Tertiary Military Hospital Research Articles

Decreasing Waiting Time for Outpatient Chronic Prescriptions Pickup Using Drive through 24/7 Automated Dispensing Carousel System at King Salman Military Hospital (KSAFH)

Extended waiting periods have an effect on healthcare accessibility and delivery. The main purpose of drive through 24/7 automated dispensing carousel system is reducing the necessity for patient to visit the hospital to dispense his/her chronic medications, increasing patient's convenience and relieving congested parking spaces in the hospital. Several methods have been implemented in other countries to reduce patient waiting time. Some of which include automated dispensing system, staff scheduling plan, postal-delivery prescription, and redesign of pharmacy workflow [1-4]. In SAUDI ARABIA, one of the methods adopted was implementation of drive through 24/7 automated dispensing carousel system (DAD). DAD was developed to make patients' chronic prescription pickups easier. The hospital has implemented Capsa Healthcare’s RoboWall as a drive-through model for the first time in the global market at King Salman Armed Forces Hospital (KSAFH) to facilitate the convenient delivery of prescription drugs to patients. DAD is a collection of innovative dispensing systems that offers patients new concepts for dispensing their prescription. Pharmacy tech workstations generally have barcode-driven internal workstations, flat screen displays facing patients, Robowall software, and SMS (text messaging) modules. This project will assess were to (1) assess the effectiveness of drive through 24/7 automated dispensing carousel system in improving waiting time for outpatient chronic prescriptions pickup and determine the feasibility of this system in a busy tertiary military hospital. Data will be extracted from routinely queuing system, hospital information systems, and patient experience. The aim of this study will focus on and explore the current practice and its barriers to waiting time for outpatient chronic prescriptions pickup. Where possible, generalize the study to other military hospitals among the Ministry of Defense and other health care providers at Saudi Arabia.

Expatriate professional nurses’ experiences of preceptorship in a tertiary hospital in Saudi Arabia

Background: Professional nurses relocate to foreign countries as expatriate nurses due to host countries’ push or pull factors. Preceptorship programs are designed to support newly hired nurses in transitioning into a new health-care environment. Aims: This study aimed to understand expatriate professional nurses’ preceptorship experiences in a tertiary hospital in Riyadh, Saudi Arabia, with the goal of providing recommendations to enhance the preceptorship program and facilitate better adaptation among expatriate nurses. Setting and Design: This study was conducted at a tertiary military hospital in Riyadh, Saudi Arabia, and employed a phenomenological research approach. Materials and Methods: Based on inclusion criteria, ten expatriate professional nurses were selected by purposive sampling. Data were collected through unstructured, audio-recorded, verbatim transcribed interviews, observations, and field notes. Statistical Analysis: Colaizzi’s seven-step methodology was employed for data analysis. Results: The results identified three themes: (1) participants experienced both positive and negative aspects of preceptorship, encountering personal adjustment challenges and issues with the initial orientation program; (2) preceptors’ abilities and dedication played a crucial role in assisting participants in adjusting to their new workplace; and (3) participants reflected on their preceptorship experience, expressing their expectations and opinions of the preceptorship program. Conclusions: Preceptorship is an effective onboarding strategy to support expatriate nurses in their adaptation process, emphasizing the importance of teamwork and continued management support.

Sepsis among Neonates in a Ghanaian Tertiary Military Hospital: Culture Results and Turnaround Times.

In this study, we described the bacterial profile, antibiotic resistance pattern, and laboratory result turnaround time (TAT) in neonates with suspected sepsis from a tertiary-level, military hospital in Accra, Ghana (2017–2020). This was a cross-sectional study using secondary data from electronic medical records. Of 471 neonates clinically diagnosed with suspected sepsis in whom blood samples were collected, the median TAT from culture request to report was three days for neonates who were culture-positive and five days for neonates who were culture-negative. There were 241 (51%) neonates discharged before the receipt of culture reports, and of them, 37 (15%) were culture-positive. Of 471 neonates, twenty-nine percent (n = 139) were bacteriologically confirmed, of whom 61% (n = 85) had late-onset sepsis. Gram-positive bacterial infection (89%, n = 124) was the most common cause of culture-positive neonatal sepsis. The most frequent Gram-positive pathogen was coagulase-negative Staphylococcus (55%, n = 68) followed by Staphylococcus aureus (36%, n = 45), of which one in two were multidrug resistant. The reasons for large numbers being discharged before the receipt of culture reports need to be further explored. There is a need for improved infection prevention and control, along with ongoing local antimicrobial resistance surveillance and antibiotic stewardship to guide future empirical treatment.

Patients’ Satisfaction about Quality and Services of Food in a Tertiary Military Hospital

Introduction: Patients’ satisfaction has become a key criterion by which quality of health care services is evaluated. Quality of food and its services in a hospital is an important component of treatment process since it sometimes is a part of treatment and often affects the patients' satisfaction. Objectives: To determine the level of patients’ satisfaction about quality of food and services and to identify the factors affecting it. Materials and Methods: This cross-sectional observational study was carried out from July 2018 to June 2019 in a tertiary military hospital, Dhaka. Structured questionnaires were used as data collection instruments and were analyzed by SPSS version 23. Results: Out of 184 respondents’ majority (60.3%) were satisfied with hospital food and food services. About 94%, 91.3%, 88%, 84.8%, 3.2% and 77.2% respondents were satisfied with amount, warmth, cleanliness of utensils, cleanliness of food servers, attitude and behaviour of food servers and food distribution time respectively. Relationship between overall satisfaction level and different aspects related to hospital food and food services was detected by chi-square and Fisher’s exact test. In logistic regression analysis result showed that taste of food, food distribution time, cleanliness of food servers and cleanliness of ward/cabin were statistically significant and most important determinants of patients’ satisfaction with the food served in hospital. Conclusion: Improving taste of food, ensuring cleanliness of the food servers and ward and adjusting food distribution time are required to improve the level of overall patients’ satisfaction towards hospital food and food services. JAFMC Bangladesh. Vol 17, No 1 (June) 2021: 3-6

Performance of a Rapid Diagnostic Test for Influenza in a Tertiary Military Hospital, Philippines.

It is important to evaluate the performance of existing rapid influenza diagnostic tests (RIDTs) and the factors that can affect performance especially when the circulation dynamics of influenza strains change such as the displacement and replacement of the circulating seasonal influenza strains. Nasal swabs were collected from patients presenting at V Luna Medical Center, Armed Forces of the Philippines Health Service Command, with influenza-like illness (ILI) with one swab tested using Quickvue (QV) influenza A+B RIDT (Quidel) and the other swab tested using the ABI 7500 (Applied Biosystems) real-time reverse transcriptase-polymerase chain reaction. Sensitivity, specificity, positive predictive value, and negative predictive value were estimated. We identified clinical symptoms predictive of influenza subtype and evaluated the independence of QV sensitivity on (1) Cycle threshold (Ct) value, controlling for timing of collection; (2) timing of collection, controlling for Ct value; and (3) Ct value and timing of collection taken together. Between August 2011 and October 2016, patients presenting with ILI (n = 2333) underwent testing. Quickvue sensitivity across all subtypes was significantly correlated with lower Ct values (higher virus titers) (P <.001) and, except for flu A/H3 (P = .974), was also significantly associated with timing of specimen collection (P <.05). No statistically significant difference was noted in QV sensitivity for Flu A/H3 (P = .130), pandemic H1/N1 (P = .207), Flu A/H3 + pandemic H1/N1 (P = .341), and Flu B (P = .103) across different age groups but sensitivity of QV significantly differed (P <.001) across the different influenza subtypes. Overall specificity of QV was high across all flu subtypes, but overall sensitivity was low (Flu A/pdm H1) to moderate (Flu A/H3 and Flu B). The findings highlight the need to develop more sensitive influenza RDTs to detect circulating influenza strains and the use of the quadrivalent flu vaccine during the annual influenza vaccination.

Evaluation of Pressure Ulcer Among the Critically Ill Patients Admitted in a Tertiary Hospital

Background: All over the world pressure ulcer is a significant health care problem due to high morbidity and mortality rates and also high health care cost. This study was carried out with the objectives to identify the characteristics and associated factors of pressure ulcer among the critically ill patients admitted in a tertiary military hospital. Few studies have been conducted on pressure ulcer in Bangladesh and very few in military hospitals. Methodology: This was a cross sectional study conducted among purposively selected 53 critically ill admitted pressure ulcer patients in CMH Dhaka from 01 July 2018 to 31 December 2018 and data were collected by face to face interview and checklist. Results: Among the study population half (50.9%) were aged between 61-80 years with the mean age 69.13 years. The most common anatomical site of pressure ulcer were buttock (51.9%) followed by sacrum (38.5%) and 30.2% had multiple pressure ulcer. Among the critically ill patients, 81.1% had developed pressure ulcer after admission into hospital. The most common place of pressure ulcer was geriatric HDU (30.2%) and officers ward (18.9%). Among the pressure ulcer patients 79.2% were male. Most common stage of pressure ulcer were stage II (66.0%) followed by stage I (18.9%), stage III (13.2%) and stage IV (1.9%). All of them were bedridden and half (50.9%) were completely immobile. According to Braden Scale, about half (50.9%) had high risk for development of pressure ulcer followed by moderate risk (26.4%) and there were none beyond risk. About three fourth (73.6%) of pressure ulcer patients had hypertension &amp; cerebrovascular diseases. Age group of 60-90 years, SSC &amp; above educational group, male sex, immobility, low Braden score group patients are statistically significant (p &lt; 0.05), and hypertensive and cerebrovascular diseased patients are not statically significant (p &gt; 0.05) but having clear trends to be associate factors of pressure ulcer. Conclusion: The number of pressure ulcer were increasing with the increase of age. The higher age, male sex, immobilization, low Braden score, hypertension, and cerebrovascular diseased patients were more prone for development of pressure ulcer among the critically ill patients. J Bangladesh Coll Phys Surg 2022; 40: 23-30

Prescribing patterns of direct oral anticoagulants for atrial fibrillation in a tertiary military hospital

Prescribing patterns of direct oral anticoagulants for atrial fibrillation in a tertiary military hospital

AN OVERVIEW OF THE FIRST "WAVE-BATTLE" OF THE SARS-COV-2 PANDEMIC: "WAR" IN A TERTIARY MILITARY HOSPITAL FROM A RADIOLOGICAL POINT OF VIEW

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: To report our experience from encountering the COVID-19 pandemic and its repercussion in the imaging of patients during the period ranging from March 2020 to October 2020 in our tertiary military hospital based in a city of 1.2 million people. METHODS: We included all patients that showed up and were examined in our tertiary hospital's specific section of the ER for suspected cases of COVID, excluding those for whom an alternative diagnosis was far more plausible and including those whose molecular testing turned out to be positive despite initial triage. RT-PCR was utilized for the confirmation of COVID cases. The imaging modalities used were chest X-ray, chest CT and CTPA and the images were assessed by two independent researchers. Chest imaging findings were categorized into 9 different radiological patterns including normal appearance. For the statistical analysis we used version 23 of IBM SPSS Statistics ®. We compared the emergence of the forementioned radiological findings in SARS-COV2 positive and negative patients and assessed their correlation with SARS-COV2 infection and possible predictive value. RESULTS: A total of 414 patients were included in the statistical analysis. 31 (7.5%) were confirmed COVID cases, 143 (34.5%) underwent imaging with chest X-ray and 145 (35%) underwent imaging with chest CT or CTPA with 12/145 being confirmed COVID cases. Among the latter, 37 (25.5%) had a normal imaging with 3/37 being confirmed COVID cases and 108 (74.5%, 9/108 COVID) had one or more of the 8 remaining radiological findings, namely 39 (26.9%, 3/39 COVID) had fibrosis, 1 (0.7%, 0/1 COVID) had PE, 31 (21.4%, 4/31 COVID) had consolidation(s), 32 (22.1%, 7/32 COVID) had ground-glass opacity (GGO), 5 (3.4%, 0/5 COVID) had tree-in-bud pattern, 8 (5.5%, 0/8 COVID) had bronchiectasis, 40 (27.6%, 0/40 COVID) had pleural effusion(s) and none had crazy paving. We observed a statistically significant association with SARS-COV2 positivity only in the cases of GGO (p=0.005) and pleural effusion (p=0.037) when assessing the entirety of our cohort. Adjusting for sex brought about the emergence of statistically significant correlation with SARS-COV2 infection only for GGO in male patients (p=0.017), while adjusting for age led to the observation of statistically significant correlation with SARS-COV2 infection in the cases of consolidation (p=0.041) and GGO (p=0.001) in elderly patients exclusively. We also used logistic regression to generate the best models predicting SARS-COV2 infection based on radiological imaging and our population under examination and acquired the best results in terms of sensitivity (58.3%), specificity (81.2%), positive predictive value (21.9%) and negative predictive value (95.6%) when GGO was present. CONCLUSIONS: Ground glass opacity appears to be the most common chest CT finding associated with SARS-COV2 infection. Microbial superinfections are encountered more often in elderly patients. CLINICAL IMPLICATIONS: During the first wave of the SARS-COV2 pandemic (March 2020-October 2020), pretest probability was low in our country and chest imaging could be utilized to contribute to clinical decision in the event of ambiguous or not clear status of SARS-COV2 infection. DISCLOSURES: No relevant relationships by Stergios Gkintikas, source=Admin input No relevant relationships by DIMITRIOS KARAPIPERIS, source=Admin input No relevant relationships by Maria Kipourou, source=Web Response No relevant relationships by KAROZIS KONSTANTINOS, source=Web Response No relevant relationships by Prodromos Koutoukoglou, source=Web Response No relevant relationships by Dimitrios MOLIVAS, source=Web Response No relevant relationships by Dimitrios Sidiropoulos, source=Web Response No relevant relationships by Ioannis Tsanaktsidis, source=Web Response

Perceived Stress and Life Satisfaction Among Chinese Clinical Nursing Teachers: A Moderated Mediation Model of Burnout and Emotion Regulation.

Our previous study indicated that clinical teaching nurses in China suffered high levels of perceived stress and burnout, mainly because they were taking double responsibilities of nursing and teaching at the same time. The study aimed to investigate the underlying mechanisms of how and when perceived stress increased the risk of burnout and decreased life satisfaction among clinical teaching nurses. Questionnaires about perceived stress, burnout, emotion regulation, and life satisfaction were self-administered to 1,372 teaching nurses from eight tertiary military hospitals in China. Correlation and hierarchical multiple regressions were employed for data analysis. The results revealed that perceived stress had direct and indirect impacts on life satisfaction, with the principal element of burnout—emotional exhaustion—acting as a mediator. Moreover, the association between perceived stress and emotional exhaustion was moderated by emotion suppression—a key emotion regulation strategy. The negative impact of perceived stress on burnout was stronger among teaching nurses with high emotion suppression than among those with low emotion suppression. The present study contributed to a deeper understanding of the relationship between perceived stress and life satisfaction and also suggested further research into emotion regulation interventions to alleviate or eliminate the impact of perceived stress on burnout and eventually improve the life satisfaction for Chinese clinical nursing teachers.

Characteristics of Road Traffic Accident Cases Reported in a Tertiary Military Hospital

Introduction: Road traffic accidents (RTA) are the eighth leading cause of death globally, and the leading cause of death in Bangladesh. The road safety situation in Bangladesh has been deteriorating with increasing number of road accident deaths, largely as direct consequences of rapid growth in population, motorization, urbanization and lack of investment in road safety.&#x0D; Objectives: To describe the injury characteristics of road traffic accidents cases that reported at Combined Military Hospital (CMH), Dhaka.&#x0D; Materials and Methods: This descriptive cross-sectional hospital based study was conducted on all the RTA cases reported to medical inspection room CMH, Dhaka from 01 March to 30 June 2010. A total of 126 RTA victims irrespective of age and sex were included, data were collected by face to face interview using a pre-tested questionnaire.&#x0D; Results: A total of 126 road traffic accident victims both sexes were studied. The majority of the study subjects were men 103 (81.7%) and most of them were in 31-40 years group (27%), Muslims (98.41%) were the majority. In our study regarding educational qualification of RTA victims most of them were SSC qualified (44’4%) and primary level (15.1%). Military services holder (45.2%) was the majority of road traffic crash victims. Bus/Minibus (32.5%) was responsible for the majority of road traffic crashes and motor vehicle passengers (42.9%) were main victims. Laceration &amp; cut injury were (38.1%) and multiple injury (18.3%) were the most common injury. Main roads (49.2%) were the commonest site of the accidents. Regarding place of occurrence main roads 62 (49.2%) was the most common site and noon 41 (32.5%) was the most common time of occurrence of accidents.&#x0D; Conclusion: Road traffic crashes constitute a major public health problem in our setting and contribute significantly to unacceptably high morbidity and mortality. Urgent preventive measures targeting at reducing the occurrence of road traffic crashes is necessary to reduce the morbidity and mortality resulting from these injuries. Early recognition and prompt treatment of road traffic injuries is essential for optimal patient outcome.&#x0D; JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 213-217

Pattern of Knee Injury Cases Attending Combined Military Hospital, Dhaka

Introduction: Knee injury one of the most common injuries among soldiers accounts for losses in efficient combat power as well as increase burden of disability placed to the different units of Armed Forces.&#x0D; Objectives: To find out the pattern of knee injury of patients attending at a tertiary military hospital.&#x0D; Materials and Methods: This descriptive cross-sectional study carried out during January 2017 to December 2017 at Orthopedic Center of CMH, Dhaka. A total of 153 knee injuries patients were selected purposively as per selection criteria and data were collected by face to face interview and record review.&#x0D; Results: Total 153 respondents’ mean age was 31.03±10.19 years, most of them (41.8%) were from age group 25-34 years and were male (90.8%). Anterior Cruciate Ligament (ACL) injury was predominant (37.9%) and main precipitating physical event was football (20.3%) followed by jumping 9 feet ditch (16.3%). Right knee was more involved (49.7%) than left knee (46.4%). Most of injuries occurred in the exercise ground (40.5%) then sports ground (35.3%). ACL injuries (19%) were common in the age group 25-34 years and 9.8% were in 15-24 years. Morbidity duration of knee injuries was &lt;1 year for 49% and 1-5 years for 36.6% of the respondents.&#x0D; Conclusion: Training-related injuries negatively impact the capabilities of any Armed Forces. Low fitness levels among soldiers are associated with increased risk for injury and attrition. Knee injury may be considered as one of the major occupational health problems of Armed Forces.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 98-101

Post-Operative Bleeding in Tonsillectomy versus Tonsillectomy with Fossa Closure in a Tertiary Military Hospital: A Cohort Study

ABSTRACT&#x0D; Objective: To determine the incidence of post-operative bleeding among patients who underwent tonsillectomy alone versus tonsillectomy with fossa closure at the Victoriano Luna Medical Center from January 2015 to December 2017.&#x0D; Methods: &#x0D; Design: Retrospective Cohort Study&#x0D; Setting: Tertiary Military Hospital&#x0D; Patients: Medical records of 83 patients that underwent tonsillectomy under the Department of Otorhinolaryngology – Head and Neck Surgery between January 2015 to December 2017 were retrospectively reviewed for data regarding sex, age, tonsillectomy with or without fossa closure and post-operative bleeding. Cases of tonsillectomy alone versus tonsillectomy with fossa closure were compared (particularly with respect to post-operative bleeding), tabulated and statistically analyzed using risk ratio and t-test.&#x0D; Results: There were 57 cases of tonsillectomy alone versus 26 cases of tonsillectomy with fossa closure. The incidence of bleeding in all cases of tonsillectomy whether tonsillectomy alone or with fossa closure was 4.8%. The incidence of bleeding was higher in cases of tonsillectomy with fossa closure at 11.5% (versus 1.8% in tonsillectomy alone). Post-operative bleeding was 0.1 times more likely to occur in patients who underwent tonsillectomy alone than those who underwent tonsillectomy with fossa closure but there was no statistically significant difference in the risk of post-operative bleeding between the two.&#x0D; Conclusion: Although the incidence of bleeding was higher in cases of tonsillectomy with fossa closure, our results suggest that there is no statistically significant difference in risk for postoperative bleeding between tonsillectomy alone or tonsillectomy with fossa closure.&#x0D; Keywords: tonsillectomy; postoperative bleeding; tonsil pillars; suturing

Battle Against Musculoskeletal Tumors: Descriptive Data of Military Hospital Experience.

Background: Management of musculoskeletal tumors remains challenging for orthopedic surgeons. The aim of this cross-sectional study was to present the prevalence and localization of musculoskeletal disorders diagnosed and treated at a tertiary referral military hospital.Method: A total of 552 patients' medical records who presented to our clinic between 2009 and 2014 with the diagnosis of musculoskeletal tumors were retrospectively analyzed according to age, gender, bone/soft tissue localization, histopathological diagnosis, incidence, and treatment.Results: Of the cases diagnosed with tumor, 225 were soft tissue localized, 317 bone localized, and 10 tumor-like lesions. The most common primary benign soft tissue tumors were lipoma, ganglion, and giant cell tumor of tendon sheath, while the most common malignant soft tissue tumors were liposarcoma and synovial sarcoma, respectively. The most common primary bone tumors were osteochondroma, enchondroma, and simple bone cyst, while the most common malignant bone tumors were osteosarcoma, Ewing sarcoma and chondrosarcoma, respectively. Myositis ossificans was found as the most common tumor-like lesion.Conclusion: Descriptive data in musculoskeletal tumors is crucial in terms of improving treatment and reducing mortality. In this study, no significant difference was found between the data of tertiary military hospital regarding epidemiology of musculoskeletal system tumors and those from the literatures around Turkey.

Comparison of Outcomes Between the National Surgical Quality Improvement Program and an Emergency General Surgery Registry.

The National Surgical Quality Improvement Program (NSQIP) has become a prevalent tool for quality improvement. At our tertiary military hospital, NSQIP collects 20% of eligible cases. We implemented an emergency general surgery (EGS) registry to prospectively review all EGS cases. We compared our EGS registry with NSQIP, hypothesizing that NSQIP sampling under-represents EGS outcomes. A formal EGS Process Improvement Program was implemented in 2016. From 2016 to 2018, the four most common operations were laparoscopic appendectomy, laparoscopic cholecystectomy, surgery for small bowel obstruction, and nonelective hernia repair. Outcomes were compared between the EGS registry and NSQIP abstracted cases. In 2016, the EGS registry identified 11/112 (9.8%) patients with a complication. National Surgical Quality Improvement Program abstracted 16% of EGS cases with 16.7% (3/18) of patients having a complication. In 2017, the EGS registry identified 10/87 (11.5%) cases with complications. National Surgical Quality Improvement Program abstracted 23% of EGS with zero complications. In 2018, the EGS registry identified 9.5% of 74 cases with complications. National Surgical Quality Improvement Program abstracted 15% of EGS cases with zero complications. National Surgical Quality Improvement Program did not capture many important EGS outcomes. In 2 of 3 years, NSQIP did not identify a single complication for EGS. National Surgical Quality Improvement Program alone may be insufficient to target EGS improvements.

Epidemiological Features of Hospital Acquired Infection in a Tertiary Military Hospital

Background &amp; objective: Hospital Acquired Infections (HAIs) are the major concern in developing countries commonly affecting the ill patients in hospital settings. This study was conducted among the surgical patients admitted in the Combined Military Hospital (CMH), Dhaka to see the prevalence of HAI and factors influencing it.&#x0D; Method: The present cross-sectional study was carried out on patients admitted in the Combined Military Hospital (CMH), Dhaka between 01 July to 31 December 2018 to find the epidemiological features of Hospital Acquired Infection (HAI). Patients who acquired infection while admitted in CMH in whom the infection was not present at admission or who were incubating pathogenic microorganisms at the time of admission and manifested signs and symptoms after discharge were the study population. However, psychologically abnormal patients were excluded. A total of 200 patients were selected consecutively. The variables included in the study were demographic characteristics, co-morbidity, immunosuppressive conditions, immunosuppressive therapy.&#x0D; Result: Out 200 patients, 24(12%) developed HAI. Analysis of demographic features revealed that age and sex of the patients did not act as determinants of HAI (0.378 and p = 0.635 respectively). Patients dependent on others for most of their day-to-day activities tend to develop HAI more often than those who did not require assistance in their daily activities (p = 0.005). Patients inserted with an invasive device were more likely to develop HAI (14.9%) than those who were not inserted with such devices (7.6%) (p = 0.121). The patients of chronic respiratory disease and diabetes mellitus frequently develop HAI than the patients with other illnesses (p = 0.040). Colostomy tube was the prime source of HAI (50%) followed by gastrostomy tube (33.3%), urinary catheter (20.6%), orthopedic fixation device (20%) and mechanical ventilation (16.7%) (p&lt; 0.001) with longer the use of invasive devices the higher is the chance of HAI (p = 0.001). No association was observed between immunosuppressive condition of the patients and development of HAI (p = 0.558). Association between immunosuppressive therapy and HAI was not found to be significant (p = 0.495). HAI demonstrated their significant presence in patients with emergency operation compared to that in patients with routine operation (p = 0.047).&#x0D; Conclusion: The study concluded that every one in eight patients admitted in CMH may develop HAI. Patients dependent on others for their daily activities and patients inserted with an invasive device more often develop HAI than those who are independent or without an invasive device. Patients of chronic respiratory disease and diabetes mellitus are more prone to develop HAI. Colostomy and gastrostomy tube also act as the main source of HAI. So does the urinary catheter, orthopedic fixation device and mechanical ventilation with longer the use of invasive devices the higher is the chance of HAI. Emergency operation also tends to be associated with HAI.&#x0D; Ibrahim Card Med J 2019; 9 (1&amp;2): 29-35

Multidrug Resistant Mycobacterium tuberculosis Among Military and Civilian Personnel seen at a Tertiary Military Hospital, Manila, Philippines (2015-2018).

About one third of the world population is estimated to be infected with Mycobacterium tuberculosis (MTB), and this proportion is expected to be higher in countries with a high tuberculosis (TB) burden. The Philippines is both a high tuberculosis burden and a high multidrug resistant tuberculosis (MDR-TB) burden country. Though TB has been extensively described in the civilian population, there is limited data on TB in the military population. The objectives are: (1) To determine MTB/MDR-TB prevalence among military and civilian patients in the Philippines presenting with clinically suspected TB in a tertiary military hospital and (2) To determine performance of direct sputum smear microscopy (DSSM) using Ziehl-Neelsen (ZN) staining compared to Xpert MTB/RIF real-time reverse transcriptase polymerase chain reaction. Sputum samples were obtained from patients, clinically suspected with TB, and/or with TB associated signs/symptoms. Sputum specimens were tested using DSSM with ZN staining and Xpert MTB/RIF assay (Cepheid, Sunnyvale, California) and patient demographic and clinical data were collected. From March 2015 to December 2018, a total of 795 (173 military personnel [164 active duty and 9 retired]; 618 civilians; and 4 with no data on military/civilian status) patients with TB associated symptoms or clinically suspected with TB were tested. Overall, MTB prevalence was 81/795 (10%). MTB prevalence among active duty and retired military personnel were 27/164 (16%) and 4/9 (44%), respectively while MTB prevalence for civilian patients was 50/618 (8%) (p value=0.0003; OR=2.48 [95% C.I. 1.5-4]). Among active and retired military personnel who tested positive for MTB, rifampin resistance was 4/27 (15%) and 1/4 (25%), respectively, while rifampin resistance for civilian patients was 9/50 (18%) (p value=1; OR=0.88 [95% C.I. 0.26-2.90]). For active duty military personnel, average MTB prevalence (based on Xpert MTB/RIF) covering years 2015-2018 was 21% and ranged from 13% to 35%, while average rifampin resistance among MTB positive active duty military personnel was 15% and ranged from 0% to 25%. Overall sensitivity and specificity of DSSM compared to Xpert MTB/RIF were 70% and 96%, respectively. Positive and negative predictive values of DSSM to accurately categorize MTB in symptomatic cases (with Xpert MTB/RIF as "true positive" reference) were 74% and 95%, respectively. Performance of DSSM varied according to MTB load detected by Xpert MTB/RIF with increasing DSSM sensitivity observed as the MTB load detected by Xpert MTB/RIF increased (p=0.02). This report describes high MTB and MDR-TB prevalence rates among symptomatic military patients with military personnel having higher odds of MTB infection compared to the civilian patients in the study. Since DSSM (ZN) sensitivity greatly varied depending on MTB load, the Xpert MTB/RIF should be used as a first-line diagnostic tool to identify MTB and detect rifampin resistance among presumptive TB cases instead of DSSM (ZN) microscopy.

Maxillofacial Gunshot and Blast Injuries Seen in a Tertiary Military Hospital

Objective: To describe the incidence, pattern, and severity of maxillofacial trauma among patients who sustained gunshot and blast injuries of the maxillofacial region in a tertiary military hospital.&#x0D; Methods:&#x0D; Design: Retrospective Case Series&#x0D; Setting: Tertiary Military General Hospital&#x0D; Participants: All patients admitted under the otorhinolaryngology service with gunshot and blast injuries to the face&#x0D; Results: A total of 108 patients were admitted due to gunshot and blast injuries to the face from January 2010 to December 2015. Most sustained gunshot injuries (73, 67.6%) compared to blast injuries (35, 32.4%). Of 108 patients, 71 had maxillofacial fractures (65.7%) while the remaining 37 only had soft tissue injuries (34.3%). Majority of those with maxillofacial fractures had single bone involvement (52, 72.2%); the rest had two or more bones affected (19, 27.8%) The most common bone injured was the mandible (77.5%), followed by the maxilla (35.2%), zygoma (12.7%), and others (frontal, nasal, and temporal bones) at 5.6%.&#x0D; Conclusion: Gunshot injuries had a higher incidence than blast injuries among military personnel with projectile injuries to the face seen during the study period. There were more fractures and combinations of fractured bones affected in gunshot injuries, although the breakdown of soft tissue injuries was similar among those with gunshot and blast injuries. However, the relation of injury patterns and severity to gunshot or blast etiology, or to other factors such as protective gear, cannot be established in this present study.&#x0D; &#x0D; Keywords: gunshot injuries; blast injuries; maxillofacial; projectile

Relationship between the time required for transfer and outcomes in patients with appendicitis: Experience at a tertiary military hospital in South Korea.

A few studies have compared patients who were directly admitted with patients who were transferred to a tertiary facility for an appendectomy. However, there have been no reports of an association between the time to transfer and outcome in patients who underwent an appendectomy. As the only tertiary military hospital in South Korea, we occasionally encountered patients who were delayed for transfer due to the military environment. We hypothesize that patients with a longer time to transfer have a worse outcome. This study aimed to evaluate the relationship between the time to transfer and the outcome of patients who underwent an appendectomy.Patients who underwent appendectomy in the tertiary military hospital in South Korea from May 2015 to April 2017 were analyzed retrospectively. The groups were divided by the time for the transfer. Four hours was used as the cut-off point to divide the early and delayed transfer groups. Time from symptom onset to hospitalization, time from diagnosis to surgery, and time from hospitalization to surgery were also analyzed to assess the effect of time for the transfer.A total of 449 patients were analyzed: 293 with direct admission, 110 with early transfer, and 46 with delayed transfer. The time required for transfer was more critical for delaying appendectomy than the time from hospital admission to surgery. There was no difference in outcomes among the groups. When patients were compared according to the perforation, no differences were found in time from hospitalization to surgery, time from diagnosis to surgery, and presence of transfer. Multivariate analysis showed that a greater than 72 hours delay from symptom onset to hospitalization was associated with perforation (odds ratio = 12.61; 95% confidence interval: 3.84–41.40; P < .001).Even if a long transfer time is necessary, an appendectomy can be performed safely if patients were administered antibiotics immediately after diagnosis.

Comparison of Carbapenem-Resistant Microbial Pathogens in Combat and Non-combat Wounds of Military and Civilian Patients Seen at a Tertiary Military Hospital, Philippines (2013–2017)

Bacterial wound infections are a danger to both military and civilian populations. The nature of injury and infection associated with combat related wounds are important in guiding antibiotic prophylaxis and empiric treatment guidelines. The isolates were screened for drug-resistance by the MicroScan Walkaway Plus System using either the Negative Breakpoint Combo Panel (NBCP) 30 or 34 or Positive Breakpoint Combo Panel (PBPC) 20 or 23. Isolates with a minimum inhibitory concentration (MIC) of ≥8 μg/mL to imipenem and/or meropenem were tested for both carbapenemase production using the CarbaNP test and real-time PCR to determine molecular resistance mechanisms. Plasmid conjugation analysis was performed to define potential for horizontal gene transfer. We characterized 634 bacterial wound isolates collected from September 2013 to December 2017 from patients seen at a Philippine military tertiary hospital presenting with combat or non-combat injuries [354 (military) and 280 (civilians)]. Staphylococcus aureus was the most predominant bacterial species isolated from wounds in both populations (104/634, 16%). A variety of Gram-negative bacterial species comprised 442/634 (70%) of the isolates identified, with the most prevalent shown to be Pseudomonas aeruginosa, Enterobacter cloacae, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter sp. Carbapenemase production was detected in 34/442 (8%) Gram-negative isolates. Testing for molecular resistance mechanisms showed 32/34 (17 military, 15 civilian) wound isolates were blaNDM positive and 2 were blaVIM positive, with the two blaVIM isolates found in the civilian population. Plasmid conjugation of 14 blaNDM and 2 blaVIM positive wound isolates representatives showed 2/16 (13%) produced E. coli J53 transconjugants (E. coli from a civilian; E. cloacae from a military). We describe in this study the wound bacterial and antibiotic resistance profile in the military (combat vs non-combat associated) and civilian population. We observed that, with the exception of Acinetobacter sp., resistance of prevalent Gram-negative bacterial species to imipenem or meropenem were not significantly different between the military and civilian populations. We also presented data on the prevalent bacterial species isolated from both combat and non-combat wounds in a military tertiary care hospital setting as well as the carbapenemase-encoding gene primarily responsible for carbapenem resistance as well as evidence of horizontal transfer via mobile genetic elements. Clinicians may use this information to guide empiric antibiotic coverage for the predominant organisms if wound culture results are not readily available.A prospective, longitudinal evaluation of the wound bacterial profile documenting the changing bacterial flora using higher resolution molecular strategies can provide a more comprehensive understanding of the diversity, composition, and abundance of bacterial composition of the wound microbial community from the time of injury, during the course of evacuation from the field to higher level of care facilities, and up to wound resolution.

Successful implementation of an appendectomy process improvement protocol

BackgroundA key component of a process improvement program is the institution of hospital-specific protocols to address certain disparities and streamline patient care. In that regard, we evaluated the implementation of...