Analysis of risk factors contributing to road traffic accidents in a tertiary care hospital. A hospital based cross-sectional study

Purpose: Road traffic accidents (RTAs) are a public health issue and cost a lot to individuals, families, communities and nations. Trauma care systems in India are at a nascent stage of development. There is gross disparity between trauma services available in various parts of the country. Rural area in India has inefficient services for trauma care, due to the varied topography, financial constraints, and lack of appropriate health infrastructure. The present study is to study the trends of occurrence of RTA cases by month, week and time of accident occurrence as well as to research the types of vehicle involved in accidents and other various risk factors related to them.Methods: During 1st January 2017 to 31st December 2017, a hospital-based and cross-sectional study of RTA victims was conducted. The patients were admitted in emergency department of Uttar Pradesh University of Medical Sciences, Saifai, Etawah, when stabilized, they were shifted to the orthopaedics and surgery ward.Results: In the study, 654 road accident victims were included, of which the majority were males (77.5%) and the most of them belonged to rural (67%). RTA victims according to the month of occurrence majority were found in January (12.5%) and evening was time of a day with maximum accidents (32.1%). Mortality cases of RTA victims based on type of road user and it shows decreasing trend of mortality of motor-cyclists (54.2%) followed by pedestrian (25.1%).Conclusion: There should be control over people driving vehicles under the influence of alcohol and drivers over-speeding and rash driving on urban roads as well as rural village roads.

The Epidemiological Profil of Digestive Cancers in Secondary and Tertiary Health Care Facilities in Cameroon

Background: Cancers have been a major public health problem in developing countries in recent years. The aim of this study was to determine the epidemiological profile of digestive cancers in secondary and tertiary health care facilities in Cameroon. Methodology: This was a cross sectional and descriptive study conducted over a period of 12 months in 14 health structures over the national territory. Included in our study were patients aged 15 and above with a histologically proven digestive cancer, patients with a clinical, biological and morphologic evidence of a digestive cancer. Socio-demographic (age, gender, region of origin, profession), clinical (symptoms on diagnosis, personal and family past history, consumption habits, tumour location) and paraclinical data were recorded on a pretested questionnaire. Data was analysed using SPSS version 20.0. Quantitative data was expressed as means with their corresponding standard deviations. Chi square was used for correlation between variables. A P value 0.05 was considered statistically significant. Results: Five hundred and eighty-two cases of digestive cancers were recorded out of 37,780 consultations/admissions during the study period giving a prevalence of 1.5% with a male predominance (58.1%). The mean age was 53.11 ± 17.26 years (15 - 99) with 33.8% of them below 45 years of age. Tumours were predominantly localized in the liver (43.5%) and colon (24.9%). Adenocarcinoma was the most common histological type in 44.5% of all cases. Alcohol consumption was found to be associated with colorectal cancer (p = 0.028) while tobacco consumption was found to be significantly associated with oesophageal cancer (p ≤ 0.001) and gastric cancer (p = 0.0047). Conclusion: A third of patients with digestive cancers were aged less than 45 years suggesting an early onset of these cancers in our setting. Relatively low prevalence with the liver being the most common site of localisation in our setting.

Second-order problem solving:Nurses'perspectives on learning from.near misses

Objectives:Near misses happen more frequently than actual errors,and highlight system vulnerabilities without causing any harm,thus provide a safe space for organizational learning.Second-order problem solving behavior offers a new perspective to better understand how nurses promote learning from near misses to improve organizational outcomes.This study aimed to explore frontline nurses’perspectives on using second-order problem solving behavior in learning from near misses to improve patient safety.Methods:A qualitative exploratory study design was employed.This study was conducted in three tertiary hospitals in east China from June to November 2015.Purposive sampling was used to recruit 19 frontline nurses.Semi-structured interviews and a qualitative directed content analysis was undertaken using Crossan’s 4I Framework of Organizational Learning as a coding framework.Results:Second-order problem solving behavior,based on the 4I Framework of Organizational Learning,was referred to as being a leader in exposing near misses,pushing forward the cause analysis within limited capacity,balancing the active and passive role during improvement project,and promoting the continuous improvement with passion while feeling low-powered.Conclusions:4I Framework of Organizational Learning can be an underlying guide to enrich frontline nurses’role in promoting organizations to learn from near misses.In this study,nurses displayed their pivotal role in organizational learning from near misses by using second-order problem solving.However,additional knowledge,skills,and support are needed to maximize the application of second-order problem solving behavior when near misses are recognized.

Medication adherence and quality of life among type-2 diabetes mellitus patients in India

BACKGROUND Diabetes mellitus(DM)is a progressively increasing metabolic disorder and a significant public health burden that demands immediate global attention.However,there is a paucity of data about adherence to antidiabetic drugs among patients with type-2(T2)DM in Uttarakhand,India.Outpatient research reported that more than 50%of patients do not adhere to the correct administration and appropriate medicine dosage.It has been reported that patients with chronic diseases who adhere to treatment may experience improvement in quality of life(QoL)and vice versa.AIM To assess the adherence to antidiabetic medication and QoL among patients with T2DM.METHODS This cross-sectional descriptive study was conducted at a tertiary care hospital in Uttarakhand,India.The Medication Adherence Rating Scale and World Health Organization QoL-BREF scale were used to assess medication adherence and QoL.RESULTS Two hundred seventy-seven patients suffering from T2DM participated in the study.Their mean age was 50.80(±10.6)years,155(56%)had a poor adherence level and 122(44%)had a good adherence level to antidiabetic medications.After adjusting for sociodemographic factors,multiple linear regression analysis found patients who were adherent to antidiabetic medications had significantly higher mean overall perception of QoL and overall perception of health,with beta scores of 0.36 and 0.34,respectively(both P=0.000)points compared with nonadherent patients.CONCLUSION There was an association between medication adherence and QoL in patients with T2DM.Hence,there is a need to plan awareness and counseling programs followed by regular follow-up to motivate patient adherence to recommended treatment and lifestyle regimens.

Pediatric endoscopy across multiple clinical settings:Efficiency and adverse events

BACKGROUND Endoscopic procedures are becoming increasingly important for the diagnosis and treatment of gastrointestinal disorders during childhood,and have evolved from a more infrequent inpatient procedure in the operating room to a routine outpatient procedure conducted in multiple care settings.Demand for these procedures is rapidly increasing and thus there is a need to perform them in an efficient manner.However,there are little data comparing the efficiency of pediatric endoscopic procedures in diverse clinical environments.We hypothesized that there are significant differences in efficiency between settings.AIM To compare the efficiency and examine adverse effects of pediatric endoscopic procedures across three clinical settings.METHODS A retrospective chart review was conducted on 1623 cases of esophagogastroduodenoscopy(EGD)or combined EGD and colonoscopy performed between January 1,2014 and May 31,2018 by 6 experienced pediatric gastroenterologists in three different clinical settings,including a tertiary care hospital operating room,community hospital operating room,and free-standing pediatric ambulatory endoscopy center at a community hospital.The following strict guidelines were used to schedule patients at all three locations:age greater than 6 mo;American Society of Anesthesiologists class 1 or 2;normal craniofacial anatomy;no anticipated therapeutic intervention(e.g.,foreign body retrieval,stricture dilation);and,no planned or anticipated hospitalization post-procedure.Data on demographics,times,admission rates,and adverse events were collected.Endoscopist time(elapsed time from the endoscopist entering the operating room or endoscopy suite to the next patient entering)and patient time(elapsed time from patient registration to that patient exiting the operating room or endoscopy suite)were calculated to assess efficiency.RESULTS In total,58%of the cases were performed in the tertiary care operating room.The median age of patients was 12 years and the male-to-female ratio was nearly equal across all locations.Endoscopist time at the tertiary care operating room was 12 min longer compared to the community operating room(63.3±21.5 min vs 51.4±18.9 min,P<0.001)and 7 min longer compared to the endoscopy center(vs 56.6±19.3 min,P<0.001).Patient time at the tertiary care operating room was 11 min longer compared to the community operating room(133.2±39.9 min vs 122.3±39.5 min,P<0.001)and 9 min longer compared to the endoscopy center(vs 124.9±37.9 min;P<0.001).When comparing endoscopist and patient times for EGD and EGD/colonoscopies among the three locations,endoscopist,and patient times were again shorter in the community hospital and endoscopy center compared to the tertiary care operating room.Adverse events from procedures occurred in 0.1%(n=2)of cases performed in the tertiary care operating room,with 2.2%(n=35)of cases from all locations having required an unplanned admission after the endoscopy for management of a primary GI disorder.CONCLUSION Pediatric endoscopic procedures can be conducted more efficiently in select patients in a community operating room and endoscopy center compared to a tertiary care operating room.

Spectrum of Pediatric Malignancies: An Observational Single Center Study from Western India

Cancer is a leading cause of death for children and adolescent worldwide.The cure rates in low middle-income countries are dismal(20%)in comparison to high income countries(80%).The first move is to assemble precise data on epidemiology of pediatric cancer across the country and its region wide variation.This study attempts to provide spectrum of pediatric malignancies from a tertiary care hospital in the state of Rajasthan,India.A total of 140 cases were studied retrospectively over a period of two years(April 2018-March 2020).Patients,0-18 years of age that are diagnosed as a case of malignancy were included in this study.The records of these patients were retrieved and analyzed.Patients were stratified in 4 groups;0-4 years,5-9 years,10-14 years and 15-18 years.Most of the patients fell in 15-18 year group(35.7%),followed by 5-9 year group(28.5%).Majority of cases,67.8%were male.The male to female ratio is 2.1:1.Leukemia(40%)was the most common malignancy followed by lymphoma,retinoblastoma and malignant bone tumors.Acute lymphoblastic leukemia comprises majority(35/56)of leukemia.Retinoblastoma was predominant malignancy among<5-year children.In all other groups,leukemia was predominant.This study gauges the trend of pediatric malignancies at one of the largest tertiary care hospitals in Rajasthan,which is important in the planning and evaluation of health strategies.As we lack a dedicated pediatric cancer registry,such epidemiological studies play a significant part for this small but distinguished group of patients.

Tropical cyclone Fani-perspective from the trauma and emergency department of an affected tertiary hospital

Purpose:To explore the epidemiological and clinical profile of patients admitted to the trauma and emergency department(TED)of a tertiary care hospital due to tropical cyclone Fani and highlight the challenges faced by the hospital in this natural disaster.Methods:A retrospective study was conducted in the TED in the affected zone.Data of all victims affected by the cyclone Fani on May 3,2019 were obtained from disaster records and medical case sheets.All patients except death on admission were included.Clinical variables included anatomical sites and severity of injuries which was assessed by revised trauma score(RTS)and injury severity score(ISS).Trauma injury severity score(TRISS)was also calculated.Results:Of 75 patients,74 were included and the other one was brought dead and thus excluded.The age,median±interquartile range(IQ),was 41.0(27.7-53.0)years.The male to female ratio was 2:1.Most of the wounded were transported by the police control room vans on day 1:first 10 h,50.0%;10-24 h,20.3%.The median±IQ range of RTS,ISS and TRISS were 20(14-28),7.84(7.841-7.841),and 97.4(91.6-98.9),respectively.Simple external injury was the dominant injury type.Polytrauma(ISS>15)was seen in 67%cases and spine injury in 14%cases(7%cervical and 7%thoracolumbar).Injury causes included sharp flying objects(broken pieces of glasses and asbestos)in 31%cases,followed by fall of trees in 20.3%.Twenty-four patients were discharged after primary treatment,30 admitted to the indoor-trauma ward or intensive care unit and 20 deferred or transferred to another center.There was no in-house mortality.Challenges were related to electricity failure,mobile network breakdown,infrastructure collapse,and delay in expertise repair from outside due to airport/railway closure.Conclusion:In cyclonic storm like Fani,sharp flying objects,fall of trees/poles and collapsing walls constitute the common mode of injuries causing harm to more than one body regions.Polytrauma was seen in the majority of patients though external injury was the commonest.The affected hospital had the uphill task of treating hospitalized patients as well as disaster victims.