scholarly journals Lessons from the frontlines: a junior doctor’s experience of the first wave of the COVID-19 pandemic in a resource-limited setting

2021 ◽  
pp. medhum-2020-012109
Author(s):  
Brabaharan Subhani ◽  
Dilushi Wijayaratne ◽  
Saroj Jayasinghe
Keyword(s):  
Structural Changes ◽  
Tertiary Care ◽  
Medical Officer ◽  
Healthcare Services ◽  
Care Hospital ◽  
Generic Skills ◽  
Quality Healthcare ◽  
Resource Limited ◽  
Uncertain Future ◽  
Second Wave

COVID-19 has stressed healthcare systems across the globe. We present the experience of an intern medical officer working in a tertiary care hospital during the first wave of the pandemic in Sri Lanka. Her narrative describes how the stress of the pandemic brought into sharp focus the strengths and weaknesses in the health system. We suggest some strategies to improve our health services as the world faces the second wave and an uncertain future. These include structural changes in healthcare services at institutional and national levels, focused educational programmes for healthcare professionals to impart generic skills of disaster management, and the development of telehealth services and computerisation of health systems. We believe that we must maintain this focus to ensure that our patients can be guaranteed quality healthcare in the future.

scholarly journals Violence against health care workforce in COVID and non COVID times: Analysis of predisposing factors

2020 ◽  
Vol 32 (4) ◽  
pp. 659-664
Author(s):  
Neeraj Garg ◽  
Ruchi Garg ◽  
Devender Kumar Sharma ◽  
Shakti Kumar Gupta ◽  
Puja DUDEJA
Keyword(s):  
Health Care ◽  
Psychiatric Patients ◽  
Tertiary Care ◽  
Healthcare Services ◽  
Disabled Persons ◽  
Care Hospital ◽  
Cross Sectional ◽  
Quality Healthcare ◽  
Media Reports ◽  
Healthcare Administrators

Background: The prevalence of violence against Health Care Workers (HCW) is showing a rising trend. Various studies have been done in the recent past shows that the prevalence of violence against HCW s ranged from 27.4% to 67%. The present study was done to compare and analyze the underlying causes of violence against HCW in a Non COVID and COVID situation to identify the commonality if any, and to suggest any remedial measures. Methodology: This was cross-sectional analytical design and was carried out in inpatient care areas of a tertiary care hospital. The study subjects comprised of Doctors, Nurses, Group C employees. Data was collected using direct interview method on a standard questionnaire. In addition, various media reports were collected and analyzed through internet. Results: Maximum incidents were experienced in emergency and OPD, where staff patient’s ratio is less. 39.4% incidents were experienced by the staff who were providing care to the Terminally ill patients, Mentally and Physically disabled persons & Psychiatric patients. Suggestion which emerged to reduce WPV are, triage in casualty, availability of trained security guards, CCTV, restricted visiting hours and limited attendants with the patients, improvement in patient amenities etc. Whereas in COVID situation the major reason is the religious and social belief, poor dietary services and lack of hygiene and sanitation. Conclusion: There is an urgent and inescapable requirement that the healthcare administrators should address the underlying precipitating factors of violence, for delivery of quality healthcare services to the patients in a safe environment.

First and second wave of COVID-19: A comparative study of tertiary care hospitalized patients in Jalgaon, Maharashtra

2021 ◽  
Vol 19 (3) ◽  
pp. 23-29
Author(s):  
Yogita G Bavaskar ◽  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical History ◽  
Care Hospital ◽  
Age Group ◽  
Number Of Patients ◽  
The Mean ◽  
Collection Form ◽  
Time Of Admission ◽  
Second Wave

Background: Most of the countries including India have witnessed two or more waves of Covid 19 pandemic. The present study was conducted to compare the differences in clinico-demographic characteristics and outcomes of Covid 19 patients admitted in first and second wave of Covid 19 pandemic in a tertiary care hospital at Jalgaon, Maharashtra. Methods: A retrospective observational study was conducted at a tertiary care Dedicated Covid hospital for Covid 19 at Jalgaon, Maharashtra. All microbiologically proven corona positive patients were included in the study. The demographic records and clinical history was extracted from the case history sheets of the patients from first as well as second wave using standardized data collection form. Clinical outcome of the patients, i.e., development of complications, death or discharge was also recorded for each enrolled subject. Results: 3845 patients of Covid-19 admitted in the hospital during the first wave of epidemic and 2956 patients during second wave of the epidemic were included in the study. The mean age of patients admitted in the second wave was significantly lower as compared to first [48.77(15.31) years vs 50.23 (14.33) years, P<0.005]. There is increase in proportion of patients in the age group of < 15 years in second wave as compared to first wave (74/2956, 2.5% vs 52/3845, 1.3%). The number of patients requiring admission in ICU at the time of admission increased by 13% in second wave as compared to first wave. [827/2956 (28%) vs 577/3845(15%), P<0.0001]. More than half of the patients who got admitted for Covid 19 in first as well as second wave were having one or more comorbidities.But the proportion of the patients with previous co-morbities was significantly higher in second wave (1684/2956, 57% vs 1960/ 3845, 51%, P= 0.0004). The mortality was also higher in second wave (533/2956, 18.03% vs 541/3845, 14%, P=0.0004). Conclusions: The demographic, clinical characteristics and outcome of Covid 19 patients was different in first and second wave of pandemic with involvement of younger patients, increased rates of admission to ICU and more mortality in the second wave as compared to first wave of the pandemic.

scholarly journals Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Kirtika Patel ◽  
R. Matthew Strother ◽  
Francis Ndiangui ◽  
David Chumba ◽  
William Jacobson ◽  
...  
Keyword(s):  
Cancer Care ◽  
Cost Model ◽  
Tertiary Care ◽  
Care Hospital ◽  
Middle Income ◽  
Western Kenya ◽  
Middle Income Countries ◽  
Resource Limited ◽  
Limited Setting ◽  
Low And Middle Income

Background: Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service.Objectives, methods and outcomes: Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to are source-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme.Conclusion: Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.

scholarly journals Delayed Presentation and Mortality in Children With Sepsis in a Public Tertiary Care Hospital in Tanzania

2021 ◽  
Vol 9 ◽  
Author(s):  
Audrey Marilyn Smith ◽  
Hendry R. Sawe ◽  
Michael A. Matthay ◽  
Brittany Lee Murray ◽  
Teri Reynolds ◽  
...  
Keyword(s):  
Parental Education ◽  
Tertiary Care ◽  
Secondary Analysis ◽  
Transportation Systems ◽  
Care Hospital ◽  
Delayed Presentation ◽  
Suspected Infection ◽  
Logistic Regression Models ◽  
Resource Limited ◽  
Pediatric Sepsis

Background: Over 40% of the global burden of sepsis occurs in children under 5 years of age, making pediatric sepsis the top cause of death for this age group. Prior studies have shown that outcomes in children with sepsis improve by minimizing the time between symptom onset and treatment. This is a challenge in resource-limited settings where access to definitive care is limited.Methods: A secondary analysis was performed on data from 1,803 patients (28 days−14 years old) who presented to the emergency department (ED) at Muhimbili National Hospital (MNH) from July 1, 2016 to June 30, 2017 with a suspected infection and ≥2 clinical systemic inflammatory response syndrome criteria. The objective of this study was to determine the relationship between delayed presentation to definitive care (&gt;48 h between fever onset and presentation to the ED) and mortality, as well as the association between socioeconomic status (SES) and delayed presentation. Multivariable logistic regression models tested the two relationships of interest. We report both unadjusted and adjusted odds ratios and 95% confidence intervals.Results: During the study period, 11.3% (n = 203) of children who presented to MNH with sepsis died inhospital. Delayed presentation was more common in non-survivors (n = 90/151, 60%) compared to survivors (n = 614/1,353, 45%) (p ≤ 0.01). Children who had delayed presentation to definitive care, compared to those who did not, had an adjusted odds ratio for mortality of 1.85 (95% CI: 1.17–3.00).Conclusions: Delayed presentation was an independent risk factor for mortality in this cohort, emphasizing the importance of timely presentation to care for pediatric sepsis patients. Potential interventions include more efficient referral networks and emergency transportation systems to MNH. Additional clinics or hospitals with pediatric critical care may reduce pediatric sepsis mortality in Tanzania, as well as parental education programs for recognizing pediatric sepsis.

Conventional PCR as a reliable method for diagnosing invasive mucormycosis in resource-limited settings

2021 ◽  
Vol 70 (5) ◽  
Author(s):  
Mragnayani Pandey ◽  
Immaculata Xess ◽  
Gagandeep Singh ◽  
Rakesh Kumar ◽  
Manoranjan Mahapatra ◽  
...  
Keyword(s):  
Antifungal Susceptibility ◽  
Tertiary Care ◽  
Care Hospital ◽  
Direct Microscopy ◽  
Specific Pcr ◽  
Resource Limited ◽  
Valuable Adjunct ◽  
Panfungal Pcr ◽  
A Prospective Study

Introduction. Invasive mucormycosis (IM) is a life-threatening infection caused by fungi belonging to the order Mucorales. Histopathology, culture and radiology are the mainstay of diagnosis but lack sensitivity, leading to a delay in timely diagnosis and intervention. Recently, PCR-based approaches have been shown to be a promising method in diagnosing IM. Hypothesis/Gap Statement. Molecular-based approaches may be a valuable adjunct to standard conventional methods for diagnosing IM, especially among culture negatives and patients on antifungal therapy. Aim. In the present study we aimed to evaluate the clinical utility of panfungal and Mucorales-specific PCR for diagnosing IM from various clinical specimens. Methodology. This was a prospective study in which 239 clinically suspected cases of IM attending our tertiary care hospital from August 2015 to March 2018 were enrolled. All the cases were defined as ‘proven’, ‘probable’ or ‘possible’ based on EORTC/MSGERC guidelines. In addition to conventional diagnostics (KOH-calcofluor stain and culture), panfungal and Mucorales-specific PCR assays were also performed. The amplified products were sequenced for species identification. In vitro antifungal susceptibility was performed on all the culture-positive isolates. Results. Among 239 clinically suspected cases of IM, only 140 cases were diagnosed by the demonstration of aseptate ribbon-like hyphae on direct microscopy. Culture was positive in 35.7 % (54/140) of direct microscopy-positive samples. Among the proven cases (n=11), the sensitivity for both Mucorales-specific nested PCR and panfungal PCR was 100 %, but specificity was 91.9 and 73.7% respectively. In probable cases (n=129), the sensitivity of both the PCRs was 98.5 % and specificity for panfungal PCR was 73.7 and 91.9 % for Mucorales-specific PCR. Conclusion. Pan fungal PCR in combination with Mucorales-specific PCR, followed by sequencing, may play a significant role in IM diagnosis especially among those negative for both direct microscopy and culture.

Prevalence of Bullying among Nurses in a Tertiary Hospital, Bangalore

2019 ◽  
Vol 9 (1) ◽  
pp. 8-12
Author(s):  
Cency Baburajan ◽  
Sakthi Arasu ◽  
Ramesh Naveen
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Workplace Stress ◽  
Work Place ◽  
Care Hospital ◽  
Quality Healthcare ◽  
Negative Acts

Background: In the last decade, research conducted in different countries has shown that bullying in the health care sector especially among nurses is a widespread and serious problem. Bullying of nurses at workplace affects their quality of life, hinders delivery of quality healthcare and contributes to increase in workplace stress. So, this study was conducted to assess the prevalence of work place bullying among nurses working in a tertiary care hospital in Bangalore. Methods: This study was conducted among 300 staff nurses providing in-patient services in a tertiary health care hospital located in Bangalore. The required sample was selected utilizing the documents maintained in the office of Chief of Nursing Services and using computer generated random numbers. The data was collected using self-administered questionnaire which comprised of socio-demographic factors and Negative Acts Questionnaire-Revised. Results: Among the 297 respondents, 26.9% were victims of bullying in the past six months according to Negative Acts Questionnaire-Revised (NAQ-R). Among the participants who were bullied, those exposed to work-related bullying, person-related bullying and physical intimidation were 80%, 60% and 21.3% respectively. Conclusion: This study suggests existence of work place bullying among nurses which can adversely affect their performance as health care professionals and their quality of personal life.

scholarly journals Prevalence and Specificity of RBC Alloantibodies in Indian Patients Attending a Tertiary Care Hospital

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Shamsuz Zaman ◽  
Rahul Chaurasia ◽  
Kabita Chatterjee ◽  
Rakesh Mohan Thapliyal
Keyword(s):  
Blood Cell ◽  
Red Blood Cell ◽  
Patient Population ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
North India ◽  
Care Hospital ◽  
Antibody Screening ◽  
Resource Limited ◽  
Transfusion Requirements

Background.Red blood cell (RBC) alloimmunization results from genetic disparity of RBC antigens between donor and recipients. Data about alloimmunization rate in general patient population is scarce especially from resource limited countries. We undertook this study to determine prevalence and specificity of RBC alloantibodies in patients admitted in various clinical specialties at a tertiary care hospital in North India.Methods.Antibody screening was carried out in 11,235 patients on automated QWALYS 3 platform (Diagast, Loos, France). Antibody identification was carried out with an 11-cell identification panel (ID-Diapanel, Diamed GmbH, Switzerland).Results.The overall incidence of RBC alloimmunization in transfused patients was 1.4% (157/11235), with anti-E being the most common specificity (36.3%), followed by anti-D (16%), anti-c (6.4%), anti-c + E (6.4%), anti-C + D (5.1%), and anti-K (4.5%). The highest incidence of alloimmunization was observed in hematology/oncology patients (1.9%), whereas in other specialties the range was 0.7–1%.Conclusion.As alloimmunization complicates the transfusion outcomes, authors recommend pretransfusion antibody screening and issue of Rh and Kell matched blood to patients who warrant high transfusion requirements in future.

scholarly journals COVID-19 Lockdown Period: Perception of Doctors regarding Telemedicine Use for General Practice

2021 ◽  
Author(s):  
Sumitha Arumugam ◽  
Dhanasekaran Ramadoss ◽  
Parthiban Brindhadevi ◽  
Subbalakshmi Easwaran ◽  
Shanthi Santhosh Kumari
Keyword(s):  
General Practice ◽  
Clinical Care ◽  
Tertiary Care ◽  
Healthcare Services ◽  
Easy Access ◽  
P Value ◽  
Care Hospital ◽  
Cross Sectional ◽  
Future Practice

Introduction: During this COVID-19 lockdown period, telemedicine is widely being used by doctors for continuing clinical care of patients so that physical distancing can be maintained and the risk of contracting the virus can be avoided. Aim: To assess perception of doctors regarding quality of healthcare by telemedicine as compared to traditional face to face consultation and, to assess the opinion of doctors on whether telemedicine could be an option for future practice after lockdown period. Materials and Methods: A questionnaire based cross-sectional study was conducted in which perception of doctors regarding their telemedicine usage for general practice during this lockdown period has been evaluated. The study was done during April to June 2020 among doctors working in a medical college attached to a tertiary care hospital in Chennai and using telemedicine for their practice during COVID-19 lockdown period. After collection of responses, data obtained were entered in excel sheet and analysed using SPSS version 23.0. Chi-square test was used to assess the association between different variables associated with perception regarding telemedicine usage for general practice. A p-value <0.05 was considered as statistically significant. Results: Easy access to healthcare services can be done with telemedicine practice according to 73.7% of doctors. Nearly 60.6% of doctors like to continue telemedicine for their practice even after COVID lockdown period. Conclusion: Telemedicine has helped doctors for continuing patient care during COVID-19 pandemic, but the quality of care delivered by telemedicine consultation was not good as compared to the quality of traditional healthcare. Telemedicine could be an option for future practice of doctors if awareness regarding proper usage of telemedicine is created among patients and if guidelines regarding legal concerns in telemedicine are properly framed.

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