scholarly journals Are all Thermometers Equal? A Study of Three Infrared Thermometers to Detect Fever in an African Outpatient Clinic.

2021 ◽  
Author(s):  
Nirmal Ravi ◽  
Mathura Vithyananthan ◽  
Aisha Amira Saidu
Keyword(s):  
Secondary Care ◽  
Cost Savings ◽  
Roc Curves ◽  
Temporal Artery ◽  
Care Hospital ◽  
Convenience Sample ◽  
Non Invasive ◽  
Electronic Thermometer ◽  
Higher Temperature ◽  
Low Sensitivity

Infrared thermometry has certain advantages over traditional oral thermometry including quick, non-invasive administration and an absence of required consumables. This study compared the performance of tympanic, temporal artery and forehead contactless thermometers with traditional oral electronic thermometer in measuring temperature in outpatients in a Nigerian secondary care hospital. A convenience sample of 100 male and 100 female adult patients (Mean age= 38.46 years, SD= 16.33 years) were recruited from a secondary care hospital in Kano, Nigeria. Temperature measurements were taken from each patient using the tympanic, temporal artery and contactless thermometers and oral electronic thermometer. Data was analyzed to assess bias and limits using scatterplots and Bland-Altman charts while sensitivity analysis was done using ROC curves. The tympanic and temporal artery thermometers systematically gave higher temperature readings compared to the oral electronic thermometer. Contactless thermometer gave lower readings compared to the oral electronic thermometer. Temporal artery thermometer had the highest sensitivity (88%) and specificity (88%) among the three infrared thermometers. Contactless thermometer showed a low sensitivity of 13% to detect fever greater than 38⁰C. Our study shows that replacing oral thermometers with infrared thermometers must be done with caution despite the associated convenience and cost savings.

scholarly journals Assessment of implementation of antibiotic stewardship program in surgical prophylaxis at a secondary care hospital in Ras Al Khaimah, United Arab Emirates

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hessa Saleh Alshehhi ◽  
Areeg Anwer Ali ◽  
Duaa Salem Jawhar ◽  
Essam Mahran Aly ◽  
Srinivas Swamy ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
United Arab Emirates ◽  
Antibiotic Stewardship ◽  
Secondary Care ◽  
Care Hospital ◽  
Surgical Prophylaxis ◽  
Patient Profile ◽  
Stewardship Program ◽  
Prescribing Practice ◽  
Surgical Antibiotic Prophylaxis

AbstractAntibiotic overuse is a major factor for causing antibiotic resistance globally. However, only few studies reported the implementation and evaluation of antimicrobial stewardship programs in Gulf Cooperation Council. This study was conducted within 8-months periods to evaluate the effect of the newly implemented antibiotic stewardship program on improving the prescribing practice of surgical antibiotic prophylaxis in a secondary care hospital in the United Arab Emirates by releasing local hospital guidelines. The data of 493 in patients were documented in the predesigned patient profile form and the prescribing practice of surgical antibiotic prophylaxis for clean and clean-contaminant surgical procedures was compared and analyzed two months’ prior (period A) and post (period B) the implementation of antibiotic stewardship program. The 347 patient’s data (PD) were analyzed during period A and 146 PD during period B. The prescription of piperacillin/tazobactam was decreased from 2.4% from all surgical prophylaxis antibiotic orders in period A to 0% in period B. The appropriateness of the antibiotic therapy was found to differ non significantly for the selection of prophylactic antibiotic (p = 0.552) and for the timing of first dose administration (p = 0.061) between A and B periods. The total compliance was decreased non significantly (P = 0.08) from 45.3 to 40.2%. Overall, the guidelines have improved the prescribing practice of antibiotics prior to surgery. However, further improvement can be achieved by initiating educational intervention via cyclic auditing strategy.

scholarly journals How Physicians Manage Medical Uncertainty: A Qualitative Study and Conceptual Taxonomy

2021 ◽  
pp. 0272989X2199234
Author(s):  
Paul K. J. Han ◽  
Tania D. Strout ◽  
Caitlin Gutheil ◽  
Carl Germann ◽  
Brian King ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Qualitative Study ◽  
Management Strategies ◽  
Acute Care Hospital ◽  
Uncertainty Management ◽  
Care Hospital ◽  
Convenience Sample ◽  
Medical Specialties ◽  
Tolerance Of Uncertainty ◽  
Medical Uncertainty

Background Medical uncertainty is a pervasive and important problem, but the strategies physicians use to manage it have not been systematically described. Objectives To explore the uncertainty management strategies employed by physicians practicing in acute-care hospital settings and to organize these strategies within a conceptual taxonomy that can guide further efforts to understand and improve physicians’ tolerance of medical uncertainty. Design Qualitative study using individual in-depth interviews. Participants Convenience sample of 22 physicians and trainees (11 attending physicians, 7 residents [postgraduate years 1–3), 4 fourth-year medical students), working within 3 medical specialties (emergency medicine, internal medicine, internal medicine–pediatrics), at a single large US teaching hospital. Measurements Semistructured interviews explored participants’ strategies for managing medical uncertainty and temporal changes in their uncertainty tolerance. Inductive qualitative analysis of audio-recorded interview transcripts was conducted to identify and categorize key themes and to develop a coherent conceptual taxonomy of uncertainty management strategies. Results Participants identified various uncertainty management strategies that differed in their primary focus: 1) ignorance-focused, 2) uncertainty-focused, 3) response-focused, and 4) relationship-focused. Ignorance- and uncertainty-focused strategies were primarily curative (aimed at reducing uncertainty), while response- and relationship-focused strategies were primarily palliative (aimed at ameliorating aversive effects of uncertainty). Several participants described a temporal evolution in their tolerance of uncertainty, which coincided with the development of greater epistemic maturity, humility, flexibility, and openness. Conclusions Physicians and physician-trainees employ a variety of uncertainty management strategies focused on different goals, and their tolerance of uncertainty evolves with the development of several key capacities. More work is needed to understand and improve the management of medical uncertainty by physicians, and a conceptual taxonomy can provide a useful organizing framework for this work.

Proton pump inhibitor use and appropriateness analysis: a snapshot from a secondary care hospital

2021 ◽  
Author(s):  
Sukaina Salim Damji ◽  
Syed Arman Rabbani ◽  
Padma G M Rao ◽  
Ain-ur Rashid Butt
Keyword(s):  
United Arab Emirates ◽  
Proton Pump ◽  
Secondary Care ◽  
Stress Ulcer ◽  
Risk Category ◽  
Care Hospital ◽  
High Prevalence ◽  
Potential Risks ◽  
Internal Medicine Wards ◽  
Ulcer Prophylaxis

Abstract Objectives Proton pump inhibitors (PPIs) have become one of the most frequently prescribed drugs since their introduction 30 years ago. Effectiveness and safety profile of PPIs has led to their overutilization and has exposed patients to a number of potential risks. The objective of this study was to evaluate the use of PPIs in a secondary care hospital in the United Arab Emirates. Methods This prospective observational drug-utilization study was conducted in patients receiving treatment with PPIs and admitted to internal medicine wards of the study site. Electronic patient case records were reviewed and data on PPI prescribing was collected and analysed. Appropriateness of PPI use was assessed as per international guidelines. Key findings Out of 172 patients enrolled, 53.5% were females with median age of 57 years (34.3, 71.0). Four different PPIs were prescribed to study patients, pantoprazole (86.6%), esomeprazole (5.8%), rabeprazole (4.1%) and omeprazole (3.5%). Ninety-two (53.5%) patients were prescribed intravenous PPI, whereas 80 (46.5%) patients were given PPI in oral form. Overall, 103 (59.9%) patients had inappropriate PPI prescriptions. Of these inappropriate prescriptions, 22 patients had no clear indication for PPI use and for 16 patients; PPIs were indicated for stress ulcer prophylaxis in low-risk category. Corticosteroid use [odds ratio (OR): 4.34, 95% confidence interval (CI): 1.22–15.46; P = 0.023] was significantly associated with greater odds of inappropriate PPI use. Conclusions We report a high prevalence of inappropriate PPI prescribing among the hospitalized patients in our study. Inappropriate PPI prescribing is a concerning issue and collective efforts should be made to check and minimize the same.

ASSESSMENT OF LIVER FIBROSIS IN ALCOHOLIC PATIENTS BY USING FIBROSCAN IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 43-47
Author(s):  
Veenit Kumar Prasad ◽  
Bapilal Bala ◽  
Biswadev Basumazumder ◽  
Achintya Narayan Ray
Keyword(s):  
Liver Disease ◽  
Alcoholic Liver Disease ◽  
Transient Elastography ◽  
Wide Spectrum ◽  
Tertiary Care ◽  
Disease Patient ◽  
Liver Stiffness ◽  
Care Hospital ◽  
Non Invasive ◽  
Number Of Patients

INTRODUCTION: Alcoholic liver disease is one of the major causes of premature deaths worldwide. Alcohol induced liver injury is the most prevalent cause of liver disease and effects 10% to 20% of population worldwide. Alcoholic liver disease comprises a wide spectrum of pathological changes ranging from steatosis, alcoholicsteato-hepatitis, Cirrhosis and nally hepatocellular carcinoma. Our aims in this study are to detect this change by non invasive method by liver broscan and its clinical implications. MATERIALS AND METHODS: Total 200 patients were taken for observational study, conducted at Coochbehar Government Medical college and hospital both outpatient department and indoor patients from May 2019 to January 2020. Liver stiffness was assessed by ultrasound based method of transient elastography using Fibroscan machine. Gradation of liver stiffness was expressed in kilopascals (KPa). RESULTS: Maximum number of patients of alcoholic liver disease were between 40 - 49 years of age (42.5%). Male patients is 87.5% and female patients 12.5%. distribution of Rural population is 36 % and Urban population is 64%. Majority of population85 patients (42.5%) had fatty liver and 40 patients (20%) have hepatomegaly, 41 patients (20.5%) had Coarse echotexture of liver parenchyma and 54 patients (27%) had Splenomegaly, 62 patients (31%) had Nodular liver and 62 patients. It is observed that 11 patients (5.5%) had Fibroscan score ≤7.5 and 47 patients (23.5%) had broscan score 7.6 -9.9 and 40 patients (20%) had broscan score 10-12.4, 36 patients (18 %) had broscan score 12.5 – 14.6 and 66 patients (33%) have broscan score ≥ 14.7. CONCLUSIONS: Transient Elastography (TE) is a newer non invasive assessment technique to detect the progression of brosis or brosis in alcoholic liver disease patient. Major advantage is it is noninvasive (costeffective) so that we can early detect progression of this cirrhosis and can give efforts to halt the disease progression.

scholarly journals 758 Etilogy of Acute Diarrhea in Children in a Secondary Care Hospital

2010 ◽  
Vol 68 ◽  
pp. 384-384
Author(s):  
S F Paupério ◽  
A Leitão ◽  
J G Dinis ◽  
A Sousa
Keyword(s):  
Acute Diarrhea ◽  
Secondary Care ◽  
Care Hospital

scholarly journals Bacterial culture and antibiotics susceptibility in chronic suppurative otitis media at the secondary care hospital in North India

2020 ◽  
Author(s):  
Anuj Kumar Singh ◽  
Amita Verma
Keyword(s):  
Otitis Media ◽  
Secondary Care ◽  
Chronic Suppurative Otitis Media ◽  
North India ◽  
Care Hospital ◽  
Suppurative Otitis Media ◽  
Pseudomonas Spp ◽  
Gram Positive Bacteria ◽  
Amoxicillin Clavulanic Acid ◽  
Antibiotics Susceptibility

Abstract Background: Chronic suppurative otitis media (CSOM) is defined as a persistent infection of the middle ear with a perforated tympanic membrane and draining exudate for more than 6 weeks. Information about the organism responsible for COSM and their antibiotic susceptibility pattern is an important for effective treatment. Aim: This study aims to develop protocol for empirical treatment by determining aerobic bacterial profile and antibiotics susceptibility in patients of chronic suppurative otitis media (CSOM) at a secondary care hospital in North India. Material and Methods: A cross-sectional study was conducted at ENT department of the secondary care hospital in North India on 85 patients, middle ear discharge sample was collected under strict aseptic conditions and antibiotic susceptibility done as per Clinical Laboratory Standards Institute guidelines. Result: 85 ear swabs were collected, and 89 bacterial isolates were identified, of which 62 (72.94%) sample with mono-microbial growth, 14 (16.47%) with polymicrobial growth, 8 (9.41%) show no growth and rest 1(1.17%) was contaminant. Among 89 isolates, 35 (39.33%) were Gram-positive bacteria, while 54 (60.67%) were Gram-negative bacteria. The most common isolates were Pseudomonas spp. (36; 40.45%), followed by MSSA (34; 38.20%), Proteus spp. ( 7; 7.87%), Klebsiella spp.(3; 3.37%), Enterobacter spp.(3; 3.37%), E. coli (3; 3.37%), Actinobacteria spp. (2; 2.25%) and MRSA (1; 1.12%). Pseudomonas spp. showed 100% susceptible to colistin, linezolid, imipenem, amikacin (97%); ciprofloxacin (92%); gentamicin (95%); Ceftriaxone (83%); meropenem (93%); Netilmicin (98%) and SXT (90%). Proteus spp. was 100% susceptible to amikacin, ciprofloxacin, Imipenem, meropenem, netilmicin; ampicillin (71%); amoxicillin–clavulanic acid (85%); ceftriaxone (85%); gentamicin (85%) and SXT (85%). Among Gram-positive bacteria, MSSA was 100 % susceptible to meropenem and Imipenem, amikacin (97%); gentamicin (81%); amoxicillin–clavulanic acid (91%); linezolid (92%); Netilmicin (94%); Vancomycin (91%); Colistin (97%) and SXT (41%). MRSA showed 100% susceptibility to gentamicin, netilmicin and vancomycin. Conclusion: Pseudomonas and MSSA were the principal bacterial isolate responsible for causing CSOM in this study though the most common organism was Pseudomonas spp. We conclude the combination of amikacin and ceftriaxone to be used as systemic therapy

scholarly journals Increased Expression of Plasma miRNA-320a and let-7b-5p in Heroin-Dependent Patients and Its Clinical Significance

2021 ◽  
Vol 12 ◽  
Author(s):  
Haixiong Liu ◽  
Wenjin Xu ◽  
Jiying Feng ◽  
Hong Ma ◽  
Jianbin Zhang ◽  
...  
Keyword(s):  
Roc Curves ◽  
Brain Diseases ◽  
Circulating Mirnas ◽  
Heroin Use ◽  
Non Invasive ◽  
Heroin Use Disorder ◽  
Subjective Reports ◽  
The Brain ◽  
Potential Use ◽  
Plasma Mirnas

Heroin use disorder is a chronic and relapsing disease that induces persistent changes in the brain. The diagnoses of heroin use disorders are mainly based on subjective reports and no valid biomarkers available. Recent researches have revealed that circulating miRNAs are useful non-invasive biomarkers for diagnosing brain diseases such as Alzheimer's disease, multiple sclerosis, schizophrenia, and bipolar disorder. However, studies on circulating miRNAs for the diagnosis of heroin use disorders are rarely reported. In this study, we investigated the differential expression of plasma miRNAs in 57 heroin-dependent patients. Based on literature research and microarray analysis, two candidate miRNAs, miR-320a and let-7b-5p, were selected and analyzed by quantitative real-time RT-PCR. The results showed miR-320a and let-7b were significantly upregulated in plasma of the heroin-dependent patients compared to that in healthy controls. The area under curves (AUCs) of receiver operating characteristic (ROC) curves of miR-320a and let-7b-5p were 0.748 and 0.758, respectively. The sensitivities of miR-320a and let-7b-5p were 71.9 and 70.2%, while the specificities of miR-320a and let-7b-5p were 76.1 and 78.3%, respectively. The combination of these two miRNAs predicted heron dependence with an AUC of 0.782 (95% CI 0.687–0.876), with 73.7% sensitivity and 82.6% specificity. Our findings suggest a potential use for circulating miRNAs as biomarkers for the diagnosis of heroin abuse.

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