Predictors of Fatal Outcome in Hospitalised Adult Patients with Acute Kidney Injury at Two Tertiary Hospitals in Sub-Saharan Africa

Introduction: Data on mortality in acute kidney injury (AKI) derives from high-income countries where AKI is hospital-acquired and occurs in elderly patients with a high burden of cardiovascular disease. In sub-Saharan Africa (SSA), AKI is community-acquired occurring in healthy young adults. We aimed to identify predictors of fatal outcomes in patients with AKI in two tertiary hospitals in Cameroon. Methods: Medical records of adults with confirmed AKI, from January 2018 to March 2020 were retrieved. The outcomes of interest were in-hospital deaths and presumed causes of death. We used multiple logistic regressions modeling to identify predictors of death. The study was approved by the ethics boards of both hospitals. Values were considered significant for a p-value of 0.05. Results: We included 285 patient records (37.2% females). The mean (SD) age was 50.1 (19.0) years. Hypertension (n = 97, 34.0%), organ failure (n = 88, 30.9%), and diabetes (n = 60, 21.1%) were the main comorbidities. The majority of patients had community-acquired AKI (78.6%, n = 224), were KDIGO stage 3 (88.8%, n = 253), and needed dialysis (52.6%, n = 150). Up to 16.7% (n = 25) did not receive what was needed. The in-hospital mortality rate was 29.1% (n = 83). Lack of access to dialysis (OR = 27.8;CI: 5.2 - 149.3, p = 0.001), hypotension (OR = 11.8;CI: 1.3 - 24.8;p = 0.001) and ICU admission (OR = 5.7;CI: 1.3 - 24.8, p = 0.001) were predictors of mortality. The presence of co-morbidities or underlying diseases (n = 46, 55%) were the main causes of death. Conclusions: In-hospital AKI mortality is high, as in other low- and middle-income economies. Lack of access to dialysis and the severity of the underlying illness are major predictors of death.

Adherence to Physical Measures during the SARS-COV2 Pandemic by Haemodialysis Patients in a Burkina Faso Tertiary Hospital: A Cross-Sectional Survey

Context: COVID-19 can spread rapidly in haemodialysis centres, leading to fatal outcomes. Implementing physical measures is crucial in limiting the spread of infection. Aims: To assess adherence to physical measures against SARS-Cov2 in haemodialysis patients. Methods and Material: From 13 to 19 July 2021, we administered the questionnaire to haemodialysis patients during or immediately after the dialysis session. The dependent variables were adherence to wearing masks, hand washing outside the dialysis centre, social distancing of at least 1.5 meters, and cough and sneeze hygiene. Statistical Analysis Used: Data were analyzed using Epi info software;descriptive statistics were presented as mean, headcount, and percentage;related factors were determined by multi-logistic regression. The significance level was 5%. The Health Research Ethics Committee approved the research protocol. Results: 142 patients were included (mean age: 42.5 ± 14 years). Wearing masks, hand-washing, social distancing, and coughing and sneezing hygiene were observed by 88%, 75%, 47%, and 60% of patients, respectively. Conclusion: Wearing masks was the most respected physical measure, while social distancing was the least respected.

Clinical Evaluation of Two Interferon-Gamma Release Assays for Diagnostic Tests of Tuberculosis Infection in a Tertiary Hospital: Clinical Evaluation of Two IGRAs for TB Infection

Background: The aim of this study was to evaluate the usefulness of two interferon-gamma release assays (IGRAs) (QuantiFERON-TB Plus (QFT-plus) and T-SPOT.TB assay) for patients suspected of having tuberculosis (TB) infection as supportive methods for diagnosing TB. Patients and Methods: The subjects consisted of 45 patients who required clinical differentiation of TB disease from June 2019 to August 2023. The final clinical diagnoses were: 14 patients with active TB disease, 4 with latent TB infection (LTBI), 17 with old (cured) TB disease, and 10 with pulmonary nontuberculous mycobacterial (NTM) disease. We used the two IGRAs for these patients and evaluated the data according to the manufacturer’s guidelines for interpretation or FDA-approved cutoffs. Results: Among the total of 14 patients with active TB disease (mean age: 64 years old, male: 9, and female: 5), a positive response was noted in 10 patients (71%) on QFT-plus and 9 (64%) on T-SPOT.TB. Four patients with a negative response on QFT-plus and T-SPOT.TB were elderly or cancer patients with lymphocytopenia or hypoalbuminemia. All four patients with LTBI showed a positive response (100%) on both QFT-plus and T-SPOT.TB. Among the seventeen patients with old (cured) TB disease, a positive response was noted in 8 patients (47%) on QFT-plus and 9 (53%) on T-SPOT.TB. All patients with pulmonary NTM disease showed a negative response on both QFT-plus and T-SPOT.TB. Conclusions: A false-negative response on QFT-plus as well as T-SPOT.TB was recognized in elderly patients and patients with an immunosuppressed condition, and half of patients with old (cured) TB showed no negative conversion after the completion of treatment through this study. Although it was recently reported that the positive response rate on QFT-plus of patients with active TB disease was high, we consider it necessary to be careful in diagnosing TB infection using IGRAs for patients with severe underlying diseases in a tertiary hospital based on the results.

Some Haematological Parameters in Primary Hypertensive Subjects Attending a Tertiary Hospital in Nigeria

Background: Hypertension is a persistent elevation of blood pressure in the arteries which if not properly managed can lead to stroke, heart failure, atrial fibrillation, peripheral vascular disease and other life threatening outcomes. This study investigated some haematological parameters of Primary hypertensive subjects. Objectives: To compare some haematological parameters (haematocrit, haemoglobin concentration, Platelets count, White Blood Cells count, red blood cell count and Red Cells Indices between hypertensive and normotensive subjects. Materials and methods: Blood samples were collected from 76 known hypertensive subjects between 30 - 70 years attending the Cardiology clinic of the University of Abuja Teaching Hospital Gwagwalada. Another 37 normotensive subjects between 30 - 65 years served as the control. All subjects gave their consents. Platelets count, Haemoglobin estimation, Packed Cell Volume, Red Blood Cell Count, Mean Cell Volume, Mean Cell Haemoglobin, Mean Cell Haemoglobin Concentration and White Blood Cell count were determined using Mythic 22 five parts haematology analyzer. Results: Results for Hypertensive and Control subjects were, White Blood Cell, 5.76 ± 1.45 × 109/l and 4.76 ± 1.03 × 109/l, Platelet count, 248.7552.45 × 109/l and 284.95 ± 27.66 × 109/l, Mean Cell Volume, 91.81 ± 3.05 fl and 85.68 ± 6.48 fl, Mean Cell Haemoglobin, 30.59 ± 1.04 pg and 27.922 ± 2.74 pg, Mean Cell Haemoglobin Concentration, 33.34 ± 0.61 g/dl and 32.32 ± 0.93 g/dl, Red Blood Cell, 4.33 ± 0.39 × 109/l and 4.50 ± 0.52 × 109/l, Packed Cell Volume, 39% ± 3.15% and 40% ± 4.41% and Haemoglobin, 13.21 ± 1.10 g/dl and 13.50 ± 1.63 g/dl respectively. Mean Cell Volume, Mean Cell Haemoglobin, Mean Cell Haemoglobin Concentration (Red cells indices) were significantly higher in hypertensive compared to normotensive subjects (P 0.05), total White Blood Cell count was also higher in hypertensive than normotensive but not statistically significant (P > 0.05). However, Platelet counts, Red Blood Cell, Packed Cell Volume and Haemoglobin were significantly lower in hypertensive compared to normotensive (P 0.05). All the parameters were within established reference ranges for the age and sex of the subjects. Our findings show that hypertension may lead to haematological derangement, if not properly managed. Conclusively, haematological parameters can be used to monitor the prognosis of the disease and manage hypertensive related complications. It is important to assess haematological parameters for hypertensive individuals which may help to prevent complications associated with haematological disorders.

Survival of Patients with Small-Cell Lung Cancer Treated at Tertiary Hospitals in the East of Thailand, 2007-2016: A Retrospective Study

Objective:?The objective of the study was to determine the survival of patients?with small-cell lung cancer treated at tertiary hospitals in the East of?Thailand. Materials and methods:?The researchers conducted this retrospective?study by reviewing medical records of patients with small-cell lung cancer?treated at Chonburi Cancer Hospital and Prapokklao Hospital from January?2007 to December 2016 and monitored via follow-up until December?2018. Results:?This study enrolled 54 patients with a median follow-up time?of 8.5 months. The median age of patients was 63 years old. Most patients?were male (83.3%) and had a history of smoking (90.7%), and 31.4% had?clinical superior vena cava obstruction at initial treatment. The Eastern Cooperative?Oncology Group performance status 0-1 was noted for 61.1% of the?study population. Median survival time of patients with limited-stage and extensive-stage small cell lung cancer who received systemic chemotherapy?and/or radiotherapy was 17.01 months (95% CI, 12.01 - 22.01) and 8.14?months (95% CI, 7.19 - 9.10), respectively, and that of patients receiving?supportive care was 2.3 months (95% CI, 0.75 - 4.03). However, the median?survival time of patients with extensive-stage small-cell lung cancer receiving?only palliative chemotherapy was 5.9 months (95% CI, 0.32 - 17.51). Conclusions:?The median survival time of patients with limited-stage small-cell lung?cancer treated in the East of Thailand was comparable to those of landmark?studies;however, the survival of patients with extensive-stage small-cell lung?cancer was shorter than those of Phase III trials. A multidisciplinary team was?necessary to improve the quality of patient care.

An implementation study of barriers to universal cervical length screening for preterm birth prevention at tertiary hospitals in Thailand:Healthcare managers’perspectives

Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised questionnaire development and data validation.In PhaseⅢ,the questionnaire was administered to 40 participants,and responses were analyzed.Results:Their average related work experience was(21.0±7.2)years;39(97.5%)respondents also had healthcare management responsibilities at their respective hospitals.Most hospitals were reported to have enough obstetricians(31 cases,77.5%)and to be able to accurately perform cervical length measurements(22 cases,55.0%).However,no funding was allocated to universal cervical length screening(39 cases,97.5%).Most respondents believed that implementing universal screening,as per Ministry of Public Health policies,would prevent preterm births(28 cases,70.0%).Moreover,they suggested that hospital fees for cervical length measurements should be waived(34 cases,85.0%).Three main perceived barriers to universal screening at tertiary hospitals were identified.They were heavy obstetrician workloads(20 cases,50.0%);inadequate numbers of medical personnel(24 cases,60.0%);not believing that the screening test could prevent preterm birth(8 cases,20%)and lack of free drug support for preterm birth prevention in high-risk cases(29 cases,72.5%).Conclusions:The main obstacles to universal cervical length screening are heavy staff workloads and inadequate government funding for ultrasound scanning and hormone therapy.The healthcare managers do not believe that the universal cervical length screening can help to reduce preterm birth.

Day of Surgery Cancellation in Urology at a Public Tertiary Hospital and a Private Specialist Hospital

Background: There is a high variability in the reasons for cancellation of elective urological surgery cases. Case cancellation rate is expected to be high in the Public Health System with perceived inefficiencies compared to private facilities in the same developing economy. Aims and Objectives: This comparative analysis was to determine the case cancellation rate and the reasons for cancellation of elective urological surgeries in a public tertiary hospital and a private specialist hospital in Accra. This is intended to form a basis for interventions aimed at reducing the case cancellation rate. Methods: This was a retrospective analysis of prospectively collected data on Day of Surgery cancelled elective urological cases from September 2014 to October 2015 at the urology unit of the Korle-Bu Teaching Hospital (KBTH), a public Tertiary Hospital and the Trust Specialist Hospital (TSH), a privately managed hospital in Accra. The reasons for case cancellation were categorized into structural factors, patient factors and process factors. Results: There was no significant difference between the case cancellation rate for elective urological cases at KBTH and the TSH which were 20.8% and 17.1% respectively (p = 0.317). For KBTH, the reasons for cancellation of elective urological cases were due to structural factors in 11/117 (9.4%), patient factors in 15/117 (12.8%) and process factors in 91/117 (77.8%) which was due mainly to surgery running late. At the TSH, the reasons were due to structural factors in 1/29 (3.4%), patient factors in 27/29 (93.1%) mainly due to patient not turning up and process factors in 1/29 (3.4%). Conclusion: The case cancellation rate of elective urological surgeries in both the Public Tertiary Hospital and the Private Specialist Hospital were high with no significant difference between the two. However, in the Public Tertiary Hospital, process factors predominated as the cause of these cancellations while patient factors were the predominant cause in the privately managed facility. Exposure of theater managers in public facilities to management practices in privately run facilities should be encouraged to help improve the efficiency of the public facilities.

Prevalence and Characteristics of Peripartum Cardiomyopathy among Women with Cadiac Failure Referred for Echocardiography in a Tertiary Hospital in Northern Nigeria

Introduction: Peripartum cardiomyopathy (PPCM) is a common clinical condition in northern Nigeria. This study aimed to determine the prevalence and characteristics of PPCM among women with heart failure referred for echocardiography. Materials and Methods: This is a retrospective study of 401 women managed for heart failure referred for echocardiography between October 2016 and September 2017. Their reports were analyzed for demographic and echocardiographic parameters. Results: The mean age of the 401 individuals studied was 41.28 ± 16.25 years. The commonest cause of heart failure was PPCM, accounting for 256 (69.5%), followed by hypertension 79 (19.7%) and rheumatic heart disease (RHD) 24 (5.9%). Conclusion: PPCM is a common and important cause of heart failure among women in Northern Nigeria.

Jaundice in Adult in-Patients at a Tertiary General Hospital

Objective: The aim of the study is to investigate the “new-onset jaundice” incidence, map of causes, approaching method, and risk factors for treatment failure in adult in-patients at a tertiary general hospital as Cho Ray Hospital, Ho Chi Minh City, Viet Nam. Method: Retrospective study was done on 416 jaundice patients administered over 38 continuous days. Laboratory tests investigated were total bilirubin, direct bilirubin, AST, ALT, AST/ALT ratio, GGT, AP, bilirubin and urobilinogen in urine. Jaundice was defined as total bilirubin ≥ 2.5 mg/dL, direct bilirubin jaundice defined as direct bilirubin > 2 mg/dL and D/T percentage > 60%, the severity of AST, ALT evaluated according to Common Terminology Criteria for Adverse Events, AST/ALT ratio, and bilirubin, urobilinogen in urine. Outcome of treatment were classified in two groups: failure (dead or discharge due to worse status) and success. Descriptive statistics and analytic statistics were applied, mono-variable analysis and multinomial logistic regression to find out the independent risk factors for treatment failure. Results: The incidence of “new-onset” jaundice in adult patients was 11 ± 5 person/day. The map of jaundice included 3 phases as pre-heaptic 13.7%, in-hepatic 58.2%, and post-hepatic 22.8%. Pancreatic and biliary tract diseases accounted 17.1%, then cirrhosis 16.3%, liver tumor 14.7%, hepatitis 8.9%, sepsis 8.9%, hematology diseases 7.9%, and cardiac diseases 7.5%. A guide for approaching causes of jaundice basing on 7 parameters as total bilirubin, D/T percentage, severity of ALT, AST/ALT ratio, severity of GGT, and bilirubin and urobilinogen in urine was established. The overall mortality was 7.5% (31/416), sepsis had highest death rate of 37.8% (14/37). Sepsis and AST/ALT ratio > 2 were the two independent risk factors of mortality. Conclusion: At tertiary hospital, jaundice is common sign in adult patient, diverse enormously in many clinical wards. The map of causes of jaundice completed all 3 phases: pre-hepatic, intra-hepatic and post-hepatic phase. Drug hepatitis jaundice was an important cause in hepatitis. Sepsis had highest mortality in adult jaundice patients. Combination of 7 criteria as total bilirubin, the D/T percentage, ALT severity, AST/ALT ratio, GGT, bilirubin and urobilinogen in urine gave the guide for approaching to jaundice. Sepsis and AST/ALT ratio > 2 were independent risk factors of treatment failure. The survey of jaundice in adult in-patients in a tertiary general government hospital gave the full picture for this common pathological sign.

Clinical characteristics of childhood cancer in emergency room in a tertiary hospital in Pakistan

INTRODUCTION Worldwide, cancer is an important cause of mortality in children aged over 1 year. Numerically, the major cancers include acute lymphoblastic leukemia, CNS tumors and lymphomas. Cancer incidence is increasing in children globally as well as in Pakistan but the etiology is poorly understood. There are an estimated 160 000 new cases and 90 000 deaths per year worldwide in children aged under 15 years.The exact incidence in Pakistan is not known as there is no national tumor registry

Invasive <i>Aspergillus</i>Infections in a Thai Tertiary-Care Hospital during 2006-2011

From an increase in the number of immunocompromised hosts including AIDS patients, organ transplantation, solid-organ tumor, hematological malignancy, corticosteroid use, and others underlying diseases, it leads to increasing the incidence of invasive aspergillosis (IA) as one of the most prevalent opportunistic mould infections. However, the epidemiological data are still limited. Our objective is to study the epidemiology of IA, patients’ characteristics in a tertiary-care hospital, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. The retrospective study of IA as principal diagnosis in both medical and laboratory records in a tertiary-care hospital, King Chulalongkorn Memorial Hospital, from January 1, 2006 to December 31, 2011, was performed. There were 69 patients who were diagnosed as IA during 2006 till 2011. They were classified as proven (45 patients), probable (3 patients), and possible (21 patients) invasive aspergillosis following the criteria of European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG), 2008. The numbers of patients in 2006 to 2011 were 3, 11, 12, 10, 10, and 23 respectively. Male patients were 58 percent. The age range was from 8 months to 87 years old. Most of patients were from Medicine ward. Others were derived from Pediatrics, Surgery, and Ear Nose Throat wards. The most common underlying disease was diabetes mellitus type 2 in the proven group. The main predisposing factors of patients were the history of pulmonary tuberculosis and using of immunosuppressive drugs. The sites of infection were lung (62%), sinus (28%), and brain (8%). Aspergillus fumigatus (69%) and Aspergillus flavus (15%) were common species from the isolated culture. The treatment used mostly was surgery and followed by amphotericin B or voriconazole. The case fatality rate of IA was 20 percent. From the epidemiological data, we can conclude that in this past ten years there is an incessant increase in the number of IA in the immunocompromised hosts especially from Aspergillus fumigatus, which is the most prevalent species found in IA. Diabetes mellitus and history of pulmonary tuberculosis will play the important role for IA in the future. The plan for prevention and treatment should be concerned about those underlying diseases and predisposing factors.

Awareness of Fathers Regarding Newborn Danger Signs: Evidence from a Tertiary Level Hospital of Kathmandu, Nepal

The neonatal period is a critical period of childhood carrying the highest risk of mortality per day than any other period during the childhood. In Nepal, a country where a neonatal mortality rate is high, raising awareness among fathers regarding newborn danger signs is crucial. This research aims to measure the awareness of fathers regarding newborn danger signs. A hospital based cross sectional descriptive study was done in maternity ward and birthing center of Tribhuvan University Teaching Hospital (TUTH) hospital. Non-probability purposive sampling technique was used to select fathers of neonate. The study was conducted on 103 fathers having newborn baby up to 7 days admitted in Maternity Ward and Birthing Center. Respondents were selected without any discrimination of education, ethnicity, economical status, marital status, religion, etc. The findings of the study showed that out of 103 respondents, most of the respondents had moderate level of awareness (63.1%), 28.2% had low level and minority of the respondents had high level of awareness (8.7%). The researcher concluded that most of the respondents had a moderate level of awareness and minority of the respondents had a high level of awareness on newborn danger signs. The findings show greater need of health education to increase awareness about newborn danger signs among fathers.

Colorectal cancer patients in a tertiary hospital in Indonesia: Prevalence of the younger population and associated factors

BACKGROUND An increasing trend in colorectal cancer(CRC)occurring at younger ages has been observed worldwide,even though incidence is declining in the general population.Most currently available guidelines still recommend CRC screening for older populations,despite an alarming rise in early-onset CRC incidence.Risk stratification is necessary to further determine the population most at risk for early-onset CRC.However,epidemiological data on related clinical characteristics and potential risk factors,especially in developing countries,have not been widely reported.AIM To investigate the prevalence,demographics,clinicopathologic features,and associated factors of young-onset CRC patients in a tertiary hospital in Indonesia.METHODS Patients undergoing colonoscopy examination between 2008 and 2019,yielding a diagnosis of CRC were identified from medical records.The subjects were classified into two groups according to their age at diagnosis,namely early-onset(18-49 years old)and late-onset(≥50-years-old).Demographic data,characteristics,and risk factors of both onset age groups were evaluated using the chisquare and Fisher’s exact test.RESULTS Among 495 CRC patients confirmed by histopathology,205(41.4%)were classified as early-onset and 290(58.6%)as late-onset.Most subjects in the earlyonset CRC group were male(53.7%),with 89.8%displaying adenocarcinoma histopathology.A majority(78%)of the early-onset CRC patients had left-sided tumors,with the rectum(41%)and rectosigmoid(17.6%)being the most common sites.Abdominal pain was the most frequent symptom in the early-onset CRC patients(55.6%),which was significantly higher than that in the late-onset CRC patients(43.8%,P<0.05).Early-onset CRC cases were more likely to be underweight(34.6%vs 20.0%,P<0.001)compared to late-onset CRC cases.The proportion of subjects with suspected hereditary nonpolyposis colorectal cancer(HNPCC)was also higher in the early-onset CRC group than in the late-onset age group(9.3%vs 4.1%,P<0.05).However,no difference was observed in the parental or family histories of CRC cases.CONCLUSION Early-onset CRC patients were more likely to have abdominal pain,underweight status,and HNPCC suspicion than late-onset CRC patients.

Management of Obstetric Emergencies in a Tertiary Hospital in Cameroon: A Milestone for End of Preventable Maternal Deaths

Background: Maternal mortality was insufficiently reduced in Cameroon in 2015 despite the adoption of Millennium development goals. To tackle the situation and meet the sustainable Millennium goals target of 140/100,000 live births by 2030, the Government adopted the strategies of building reference hospitals where high quality obstetric care, timely and optimal management of obstetric emergencies will be offered. The objective of this study was to describe the patterns of obstetric emergencies in Douala Gynaeco-obstetric and Paediatric Hospital, evaluate the outcomes of their management and the contribution to maternal mortality. Patients and Methods: 418 patients with obstetric emergencies were included in a two-phase cross-sectional study. Data were retrieved from patients’ case notes during the retrospective phase and a questionnaire filled for each case received during the prospective phase. Patterns of obstetric emergencies were determined and for each, the following were analysed: patient managed in this hospital or referred from other hospitals, management according to hospital guidelines, timing of care, result of management (recovery with no admission in ICU (intensive care unit), admission in ICU, death). Factors associated with each case of death were analysed. Results: The patterns of obstetric emergencies (OE) were dominated by HDP (hypertensive diseases in pregnancy) (20.57%), abortions (14.83%), Ectopic pregnancies (13.87%), Acute foetal distress (13.15%) and Obstructed labour (9.56%). PPH (post partum haemorrhage) represented 7.65% and Sikcle cell crisis (SCA) 0.91%. 40% of cases were referred from other hospitals. Six cases of deaths were recorded with a global case fatality of 1.43%. The causes of death were PPH, HDP, and Sickle cell anaemia 33.33% each. The case fatality of SCA was 50%, disclosing our worst performance. Conclusion: Management of OE following standardized hospital guidelines, reinforcement of referral systems, upgrading obstetrical services with ICU will result in least adverse maternal outcomes and especially reduced maternal mortality.

Lower Segment Caesarean Section Audit Is a Promising Tool to Improve the Quality of a Standard Care at a Tertiary Hospital in Kuwait “Cross-Section Study”

Aim: Clinical audit is a tool to improve quality of care and to reduce maternal and perinatal morbidity and mortality. Auditing the CS according to a standard parameter will lead to strategies to avoid unnecessary intervention and to advice uniform practice. The aim was to evaluate the current practice and audit against international standards for various parameters relating to elective lower segment caesarean section and to assess compliance of physicians to audit standards. Subject and methods: This is a cross-sectional study which was in a tertiary hospital in Kuwait from 1st October 2019 until 1st October 2020. The hospital medical, electronic records and case notes of three hundred and twenty-six (326) cases of elective caesarean sections were reviewed for study participants. Those women were booked under the care of internal and external physicians. Demographic data and primary outcomes were collected. Results: Outcome was measuring the compliance to the recognized Caesarean Section international standards: consent form, grade of LSCS, antacid and anti-emetics, type of anesthesia, uses of antibiotics, umbilical cord blood PH, and thromboprophylaxis. The compliance for a signed consent form and cord blood PH was (100%), the use of preoperative antacid and antiemetic was (99.4%), combined regional anesthesia was given in (53.4%) of cases, preoperative antibiotics prophylaxis of second generation cephalosporin was to (61.3%) of cases, post-operative thromboprophylaxis was given in (78.5%) of cases of which (33.6%) completed a 10 days duration. There was a statistically significant difference between internal and external physicians’ compliance regarding, type of anesthesia 2.3 (95% CI, 1.3 - 4.1, p = 0.004), type and timing of antibiotics 0.42 (95% CI 0.22 - 0.79, p = 0.007) and 0.33 (95% CI 0.172 - 0.63, p = 0.0006) and thromboprophylaxis 8.1 (95% CI 2.80 - 23.23, p = 0.000). Conclusion: The results are encouraging, but suboptimal compliance is noticed mainly among external physicians.

Characterization of Defaulters from Tuberculosis Treatment in a Tertiary Hospital in South Eastern Nigeria

Background: Tuberculosis is second only to HIV/AIDS as the greatest killer worldwide, due to a single infectious agent. Directly Observed Treatment Short-Course (DOTS) is presently the WHO recommended programme to fight tuberculosis worldwide. There is a need to understand the characteristics of patients who default from treatment for tuberculosis. This will help modify the strategies to reduce such default to the barest minimum and achieve higher levels of adherence. Objective: The aim of this study was to describe the characteristics of patients that defaulted from treatment for TB at Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi DOTS clinic for the period 1st January 2011 to 31st December 2012. Materials and Methods: This was a retrospective study conducted at the DOTS clinic at Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, Nigeria. The records of patients who received treatment from the clinic from 1st January 2011 to 31st December 2012 (2 years) were reviewed. The data collected include patients’ demographic characteristics, treatment category, patient type, baseline sputum smear result, and retroviral status. From the data, default rate was calculated and its relationship with other variables noted. Associations between patients’ characteristics were determined using chi square test of independence. The significance level was set at p = 0.05. Results: A total of 765 patients enrolled for TB treatment in the DOTS clinic of the study area within the study period of 1st January 2011 and December 31st 2012. The mean age at commencement of the treatment was 33.14 years (±18.09). The outcome of treatment showed that 260 (34%) had treatment completed, 230 (30.1%) cured, 120 (15.7%) defaulted, 103 (13.5%) died, 40 (5.2%) were transferred-out, and 12 (1.6%) failed in the treatment, giving a treatment success rate of 64.1%. Among the 120 (15.7%) patients that defaulted from treatment, majority 80 (66.7%) were males, and most 30 (25.0%) were in the 30 - 39 years age group. Conclusion: Defaulting starts with treatment interruption hence prompt management of interruption of treatment and default will largely help in preventing drug-resistant TB.

Nurses’ Experiences in Service Provision a COVID-19 Dedicated Tertiary Public Hospital

Objectives: To assess the nurses’ experiences in service provision a COVID-19 dedicated tertiary public hospital. Materials and Methods: This descriptive cross-sectional study was conducted in one tertiary level public hospital namely Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from January to December 2021. Data were collected through face-to-face interview using a structured questionnaire containing demographic details and experiences faced by the nurses in service provision during COVID-19. Data was analysed by using SPSS (Statistical Package for Social Science) software version 23. Results: The findings revealed that the mean age of the respondents was 32.35 ± 7.248 years, the minimum age was 23 years and maximum age was 58 years. About half of the respondents 52.1% were in 21 - 30 years. The majorities 89% were female. More than half of the respondents 72.6% were Muslim and 63.83% of respondents have completed Diploma in nursing. About 32.2% respondents were living with senior citizen, 33% respondents were infected by COVID-19, 24.23% respondent mentioned nurse-Patient ratio in general ward was 1:7 and 71.08% mentioned nurse-patient ratio in I.C.U/C.C.U. was 1:3 (December 2021). PPE were available among 88.0% respondents and N95 mask were available among 84.0% respondent. About 34.8% respondents got COVID-19 guideline training and 32.4% got donning and doffing training. More than half of the respondents 76% stated that equipment is adequate, 56.38% respondents mention that insufficient of nurses and 53.7% were mentioned insufficient of subordinate staff. About 22.6% respondents faced social stigma and majorities 96.5% respondents mentioned they got proper family support. There was a significant association found between Professional educational qualification and satisfaction of current designation (p value = 0.001 Conclusion: The most important findings of this study was lack of training, insufficient of manpower especially nurses and subordinate staff, high nurse-patient ratio and fear about personal and family safety. The findings of the study will be helpful for the authority in planning for future course of action.

基于合成控制法的DRG改革对住院费用的影响——以北京市三级公立医院为例

目的:分析DRG改革对北京市三级公立医院例均住院总费用及其增速、内部结构的短期效应与长期影响。方法:基于2009—2018年北京市三级公立医院住院费用的年度报表数据,采用合成控制法分析2011年的DRG改革对例均住院总费用及各项费用占比的影响。结果:与未试点的医院相比,短期内试点医院的例均住院总费用有所降低,药占比下降显著,耗材费用占比增速下降明显,手术、治疗、护理费用占比有所下降,检查、化验费用占比略有上升。长期看,试点医院例均住院总费用与增速超过非试点医院,药占比、手术、治疗、护理费用占比低于非试点医院,耗材费用占比大幅提高,检查、化验费用占比呈现较强的个体差异性。结论:DRG改革短期内对控制费用增长具有积极作用,长期效果有待改善,费用结构有待优化;未来应从发挥“双中心”的多元作用、与三级公立医院绩效考核结合、提高体现医生技术劳动价值的收入等方面完善DRG改革。

青海省三级医院信息化护理质控平台建设及应用

目的/意义建立青海省三级医院信息化护理质控平台,分析其对护理质量的影响。方法/过程根据青海省护理质量管理现状,依托青海省护理质量数据平台,建立护理质量指标监测模块,选取1家三级医院作为试点,采用历史对照研究方法,将2021年1—6月该医院护理质量数据作为对照组,2022年1—6月采用信息化护理质控平台收集的数据作为观察组,对比平台应用前后护理质量的变化情况。结果/结论信息化护理质控平台应用后,住院患者身体约束率和气管插管非计划拔管率显著下降,患者对护理工作满意度评分显著提升,平台可操作性强,具有临床应用价值。

三级公立医院绩效考核背景下医院运营管理的研究

国家三级公立医院绩效考核开始于2019年,运营效率作为考核的一部分,相关的国家监测指标有9个,包含收支结构和费用控制。绩效考核是医改工作的有力抓手,也是加快现代医院管理制度建立的强劲推手。通过分析某三级甲等口腔专科医院在绩效考核背景下运营效率指标的得分情况,找出原因;并通过加强党建引领,做好医院运营管理体系架构顶层设计,加强医疗质量管理,落实医改相关政策,加强能耗管理,不断提高员工福利待遇,强化公立医院功能定位,提高医疗服务收入占比,绩效分配体现医务人员的劳动技术价值,提高运营管理能力,助推医院高质量发展。