia, elevated transaminases, anemia, thrombocytopenia leucopenia and leucocytosis. Hepatitis in 48 (75%) was most common complication followed by pneumonia. Other reported complications were myocarditis, acute kidney injury, pneumonia, bleeding, meningitis, enchepalopathy , papilledema, ARDS and hemophagocytosis. Conclusions: Pediatrician should keep high index of suspicion for suspect scrub typhus in a child presents with febrile illness and early treat should be started. Hepatitis is most common complication. As Scrub typhus is associated with multisystem involvement, thorough assessment of patient should be done to look for these complications and appropriate management of complications should be provided to prevent mortality.

Clinical validation of the nursing diagnosis of impaired mood regulation among individuals with experience of mood disorders

AbstractPurposeThe aim of the study was to validate the defining characteristics (DCs) of the nursing diagnosis impaired mood regulation using related criteria in an African context.MethodsThis descriptive study was conducted in two tertiary mental healthcare institutions in Nigeria. Richard Fehring's clinical diagnostic validity model was employed to collect data from 87 individuals experiencing mood problems. Their scores were validated with other criteria, and the influence of socio‐demographic and clinical variables on participants’ identification of the DCs was determined using analysis of covariance (ANCOVA). The significance level was 0.05.FindingsFive of the 27 DCs validated were rated major, 5 considered not characteristics, and the rest were minor characteristics of the diagnosis. A two‐way subject ANCOVA was significant for diagnosis alone, F (2, 87) = 7.41, p = 0.006 (after eliminating the effect of age and gender of the participants), and when combined with duration of illness, F (38, 87) = 2.38, p = 0.036. A positive but weak correlation was found between the DC scale and mood disorder questionnaire, rs (85) = 0.353, n = 87, p = 001 with R2 = 0.102, but a positive and strong correlation with patient health questionnaire, rs (85) = 0.733, n = 87, p = 000 with R2 = 0.565.ConclusionsThe DCs listed in NANDA‐I nursing diagnoses manual were valid for the nursing diagnosis. However, there are additional characteristics that would further enhance the applicability of the diagnosis.Implications for nursing practiceThe result of this study will contribute immensely to the identification of individuals experiencing problems with mood regulation that would otherwise have been missed, thus facilitating early intervention and good outcome. Furthermore, additional characteristics validated in this study offered opportunity for further research on the diagnosis.