Tertiary Care Level Research Articles

Testing for SARS-CoV-2 in resource-limited settings: A cost analysis study of diagnostic tests using different Ag-RDTs and RT-PCR technologies in Mozambique.

Early diagnosis of SARS-CoV-2 is fundamental to reduce the risk of community transmission and mortality, as well as public sector expenditures. Three years after the onset of the SARS-CoV-2 pandemic, there are still gaps on what is known regarding costs and cost drivers for the major diagnostic testing strategies in low- middle-income countries (LMICs). This study aimed to estimate the cost of SARS-CoV-2 diagnosis of symptomatic suspected patients by reverse transcription polymerase chain reaction (RT-PCR) and antigen rapid diagnostic tests (Ag-RDT) in Mozambique. We conducted a retrospective cost analysis from the provider's perspective using a bottom-up, micro-costing approach, and compared the direct costs of two nasopharyngeal Ag-RDTs (Panbio and Standard Q) against the costs of three nasal Ag-RDTs (Panbio, COVIOS and LumiraDx), and RT-PCR. The study was undertaken from November 2020 to December 2021 in the country's capital city Maputo, in four healthcare facilities at primary, secondary and tertiary levels of care, and at one reference laboratory. All the resources necessary for RT-PCR and Ag-RDT tests were identified, quantified, valued, and the unit costs per test and per facility were estimated. Our findings show that the mean unit cost of SARS-CoV-2 diagnosis by nasopharyngeal Ag-RDTs was MZN 728.00 (USD 11.90, at 2020 exchange rates) for Panbio and MZN 728.00 (USD 11.90) for Standard Q. For diagnosis by nasal Ag-RDTs, Panbio was MZN 547.00 (USD 8.90), COVIOS was MZN 768.00 (USD 12.50), and LumiraDx was MZN 798.00 (USD 13.00). Medical supplies expenditures represented the main driver of the final cost (>50%), followed by personnel and overhead costs (mean 15% for each). The mean unit cost regardless of the type of Ag-RDT was MZN 714.00 (USD 11.60). Diagnosis by RT-PCR cost MZN 2,414 (USD 39.00) per test. Our sensitivity analysis suggests that focussing on reducing medical supplies costs would be the most cost-saving strategy for governments in LMICs, particularly as international prices decrease. The cost of SARS-CoV-2 diagnosis using Ag-RDTs was three times lower than RT-PCR testing. Governments in LMICs can include cost-efficient Ag-RDTs in their screening strategies, or RT-PCR if international costs of such supplies decrease further in the future. Additional analyses are recommended as the costs of testing can be influenced by the sample referral system.

Factors associated with conflict and styles of conflict management among health professionals

<p><strong>Introduction.</strong> Conflict is a process during which one person consciously and intentionally makes an effort to prevent the other person’s efforts, some kind of blockade that will lead to interruption in achieving the goals and interests of the other person. Conflicts in the healthcare team are common and can lead to reduced productivity in the work of healthcare professionals, which can have a negative impact on the care and treatment of patients. <strong>Methods. </strong>This cross-sectional study involved 100 health professionals, nurses and doctors employed in the primary, secondary and tertiary levels of health care. The research was conducted from March to August 2020. A questionnaire on socio-demographic characteristics of respondents, a questionnaire on conflicts of health professionals, and a standardized scale of depression, anxiety and stress with 21 questions (DASS-21) were used to measure the level of subjective depression, anxiety and stress <strong>Results.</strong> Seventy-four health workers (74%) had experience of conflict in the workplace, doctors (95%) significantly more often than nurses (58%) (p=0.001). Forty percent of health workers stated that communication problems were the most common cause of conflict. Seventy-nine respondents (79%) chose cooperation and compromise as a style in conflict resolution. Doctors chose cooperation more often (84%) than nurses (74%) and the difference was statistically significant (p=0.048). Subjects who had experience of conflict had significantly higher average values of anxiety (8.01±2.12) (p=0.026) and stress (10.32±2.91) (p=0.008) compared to subjects who had no experience of conflict (6.13±1.91; 6.12±2.03). <strong>Conclusion.</strong> Doctors were significantly more likely to have conflict situations in the workplace. For conflict resolution doctors were more likely to choose a style of cooperation and compromise than nurses who were more likely to choose a style of conflict avoidance.</p>

Is the Affordable Care Act Moving the Needle for Advanced Heart Failure Therapies for Black Patients?

Is the Affordable Care Act Moving the Needle for Advanced Heart Failure Therapies for Black Patients?

International EMT-Operational Plan–ODESA Escalation

Introduction:Since February 24, 2022, at the time of writing this plan, approximately 400,000+ refugees had entered Moldova and 282,842 had exited Moldova. EMTCC will need to coordinate international medical teams assisting with the increasing refugee numbers crossing into Moldova from southern Ukraine for the MOH and international EMT’s in support of trauma management in Palanca and related borders and referral to health care facilities within Moldova.Method:This EMTCC operational plan sets objectives and explores trigger points that require actions in the context of International EMT’s, two service levels were trauma triage/stabilization and primary health care.Results:Odesa was a city located approximately 60 kilometers from the Moldova border crossing of Palanca. Trauma patients reaching the Palanca border would need to be identified in vehicular columns by roving triage teams (EMT 1 M) and expedited through the border. Survivability of severe trauma patients proceeding through the border crossing and expected to transit through to tertiary level care would be low without the intervention of trauma stabilization teams (damage control). The initial positioning of at least 2 trauma stabilization points would require the support, skills, logistics and self sustainability of classified EMT’s or similar. These would also need the additional support of specialized trauma/surgical cells at both Stefan Voda and Causeni Hospitals.Conclusion:Odessa escalation should have been the worst scenario, but we were able to work with MOH in Moldova to develop a plan to save more lives for trauma patients reaching the Palanca border.

The Association of Total Prehospital Time to Severe Trauma Patient Outcomes in Physician Staffed Emergency Medical Teams in Sarajevo, Bosnia, and Herzegovina

Introduction:The Institute for Emergency Medical Assistance of Canton Sarajevo covers 1,777 square kilometers. All teams are physician staffed and are organized in ten geographic points. Patients are transported to a tertiary care level facility–University Clinical Center Sarajevo. Our objective was to determine the association between total prehospital time and severe trauma patient outcomes in a physician staffed emergency medical system with the hypothesis that the length of prehospital time is insignificant to patient outcome if physician treatment begins on scene.Method:This was a descriptive, retrospective, analytical study conducted from June to December 2020. The data of 153 patients with an ISS score of ≥ 16 was selected from patient registries of both facilities. According to transport duration, patients were assigned to one of four groups: <15 minutes (group 1); 16 to 30 minutes (group 2); 31-45 minutes (group 3) and > 45 minutes (group 4). Both groups according to the TRISS score were equal in mortality with an expected survival rate margin taken at 70% due to this being the approximate intrahospital survival rate of our patients. The primary outcome was in-hospital mortality, and secondary outcomes included length of hospital stay, length of ICU stay and 30-day survival rate.Results:We found no statistically significant difference to in-hospital mortality in relation to the length of pre-hospital transport when physician treatment begins on scene (p = 0,186). We ruled out any significant difference in length of stay and ICU stay (p = 0,179 and p = 0,173, respectively) among the preselected groups in relation to the length of prehospital time. Also, the 30 day survival rate was unaffected by the length of transport in physician led teams (p = 0,156).Conclusion:With strategically placed physician staffed EMS teams and physician treatment beginning on scene, patient outcome is unaffected by the length of transport.

Renal biopsy - indication and its implications in management of children admitted at a tertiary care hospital, Mangalore

Background: Percutaneous renal biopsy is an established diagnostic tool for identification of renal pathology required for diagnosis, treatment, and prognostication. The present study was conducted to know the common indications and histopathological findings of renal biopsy, impact of biopsy report on treatment, and complications of procedure. Methods: This was a retrospective observational study conducted in the paediatric ward of a tertiary care level hospital. Indications of renal biopsy as suggested by medical records were noted down. Any treatment changes happened after final histopathological report were recorded. Statistical analysis was made using statistical package for the social sciences (SPSS) version 20.0 (IBM, NY). Results: The mean age of patients at which biopsy was done was 9.83±5.31 years. Most common indications of renal biopsy were nephritic onset nephrotic syndrome (34.8%), steroid-resistant nephrotic syndrome (21.7%), steroid-dependent nephrotic syndrome requiring calcineurin inhibitors (CNI) (17.4%), lupus nephritis (8.7%), nephrotic syndrome with later age of onset (8.7%), acute kidney injury (AKI) stage 3 (4.3%) and for evidence of calcineurin inhibitor toxicity (4.3%). Focal segmental glomerulosclerosis (26.1%), minimal change disease (21.7%) and membranoproliferative glomerulonephrosis (17.4%) were the most common histopathological findings. Conclusions: This study reiterates the fact that renal biopsy is one of the decisive and diagnostic procedures and has good prognostic value in further management of medical renal disease.

Clinical Profile and in Hospital Outcome of Acute Poisoning Cases Admitted in Tertiary Care Hospital: A Prospective Observational Study

Objectives: Acute poisoning is a medical emergency. Data are scarce from the Indian subcontinent regarding the profile and outcome of patients presenting with acute poisoning admitted to intensive care unit (ICU). Hence, the present study was undertaken to assess the clinical profile and hospital outcome of acute poisoning cases admitted in tertiary care hospitals. Material and Methods: A total of 148 patients with acute poisoning aged >18 years and admitted in the intensive care unit and medicine wards of tertiary care hospital during a period of 1 year from September 1, 2019, to August 31, 2021, were studied. Results: Poisoning was more common in the 21–30 years age group (42.57%) with male predominance (55.41%). Poisoning with suicidal intention constituted 81.76%: 44.59% of cases seeking medical help within 2–4 h. In 81.76% of cases, route of poisoning was oral. Organophosphorus was the most common acute poisoning (28.38%), and most common symptoms were nausea/vomiting. Complications noted were ventilator-associated pneumonia (VAP) (4.72%), renal failure (6.08%) and hepatic failure (2.7%). Mortality was seen in 11.49% of cases. Out of 148 cases, 121 were of suicidal poisoning, while 14 patients out of them expired so psychiatric evaluation of 107 patients can be made and out of that all patients had some underlying psychiatric illness. Patients requiring ventilatory support constituted 25.67% of cases. Conclusion: Clinical profile of acute poisoning depends on the nature of compound/poison, quantity of compound consumed/exposed, first aid received at the primary care level and time taken to shift the patient from primary care level to tertiary care level. In-hospital mortality mostly depends on the dedicated facilities available at the tertiary care level in addition to the factors described above for clinical profile.

End-tidal carbon dioxide measured at emergency department triage outperforms standard triage vital signs in predicting in-hospital mortality and intensive care unit admission.

This study assessed the ability of end-tidal carbon dioxide (ETCO2 ) in predicting in-hospital mortality and intensive care unit (ICU) admission compared to standard vital signs at ED triage as well as comparing to measures of metabolic acidosis. This prospective study enrolled adult patients presenting to the ED of a tertiary care Level I trauma center over 30 months. Patients had standard vital signs measured along with exhaled ETCO2 at triage. Outcome measures included in-hospital mortality; ICU admission; and correlations with lactate, sodium bicarbonate (HCO3 ), and anion gap. There were 1136 patients enrolled and 1091 patients with outcome data available. There were 26 (2.4%) patients who did not survive to hospital discharge. Mean ETCO2 levels were 34 (33-34) in survivors and 22 (18-26) nonsurvivors (p< 0.001). The area under the curve (AUC) for predicting in-hospital mortality for ETCO2 was 0.82 (0.72-0.91). In comparison the AUC for temperature was 0.55 (0.42-0.68), respiratory rate (RR) 0.59 (0.46-0.73), systolic blood pressure (SBP) 0.77 (0.67-0.86), diastolic blood pressure (DBP) 0.70 (0.59-0.81), heart rate (HR) 0.76 (0.66-0.85), and oxygen saturation (SpO2 ) 0.53 (0.40-0.67). There were 64 (6%) patients admitted to the ICU, and the ETCO2 AUC for predicting ICU admission was 0.75 (0.67-0.80). In comparison the AUC for temperature was 0.51, RR 0.56, SBP 0.64, DBP 0.63, HR 0.66, and SpO2 0.53. Correlations between expired ETCO2 and serum lactate, anion gap, and HCO3 were rho=-0.25 (p< 0.001), rho=-0.20 (p< 0.001), and rho=0.330 (p< 0.001), respectively. ETCO2 was a better predictor of in-hospital mortality and ICU admission than the standard vital signs at ED triage. ETCO2 correlated significantly with measures of metabolic acidosis.

Strategies to integrate physiotherapists into primary health care in South Africa.

Health services are inaccessible in low-income countries. The National Health Insurance (NHI) bill, linked to primary health care (PHC), was introduced in South Africa to improve access to health services. Physiotherapists contribute to healthcare and improve individuals' health status across their lifespan. The South African healthcare system has many challenges: physiotherapists mostly practising at secondary and tertiary levels of care; a shortage of physiotherapists in the public health systems and rural areas; the omission of physiotherapy in health policies. To explore strategies to integrate physiotherapy services in PHC settings in South Africa. Our study used a qualitative, exploratory and descriptive approach to collect data from nine doctorate physiotherapists at South African universities. Data were thematically coded. The themes are to (1) improve societal knowledge of physiotherapy, (2) ensure policy representation of the profession, (3) transform physiotherapy education, (4) broaden the role of physiotherapy, (5) eradicate professional hierarchy and (6) increase the physiotherapy workforce. Physiotherapy is not well known in South Africa. Physiotherapy is needed to feature in health policies to transform education focussing on disease prevention, health promotion and functioning in PHC. Broadening physiotherapy roles should consider the regulator's ethical rules. Physiotherapists should proactively collaborate with other health professionals to dismantle professional hierarchies. Without addressing the urban-rural, private-public divide, the physiotherapy workforce cannot improve, to the detriment of PHC. Implementing the suggested strategies may facilitate physiotherapy integration into PHC in South Africa.

A study on cancer awareness among people attending a tertiary level care hospital in West Bengal

Background: A cross-sectional observational study conducted in the outpatient registration counter among people seeking registration ticket in a government Medical College. Sample size was 214 with equal representation of each sex. Aims and Objectives: (1) The study’s aims at assessing the knowledge quotient about the occurrence, site presenting symptoms risk factors and outcome of various cancers. (2) Sex specific cancer screening program self-breast examination, mammography, pap smear awareness, and usage among females of study population have been investigated. Materials and Methods: A cross-sectional observational study. Predesigned pretested questionnaire was administered to consenting participants among those registering for outpatient tickets at Calcutta National Medical college Hospital. Statistical analysis Used: Descriptive statistics was used with MS Excel. Results: Awareness was 69.8% with 69% stating gastrointestinal tract to be the most common site, Of the population 70% stated pain was to be the most common presenting symptom, tobacco was said to be the most common causative agent by 72% and 70% stated it to be non-treatable. Among sex specific cancers 40% women identified breast as site of cancer presenting with nipple discharge and 34% stated the presenting feature to be lump. Screening method of self-breast examination and PAP smear was said by 5% and 2%, respectively. Conclusion: The awareness regarding site cardinal signs outcome and risk factors was not good among study population. Much effort is to be given to address the state of things.

Otolaryngologic manifestations of Mpox: the Atlanta outbreak

Background In 2022, Mpox (MPX) has become clinically relevant as otolaryngologists are evaluating this exotic disease process due to its many otolaryngologic manifestations. Aims/Objective To characterize our cohort of otolaryngology-relevant MPX confirmed cases. Materials and methods A descriptive case series was performed via retrospective review. Adult patients who underwent inpatient or emergency department otolaryngology consultation at an Emory University-affiliated tertiary care level hospital for MPX were included. Results Seven patients (age 18–58 years; median 32 years) were identified. All patients were male. Six patients (86%) were black and six patients (86%) were HIV positive with varied immunocompetence. Otolaryngology was consulted for lymphadenopathy (n = 2), pharyngeal involvement (n = 1), and airway evaluation (n = 4). All 6 patients with active MPX developed the classic rash, which developed after oropharyngeal symptoms in 3 patients. Three patients had laryngeal involvement. Conclusion MPX manifests with symptoms requiring otolaryngology expertise, especially when the airway is involved. Infectious disease consultation is key. Mpox can be identified with a specific constellation of demographic identifiers and physical exam findings, which is key to determining appropriate treatment and protection for the consulting otolaryngologist. Significance This is the first otolaryngologic study of Mpox and first description of Mpox laryngeal involvement.

Association of Low Placental Growth Factor Gene Expression with Maternal and Neonatal Outcomes in Type 1 Diabetes: A Single Center, Cross-Sectional Study

Objective : The placental growth factor (PlGF) plays a crucial role in early and late pregnancy placental development. Pregestational type 1 diabetes (T1D) is a pregnancy complication that may lead to serious fetomaternal complications. Our study analyzed the association between placental PlGF mRNA expression and metabolic control, fetal weight and development in women with T1D. Materials and methods : A cross-sectional study on 65 pregnant women with T1D in singleton pregnancies admitted to the tertiary-level perinatal care unit. The study examined associations between the placental mRNA-PlGF gene expression measured with quantitative real-time PC and markers of maternal metabolism in the third trimester. The expression was also compared across maternal subgroups stratified according to the birth weight (small- vs. appropriate- vs. large-for-gestational age; SGA, AGA, LGA, respectively) and the following neonatal outcomes: mode of delivery, Apgar score and pH in the umbilical vessels. Results : Placental PlGF mRNA expression was significantly lower in SGA than in AGA and LGA patients (0.60 ± 0.34 vs. 0.63 ± 0.54 vs. 1.02 ± 0.15, respectively, p &lt; 0.05). In the SGA group, the expression of the PlGF-mRNA correlated positively with maternal 3 rd trimester BMI (r = 0.49, p = 0.04), pH and BE cord blood values, and maternal 3 rd trimester mean BP. There was no correlation between 3 rd -trimester glycated hemoglobin and mean blood glucose levels (MBG) and PlGF expression. Conclusions : Our data suggest that lower PlGF mRNA expression may predict neonatal outcomes in women with T1D giving birth to SGA newborns.

Evaluation of a Secure Messaging System in the Care of Children With Medical Complexity: Mixed Methods Study.

The Connecting2gether (C2) platform is a web and mobile-based information-sharing tool that aims to improve care for children with medical complexity and their families. A key feature of C2 is secure messaging, which enables parental caregivers (PCs) to communicate with their child's care team members (CTMs) in a timely manner. The objectives of this study were to (1) evaluate the use of a secure messaging system, (2) examine and compare the content of messages to email and phone calls, and (3) explore PCs' and CTMs' perceptions and experiences using secure messaging as a method of communication. This is a substudy of a larger feasibility evaluation of the C2 platform. PCs of children with medical complexity were recruited from a tertiary-level complex care program to use the C2 platform for 6 months. PCs could invite CTMs involved in their child's care to register on the platform. Messages were extracted from C2, and phone and email data were extracted from electronic medical records. Quantitative data from the use of C2 were analyzed using descriptive statistics. Messaging content codes were iteratively developed through a review of the C2 messages and phone and email communication. Semistructured interviews were completed with PCs and CTMs. Communication and interview data were analyzed using thematic analysis. A total of 36 PCs and 66 CTMs registered on the C2 platform. A total of 1861 messages were sent on C2, with PCs and nurse practitioners sending a median of 30 and 74 messages, respectively. Of all the C2 messages, 85.45% (1257/1471) were responded to within 24 hours. Email and phone calls focused primarily on clinical concerns and medications, whereas C2 messaging focused more on parent education, proactive check-ins, and nonmedical aspects of the child's life. Four themes emerged from the platform user interviews related to C2 messaging: (1) connection to the care team, (2) efficient communication, (3) clinical uses of secure messaging, and (4) barriers to use. Overall, our study provides valuable insight into the benefits of secure messaging in the care of children with medical complexity. Secure messaging provided the opportunity for continued family teaching, proactive check-ins from health care providers, and casual conversations about family and child life, which contributed to PCs feeling an improved sense of connection with their child's health care team. Secure messaging can be a beneficial additional communication method to improve communication between PCs and their care team, reducing the associated burden of care coordination and ultimately enhancing the experience of care delivery. Future directions include the evaluation of secure messaging when integrated into electronic medical records, as this has the potential to work well with CTM workflow, reduce redundancy, and allow for new features of secure messaging.

97. Adolescents’ Perception of Health Care Services in a Tertiary Level Care Hospital

97. Adolescents’ Perception of Health Care Services in a Tertiary Level Care Hospital

Study on the assessment of disease severity in COVID-19 patients from D-dimer estimation in a tertiary care level hospital, in West Bengal

Background: Coronavirus disease 2019 (COVID-19) is a RNA virus which infects both human beings and animals. COVID-19 infection is presently a very important, global health related problem. It is contagious. The COVID-19 or severe acute respiratory syndrome (SARS)-CoV-2 virus affects the lungs very commonly through the angiotensin converting enzyme 2 receptor which is present in abundance on the surface of type II alveolar cells. It leads to SARS. The severely ill COVID-19 patients suffer from massive intra vascular clot formation. Therefore, coagulation tests are very useful to assess the severity of the cases. Aims and Objectives: The aim of our study is to assess, that whether by examining the blood of a COVID-19 patient for D-Dimer, the treating physician can judge the severity of the case and come to a conclusion regarding the line of management. Materials and Methods: This is a retrospective study conducted in the departments of Pathology and Radiology of RG Kar Medical College. Records of the patients who were admitted for COVID-19, from September 2020 to September 2021, have been studied for their D dimer levels. The computed tomography (CT) scan findings of the respective patients have also been studied from the departmental records. Results: In our study, the median value of D-Dimers of 80 samples came out to be 1.4. (1) CT scores, (2) presence or absence of crazy paving sign, and (3) perilobular fibrosis in CT scan have been studied and compared with the median D Dimer values. It has been seen from our study that out of 54 cases whose D-Dimers were &lt;1.4, 41 cases had moderate CT score, and 13 had CT score in the severe range, 26 cases had crazy paving sign in their CT findings, and 28 cases did not show crazy paving sign in their CT findings, and 22 cases had perilobular fibrosis in their CT reports, and 32 cases did not have perilobular fibrosis. The P-values came out to be &lt;0.05 for all the three parameters. Conclusion: We concluded from the study that D-Dimer levels can reflect the severity of lung parenchymal injury and can be used to judge the severity and to plan the line of management of COVID cases.

What Helping Babies Breathe knowledge and skills are formidable for healthcare workers?

Most neonatal deaths occur in the first week of life, due to birth asphyxia. Helping Babies Breathe (HBB), is a simulation-based neonatal resuscitation training program to improve knowledge and skills. There is little information on which knowledge items or skill steps are challenging for the learners. We used training data from NICHD's Global Network study to understand the items most challenging for Birth Attendants (BA) to guide future curriculum modifications. HBB training was provided in 15 primary, secondary and tertiary level care facilities in Nagpur, India. Refresher training was provided 6 months later. Each knowledge item and skill step was ranked from difficulty level 1 to 6 based on whether 91%-100%, 81%-90%, 71%-80%, 61%-70%, 51%-60% or <50% of learners answered/performed the step correctly. The initial HBB training was conducted in 272 physicians and 516 midwives of which 78 (28%) physicians and 161 (31%) midwives received refresher training. Questions related to timing of cord clamping, management of a meconium-stained baby, and steps to improve ventilation were most difficult for both physicians and midwives. The initial steps of Objective Structured Clinical Examination (OSCE)-A i.e. equipment checking, removing wet linen and immediate skin-to-skin contact were most difficult for both groups. Midwives missed stimulating newborns while physicians missed cord clamping and communicating with mother. In OSCE-B, starting ventilation in the first minute of life was the most missed step after both initial and 6 months refresher training for physicians and midwives. At the retraining, the retention was worst for cutting the cord (physicians level 3), optimal rate of ventilation, improving ventilation & counting heart rate (midwives level 3), calling for help (both groups level 3) and scenario ending step of monitoring the baby and communicating with mother (physicians level 4, midwives 3). All BAs found skill testing more difficult than knowledge testing. The difficulty level was more for midwives than for physicians. So, the HBB training duration and frequency of retraining can be tailored accordingly. This study will also inform subsequent refinement in the curriculum so that both trainers and trainees will be able to achieve the required proficiency.

Risk Assessment and Perception of Healthcare Professionals in the Age of the Covid-19 Pandemic.

Introduction: Knowledge of all safety factors: teamwork, employee satisfaction, work environment, stress awareness, risk perception and attitude are the basis for improving the safety performance of health care providers - health professionals. The aim of the research is to analyze the risk perception of health professionals on aspects of occupational safety in relation to the workplace during the COVID-19 pandemic.&#x0D; Methods: A descriptive cross-sectional study included health professionals of all profiles from the Sarajevo Canton. It was conducted in the period from November to the end of December 2021. Respondents voluntarily and anonymously filled out a survey questionnaire, distributed electronically in the Google forms form.&#x0D; Results: The research included 266 health professionals of all profiles employed in health care institutions at the primary, secondary and tertiary levels of health care.&#x0D; Conclusion: The concept of risk perception of health professionals in a pandemic should be viewed as a group rather than an individual phenomenon.perception

People with early-onset colorectal cancer describe primary care barriers to timely diagnosis: a mixed-methods study of web-based patient reports in the United Kingdom, Australia and New Zealand

BackgroundPeople with early-onset colorectal cancer, under the age of 50, are more likely to experience diagnostic delay and to be diagnosed at later stages of the disease than older people. Advanced stage diagnosis potentially requires invasive therapeutic management at a time of life when these patients are establishing intimate relationships, raising families, building careers and laying foundations for financial stability. Barriers to timely diagnosis at primary care level have been identified but the patient perspective has not been investigated.MethodsPersonal accounts of cancer care are increasingly accessed as rich sources of patient experience data. This study uses mixed methods, incorporating quantitative content analysis and qualitative thematic analysis, to investigate patients’ accounts of early-onset colorectal cancer diagnosis published on prominent bowel cancer support websites in the United Kingdom, Australia and New Zealand.ResultsPatients’ perceptions (n = 273) of diagnostic barriers at primary care level were thematically similar across the three countries. Patients perceived that GPs’ low suspicion of cancer due to age under 50 contributed to delays. Patients reported that their GPs seemed unaware of early-onset colorectal cancer and that they were not offered screening for colorectal cancer even when ‘red flag’ symptoms were present. Patients described experiences of inadequate information continuity within GP practices and across primary, specialist and tertiary levels of care, which they perceived contributed to diagnostic delay. Patients also reported tensions with GPs over the patient-centredness of care, describing discord related to symptom seriousness and lack of shared decision-making.ConclusionsWider dissemination of information about early-onset colorectal cancer at primary care level is imperative given the increasing incidence of the disease, the frequency of diagnostic delay, the rates of late-stage diagnosis and the dissatisfaction with patient experience reported by patients whose diagnosis is delayed. Patient education about diagnostic protocols may help to pre-empt or resolve tensions between GPs’ enactment of value-based care and patients’ concerns about cancer. The challenges of diagnosing early-onset colorectal cancer are significant and will become more pressing for GPs, who will usually be the first point of access to a health system for this growing patient population.

Neonatal Candidiasis: Clinical Spectrum and Epidemiology at a Tertiary Care Centre, Bhopal, India

Introduction: Neonatal candidiasis is one of the leading causes of sepsis amongst newborns admitted to newborn care unit, especially premature and Low Birth Weight (LBW) babies. It is one of the significant contributors to neonatal morbidity and mortality. Aim: To describe the spectrum and epidemiology of fungal sepsis in Neonatal Intensive Care Unit (NICU) at a tertiary care level. Materials and Methods: A longitudinal study was conducted from January 2018- December 2019 in NICU of Chirayu Medical College and Hospital, a tertiary level hospital in Bhopal, Central India. All neonates, who had positive fungal blood culture were included in the study, their demographic data was analysed (age, birth weight, predisposing factors etc.,), maternal history, their response to the antifungal treatment documented and complications. Statistical analysis was done using the Chi- square test with the help of Statistical Package for Social Sciences (SPSS) software version 2.0. Results: A total of 409 neonates admitted in the NICU during the study period, were suspected clinically to have sepsis and their blood culture was done, of which 110 samples were culture positive. Amongst the 110 neonates, 41(37.2%) were positive for fungal infection {29 showed Candida albicans, 12 Non Albicans Candida (NAC)}. Total 25 neonates were preterm (60.97%). The mean age of admission was 3.02 days, 51.2% (21/41) of the neonates had a history of respiratory distress and related symptoms at birth. There was no significant maternal history. Amongst the risk factors, lower birth weight (&lt;2.5 kg), preterm (&lt;34 weeks), and presence of invasive central lines were statistically associated with morbidity. Urine for candidial hyphae was positive in 12 out of 41 cases (29.27%). Incidence of candidal meningitis was seen in four neonates (13.33%). Thrombocytopenia was the most common laboratory finding amongst these cases (32/41). Among the different regimens used the combination regimen of Lipid based amphotericin B and voriconazole was associated with a better survival. Conclusion: Candida sepsis was found to be the most common cause of septicaemia in the NICU. LBW and preterm babies are especially at greater risk of candida sepsis. Candida albicans still continues to be a dominant aetiology for fungal sepsis, as compared to non candida species.

Spatial Disparity in Availability of Tuberculosis Diagnostic Services Based on Sector and Level of Care in Nigeria

Background: Delay in Tuberculosis (TB) diagnosis can contribute to late presentation, severe disease, and continued transmission. KNCV TB Foundation Nigeria through the United States Agency for International Development (USAID) funded the TB Local Organization Network (LON) 1 and 2 projects that explored the availability of Tuberculosis services based on sector and levels of care. Methods: TB Patient Pathway Analysis was carried out in 14 states comprising 92 facilities. It involved primary, secondary, and tertiary levels of health care in both the public and private sectors. This was a cross-sectional study under program implementation. Proforma was used to collect data on the available TB diagnostic services. Results: In public health facilities, GeneXpert was available at 100% in tertiary facilities in 8 (57%) states; up to 82% in 4 (33%) states, 50% available at secondary facilities in 2 states, and There is none at the primary facilities. Smear microscopy was available at 100% in tertiary facilities in 9 (64%) states and 3 (25%) states have 50% to 82%; secondary -10 (71%) states have > 70% at facilities; primary 1 (7%) state has it in 61% of facilities. Loop-mediated isothermal amplification (TB-LAMP) in tertiary 2 (17%) states have 20% and 100% respectively; secondary 4 (and only 2 states (14%) at tertiary facilities. Only 1 (7%) state has GeneXpert in all tertiary facilities, 2 (14%) states have secondary facilities, and 4 states in about 1% of facilities. TB LAMP was not available in any tertiary facility, one (7%) state at secondary with coverage of 1%, and 2 (14%) states at primary both with 4% overall facility coverage. Conclusions: There is an inequitable distribution of TB diagnostic services in both sectors and levels of care in Nigeria. TB care and control will improve with enhanced equitable distribution of TB diagnostic services across the health system.