Urban Tertiary Care Hospital Research Articles

Optimization of Infant Nutrition: Exploring Feeding Practices Among Indian Mothers.

This study aims to investigate infant and young child feeding practices in an outpatient setting in India. About 103 parents of healthy children aged ≤6 years seeking outpatient pediatric care at an urban tertiary care hospital over one month were included in this observational study. Data regarding feeding practices was collected using a pre-designed and pretested questionnaire. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, USA) and Microsoft Excel (Microsoft Corporation, Redmond, USA). The average age of the study population was 21.26 ±16.561 months. About 45.6% of children were <12 months old. Around 42.7% of children were exclusively breastfed, 21.4% were formula-fed, and 35.9% were mixed-fed. About 49.15% of parents chose formula feeding voluntarily, and 50.85% due to inadequate milk supply. Around71.2% were recommended by the clinician, 16.9% chose formula based on online information, and 11.9% chose autonomously. Nestle NanPro was the most used formula, followed by Similac Advance, Pediasure Advance, Danone, and NeoSure.Also,54.4% of parents monitored their child's growth. Nearly 15.5% and 6.8% of parents were concerned regarding insufficient weight and height gain, respectively. About 38.8% of parents introduced salt, sugar, or cow's milk before their child reached one year.Around 62.1% of children were given vitamin supplements. Our study revealed that most parents adhered to recommended guidelines by exclusively breastfeeding their children, which holds crucial significance in a developing country like India. Parents resorted to formula feeding only when necessary for optimal nutrition. Nestle NanPro was the preferred choice. While most parents demonstrated commendable awareness through growth monitoring and supplementation, there's a crucial need for campaigns to dispel misconceptions and promote proper feeding practices.

Perceptions about hypertension in an urban population in Pakistan.

As the risk factors and prevalence of hypertension continue to increase in Pakistan, it is imperative to understand the perceptions of patients about its prevention, symptoms, diagnosis, treatment, and management to inform the design of programmes to improve management. To explore patients' perceptions about the treatment, management and control of hypertension in an urban population in Pakistan. Using a semi-structured questionnaire, we conducted one-on-one interviews with 30 hypertensive patients at 2 urban government tertiary care hospitals in Lahore and Sargodha. The patients were aged 35-70 years, diagnosed with hypertension by a registered medical doctor, and being treated with anti-hypertensive medication. The interviews were recorded, transcribed and analysed using Quirkos. Almost all the patients recognized the potential long-term consequences of hypertension. Most of them said regular use of prescribed medication was beneficial, including for blood pressure control and relief of symptoms. They understood the benefits of lifestyle modification, such as engaging in physical activity, for the management of blood pressure. They however had inadequate knowledge of their treatment regimens; some of them took their medications irregularly, while some took them only when they felt symptoms. Most patients relied solely on medical management. We identified major challenges with the management of hypertension among the study population. Patients and caregivers relied mostly on medical management, with insufficient follow-up after initiating treatment. There is a need to improve patient follow-up and provide better patient education on the benefits of adhering to treatment regimens and adopting lifestyle changes including dietary and exercise management.

B-300 Fentanyl and Xylazine Positivity Patterns at a Northeast U.S. Children’s Hospital

Abstract Background In the U.S., fentanyl mixed with xylazine has been designated as an emerging health threat. Information on whether xylazine is present with fentanyl poisoning could help better navigate the management of children exposed to fentanyl mixed with xylazine. The detection of xylazine can be a marker used to differentiate medical vs non-medical fentanyl exposure. We aimed to explore the trends in positivity rates of fentanyl and/or xylazine at an urban pediatric tertiary care hospital. Methods We conducted a retrospective analysis from October 2021 - January 2024 of fentanyl positive urine drug screen (UDS) results by immunoassay performed in-house, and the reflex confirmatory testing by liquid chromatography-tandem mass spectrometry (LC-MS/MS), performed by an external laboratory. When available, xylazine detection results by gas chromatography mass spectrometry (GC-MS) were also included in the analysis. A chart review of fentanyl positive UDS cases was conducted to determine if fentanyl was medically administered prior to the UDS. We evaluated the positivity rate of fentanyl, the co-detection of xylazine, and the positivity patterns based on age, sex, and collection department. Results Fentanyl positive tests encompassed 3.4% (227/6632) of all UDS performed at our institution and 11.0% (227/2058) of all positive UDS tests, with medical fentanyl administration prior to UDS documented in 76.2% (173/227) of cases. 217/227 samples had confirmatory testing with 96.8% (210/217) confirmed by LC-MS/MS. The median age of fentanyl positives was 7 years (41.9% ≤ 3 years old) and 57.3% were male. Fentanyl-only positive UDS were seen in 33.0% (75/227) of all fentanyl positives and 45.6% (108/227) were also positive for benzodiazepines. 68.7% (156/227) were collected in the intensive care units, and 19.8% (45/227) were from the emergency department. 46.7% (106/227) of fentanyl positive cases had concurrent GC-MS results available. Xylazine was detected in 13.2% (14/106) of these cases, with 13 cases reported as unintentional exposure on patients' chart, and 12 cases having a fentanyl-only positive UDS. The median age of xylazine positives was 2 years (71.4% ≤ 3 years old, age ranged from 19 days to 14 years) and 78.6% were male. 7/14 fentanyl mixed with xylazine cases were collected in the emergency department and 7/14 were collected in intensive care. 2/14 of the xylazine positive cases had medical fentanyl administration prior to UDS. Conclusions Detection and management of fentanyl poisoning, especially when mixed with xylazine, remains a challenge in children. Presence of xylazine is a distinct marker of exposure to non-medical fentanyl. Continued surveillance of these cases could shed light on patterns that could aid further the management of affected children and contribute to harm reduction efforts.

S2870 An Outbreak of Shigella Dysentery at an Urban Tertiary Care Hospital

S2870 An Outbreak of Shigella Dysentery at an Urban Tertiary Care Hospital

Vitamin D Status among Patients Visiting an Urban Tertiary Care Hospital, Dhaka

Background: Majority of the Bangladeshi population lives in an areas receiving ample sunshine throughout the year. Despite this fact multiple studies have shown wide prevalence of vitamin D deficiency in our country in all ages and both sexes. Adequate vitamin D status has an important clinical advantage for maintaining various activities as well as preventing diseases. In this lab based retrospective study, it was determined the prevailing condition of vitamin D deficiency among adult patients visiting MH Samorita Hospital and Medical College outdoor. The present study aimed to focus on assessing Vitamin D status of adult patients visited a tertiary care hospital of Dhaka city. Materials and methods: This was a retrospective study. A total of 72 cases were chosen by random sampling with records of vitamin D status, age and sex from July to December, 2022.The results were statistically analyzed with Statistical Packages for Social Science (SPSS-24). Results: Out of total subject (n=72) none of them showed toxic serum concentration of vitamin, 12.5 % had sufficient, 23.6% had insufficient and 63.9% had deficient levels of vitamin D. Gender wise comparison of vitamin D status showed male patients, 28.3% were deficient in vitamin D, 47.1% were insufficient, and a substantial 77.8% had sufficient levels. In contrast, a much higher proportion of female patients were deficient (71.7%) or insufficient (52.9%) in vitamin D, with only 22.2% having sufficient levels. According to age wise distribution, the highest percentage of vitamin D deficiency (58.7%) was observed in the youngest age group (18-30 years), while the proportion decreased in older age groups (30.4% for 31-50 years and 10.9% for 51-65 years). Conclusion: Vitamin D is an important vitamin which impacts many systems of the body .This study indicates that 63.9 % of subjects are vitamin D deficient which is very much alarming. So, it becomes paramount to further scrutinize the associated factors apart from age and gender. To this end, further studies are needed. IAHS Medical Journal Volume 6(2) December 2023; 68-72

Beliefs, preferences, and acceptance of personal protective equipment for a shock room team in a tertiary care center.

During coronavirus disease of 2019 pandemic a standard usage of personal protective equipment (PPE) in healthcare was mandatory, while actually the usage of PPE is currently decreasing. This raises the question about the further use of PPE in the clinical setting because healthcare workers (HCW) are at greater risk of being infected with SARS-CoV-2 than the general population. The primary objective of this study is to determine the proportion of shock room team members approving the further use of PPE including a FFP2 respirator in simulation training and reality. The secondary objectives are to describe the expertise and difficulties faced while using PPE in the shock room care. Fifty-four HCW participated in a shock room simulation training at a large urban tertiary care hospital in Germany, utilizing a PPE comprising an FFP2 mask, gloves, goggles, and gown. Subsequently, participants completed an online questionnaire featuring 15 questions presented on a 5-point Likert scale or as multiple-choice questions with predefined answers. Sixty-eight point five percent of our participants voted for an established standard PPE in shock room care. The largest fraction of our participants (40.7%) favors a standard PPE consisting of FFP2 mask, gown, and gloves. Less HCW (31.5%) want to wear PPE in shock room simulation training. Except for goggles we could not detect relevant difficulties faced while using PPE in the shock room environment. Incorrect use of PPE was observed in 14.8%. A majority of our participants favored a standard PPE including a FFP2 respirator in shock room care. In addition, we recommend the use of PPE in shock room simulation training, while further awareness of and training in proper use of PPE seems to be necessary to reduce risk of infectious diseases for HCW.

Knowledge of Mental Illness and Its Associations Among Caregivers of Patients With Schizophrenia.

Schizophrenia is a severe mental illness that greatly impacts the real-world functioning of patients. In India, caregivers are primarily responsible for their patients and function as their support system, often taking treatment decisions on their behalf. However, they may have insufficient knowledge of the illness, which can have a negative impact on their roles as effective caregivers. The knowledge of schizophrenia and its associations among caregivers has received very little research attention. To examine the knowledge of mental illness and its socio-demographic and psychosocial associations among caregivers of patients with schizophrenia. The objectives were to assess the knowledge of mental illness and its treatment in caregivers of patients with schizophrenia, to assess the socio-demographic and clinical associations of this knowledge, and to assess the caregivers' psychosocial variables associated with this knowledge. This cross-sectional observational data was taken from a larger study carried out between August 2018 and January 2021 at an urban tertiary care hospital in the capital city of India. One hundred fifty-eight patients with schizophrenia and their caregivers (n=158) were taken using purposive sampling. Knowledge of Mental Illness Scale was used to evaluate the knowledge and understanding of the illness and its treatment among caregivers. Caregivers coming to this institution in New Delhi were also assessed with respect to their demographic variables, caregiving experience, family functioning, coping strategies, available social support, psychological distress, quality of life, and spiritual, religious, and personal beliefs. The assessment also included demographic and clinical variables of the patients. Caregivers possessed relatively greater knowledge regarding the medication being taken (52.5%), its side effects (38%), and the diagnosis (36.1%). However, their knowledge was poorer with respect to the meaning and implications of the diagnosis (21.5%) and the purpose of the medication (10.1%). In multivariate regression analysis of these five domains with socio-demographic, clinical, and psychosocial variables; the knowledge of the diagnosis was associated with a family history of psychiatric illness in a second-degree relative, the total duration of treatment, and stigma in caregivers. The meaning of the diagnosis was associated with the environmental domain of quality of life and positive symptoms of the patient. Knowledge of medication was associated with the number of patient hospitalizations, caregivers supervising medications, caregiver age, and the total duration of illness. Knowledge of the purpose of medication was associated with the total duration of illness and patient positive symptoms. Knowledge of medication side effects was associated with the roles domain of family functioning, positive caregiving experience, patient negative symptoms, and the acceptance/redefinition domain of coping. A range of associations were examined in this study. Correct knowledge of schizophrenia is necessary to promote timely help-seeking, preventing a longer duration of untreated psychosis and a poor prognosis. In research, knowledge of illness is a construct with immense potential applicability. In patient care, this knowledge may help caregivers participate in treatment planning, improve patient functioning, and support their patients toward better functional outcomes.

Are first-trimester pregnant women consuming adequate and diverse diet? A hospital-based cross-sectional study in Karachi, Pakistan

BackgroundMaintaining a healthy and diverse diet during pregnancy is crucial for maternal well-being and fetal development. The first trimester marks the beginning of vital developmental processes influenced by maternal nutritional status. Therefore, we aimed to determine dietary adequacy and diversity among first-trimester pregnant women.MethodsIn this cross-sectional study, we recruited 306 first-trimester pregnant women from the antenatal clinics of Aga Khan University Hospital, Karachi (January 2020 to September 2021). Eligible women possessed smartphones (for the mHealth intervention trial) and reported no major comorbidities or medication use. Data about socio-demographic, obstetric, and dietary history were collected through interviews using a structured questionnaire. Booking weight, height, blood pressure, and haemoglobin levels were extracted from medical records. An aggregate dietary risk score (DRS) was calculated separately for quantity and quality by summing the DRS for each of the six major food groups. A score of 0 was assigned to adequate, 1.5 to intermediate, and 3 to inadequate quantity or quality categories. Data were analysed using STATA 14.0.ResultsThe mean ± SD for DRS quantity and quality were 10.6 ± 2.4 and 7.5 ± 2.5, respectively. Adequate dietary quantity and quality per week for starch-based food were reported by 14.4% and 21.2%, for vegetables by 0.3% and 49%, for fruits by 41.2% and 88.6%, for animal and plant protein by 19% and 0%, for milk and milk products by 1% and 37.6% and for oils and fats by 90.5% and 8.8%, respectively. Sweet and savoury snacks were eaten by 74.8% and 53.9%, respectively. Ready-made meals, carbonated beverages, packaged juices, and additional salt were consumed by 55.2%, 46.4%, 34.3%, and 7.5%, respectively. The median (IQR) water intake was 6 (4–8) glasses/day.ConclusionsDuring the early stages of pregnancy, women enrolled for antenatal care at an urban private tertiary care hospital report inadequate dietary intake for various food groups, except for the quantity of oils/fats and the quality of fruit consumption. Poor dietary practices underscore the need for focused and impactful dietary counselling during the initial stages of pregnancy.

Toward Standardization and High Reliability: Improved Sepsis Screening in Emergency Department Triage Across an Academic Health System

Sepsis is a life-threatening emergency, and early recognition and treatment in the emergency department (ED) is critical to improving outcomes. The authors implemented an interdisciplinary quality improvement (QI) project to standardize sepsis screening workflow across an academic health system consisting of a large tertiary care urban hospital, one freestanding ED, and two small rural affiliate hospitals (RA-1 and RA-2). The research team used the Institute for Healthcare Improvement Model for Improvement framework, consisting of iterative Plan-Do-Study-Act (PDSA) cycles. The primary outcome was rates of screening for sepsis at each site. Secondary outcomes included sepsis mortality and Centers for Medicare & Medicaid Services (CMS) sepsis bundle (SEP-1) compliance at our main medical center. Primary outcome was assessed using electronic dashboards extracting the ratio of ED encounters with electronic health record (EHR)-documented sepsis screening per total ED encounters. The SEP-1 bundle was assessed as percent compliance, and mortality was calculated as average observed to expected (O:E). Averages were compared from preintervention to after initiating improvements using two-tailed t-tests. This QI project took place from December 2022 to December 2023 across four EDs that experience around 138,000 visits annually. A standardized workflow was established at ED triage with an EHR-based question and an associated nurse and physician defined response. Preintervention (October 2022 to November 2022) triage rates for sepsis were 1.7% (163/9,560), 25.3% (523/2,068), 11.0% (360/3,272), and 36.5% (915/2,506) at our main hospital, freestanding ED, RA-1, and RA-2, respectively. After four PDSA cycles, triage rates rose to 91.9% (4,927/5,360), 97.5% (1,032/1,059), 99.0% (1,845/1,863), and 97.4% (1,328/1,363), respectively (p < 0.005). Sepsis triage rates rose most slowly at the large academic medical center, where progressive PDSA cycles were needed to achieve > 90% screening for sepsis. Mean O:E mortality was 0.99 for the 9 months of available data preintervention and 0.83 in the 17 months postintervention (p = 0.07). CMS sepsis bundle compliance was 28.4% for the 15 months preintervention and 40.5% in the 17 months postintervention, (p = 0.14). An interdisciplinary QI project leveraged EHR optimization to integrate with human workflows over four PDSA cycles to achieve standardized and improved screening for sepsis in the ED. This resulted in lower sepsis mortality and increased sepsis bundle compliance, though results were not statistically significant.

To Determine the Accuracy and Reliability of Broselow Tape in Comparison with Actual Weight and Advance Pediatric Life Support Formula Weight Assessment among the Pediatric Population Presenting to Emergency Department of a Low Income Setting

Background: Near precise weight assessment among sick pediatric patients remains a dilemma and conventionally accepted weight assessment methods, in busy ED might be inaccurate or unreliable. Children have different weights at different ages, and accurate/precise weight measurement is of utmost importance for weight-related dose calculation of drugs/fluids, equipment sizes, an accurate dose of electrical currents during cardiac shock, etc. Several weight estimation methods are available and are dependent on the child's age, length, or both. However, length or length-and-age-based methods may have greater accuracy than merely age-based, still precise weight measurement while children are recumbent (length) has its own challenges. Objective: We determined the accuracy and reliability of BT by comparing it with actual weight and advanced pediatric life support formula (APLS) among the pediatric population presenting to the emergency department. Methods: This was a single-center, cross-sectional study design. This study was conducted at pediatric emergency of an urban tertiary care hospital after ethics committee approval and written consent from parents/caregivers during July 2021- June 22. Pediatric patients aged 1 month to 12 years, weight 3-36 kg, and height 46.5-142.5 cm on BT were included. Actual weight was measured on a standard weighing machine. We use Broselow pediatric emergency tape (2017 edition), APLS formula was also used to measure the estimated weight by using the age provided by parents. Descriptive analysis, mean and standard deviation were calculated, frequencies and percentages were calculated for categorical variables. Cronbach’s alpha and Passing-Bablok regression analysis was applied to assess the reliability and identify systematic biases between actual body weights with estimated BT. Bland–Altman analysis was also performed to measure the precision, accuracy, and bias. Results: 250 children were included with equal gender distribution and were divided in to three categories as per the weight estimation by BT in to &lt;10 kg (n=58, 23.2%), 10-18 kg (n=151, 60.4%) and &gt;18 kg (n=41, 16.4%). The mean age was 5.26 (±2.37) years, majority of children were below 5 years of age (n=144, 58%). Positive agreement between BT weight with actual weight and other formulas in weight category of &lt;10 kg, however as weight increases from 10 kg, onward results are not significant. Passing and Bablok Regression analysis showed a positive correlation between the estimated and actual (AW) body weight (r=0.9280, p&lt;0.001) and accuracy (r2=0.929), and the accuracy of BT weight decreases with the increasing weight of children. Similarly, 95% agreement limit and mean biased was 0.465 to 1.113 and 0.789±2.602 between BT and APLS, BT with AW was -0.50 to -0.28 and -0.39±0.885. Comparing and correlating weight assessment of APLS formula vs LF and TF didn't show significance with a p-value of 0.041 and 0.034 respectively. Bland-Altman plot between BT measurement with AW demonstrates a bias equal to 1.096 kg with a limit of 0.870 to 1.815. Conclusion: BT may be an accurate and time bound method of weight measurement as compared to other methods of weight estimation, however the accuracy of BT may be adversely affected with age exceeding 95 months and weight &gt;26 kg. BT may be safely used in the younger pediatric population. Health care professionals may consider this information while using BT to estimate weight for pediatric resuscitation, however, this is a single center hospital based study with limited cases, we recommend to have a large scale community based study or a census before to generalize these results to general population.

New solutions to old problems: A practical approach to identify samples with intravenous fluid contamination in clinical laboratories

ObjectivesContamination with intravenous (IV) fluids is a common cause of specimen rejection or erroneous results in hospitalized patients. Identification of contaminated samples can be difficult. Common measures such as failed delta checks may not be adequately sensitive nor specific. This study aimed to determine detection criteria using commonly ordered tests to identify IV fluid contamination and validate the use of these criteria. MethodsConfirmed contaminated and non-contaminated samples were used to identify patterns in laboratory results to develop criteria to detect IV fluid contamination. The proposed criteria were implemented at a tertiary care hospital laboratory to assess performance prospectively for 6 months, and applied to retrospective chemistry results from 3 hospitals and 1 community lab to determine feasibility and flagging rates. The algorithm was also tested at an external institution for transferability. ResultsThe proposed algorithm had a positive predictive value of 92 %, negative predictive value of 91 % and overall agreement of 92 % when two or more criteria are met (n = 214). The flagging rates were 0.03 % to 0.07 % for hospital and 0.003 % for community laboratories. ConclusionsThe proposed algorithm identified true contamination with low false flagging rates in tertiary care urban hospital laboratories. Retrospective and prospective analysis suggest the algorithm is suitable for implementation in clinical laboratories to identify samples with possible IV fluid contamination for further investigation.

A Nerve Block Team in the Emergency Department

Objectives To improve pain management in the emergency department (ED), emergency physicians are performing an increasing number of ultrasound-guided regional anesthesia procedures (nerve blocks). We aimed to examine the effect of a dedicated emergency department (ED) nerve block team (NBT) on the number and types of ultrasound-guided nerve blocks administered in the ED. Methods We performed a retrospective chart review comparing the nine-month period before and after the creation of a dedicated NBT. This was performed at a tertiary care urban hospital that is a level 1 trauma center. We assessed and compared the number and types of nerve blocks performed, level of learners who performed nerve blocks, and time of ED arrival to disposition, before and after implementation of the NBT. Results The utilization of nerve blocks rose from 79 prior to the establishment of the NBT to 108 following its creation, representing a 36.7% increase. The average duration of stay in the emergency department decreased by 51 minutes, though this change did not demonstrate statistical significance (P=0.1237). There was an increased variety in the types of nerve blocks performed. Conclusion The introduction of a NBT led to a rise in both the quantity and diversity of nerve blocks conducted in the ED.

Caring for Children With Medical Complexity: A Clinical, Patient-Focused Curriculum.

Caring for children with medical complexity (CMC) requires specialized knowledge and skills. However, no standardized curricula are used across training programs as institutions have varying needs and resources. We created a patient-focused, interactive curriculum for two CMC topics: feeding/nutrition and pain/irritability. We integrated the 45-minute sessions into morning protected patient-care time on an inpatient pediatric team at an urban tertiary care hospital. Targeted toward all pediatric residents and medical students rotating in inpatient pediatrics over a 12-month period, the sessions used a mix of didactic, discussion, and hands-on activities. Learners on one of two inpatient teams received the curriculum, while those on the other received a curriculum unrelated to CMC and served as a control group. Both groups completed retrospective pre/post self-assessments to evaluate self-efficacy with respect to the learning objectives. Over the 12-month period, 72 surveys were completed for the feeding/nutrition session, 78 surveys for the pain/irritability session, and 42 control surveys. The intervention group saw the greatest increase in self-efficacy scores generally in the feeding/nutrition session. All eight learning objectives saw significant improvement in self-efficacy scores for the intervention group. There was significantly greater improvement in self-efficacy for the intervention group compared to the control for all eight learning objectives. Through this patient-focused curriculum, learners had improved self-efficacy scores compared to the natural learning occurring on the inpatient service. The curriculum could be adapted to fit the needs of other institutions and provides a practical, hands-on approach to learning about caring for CMC.

Study of Different Breastfeeding Parameters by Using Breastfeeding Assessment Tools in Urban Tertiary Care Hospital

Background: In India, only 56% of mothers breastfeed exclusively for the first six months, as recommended. Given India’s extraordinarily high rates of preterm births, infant mortality, neonatal deaths and maternal fatalities, exclusive breastfeeding becomes even more crucial. There are many advantages of breastfeeding, but there are lots of barriers that need to be addressed. These problems need a proper objective assessment. Aims: To assess optimum positioning and attachment in mother-infant dyads, infant breastfeeding behaviour in the early neonatal period and early breastfeeding skills in mothers. Methods: A prospective cross-sectional study was conducted in the postnatal ward of a tertiary care hospital. In total, 208 full-term neonates (Age - 24 hours to 7 days) who were admitted to a postnatal ward of a tertiary care hospital and who were on direct breastfeeding were observed for breastfeeding. Objective assessment of breastfeeding was done by using the Bristol Breastfeeding Assessment Tool, Infant Breast-Feeding Assessment tool and LATCH tool. Statistical analysis was done by using SPSS version 25 with appropriate statistical tests. Result: For the BBAT tool, 110 (52.9%) infants were well supported while feeding and 118 (56.7%) had proper latching or attachment. For IBFAT Score Analysis, 109 (52.4%) infants were effective vigorous feeders and 95 (45.7%) and 4 (1.9%) were moderately effective feeders and poor feeders, respectively. For LATCH Score Analysis, 173 (83.2%) mother-infant dyads achieved a high score and 35 (16.8%) achieved moderate score. Conclusion: Objective assessment of breastfeeding by using these tools will help to identify the problem related to breastfeeding for both baby and mother. Addressing a particular problem in a timely manner will help the mother and the baby to establish, initiate and sustain exclusive breastfeeding. Caesarean-delivered mothers as well as primiparous mothers both needed more focused counselling for breastfeeding positioning, motivation for early initiation breastfeeding, a strong supportive relationship, adequate assistance during the early neonatal period for breastfeeding and proper guidance to sustain exclusive breastfeeding.

An observational multi-center study on type 2 diabetes treatment prescribing pattern and patient adherence to treatment

In 2021, the International Diabetes Federation (IDF) reported that the prevalence of diabetes in Pakistan was 9.6%, higher than the global average. However, adherence to treatment guidelines, e.g., American Diabetes Association and Pakistan Endocrine Society and prescription patterns for Oral anti-diabetes (OAD), is poorly understood in Pakistan. Therefore, this study aimed to examine the prescribing practices of anti-diabetic medications, an association of lifestyle modification with drugs prescribed, and their effectiveness in preserving ideal glycemic levels in diabetic patients undergoing treatment in tertiary care teaching hospitals in rural and urban Pakistan. In this cross-sectional study, data were collected from prescriptions of outpatient diabetic patients from different rural and urban tertiary care hospitals between October 2021 and February 2022. 388 participants were enrolled in the study for a detailed interview on prescription evaluation and glycemic control. The coinvestigators conducted an interview with the patient and used a pre-validated questionnaire to collect the data. The relationship between following treatment guidelines and clinical and demographic factors was found using chi-square tests for bivariate analyses. The study reported that out of 388, the mean ages of the patients were 48 ± 12.4, and the majority were female. It was observed that 60.1% and 66.5% have uncontrolled fasting and random blood glucose, respectively. The education level of the study participants was also below par to have a complete understanding of the medical condition and self-management therapy. Even though they were taking the right medications—an average prescription regimen included 5.08 medications—52.1% of the studied people had glycated haemoglobin (HbA1c) levels higher than the therapeutic threshold set by the International Diabetes Federation. In this modern era, it was observed that the prescribing trend was still focused on traditional therapeutic options Biguanides, sulfonylureas, and dipeptidyl peptidase-4 inhibitors were prescribed in 64.6% of the patients. A significant association was found between glycemic control and body mass index, adherence to lifestyle modifications, and the number of medications prescribed (p-value < 0.05). The study reveals that Pakistan's prescribing practices do not align with international and national guidelines, leading to a high prevalence of uncontrolled diabetes and widespread use of polypharmacy among patients. To address this issue, policymakers should prioritize establishing a comprehensive national diabetes action plan. Additionally, there is a pressing need to develop diabetes education and awareness programs emphasizing the importance of lifestyle modifications for effective diabetes management.

Folic acid prescription practice for high-risk prevention of spina bifida at a tertiary care hospital in Addis Ababa, Ethiopia.

Mothers who have had a pregnancy affected by spina bifida are advised to take 4-5 mg/day folic acid pills to prevent recurrence. The folic acid prescription pattern was examined for high-risk mothers whose children received spina bifida surgery in an urban Ethiopian hospital. Data were analyzed from a large Ethiopian urban tertiary care hospital that provided spina bifida care. General practitioners recorded 5 mg/day folic acid prescriptions administered to mothers of infants with spina bifida born between January 2019 and June 2022. Among 500 baby-mother pairs, 340 (68%) received a 120-day prescription for 5 mg/day folic acid pills. Of these 340 mothers, 331 (97%) received their folic acid prescription at their child's first or second patient encounter. Almost all mothers (94%) had documentation of only one prescription for the study duration. The percentage of mothers receiving at least one prescription varied by the baby's year of birth (2019:75%; 2020:92%; 2021:46%; Jan 2022 -June 2022:79%). This prioritization of spina bifida recurrence prevention demonstrates feasibility for other healthcare centers in low-income countries. Sustained funds to provide women with free folic acid pills can favor high compliance and uptake of this prevention intervention.

Factors influencing the need and willingness for presbyopic correction: a cross sectional study from south India

Presbyopia is an age-related physiological phenomenon in which eye gradually losses its ability to accommodate. It is one of the leading causes of visual impairment worldwide, especially in adults above the age of 40. If uncorrected, it can significantly impair a patient's quality of life. This study aims to evaluate the factors which affects patient’s need and willingness to accept presbyopic correction. This cross-sectional analytical study was carried out in a semi urban tertiary care hospital from Jan 2021 to June 2022 among patients aged 40 and above who presented to Outpatient department (OPD). Demographic details, medical history, presenting ocular complaints pertaining to presbyopia, spectacle use and decision regarding using near vision correction were noted. Ocular examination included refraction and ocular biometry. Factors that may have influenced complaints of presbyopia or willingness to accept presbyopic correction were analysed. Three hundred and forty two patients with a mean age of 48.55 ± 6.68 years were included. Of these, 262 (76.61%) patients presented with chief complaints related to presbyopia. Those with higher educational qualification (p = 0.031), hypermetropia (p = 0.021), shallower AC depth (p = 0.028) and on medications for systemic ailments (p = 0.01), were more likely to present with chief complaints attributable to presbyopia. Among them, those with higher educational qualifications (p = 0.02) and skilled workers were more likely to accept near vision glasses (p = 0.02), while those with lower Hb (p = 0.01) and myopia (p = 0.01) were less likely to accept correction for presbyopia. Among the 80 patients without chief complaints related to presbyopia, 35 (43.75%) were not willing to accept near vision glasses. Those with higher BMI (p = 0.04) and hypermetropes (p = 0.05) were more willing to accept presbyopic correction. Presbyopia constitutes a significant reason for patients above the age of 40 visiting eye care facility. Multiple socio-economic, systemic and ocular factors influenced both the chief complaints related to presbyopia and willingness to accept presbyopic correction.

Psychological Burden of Systemic Racism-Related Distress in New York City Healthcare Workers During the COVID-19 Pandemic.

Little is known about the relationship among systemic racism, psychological symptoms (depression, anxiety, and/or post-traumatic stress disorders), and burnout in healthcare workers (HCWs). To determine whether distress related to awareness of systemic racism contributes to psychological symptoms and/or burnout in HCWs. We explored whether this form of racism-related distress may moderate the relationship between race, ethnicity, psychological symptoms, and burnout. A cross-sectional survey was conducted from November 19, 2020, through January 11, 2021. Statistical analysis was conducted from May 3, 2022, to June 15, 2022. Frontline HCWs at an urban tertiary care hospital in New York City. Distress related to awareness of systemic racism (SR) and racial disparities in COVID-19 outcomes (RD), psychological symptoms, and burnout. Two thousand one of 4654 HCWs completed the survey (response rate 43.0%). Most HCWs reported experiencing distress related to awareness of systemic racism (1329 [66.4%]) and to racial disparities in COVID-19 outcomes (1137 [56.8%]). Non-Hispanic Black participants (SR odds ratio (OR) 2.84, p < .001; RD OR 2.34, p < .001), women (SR OR 1.35, p = .01; RD OR 1.67, p < .001), and those with history of mental illness (SR OR 2.13, p < .001; RD OR 1.66, p < .001) were more likely to report SR- and RD-related distress, respectively. HCWs who experienced "quite-a-bit to extreme" SR-related distress were more likely to screen positive for psychological symptoms (OR 5.90, p < .001) and burnout (OR 2.26, p < .001). Our findings suggest that distress related to awareness of systemic racism, not race/ethnicity, was associated with experiencing psychological symptoms and burnout in HCWs. As the medical community continues to critically examine the role of systemic racism in healthcare, our work is a first step in characterizing its toll on the psychological well-being of HCWs.

30 Promoting Child and Youth Rights Literacy and the United Nations’ Convention on the Rights of the Child (UNCRC) for Equity-deserving Populations: A Multi-Partner, Mixed Methods Pilot Study

Abstract Background The UNCRC outlines the rights of children and youth to develop their greatest potential. These rights provide a framework for a child-centred approach in paediatric clinical practice and are associated with improved patient outcomes and experiences. While these rights are increasingly acknowledged globally, more work is needed within clinical settings to adopt this rights-based approach. A pilot survey was developed in partnership with an equity-deserving urban youth recreation centre and youth with chronic health conditions from a provincial paediatric tertiary care teaching hospital’s Youth Advisory Committee (YAC) regarding their knowledge of, and access to, the UNCRC. Objectives 1) To identify urban community youth knowledge of, and access to, UNCRC; 2) To identify and compare YAC knowledge of, and access to, UNCRC. Design/Methods Ethics approval was obtained. A survey developed to facilitate UNCRC discussions was presented to the urban community youth, iteratively from 2020 to 2021. Participants were recruited using convenience snowball sampling. Zoom dialogues between the research team and YAC members were held to adapt the survey to YAC context. The survey was completed by YAC members on Qualtrics from May to August 2022. Demographic information and survey results were analyzed using descriptive statistics. Results 57 participants completed the survey, including 18 youth, 16 caregivers, and 11 staff members from the community, and 11 youth and 1 staff member from YAC. The median ages of urban and YAC youth were 16.4 years and 23 years respectively. Prior to the study, 70% of youth participants did not know, or only sort of knew that the UNCRC existed. Both urban youth and YAC reported that children aged 0 to10 and 11 to 14 have the most access to article 31 (rest and play). However, urban youth reported that 15 to24-year-olds have the most access to article 24 (health and health services), whereas YAC reported article 12 (respect for children’s views) for this age group. Both youth groups reported that children and youth of all ages have the least access to articles 28 and 29 (education), article 12 (respect for children’s views), and article 23 (support for children with disabilities). Conclusion A lack of knowledge of the UNCRC was prevalent in youth from both an urban community and tertiary care hospital, indicating a need for increased dialogue among this community, clinicians, and the healthcare system. These results will also inform patient advocacy communities on gaps in knowledge and access to empower advocacy around child rights.

A Resilience Program for Hospital Security Officers During the COVID-19 Pandemic Using a Community Engagement Model.

Security officers in health systems are subject to high levels of stress and current support interventions do not necessarily target their needs. To address this gap, a resilience center at a major urban tertiary care hospital utilized community engagement principles to adapt and implement resilience and mental health awareness workshops, which were informed by initial piloting. The program consisted of twelve short briefings in which officers were provided psychoeducation on psychological first aid and adaptive coping. The program reached 107 security officers (89.5% men, 95.2% people of color); both qualitative and quantitative feedback indicated a generally positive reception. Further efforts to support security officers are warranted given their high exposure to patient crises and under-acknowledgement as frontline workers in healthcare.