Association of Psychiatric Disorders in Children and Adolescents with Epilepsy in a Tertiary Care Hospital in Bangladesh

Abstract Background Psychiatric disorders are important aspects of epilepsy and have received increasing attention in the last several years. Although a significant number of children are afflicted with epilepsy with psychiatric comorbidities, the actual burden was not evaluated sufficiently. Objective To determine the types and frequency of psychiatric disorders in children with epilepsy. Materials and Methods This hospital-based case-control study was conducted at the outpatient department of a tertiary care center in Dhaka, Bangladesh, from September 2018 to August 2019. In total, 68 epileptic children, ranging from 5 to 17 years of age, were enrolled as cases. A similar number of nonepileptic children of age, sex, and sociodemographic status matched were enrolled as control. Parent, teacher, and self-version of Bengali Development and Well-Being Assessment (DAWBA) were used to assess the psychiatric disorders, and the diagnosis was assigned as Diagnostic and Statistical Manual (DSM)-V of Mental Disorders. Results Higher proportion of psychiatric illness were found significantly among the cases (83.8% vs. 16.2%; p < 0.001) and broad categories of disorders, namely, neurodevelopmental (30.9% vs. 1.5%, p < 0.001), emotional (48.5% vs. 7.4%, p < 0.001) and behavioral disorder (19.1% vs. 7.4%, p = 0.043) compared with controls. There was a significant relationship between psychiatric disorders with the duration of epilepsy of the respondents (p = 0.032). Conclusions This study result showed the significant association of psychiatric disorders with epilepsy among children and adolescent population. Thus, psychiatric disorders should be properly addressed during treatment of epilepsy.

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Coexistence of Metallo Beta Lactamase Resistant Gene Variants Among Clinical Isolates in Tertiary Care Hospital

Anti-Infective Agents ◽

10.2174/2211352518666200121144301 ◽

2021 ◽

Vol 18 (4) ◽

pp. 429-436

Author(s):

Santhiya K. ◽

Jayanthi S. ◽

Ananthasubramanian M. ◽

Appalaraju B.

Keyword(s):

Care Center ◽

Tertiary Care ◽

Medical Science ◽

Geographical Location ◽

Carbapenem Resistance ◽

Clinical Isolates ◽

Care Hospital ◽

Detection Rates ◽

Carbapenem Resistant ◽

Global Threat

Background: Carbapenem-resistant Enterobacteriaceae (CRE) has emerged as a global threat with mortality risk ranging from 48%-71% worldwide. The emergence of MBL resistance is threatening as carbapenem is one of the last line antibiotics. A total 24 variants of NDM resistance raises a concern to the clinicians and epidemiologists worldwide. Objective: The study aims at identifying MBL resistance (NDM, IMP, VIM, GIM, SPM, and SIM) and its coexistence in clinical isolates in a single tertiary care center. Methodology: Forty five clinical isolates characterized phenotypically for Carbapenem resistance obtained from PSG Institute of Medical Science and Research (PSG IMSR), Coimbatore, between February to March 2018 were taken for analysis. Result: Out of the 45 Clinical isolates, 38 isolates (84%) were detected as MBL carriers. VIM, NDM, GIM, and SPM were the predominant resistance genes, with detection rates of 48.8%, 28.8%, 24.4%, and 22.2% respectively. Fifteen isolates were observed to harbor more than one MBL gene in coexistence. Two isolates - U42 and R714 (K. pneumoniae) were found to harbor all 5 MBL variants in combination. Conclusion: 33% of clinical isolates harboring multiple MBL variants is a concern in clinical settings. The presence of SPM and GIM gene amongst isolates in this geographical location within India is an indicator demanding continuous monitoring of these resistance determinants.

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Gender-wise Comparative Assessment of Lifestyle Patterns and Well-being Status among Healthcare Employees at a Tertiary Care Hospital

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0041-1727578 ◽

2021 ◽

Author(s):

Vanajakshamma Velam ◽

Vyshnavi Kancherla ◽

Latheef Kasala ◽

Anusha Kancherla ◽

Mounica Reddy Pillaram

Keyword(s):

Tertiary Care Hospital ◽

Tertiary Care ◽

Well Being ◽

Care Hospital ◽

Cross Sectional ◽

Significant Difference ◽

Female Employees ◽

The Mean ◽

Lifestyle Patterns ◽

Comprehensive Study

Abstract Background This study was an attempt to assess and compare the gender-wise lifestyle patterns and well-being status among the employees of a tertiary care teaching hospital. Material and Methods This is a cross-sectional, questionnaire-based study conducted at a tertiary care hospital between May and August 2019. A total of 777 employees belonging to both genders (male and female) and working at different professional levels were assessed. All the enrolled employees were subjected to a comprehensive study tool consisting of various dimensions of their health, which included physical, mental, social, spiritual and intellectual health dimensions. Results Among the participants, 327 (42.1%) were male and 450 (57.9%) were female. There was no significant difference in the mean age of male (37.91 ± 7.52) and female (36.85 ± 8.16) employees (p = 0.07). A significantly higher proportion of diabetes and hypertension were seen in male employees (9.8% and 14.4%, respectively) than in female (5.6% and 6.2% respectively). The overall well-being was better in male employees than in females and was statistically significant (p < 0.0001). We found that male employees had statistically significant better well-being in terms of physical, mental and social health whereas female employees had intellectual health. Conclusion The overall well-being in healthcare staff was good at our tertiary care hospital, and the outstanding/good well-being rate was higher in male employees than in female employees. Female employees experienced risks with regard to their physical health.

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Impact of Rapid PCR Influenza Testing on the Rate of Inpatient Admissions During Influenza Season at a Tertiary-Care Center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.830 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s263-s264

Author(s):

Jordan Polistico ◽

Avnish Sandhu ◽

Teena Chopra ◽

Erin Goldman ◽

Jennifer LeRose ◽

...

Keyword(s):

Influenza Season ◽

Care Center ◽

Tertiary Care ◽

The United States ◽

Turnaround Time ◽

Care Hospital ◽

Tertiary Care Center ◽

Pediatric Hospital ◽

Rapid Pcr ◽

The Impact

Background: Influenza causes a high burden of disease in the United States, with an estimate of 960,000 hospitalizations in the 2017–2018 flu season. Traditional flu diagnostic polymerase chain reaction (PCR) tests have a longer (24 hours or more) turnaround time that may lead to an increase in unnecessary inpatient admissions during peak influenza season. A new point-of-care rapid PCR assays, Xpert Flu, is an FDA-approved PCR test that has a significant decrease in turnaround time (2 hours). The present study sought to understand the impact of implementing a new Xpert Flu test on the rate of inpatient admissions. Methods: A retrospective study was conducted to compare rates of inpatient admissions in patients tested with traditional flu PCR during the 2017–2018 flu season and the rapid flu PCR during the 2018–2019 flu season in a tertiary-care center in greater Detroit area. The center has 1 pediatric hospital (hospital A) and 3 adult hospitals (hospital B, C, D). Patients with influenza-like illness who presented to all 4 hospitals during 2 consecutive influenza seasons were analyzed. Results: In total, 20,923 patients were tested with either the rapid flu PCR or the traditional flu PCR. Among these, 14,124 patients (67.2%) were discharged from the emergency department and 6,844 (32.7%) were admitted. There was a significant decrease in inpatient admissions in the traditional flu PCR group compared to the rapid flu PCR group across all hospitals (49.56% vs 26.6% respectively; P < .001). As expected, a significant proportion of influenza testing was performed in the pediatric hospital, 10,513 (50.2%). A greater reduction (30% decrease in the rapid flu PCR group compared to the traditional flu PCR group) was observed in inpatient admissions in the pediatric hospital (Table 1) Conclusions: Rapid molecular influenza testing can significantly decrease inpatient admissions in a busy tertiary-care hospital, which can indirectly lead to improved patient quality with easy bed availability and less time spent in a private room with droplet precautions. Last but not the least, this testing method can certainly lead to lower healthcare costs.Funding: NoneDisclosures: None

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Medical Trainee Continuity of Care Following Emergency Department Consultations in a Pediatric Hospital

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00018.1 ◽

2016 ◽

Vol 8 (1) ◽

pp. 33-38 ◽

Cited By ~ 1

Author(s):

Kim Bjorklund ◽

Emily A. Eismann ◽

Roger Cornwall

Keyword(s):

Emergency Department ◽

Continuity Of Care ◽

Broad Spectrum ◽

Medical Records ◽

Care Center ◽

Tertiary Care ◽

Well Being ◽

Tertiary Care Center ◽

Pediatric Hospital ◽

Medical Trainee

ABSTRACT Background The importance of continuity of care in training is widely recognized; however, a broad-spectrum assessment across all specialties has not been performed. Objective We assessed the continuity of care provided by trainees, following patient consultations in the emergency department (ED) across all specialties at a large pediatric tertiary care center. Methods Medical records were reviewed to identify patients seen in consultation by a resident or fellow trainee in the ED over a 1-year period, and to determine if the patient followed up with the same trainee for the same condition during the next 6 months. Results Resident and fellow trainees from 33 specialties participated in 3400 ED consultations. Approximately 50% (1718 of 3400) of the patients seen in consultation by a trainee in the ED followed up with the same specialty within 6 months, but only 4.1% (70 of 1718) followed up with the same trainee for the same condition. Trainee continuity of care ranged from 0% to 21% among specialties, where specialties with resident clinics (14.4%) have a greater continuity of care than specialties without resident clinics (2.7%, P < .001). Continuity of care did not differ between fellows (4.2%) and residents (4.0%, P = .87), but did differ between postgraduate years for residents (P < .001). Conclusions Trainee continuity of care for ED consultations was low across all specialties and levels of training. If continuity of care is important for patient well-being and trainee education, efforts to improve continuity for trainees must be undertaken.

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Abstract 448: Impact of Novel Healthcare Facility First Responder Training on Resuscitation Task Self-Efficacy Measures

Circulation ◽

10.1161/circ.140.suppl_2.448 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Les R Becker ◽

Cheryl Camacho ◽

Sheryl J Titus ◽

Janet L Thorne ◽

Munish Goyal

Keyword(s):

Ambulatory Care ◽

Self Efficacy ◽

Repeated Measures ◽

Care Center ◽

Tertiary Care ◽

Sudden Cardiac Arrest ◽

Healthcare Facility ◽

Care Hospital ◽

Ambulatory Care Setting ◽

Before And After

Introduction: When sudden cardiac arrest occurs in non-resuscitation focused care settings, bedside clinicians may not intervene prior to dedicated resuscitation team arrival. As perceived self-efficacy (SE) contributes to cognitive functioning, facilitating effective intervention, we developed and evaluated a mock code training approach, First Five (FF) , to enhance bedside responders’ resuscitation task SE using an entity’s defibrillator and manikin. Self-efficacy is knowing that one can perform actions in principle and envision performing the steps to reach a goal. Hypotheses: Participants’ resuscitation SE will improve after FF training; 2) Inpatient (IP) and Ambulatory Care Center (ACC) providers will differ in their pre-SE and post-SE in response to FF training. Methods: Participants enrolled from ACCs and medical-surgical IP units at a large, urban tertiary care hospital from May 2018 to April 2019 completed a de-identified 10-point Likert-scale SE survey before and after they were trained to perform initial bedside resuscitation tasks (Figure 1 x-axis labels). Matched, complete, pre/post data for 85 in-hospital and 107 ACC participants were analyzed via repeated measures multivariate analysis of variance. Results: Patterns of reported change in the seven resuscitation task SE measures of IP personnel differed significantly from those of ACC personnel [Pillai’s Trace = .222, F(7,184)=7.483, p=.0005, partial η 2 = .222]. In both settings, post-session SE measures increased significantly from pre-session SE measures [Pillai’s Trace = .588, F(7,184)=37.438, p=.0005, partial η 2 = .588]. Moreover, though ACC providers consistently reported lower pre-training SE resuscitation task scores, post-training scores from both settings were comparable (Figure 1). Conclusions: First Five training is effective in enhancing resuscitation task SE among inpatient and ambulatory care setting providers that are not resuscitation-focused.

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Abstract 14747: Dwindling Trends of Cardiology Admissions Amidst Covid-19 Pandemic in a Tertiary Care Center of Pakistan

Circulation ◽

10.1161/circ.142.suppl_3.14747 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jamshed Ali ◽

Osman Faheem ◽

Pirbhat Shams ◽

ghufran adnan ◽

Maria Khan

Keyword(s):

Care Center ◽

Tertiary Care ◽

Electronic Record ◽

Medical Attention ◽

Care Hospital ◽

Record System ◽

Admission Rates ◽

Cardiovascular Morbidity And Mortality ◽

Number Of Patients ◽

The Impact

Introduction: Social containment measures have been adopted globally to control COVID-19 outbreak. Reduction in hospital visits and inpatient admission rates have become cause for concern. Through this study we aimed to analyze the impact of SARS-CoV-2 virus Outbreak on cardiology inpatient admissions at a tertiary care hospital in Pakistan. Hypothesis: COVID-19 pandemic has resulted in significant decline in cardiology admissions. Methods: We conducted a retrospective study at our center. Admission log was accessed via electronic record system. Comparison was made for same months of 2019 and 2020 with regard to cardiology inpatient admissions. Results: A total of 239 patients were admitted to cardiology services in 2019 period and 106 in 2020 period with resultant reduction of 55.6%. Number of patients admitted to the coronary care unit were 179 and 78 respectively where as the numbers declined to 28 from 60 for cardiac step down. Reduction for admission numbered to 52.4% for males and 38.89% for females. 9.3% patients left against medical advice in 2019 and 3.4% in 2020. Conclusions: Our study concludes that numbers of cardiology admissions have dwindled. Possible explanation for this can be implementation of social containment and fear of acquiring infection. This has raised a question of whether a significant number of cardiovascular morbidity and mortality has occurred without seeking medical attention and has went unrecorded during the pandemic. This calls for stringent diagnostic measures in future to diagnose previously unrecorded burden.

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Distribution of age, gender and body weight in AMI patients in a tertiary care center of Eastern India

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i6.34945 ◽

2021 ◽

Vol 12 (6) ◽

pp. 75-58

Author(s):

Tanushri Khatua ◽

Tanima Mandal ◽

Mita Saha ◽

Biswajit Majumder

Keyword(s):

Body Weight ◽

Family History ◽

Care Center ◽

Tertiary Care ◽

Positive Family History ◽

Premenopausal Women ◽

Care Hospital ◽

Risk Of Mortality ◽

And Gender ◽

Risk Predictors

Background: The leading cause of death in the world is coronary heart disease (CHD). In India, CHD manifests almost a decade earlier than in Western countries. Gender differences play an important role in the pathophysiology of AMI. Body weight and family history are claimed to be the indicators of relative risk of mortality. Aims and Objective: To look for the age and gender distribution pattern in patients with recent diagnosed AMI and to find out the association of some of the risk factors like BMI, family history. Materials and Methods: A descriptive study was conducted in a tertiary care hospital with 50 recent diagnosed AMI patients of either sex as cases after considering the inclusion and exclusion criteria. The biochemical parameters were measured by validated methods. Results: On statistical analysis, 58% of total AMI cases occurred before 50 years of age; out of which 18% belong to 31 - 40 years, 40% belong to 41- 50 years. Out of total 50 AMI cases, 60% is male and 40% is female. Obesity seen in 14% cases and 56% is overweight; 16% having positive family history. Conclusion: The study indicates a trend of early age onset AMI. Increased body weight and positive family history can be the risk predictors. It is suggested that younger age males and premenopausal women should not be ignored regarding the risk of MI. Further studies are required for verification.

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Transport Factors Affecting the Outcome of Referred Neonates Admitted in A Tertiary Care Hospital

Bangladesh Journal of Child Health ◽

10.3329/bjch.v41i3.36951 ◽

2018 ◽

Vol 41 (3) ◽

pp. 159-164 ◽

Cited By ~ 1

Author(s):

Madhabi Baidya ◽

Mahfuza Shirin ◽

Liton Chandra Saha

Keyword(s):

Perinatal Asphyxia ◽

Care Center ◽

Tertiary Care ◽

Preterm Neonates ◽

P Value ◽

Care Hospital ◽

Cross Sectional ◽

Neonatal Transport ◽

Group I ◽

Group Ii

Background: Adequate neonatal transport is a key component of care of the sick newborns who require referral to tertiary care center. Poor transportation is one of the iatrogenic factors associated with greater neonatal mortality. Neonatal transport is the greatest challenge faced today in our country. The purpose of this study was to find out characteristics of transport of referred neonates and to idention the factors that contribute to mortality.Methodology: This cross sectional study was conducted in Dhaka Shishu (Children) Hospital from June 2013 to November 2013. Both term and preterm neonates who were referred within first seven days of life were included and those with gross congenital abnormalities and left against medical advice were excluded from the study. After enrollment, data were collected using a structured questionnaire including birth details, interventions before transportation, reasons for referral, and details of transportation. Outcome & duration of hospital stay were also recorded. Neonates who were expired considered as group I and who were survived considered as group II. The study variables were analyzed for their association with immediate outcome by applying chi square test and t test. P value <0.05 was considered significant.Results: This study found that out of 332 neonates 181 were expired with 54.5% mortality rate. One eighty one neonates who were expired, considered as group I and one fifty one neonate were survived, considered as group II. The mortality was significantly high in male neonates [RR 0.80 (0.66-0.97)] and neonates those delivered at home [RR 1.34(1.10-1.64)] (p<0.05). Perinatal asphyxia, pre-term low birth weight, neonatal sepsis were the main causes of referral. It was found that transportation without any referral note [RR 1.40 (1.14- 1.71)], no advice regarding maintenance of airway[RR 1.50(1.17- 1.92)]and keeping warm [RR 1.51(1.17-1.950], resuscitation on admission [RR 1.63(1.23-2.17)] and transportation required > 3hours [RR 1.36(1.09-1.69)] were associated with significantly higher mortality among referred transported neonates(p<0.05).Conclusions: This study found that male neonates, home delivery, transportation without any referral note, no advice regarding maintenance of airway and keeping warm, resuscitation needed on admission and prolonged transportation time were significantly associated with mortality of referred transported neonates.Bangladesh J Child Health 2017; VOL 41 (3) :159-164

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Family-Centered Approach to Monitoring Children’s Development in a Paediatric Outpatient Setting: Feasibility Study from Pakistan

10.21203/rs.3.rs-194080/v1 ◽

2021 ◽

Author(s):

Muneera A. Rasheed ◽

Waliyah Mughis ◽

Kinza N Elahi ◽

Babar S. Hasan

Keyword(s):

Service Providers ◽

Psychosocial Support ◽

Tertiary Care ◽

Wait Time ◽

Well Being ◽

Parent Report ◽

Outpatient Setting ◽

Theory Of Change ◽

Care Hospital ◽

Family Centered

Abstract Background: The purpose of the study was to design and test the feasibility of a recent guideline of family-centered psychosocial support as an approach to developmental monitoring in a pediatric outpatient setting.Methods: The patient experience team at a private tertiary care hospital leveraged an on-going patient and family-centric initiative in the service to implement the intervention. The intervention delivery model was designed using the theory of change model and entailed the following i) the service providers: paediatricians but with support from psychology trainee volunteers to address time constraints; ii) monitoring form: Survey of Well-Being of Young Children (SWYC) being feasible and designed for regular developmental monitoring as parent report; iii) family support intervention: the Care for Child Development module to enhance parent-child interactions given team’s successful experience with inpatient children; iv) timing: utilize wait time to also enhance families’ experience and v) reinforcement: reinforced by the paediatrician in the consultation visit to capitalize on the established rapport and relationship with families. All families with children under 5 years 5 months of age in selected clinics (acute care, complex care, developmental issues) were eligible. The study was evaluated for acceptability and implementation feasibility. Families were interviewed about their experience; trainees provided a written narrative while physicians provided feedback on email. These were thematically analyzed using an inductive approach.Results: A total 182 families were administered the SWYC with 54% children detected for further review on cognitive milestones and 76% on social-emotional milestones. Forty-eight families were interviewed regarding their experience with the intervention. They reported the monitoring process to be useful and important for them as parents indicating acceptability. Paediatricians and trainees found the intervention to be important for parents and children’s health also requesting further understanding about child’s functioning. The trainees further expressed the experience to be significant for their own learning.Conclusion: The authors conclude that the intervention model for a family-centric approach to monitoring was acceptable to the families and the service providers. The intervention when implemented using a robust behaviour change framework can enhance feasibility.

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Knowledge and Practices of Pregnant Women regarding Oral Health in A Tertiary Care Hospital in Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.4420 ◽

2019 ◽

Vol 57 (217) ◽

Author(s):

Neha Gupta ◽

Manisha Chhetry

Keyword(s):

Oral Health ◽

Pregnant Women ◽

Dental Care ◽

Dental Health ◽

Care Center ◽

Tertiary Care ◽

Care Hospital ◽

Perinatal Complications ◽

Institutional Review ◽

In Pregnancy

Introduction: Poor dental hygiene has been associated with various perinatal complications in studiesdone worldwide but few studies in Nepal have explored the knowledge of pregnant ladies regardingdental hygiene. The aim of the study was to know the knowledge and practices of pregnant womenregarding oral health in a tertiary care center in Nepal. Methods: A qualitative study was carried out in Nobel Medical College and Teaching Hospital fromJanuary 15, 2018 to June 15, 2018 after approval from the Institutional Review Committee of NobelMedical College. Convenience sampling was done. Fifty pregnant women admitted in antenatalward were interviewed regarding their knowledge of dental care in pregnancy, the common dentalproblems they faced and the treatment taken. A predesigned proforma was used and results wereanalyzed using SPSS version 17. Results: Twenty two (44%) patients reported dental problems during pregnancy. Bleeding gumswas seen in 7 (14%) and toothache in 7 (14%) were commonly reported dental problems. Forty seven(94%) patients acknowledged that routine dental care was needed for health, only 6 (12%) wereaware that poor dental health could affect baby weight. Oral health not seen as priority in 24 (48%)was the main barrier to seeking dental care in pregnancy followed by costs of treatment in 18 (36%)and safety concerns in pregnancy in 8 (16%) cases. Conclusions: Though dental problems were a common occurrence in pregnancy, utilization ofservices was low for the same. The participants reported significant barriers to obtaining dental careincluding lack of knowledge about the importance of maternal oral health and the treatment costs.

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