scholarly journals Influence of Supervision Ratios by Anesthesiologists on First-case Starts and Critical Portions of Anesthetics

2012 ◽  
Vol 116 (3) ◽  
pp. 683-691 ◽  
Author(s):  
Richard H. Epstein ◽  
Franklin Dexter
Keyword(s):  
Confidence Interval ◽  
Information Management ◽  
Confidence Limit ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Real Data ◽  
Information Management System ◽  
Release Time ◽  
Care Hospital ◽  
First Case

Background Anesthesia groups may wish to decrease the supervision ratio for nontrainee providers. Because hospitals offer many first-case starts and focus on starting these cases on time, the number of anesthesiologists needed is sensitive to this ratio. The number of operating rooms that an anesthesiologist can supervise concurrently is determined by the probability of multiple simultaneous critical portions of cases (i.e., requiring presence) and the availability of cross-coverage. A simulation study showed peak occurrence of critical portions during first cases, and frequent supervision lapses. These predictions were tested using real data from an anesthesia information management system. Methods The timing and duration of critical portions of cases were determined from 1 yr of data at a tertiary care hospital. The percentages of days with at least one supervision lapse occurring at supervision ratios between 1:1 and 1:3 were determined. Results Even at a supervision ratio of 1:2, lapses occurred on 35% of days (lower 95% confidence limit = 30%). The peak incidence occurred before 8:00 AM, P < 0.0001 for the hypothesis that most (i.e., >50%) lapses occurred before this time. The average time from operating room entry until ready for prepping and draping (i.e., anesthesia release time) during first case starts was 22.2 min (95% confidence interval 21.8-22.8 min). Conclusions Decreasing the supervision ratio from 1:2 to 1:3 has a large effect on supervision lapses during first-case starts. To mitigate such lapses, either staggered starts or additional anesthesiologists working at the start of the day would be required.

scholarly journals Hyponatremia among Postoperative Children Administered with Hypotonic Fluids in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (243) ◽  
pp. 1131-1135
Author(s):  
Ashish Lal Shrestha ◽  
Susan Jehangir Homi ◽  
Reju Joseph Thomas
Keyword(s):  
Confidence Interval ◽  
Postoperative Period ◽  
Tertiary Care Hospital ◽  
Elective Surgery ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Hypotonic Fluids

Introduction: Hypotonic solutions in postoperative children may cause hyponatremia. Considering humidity and temperatures in India, this study was conducted to find out the prevalence of hyponatremia among postoperative children who were administered with hypotonic solutions in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital. Ethical approval was taken from the institutional review board of Christian Medical College, Vellore, India (Reference number: 9177). Children aged less than 15 years undergoing elective surgery, requiring fasting for more than 12 hours post-operatively with normal preoperative electrolytes and renal functions were included. Hypotonic fluids were administered following existent protocol. Electrolytes were repeated immediate postoperatively and at 12-24 hours. Data was entered into and analyzed using the Statistical Package for the Social Sciences version 18.0. Point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Among 109 participants, hyponatremia in the postoperative period was seen in 53 (48.6%) (40.7-56.5 at 90% Confidence Interval) children. Hyponatremia was found in the immediate postoperative period in 10 (9.2%) children. All received Ringer Lactate as maintenance intra-operatively and none were severe enough to need correction. In the 12–24-hour sample, 43 (39.41%) had hyponatremia and none in severe category. Conclusions: Asymptomatic hyponatremia was noted in normal children planned for elective surgery. Among children managed with the existing institutional perioperative (hypotonic) fluid management protocol, subclinical postoperative hyponatremia within 12-24 hours of surgery was noted in a significant proportion, which was more in the hot and warm months in tropics. There are grounds for switching to isotonic fluids for perioperative management.

scholarly journals Robson’s Group 2 Criteria among Total Caesarean Sections in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (243) ◽  
pp. 1098-1101
Author(s):  
Pratigyan Gautam ◽  
Chanda Karki ◽  
Asmita Adhikari
Keyword(s):  
Caesarean Section ◽  
Confidence Interval ◽  
Cesarean Section ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Group 2

Introduction: Globally, there is a dramatic rise in cesarean section rate which has increased the maternal morbidity and adverse effects in a subsequent pregnancy. Robson’s classification will aid in the optimization of the cesarean section use, assessment of the strategies aimed to decrease the cesarean section rate and thus improve the clinical practices and quality of care in various health care facilities. The main aim of this study is to find out the prevalence of caesarean section for Robson’s group 2 among total caesarean sections done in a tertiary care hospital. Methods: A descriptive cross-sectional study was carried out at a tertiary care centre in Nepal from August 2020 to January 2021. Ethical approval was taken from the institutional review committee (reference number: 1607202003) and data were entered using Robson’s criteria. The convenient sampling technique was used. Data was analyzed using Microsoft Excel. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: According to Robson’s group 10 classification, among 380 caesarean sections, 110 (28.94%) (24.38-33.50 at 95% Confidence Interval) cases were in Robson’s group number 2. Conclusions: This study showed that the prevalence of caesarean section which lies in Robson’s group 2 in our study is higher than the standard of World Health Organization. It showed that Robson’s group 2 was one of the significant contributors to the greater caesarean section rate. Improved case selection, standardization, and protocol for induction of labour as well as regular audit could also reduce caesarean section rates.

scholarly journals Postpartum Hemorrhage in Pregnancy beyond 40 Weeks of Gestation in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (237) ◽  
Author(s):  
Rashmi Bastakoti Gaire ◽  
Suman Raj Tamrakar ◽  
Anjana Singh Dongol
Keyword(s):  
High Risk ◽  
Confidence Interval ◽  
Postpartum Hemorrhage ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
In Pregnancy

Introduction: Postpartum hemorrhage is defined as a blood loss of 500ml or more within 24 hours after birth. It is the leading cause of maternal mortality in low-income countries and the primary cause of nearly one-quarter of all maternal deaths globally. It occurs in up to 18% of total births. Post-dated pregnancy is a high-risk pregnancy with increased maternal morbidity. This study aims to determine the prevalence of postpartum hemorrhage in pregnancy beyond 40 weeks of gestation in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted among pregnant women beyond 40 weeks in Dhulikhel hospital from October 2016 to March 2017. The study was conducted after ethical clearance from the hospital research committee (reference number#128/16). The sample size was calculated and convenient sampling was done. Statistical Package for the Social Sciences is used for analysis. Point estimate at 95% confidence interval was calculated along with frequency and percentage for binary data. Results: Out of 465 ladies enrolled in this study postpartum hemorrhage was seen in 6 (1.29%) (95% Confidence Interval = 0.267-2.31), and the mean age was 24.25+4.8. About 346 (74.4%) had a normal delivery, 104 (22.36%) had cesarean section and 15 (3.22%) had instrumental delivery. Conclusions: Postpartum haemorrhage prevalence is low among the pregnant women beyond 40 weeks compared to the standard study. Postpartum hemorrhage is the common leading cause of maternal mortality. So high-risk cases should be identified and active management should be done to reduce morbidity and mortality.

scholarly journals Skin Tumors among Biopsy Samples in Patients Attending Dermatological Out Patient Department in a Tertiary Care Hospital of Nepal: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (241) ◽  
pp. 886-891
Author(s):  
Shristi Shrestha ◽  
Arnija Rana ◽  
Deepika Karki ◽  
Asim Shrestha
Keyword(s):  
Confidence Interval ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Skin Tumors ◽  
World Health ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Skin Biopsies

Introduction: Skin tumors are on the rise in the Nepalese community. The different morphological pattern of skin tumors requires its meticulous categorization for understanding its effect on prognosis and treatment. Our study aimed at studying the prevalence of skin tumors among the skin biopsies performed in the dermatology outpatient department in a tertiary care hospital of Nepal. Methods: A descriptive cross-sectional study was done from skin biopsy samples from 1st January, 2017 to 31st December, 2019, at a tertiary care center. Ethical clearance was taken from the institutional review committee (IRC), Ref No: 056-077/078. Convenience sampling was done. A self-designed proforma containing questions on the patients' socio-demographic data and clinical details were used, and a biopsy of those clinically suspected to have skin tumors was done. Skin tumors were classified according to the World Health Organization 2018 classification of skin tumors. Data were analyzed using Statistical Package for the Social Sciences Version 16. Point estimate at 95% Confidence Interval was done, and frequency and proportion were calculated. Results: A total of 671 skin biopsies were done during this study, out of which 125 (18.63%) at 95% Confidence Interval (15.68-21.57) were diagnosed with skin tumors. Among them, 77 (61.6%) were female, and 48 (38.4%) were male. Among the diagnosed cases, 105 (84%) were benign, and 20 (16%) were malignant. Conclusions: The findings from our study show the increasing prevalence of skin tumors, and the results were comparable to other similar studies conducted in various parts of Nepal.

Leclercia adecarboxylata isolates in a tertiary-care hospital: A propos of the first case of prosthetic joint infection

2020 ◽  
Vol 38 (10) ◽  
pp. 503-505
Author(s):  
Bartolomé Gómez-Arroyo ◽  
Patricia González-Donapetry ◽  
Alicia Rico-Nieto ◽  
Iker Falces-Romero
Keyword(s):  
Prosthetic Joint Infection ◽  
Tertiary Care Hospital ◽  
Joint Infection ◽  
Tertiary Care ◽  
Care Hospital ◽  
First Case ◽  
Prosthetic Joint

scholarly journals COVID-19 infection in a HIV positive health care worker: first case report from a tertiary care hospital of North India

VirusDisease ◽  
2021 ◽  
Author(s):  
Ritin Mohindra ◽  
Poonam Kanta ◽  
Pradakshana Porchezhian ◽  
Kapil Goyal ◽  
Vikas Suri ◽  
...  
Keyword(s):  
Health Care ◽  
Case Report ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
North India ◽  
Hiv Positive ◽  
Care Hospital ◽  
Positive Health ◽  
First Case ◽  
Care Worker

scholarly journals Prevalence of Hemolysis, Elevated Liver Enzymes, Low Platelet Count Syndrome in Pregnant Women in a Tertiary Care Hospital

2020 ◽  
Vol 58 (226) ◽  
Author(s):  
Sarita Sitaula ◽  
Tara Manandhar ◽  
Baburam Dixit Thapa ◽  
Ramesh Shrestha ◽  
Dinesh Dharel
Keyword(s):  
Platelet Count ◽  
Confidence Interval ◽  
Liver Enzymes ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Perinatal Morbidity ◽  
Elevated Liver Enzymes ◽  
Low Platelet Count

Introduction: Hemolysis, Elevated Liver Enzymes, Low Platelet count syndrome refers to biological syndrome occurring in pre-eclamptic and eclamptic women. There is a higher rate of maternal and perinatal morbidity and mortality due to the syndrome. So, the objective of the study is to find the prevalence and maternal- perinatal outcome in the syndrome. Methods: A descriptive cross-sectional study was done in a tertiary care hospital from 1st April 2017 to 30th March 2018 after obtaining ethical clearance from the Institutional Review Committee. The inclusion criteria were patients giving consent for participation and those who delivered in our hospital. Patient with the syndrome who delivered outside and referred in the postpartum period was excluded because details of the neonate may not be available. The Statistical Package for Social Sciences version 21 was used for the analysis of the data. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 11974 deliveries, the prevalence of Hemolysis, Elevated Liver Enzymes, Low Platelet count syndrome was 83 (0.69%) at 95% Confidence Interval (59.06-78.94). Maternal complications were seen in 19 (22.9%) and common complications being acute renal failure 9 (47.37%) followed by postpartum hemorrhage 4 (21.05%). Nearly 27 (33%) of patients required maternal ICU stay and there was one maternal mortality. Conclusions: Hemolysis, Elevated Liver Enzymes, Low Platelet count syndrome is one of the major causes of maternal and perinatal morbidity and mortality. Hence early recognition and prompt management may improve maternal and fetal outcomes.

scholarly journals Composite Anxiety-depression among Medical Undergraduates during COVID-19 Pandemic in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

2021 ◽  
Vol 59 (241) ◽  
pp. 881-885
Author(s):  
Pratikshya Chalise Chalise ◽  
Avilasha Singh ◽  
Era Rawal ◽  
Pravash Budhathoki ◽  
Satyasuna Sharma ◽  
...  
Keyword(s):  
Mental Health ◽  
Confidence Interval ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Care Hospital ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medical Undergraduates ◽  
Anxiety Depression

Introduction: Fear and anxiety is a natural response during crisis. From constant worry of getting infected, death of loved ones, transitioning of lifestyle to loss of social connection; there can be several psychological triggers. The effect on mental health on the general population could be greater than those affected by the infection itself during the pandemic. Among medical students, who already have several other psychological afflictions, these triggers might be detrimental. Hence, this study aims to find out the prevalence of composite anxiety-depression among medical undergraduates in a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted among medical undergraduates in a tertiary care hospital from 20th December 2020 to 5th January 2021. Ethical approval was taken from the Institutional Review Committee. The sample size was calculated and convenient sampling was done. The data were entered in International Business Machines Statistical Package for Social Sciences version 20.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 315 participants on the Patient Health Questionnaire-Anxiety and Depression Scale, severe composite anxiety-depression was seen in 10 (3.17%) at 95% Confidence Interval (1.23-5.1) participants, moderate in 35 (11.11%) at 95% Confidence Interval (7.63-14.58) and mild in 98 (31.11%) at 95% Confidence Interval (25.99-36.22). And 172 (54.6%) at 95% Confidence Interval (49.1-60) were normal. Conclusions: The rapid rise of apprehension among people amidst infectious outbreaks can ensue and medical students are no exception. So, at this time of crisis, there is a need to protect their mental health and it should be emphasized and endorsed.

scholarly journals Prevalence of Laryngomalacia among Young Children Presenting with Stridor in a Tertiary Care Hospital

2020 ◽  
Vol 58 (230) ◽  
Author(s):  
Apar Pokharel
Keyword(s):  
Young Children ◽  
Confidence Interval ◽  
Binary Data ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Point Estimate ◽  
Care Hospital ◽  
Cross Sectional ◽  
Female Ratio

Introduction: Laryngomalacia is one of the most common causes of stridor in young children. It can be a serious concern to both parents and caregivers. The main objective of this study is to find the prevalence of laryngomalacia among young children presenting with stridor in a tertiary care hospital in central Nepal. Methods: A descriptive cross-sectional study was carried out form 1st December 2017 to 1st May 2020 in children less than two years of age in a tertiary care hospital. Ethical approval was taken from the Institutional Review Committee of the hospital (reference number: 2020/23). Convenient sampling was done. Detailed demography, clinical examination, and video laryngoscopy findings were evaluated to find the prevalence of laryngomalacia among all children with stridor. Data were analyzed by using Statistical Package for the Social Sciences version 20. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 430 participants who presented with stridor, the laryngomalacia was found in 234 (66%) (58.7-74.07) cases at a 95% confidence interval. The male: female ratio was 1.7:1. Most children, 192 (67.6%), presented with a milder form of laryngomalacia. The most common type was a mixed type of laryngomalacia in 159 (56%). Sleep-disordered breathing was seen in 113 (39.79%) of children diagnosed with laryngomalacia. Conclusions: Our study concluded that laryngomalacia was the most common cause of stridor in children less than two years of age. However, in most cases, the problem is not serious and a regular follow-up with weight monitoring is warranted.

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