Wards Of Tertiary Care Hospital Research Articles

Study of drug prescription pattern among COPD patients admitted to medicine in-patient department of tertiary care hospital

Background: Drug utilization studies can provide insights into a pattern, quality, determinants and outcomes of drug use. COPD is one of the leading causes of death among Indian population and there is a lack of drug utilization studies in this field.Methods: A prospective, observational study was conducted among the patients admitted in inpatient department of medicine ward of Tertiary care hospital. Data has collected from COPD patients admission records. Parameters like demographic profile, common associated diseases, WHO core drug indicators and commonly prescribed drugs were assessed from the prescriptions.Results: A total 284 inpatient records were scrutinized. Out of 284 patients, 66.19% were male and 33.80% were female. Average numbers of drugs per prescription were 7. Mean age was 66.9 years. Antimicrobials (88.7%) were most commonly prescribed drugs followed by inhaled bronchodilators (84.5%).Conclusions: Study data highlights that average numbers of drugs prescribed were higher than WHO norms, antibiotics were commonly used, and drugs prescribed with brand names were higher than the generic names.

A comparative study to assess knowledge, health beliefs and preventive practices among women with cervical cancer and general population at tertiary care hospital, New Delhi

Background: Awareness regarding cervical cancer, its risk factors and preventive practices is very low among Indian women. The objectives of the study was to compare knowledge, health beliefs and preventive practices regarding cervical cancer among women with cervical cancer and general population at tertiary care hospital, New Delhi; to study the correlation among knowledge, health beliefs and preventive practices of women with cervical cancer and general population and their selected demographic variables.Methods: A comparative study was conducted using descriptive, cross sectional survey among conveniently sampled 100 women with cervical cancer (cases) taking treatment from cancer department of tertiary care hospital and 100 women relatives of patients with non-malignant diseases admitted in different medical, surgical, pediatrics wards of tertiary care hospital (controls). Self-developed, pretested, structured questionnaires validated by experts were used for data collection.Results: Majority of subjects had poor knowledge (78% cases and 90% controls) and positive health beliefs (83% cases and 67% controls). Majority of cases (93%) had fair preventive practices while most of controls (62%) had poor preventive practices regarding cervical cancer. There was positive correlation of knowledge with health beliefs (p=0.0001) and health beliefs with preventive practices (p=0.0469) among controls; but in cases none of these correlations were found.Conclusions: Substantial gaps in knowledge and preventive practices regarding cervical cancer were present in both groups. So there is a need to raise public awareness regarding risk factors and prevention of cervical cancer by modifying the risk factors.

Pharmacovigilance by World Health Organisation Uppsala Monitoring Center Causality Assessment Algorithm in Medicine Ward of Tertiary Care Hospital of New Delhi

Introduction Pharmacovigilance is not new to India and has in fact been going on since 1998. Adverse drugs reaction (ADRs) are important causes of morbidity and mortality all over the world. They account for approximately 10-20% of all hospitalized patients. The overall incidence of serious ADRs is 6.7% and that of fatal is 0.32%.Objective The objectives of the study was to find the pattern of adverse drug reactions in patients attending medicine ward of a tertiary care center of New Delhi.Methodology A prospective study was conducted from March 2013 to December 2013. On the basis of WHO-UMC causality assessment algorithm, the incidence and pattern of ADRs were assessed from 300 patients of 18 to 70 years of age. The collected data was entered in Microsoft Excel, Common Terminology Criteria for Adverse Events (CTCAE) and analysed by SPSS.Results The incidence of ADRs was found to be 13.67%. More than one ADRs has been reported from some patients. The gender of the patients has no significance in the occurance of ADRs (p=0.194). Highest number of ADRs were found in gastrointestional system followed by central nervous system. Gastrointestional ADRs were must commonly associated with the uses of antimicrobials. The most frequently seen ADRs were diarrhea, gastritis, abdominal pain followed by nausea and vomiting. Decreased level of consciousness (sedation, drowsiness) followed by dizziness and tremors were the frequent ADRs related to the central nervous systems. Based on WHO-UMC causality assessment algorithm, it was observed that a total of 57 ADRs were possible and 2 were probable. No other causality assessment category was observed.Conclusion The ADRs incidence was common even in a tertiary care center. The Gastrointestional and central nervous system disorder were common. The concern of Pharmacovigilance should be initiated.Birat Journal of Health Sciences 2016 1(1): 61-64

Drug utilization study in postoperative patients in obstetrics and gynaecology ward of tertiary care hospital

Background: A growing number of pharmaceutical products are available in the world market and there has been an increase both in the consumption of the drugs and in expenditure on them. The aim of the study was to analyse drug usage in post-operative patients in obstetrics and gynaecological ward and to assess the prescribing indicators (WHO: Core Drug Use Indicators). Methods: A prospective observational study was conducted over a period of six months, after getting approval from Institutional Ethics committee. A specially designed proforma was used to collect the data of post-operative patients in Obstetrics and Gynaecological ward of a tertiary care hospital. The data was analysed using descriptive analysis with the help of SPSS software. Results: A total of 582 cases were analysed during the study. Out of 582 patients, 559 (96%) were prescribed with parenteral cefotaxime and metronidazole. Post-operative pain was managed with tramadol (96%). All patients were prescribed with an antibacterial agent and analgesic (100%). The percentage of encounters with an injection prescribed was 100% in our study. Out of 19 different drugs prescribed, 16 (84.21%) were from the Essential Medicines WHO Model List (2015) and 10 (52.63%) were prescribed by their generic name. Conclusions: The present study provides valuable insight about the overall pattern of drug used in postoperative patients. The study is useful in decreasing the irrational prescription, which helps to decrease the morbidity and health care burden in the society.

Arterial ammonia levels: Prognostic marker in traumatic hemorrhage.

Background:In blunt trauma, extent of hemorrhage cannot be determined by physical examination, and vital signs may also not give clear picture in all the patients, especially young healthy ones. Hemorrhagic shock has been reported to increase blood ammonia levels. Arterial ammonia was analyzed in blunt trauma abdomen patients and correlated with shock index (SI). Its predictive value was determined for timely decision of intervention.Materials and Methods:Hundred blunt trauma abdomen patients presented in the emergency ward of tertiary care hospital were included in the study. Group I comprised 62 patients requiring either blood transfusion ≥2 units and/or intervention to control bleeding within 24 h following admission. Group II had 38 patients: Not requiring transfusion/intervention during hospital stay. Arterial blood sample was taken immediately after admission; ammonia was analyzed within 20 min of sampling on Cobas 6000 (Roche). SI was calculated. Predictive value of ammonia was determined using receiver operating characteristic curve.Results:Ammonia levels and SI were significantly (P < 0.001) higher in Group I compared to Group II patients (68.55 ± 14.36 umol/L vs. 37.55 ± 7.41 umol/L and 1.28 ± 0.5 vs. 0.74 ± 0.12, respectively). Significantly higher number of patients in Group I (88.7% vs. 13%) had SI > 0.9. Ammonia levels were significantly higher in patients with complications and in those expired.Conclusions:Ammonia levels were significantly higher in patients requiring blood transfusion/intervention in 24 h of admission. The best cutoff value to maximize sensitivity and specificity was ammonia >58.85 μmol/L. Ammonia estimation at admission can be clinically significant indicator of traumatic hemorrhage needing intervention.

Assessment of cost of illness for diabetic patients in South Indian tertiary care hospital.

Background:The impact of diabetes on health-care expenditures has been increasingly recognized. To formulate an effective health planning and resource allocation, it is important to determine economic burden.Objective:The objective of this study is to assess the cost of illness (COI) for diabetic inpatients with or without complications.Methodology:The study was conducted in the medicine wards of tertiary care hospital after ethical approval by the Institutional Ethical Committee. A total of 116 each diabetic with or without complications were selected and relevant data were collected using COI questionnaire and data were analyzed using SPSS version 20. Mann–Whitney U test is used to assess the statistical significant difference in the cost of treatment of diabetes alone and with complications’. P ≤ 0.05 was considered statistically significant.Results:Total COI includes the cost of treatment, investigation, consultation fee, intervention cost, transportation, days lost due to work, and hospitalization. The median of total COI for diabetic care without any complication was Rs. 22,456.97/- per patient per annum and with complication was Rs. 30,634.45/-. Patients on dialysis had to spend 7.3 times higher, and patients with cardiac intervention had to spend 7.4 times higher than diabetic patients without any complication.Conclusion:Treatment costs were many times higher in patients with complications and with cardiac and renal interventions. Complications in diabetic patients will increase the economic burden to family and also to the society.

Workplace Violence towards Nurses:An Act of Remorse upon Feminity

An intimidating work environment, in which insulting or obnoxious comments, persistent criticism or even physical abuse and threats triumph, is a reality for many employees in both public and private organizations. One novice RN was dealing with a patient in private ward of tertiary care hospital with a 35 year old male patient encountered with physical abuse when the patient touched her one of the private body part while performing IV cannulation. She also experienced unpleasant remarks and dirty gestures of patient as well as his relatives. As the incident took place she immediately stopped doing cannulation and started leaving room but was stopped by the relative and she has to tolerate aggression that she is incompetent which leads her to post traumatic stress syndrome. Violence towards nurses has been seen a major issue in both developing and developed countries and is increasing progressively in society and workplace.

Mass counseling: Effective tool to improve knowledge, attitude and behavior regarding blood donation

Background:Annually, India meets only half of its blood requirement and half of it from unsafe blood donors. There is a need to increase blood donations from safe and voluntary blood donors. Recruitment and retainment of voluntary blood donors are key challenges for blood agencies.Aim:The aim of this study is to assess the impact of mass counseling in the creation of voluntary blood donor.Subjects and Methods:Interventional study with intervention of mass counseling of relatives of patients admitted in the wards of Tertiary Care Hospital attached to medical college in Pune. It was carried out during 1st May 2010 to 31st May 2010. 110 relatives were randomly selected for the study. Mass counseling of cases regarding voluntary blood donation was carried out by trained persons. Pre-counseling and post-counseling knowledge, attitude, and behavior (KAB) scores regarding blood donation were assessed using a pre-tested semi-structured questionnaire.Results:Counseling improved knowledge, attitude and behavior score (KAB) regarding blood donation significantly. Pre-counseling and post-counseling KAB scores difference was statistically significant (P < 0.001) and was not merely by chance. Counseling helped to improve behavior of cases regarding blood donation, too.Conclusion:Continuous counseling sessions for blood donation may serve the purpose for institutes dealing with a large number of people every-day. Establishment of mobile counseling units by blood banks may help to create a voluntary blood donor. Changes in motivation and the development of self-identity as a blood donor are needed to retain voluntary blood donors. Incentive's offered for voluntary blood donation card should be strengthened.

Diagnostic value of lactate levels in acute abdomen disorders.

The supply of oxygen is limited in certain intra abdominal conditions due to direct vascular invasion or inflammatory process, resulting in high lactate levels. Aim of this study was to find the predictive value of lactate levels in the peritoneal fluid (PF) and blood of patients with acute abdomen. The study comprised of fifty patients with acute abdominal conditions, admitted in emergency ward of tertiary care hospital, thirty patients were with surgical abdomen (group I) and twenty patients with non surgical abdomen (group II). Lactate was estimated in PF and blood on Blood Gas Analyzer (NOVA, M-7). The mean lactate levels in PF were significantly higher in group I as compared to group II (14.65±1.195 vs. 5.92±0.97mmol/L, p<0.001). There was no significant difference in blood lactate levels in both the groups. When PF and blood lactate levels were compared within groups, we found that PF levels were significantly higher than blood in group I (14.65±1.195 vs. 3.85±0.54mmol/L, p<0.001) but not in group II (5.92±0.97 vs. 4.36±0.95mmol/L). Diagnostic value was obtained using ROC curve. Cut off values obtained for PF lactate, difference and ratio of PF and blood lactate (≥6.4mmol/L, ≥3.3 and ≥2.1 respectively) are at very high degree of sensitivity and specificity. So it can be useful marker of surgical emergency in patients with acute intra abdominal pathology, especially in clinically ill patients or in whom physical examination is not yielding because of neurologic disorders or unresponsiveness.