scholarly journals Improving paper-based discharge process; a continuous full-cycle quality improvement project in low resource setting

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 324
Author(s):  
Ihab B Abdalrahman ◽  
Mohammed Elsanousi Huzaifa Mohammed ◽  
Abdelmohaymin A Abdalla ◽  
Sulaf Ibrahim Abdelaziz ◽  
Aboaagla Abdalbagi Ali ◽  
...  
Keyword(s):  
Discharge Summary ◽  
University Hospital ◽  
Practical Training ◽  
Discharge Process ◽  
Improvement Project ◽  
Resource Setting ◽  
Low Resource Setting ◽  
The Moment

Background: The moment of hospital discharge is a time for vulnerability for many patients and might jeopardize their safety. We found that the current structure of the discharge card at Soba University Hospital (SUH) does not improve the quality of the discharge summary. This hinders the delivery of valid, relevant and adequate health information and can negatively affect outpatient care.   Methods: We implemented a new discharge card design with structured headings at the Department of Medicine at Soba University Hospital from the beginning of March to April 15th, 2017.  This was coupled with educational sessions highlighting the problems that might occur if there were gaps in patient transition from inpatient to outpatient. Results: There was a significant improvement in documentation of the majority (>90%) of the items, including name, age, source of admission treating doctor, diagnosis and medication, but there was a drop in documentation of comorbidities. We also noticed that the new discharge summary format significantly improved the documentation of the majority of the headings (all P values were <0.001), yet, there was a drop in documentation of comorbidities and dates for follow up. Conclusions: Recording of paper-based health records like discharge summaries could be substantially improved by use of well-structured formats and practical training sessions. Improvement is a dynamic process. Some gaps might appear during execution, these need monitoring and continuous improvement to establish sustainability.

scholarly journals Medical management of ectopic pregnancy in a low resource setting: the role of methotrexate

2021 ◽  
Vol 10 (3) ◽  
pp. 879
Author(s):  
Simon Birame Ndour ◽  
Mamour Gueye ◽  
Abdoul Aziz Diouf ◽  
Moussa Diallo
Keyword(s):  
Developing Countries ◽  
Medical Treatment ◽  
Ectopic Pregnancy ◽  
Medical Management ◽  
University Hospital ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Ectopic Pregnancies

Background: Medical treatment using methotrexate. However, its indications and the protocol of administration are still under discussion. Even if follow-up problems are often raised in developing countries, medical treatment of ectopic pregnancy remains a reasonable option that we practice and share our experience here.Methods: We performed a retrospective cohort study of patients managed for an unruptured ectopic pregnancy in two university hospital facilities in Dakar: the Centre Hospitalier National de Pikine and the Centre de Santé de Philipe Maguilen Senghor. The data of this study are spread over a period of 10 years, from 2010 and 2019. We planned to evaluate maternal age, parity, gestational age, diagnosis circumstances, medical management, monitoring, and outcome. A single dose protocol was used. Data extracted from the registries were transferred to Microsoft Excel 2019, Mac version and then moved to SPSS (Statistical Package for Social Sciences, 26.Results: Over ten years, we had registered 18 patients who had received medical treatment out of a total of 263 ectopic pregnancies treated in the two facilities, i.e., a frequency of 6.8%. The average age was 28.8 years. The average initial HCG level was 10,460 mIU/ml. Treatment succeeded in more than 6 out of 10 patients (61.1%). However, we noted 5 cases of failure that had secondarily benefited from salpingectomy by laparotomy.Conclusions: Methotrexate is now part of the therapeutic arsenal in the management of unruptured tubal ectopic pregnancies. However, in developing countries, particularly in Senegal, there is a reluctance to use this therapeutic method, which, however, when a personalized follow-up is carried out, is achievable with a success rate comparable to other therapeutic methods.

TREATMENT OF SPINAL TUMORS USING CYBERKNIFE FRACTIONATED STEREOTACTIC RADIOSURGERY

Neurosurgery ◽  
2009 ◽  
Vol 64 (2) ◽  
pp. 297-307 ◽  
Author(s):  
Gregory J. Gagnon ◽  
Nadim M. Nasr ◽  
Jay J. Liao ◽  
Inge Molzahn ◽  
David Marsh ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Stereotactic Radiosurgery ◽  
University Hospital ◽  
Postoperative Treatment ◽  
Spinal Tumors ◽  
Radiation Toxicity ◽  
Pain Scores ◽  
Component Scores

Abstract OBJECTIVE Benign and malignant tumors of the spine significantly impair the function and quality of life of many patients. Standard treatment options, including conventional radiotherapy and surgery, are often limited by anatomic constraints and previous treatment. Image-guided stereotactic radiosurgery using the CyberKnife system (Accuray, Inc., Sunnyvale, CA) is a novel approach in the multidisciplinary management of spinal tumors. The aim of this study was to evaluate the effects of CyberKnife stereotactic radiosurgery on pain and quality-of-life outcomes of patients with spinal tumors. METHODS We conducted a prospective study of 200 patients with benign or malignant spinal tumors treated at Georgetown University Hospital between March 2002 and September 2006. Patients were treated by means of multisession stereotactic radiosurgery using the CyberKnife as initial treatment, postoperative treatment, or retreatment. Pain scores were assessed by the Visual Analog Scale, quality of life was assessed by the SF-12 survey, and neurological examinations were conducted after treatment. RESULTS Mean pain scores decreased significantly from 40.1 to 28.6 after treatment (P &lt; 0.001) and continued to decrease over the entire 4-year follow-up period (P &lt; 0.05). SF-12 Physical Component scores demonstrated no significant change throughout the follow-up period. Mental Component scores were significantly higher after treatment (P &lt; 0.01), representing a quality-of-life improvement. Early side effects of radiosurgery were mild and self-limited, and no late radiation toxicity was observed. CONCLUSION CyberKnife stereotactic radiosurgery is a safe and effective modality in the treatment of patients with spinal tumors. CyberKnife offers durable pain relief and maintenance of quality of life with a very favorable side effect profile.

scholarly journals RETROSPECTIVE ANALYSIS OF EVENTS OF DEATH AT HOME AMONG PATIENTS UNDER FOLLOW-UP OBSERVATION

2018 ◽  
Vol 35 (1) ◽  
pp. 68-74
Author(s):  
Ya P Sandakov
Keyword(s):  
Cardiovascular Diseases ◽  
Medical Records ◽  
Emergency Calls ◽  
Significant Difference ◽  
Duration Of Disease ◽  
The Moment ◽  
Age Of Death ◽  
At Home

Aim. To study the peculiarities of asking for medical care by patients from among those dead at home, who had been under follow-up observation. Materials and methods. The data, received from ambulatory medical records of 100 dead at home patients with follow-up, were analyzed using the methods of descriptive and inductive statistics. Results. A mean age of death was 74.9 ± 13.4 years, men - 65.8 ± 14.1 years, women - 79.2 ± 10.9 years. Cardiovascular diseases were the cause of follow-up observation in 78 % of cases and the cause of death in 85 %; in 30 % of patients the disease was detected while carrying out prophylactic medical examination. A mean duration of disease by the moment of death was 13.0 ± 8.0 years, among pensioners 13.7 ± 8.5 years, in able-bodied persons 9.6 ± 4.3 years. A mean duration of follow-up observation was 9.2 ± 5.8 years. An average number of planned visits was 2.8 ± 0.89, but the number of real visits during the last year of follow-up observation was 2.4 ± 1.2. Disability was registered in 77.6 % of patients, concomitant diseases - in all patients. For the last year, exacerbations were recorded in 92 % of patients, emergency calls - in 80 %, hospitalization events - 52 %, including 55.8 % - urgent ones. Conclusions. The absence of significant difference regarding the duration of disease between pensioners and able-bodied patients (т = 0.16, р = 1.43) as well as the absence of correlation between the age and duration of disease (χ2 = 0.19, p = 0.2) indirectly prove the influence of duration of disease on its outcome, but not the age. Attendance, characterizing clinical loyalty to treatment, does not depend on age (χ2 = -0.19, р = 0.18), sex (т = 1.0, р = 0.32), way of detecting disease (f = 0.9, p = 0.4), class of main disease (f = 0.91, p = 0.44), duration of disease (χ2 = -0.13, р = 0.49), exacerbations (χ2 = -0.17, р = 0.24), concomitant diseases (χ2 = 0.006, р = 0.9). The number of emergency calls, hospitalizations, urgent hospitalizations does not depend on duration of follow-up observation, regularity and number of real visits to a doctor (p > 0.05) that indicates unsatisfactory quality of follow-up observation.

scholarly journals Performance of colposcopic scoring by modified International Federation of Cervical Pathology and Colposcopy terminology for diagnosing cervical intraepithelial neoplasia in a low-resource setting

2019 ◽  
Vol 08 (04) ◽  
pp. 218-220 ◽  
Author(s):  
Prabhakaran Nair Rema ◽  
Aleyamma Mathew ◽  
Shaji Thomas
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Scoring Systems ◽  
Intraepithelial Neoplasia ◽  
International Federation ◽  
Screening Tests ◽  
Substantial Agreement ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting

Abstract Introduction: Colposcopy is a tool to evaluate women with cervical pre-cancer and cancer. To interpret the colposcopic findings, various scoring systems are used but with inter observer variations. To improve the quality of colposcopy, International Federation of Cervical Pathology and Colposcopy (IFCPC) has introduced a colposcopic nomenclature in 2011. Colposcopic scoring helps to select patients who need treatment for cervical intraepithelial neoplasia. Aim of the Study: The study aimed to evaluate the agreement between colposcopic diagnosis with the modified IFCPC terminology and cervical pathology in patients with abnormal screening tests and to assess the utility of this colposcopic scoring system in low resource settings. Methodology: Patients with abnormal screening tests who underwent colposcopic assessment in the department of Gynaecological oncology were included in the study. Colposcopic scoring was done by the modified IFCPC nomenclature. The results were compared with cytology and the final histopathology. Results: 56 patients were included in the study. The colposcopic scoring when compared to histopathology showed agreement in 65.7% which indicated the agreement was substantial and was statistically significant (P = 0.0001). With cytology the colposcopic score showed agreement in 35.6% indicating a fair agreement and this was also statistically significant (P = 0.001). Conclusion: Colposcopic scoring by modified IFCPC 2011 criteria showed substantial agreement with cervical histopathology. Compared to traditional methods, 2011 international terminology of colposcopy could improve colposcopic accuracy.

scholarly journals Finding Installed Capacity For Practical Training Of A Designated Medical Specialty At A University Hospital

2021 ◽  
Vol 25 ◽  
Author(s):  
Ciro Alberto Amaya-Guio ◽  
Lina Patricia Navas ◽  
Cesar Humberto Torres-Gonzalez
Keyword(s):  
Patient Care ◽  
Medical Specialty ◽  
University Hospital ◽  
Practical Training ◽  
Step Procedure ◽  
Practice Of Medicine ◽  
Integer Linear Model ◽  
San Rafael ◽  
Installed Capacity

Objective: Propose a methodology to determine the number of medical students who can rotate, for the practice of medicine, in a university hospital, so that the quality of training processes and in-patient care are assured. Materials and Methods: A three-step procedure is presented, in order to find the number of students that the institution can accept simultaneously. Results: The method is based on an integer linear model and it was implemented to assess installed capacity of General Surgery service at Hospital Universitario Clínica San Rafael, increasing in two students (33 %) the training capacity. Conclusions: The proposed methodology not only guaranties the quality of training processes and in-patient care, but also generates other intangible results such as having a more agile way of planning, reducing the planification time. The methodology is easily extended to other services within hospitals.

scholarly journals URINARY INCONTINENCE;

2017 ◽  
Vol 24 (06) ◽  
pp. 824-827
Author(s):  
Ambreen Amna ◽  
Farkhunda Nadeem ◽  
Pushpa Srichand
Keyword(s):  
Urinary Incontinence ◽  
Stress Incontinence ◽  
Urinary Fistula ◽  
University Hospital ◽  
Persistent Symptoms ◽  
Grade 3 ◽  
Time Of Admission ◽  
Study Setting

Background: Genitourinary fistula remains a major cause of morbidity worldwide.Approximately 2 million of women suffer from urinary leakage. Since the establishment ofGenito urinary Fistula center at Isra University Hospital –Hyderabad Sindh. We are able to shareour experience of fistulous women at the time of admission and at follow up visit. Objectives:To determine the different types of urinary incontinence in a woman after genitourinary fistularepair. Study Design: A Follow-up Descriptive study. Study Setting: This Study was done atFistula center Isra University Hospital Hyderabad GU – 11 from January 2011 to December2013. All the women who were admitted with true incontinence followed by Obstetrical andmajor gynecological surgeries were included. However women with stress incontinence andurge incontinence and women who are not willing to include in the study were excluded.Result: Out of one hundred and ten (110) women included in this study, 59 (53.6%) were foundto have obstetrical fistula, while 43 (39%) were suffering from Iatrogenic fistula. Continencestatus were explored at follow up visit. Out of 110 women, 108 (98.18%) & 96 (87.27 %) werehaving no signs of incontinence on examination at first visit and after six week and secondvisit after three month respectively. Only 7 % women fell into incontinence grade 2 at six weekfollow up and only one percent had persistent symptoms of stress incontinence at 3 monthrespectively. Women fall on incontinence grade 3, 4 and 5 were completely cured at 3 month.Conclusion: Success rate of genitor- urinary fistula repair is 98 %. Majority of women (96 %)on short term follow up at 6 weeks showed improved urinary symptoms. Moreover on follow upvisit at 3 months, these women reported improved quality of life and social reintegration afterfistula closure.

Evaluation of a simulation faculty training workshop in a low-resource setting: a qualitative study

2021 ◽  
pp. bmjstel-2020-000829
Author(s):  
Rajasri Rao Seethamraju ◽  
Kimberly Stone ◽  
Michael Shepherd
Keyword(s):  
Qualitative Study ◽  
Positive Impact ◽  
Faculty Training ◽  
Research Approach ◽  
Instructor Training ◽  
Low Resource ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Kirkpatrick Model

IntroductionSimulation instructor training courses are infrequent in low-resource countries. PediSTARS India organisation has been conducting a Training of Trainers (TOT) workshop annually since 2014 and has trained 380 instructors in the last 6 years. The objective of this study is to evaluate this workshop using the basic Kirkpatrick model with a blended evaluation approach.MethodsA qualitative study design was used with purposive sampling from the 2018 workshop cohort. An initial online questionnaire gathered demographic and professional profile of participants. Semistructured interviews with those who consented explored their perceptions about the workshop and their experiences using simulation for training at their workplaces. The analysis was done based on a deductive research approach around the framework of the first three levels of the Kirkpatrick model.ResultsA total of 11 in-depth interviews were conducted. Participants reported long-term retention, translation and positive impact of the knowledge and skills gained at the TOT workshop. The results achieved saturation and underwent respondent validation.ConclusionThis study provides evidence to support simulation faculty training workshops as an effective educational intervention in promoting simulation-related workplace-based education and training among health practitioners and that follow-up activity may be useful in some cases. This is the first study of its kind in a low-resource setting, and supports similar simulation instructor training in these settings and provides a blueprint for such training. Follow-up studies are required to evaluate the longer term impact of this simulation instructor training.

scholarly journals A porcine model for teaching surgical cricothyridootomy

2015 ◽  
Vol 42 (3) ◽  
pp. 193-196 ◽  
Author(s):  
Fernando Antonio Campelo Spencer Netto ◽  
Patricia Zacharias ◽  
Raphael Flavio Fachini Cipriani ◽  
Michael De Mello Constantino ◽  
Michel Cardoso ◽  
...  
Keyword(s):  
Medical Students ◽  
Surgical Technique ◽  
Porcine Model ◽  
Human Anatomy ◽  
University Hospital ◽  
Medical Residents ◽  
Practical Training ◽  
Southern Brazil ◽  
Anatomical Correlation

<sec><title>OBJECTIVE:</title><p> To evaluate the acceptability of an educational project using A porcine model of airway for teaching surgical cricothyroidotomy to medical students and medical residents at a university hospital in southern Brazil.</p></sec><sec><title>METHODS:</title><p> we developed a teaching project using a porcine model for training in surgical cricothyroidotomy. Medical students and residents received lectures about this surgical technique and then held practical training with the model. After the procedure, all participants filled out a form about the importance of training in airway handling and the model used.</p></sec><sec><title>RESULTS:</title><p> There were 63 participants. The overall quality of the porcine model was estimated at 8.8, while the anatomical correlation between the model and the human anatomy received a mean score of 8.5. The model was unanimously approved and considered useful in teaching the procedure.</p></sec><sec><title>CONCLUSION:</title><p> the training of surgical cricothyroidotomy with a porcine model showed good acceptance among medical students and residents of this institution.</p></sec>

scholarly journals Safety, Tolerability, and Efficacy of Generic Dolutegravir-containing Antiretroviral Therapy Regimens Among South Indian Human Immunodeficiency Virus-infected Patients

2018 ◽  
Vol 68 (6) ◽  
pp. 1048-1051 ◽  
Author(s):  
Nagalingeswaran Kumarasamy ◽  
Sandeep Prabhu ◽  
Ezhilarasi Chandrasekaran ◽  
Selvamuthu Poongulali ◽  
Amrose Pradeep ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Antiretroviral Therapy ◽  
Prospective Cohort ◽  
Large Scale ◽  
First Line ◽  
South Indian ◽  
Resource Setting ◽  
Low Resource Setting ◽  
Immunodeficiency Virus

AbstractIn this first study of generic dolutegravir (DTG)-containing regimens in a low-resource setting, we assessed safety, tolerability, and efficacy within a prospective cohort of 564 patients with at least 6 months of clinical follow-up. We provide support for a large-scale transition to DTG as part of first-line regimens.

scholarly journals A Structured Workshop to Improve the Quality of Resident Discharge Summaries

2012 ◽  
Vol 4 (1) ◽  
pp. 87-91 ◽  
Author(s):  
Jaideep S. Talwalkar ◽  
Jason R. Ouellette ◽  
Shawnette Alston ◽  
Gregory K. Buller ◽  
Daniel Cottrell ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Discharge Summary ◽  
Faculty Members ◽  
Evaluation Tool ◽  
Outpatient Physician ◽  
Hospital Discharge Summary ◽  
Structured Program ◽  
Discharge Summaries

Abstract Background Poor communication at hospital discharge can increase the risk of adverse events. The hospital discharge summary is the most common tool for detailing events related to hospitalization in preparation for postdischarge follow-up, yet deficiencies in discharge summaries have been widely reported. Resident physicians are expected to dictate discharge summaries but receive little formal training in this arena. We hypothesized that implementation of an educational program on chart documentation skills would result in improvements in the quality of hospital discharge summaries in a community hospital internal medicine residency program. Methods A monthly, 1-hour workshop was launched in August 2007 to provide consistent and ongoing instruction on chart documentation. Guided by a faculty moderator, residents reviewed 2 randomly selected peer chart notes per session using instruments developed for that purpose. After the workshop had been in place for 2 years, 4 faculty members reviewed 63 randomly selected discharge summaries from spring 2007, spring 2008, and spring 2009 using a 14-item evaluation tool. Results Mean scores for 10 of the 14 individual items improved in a stepwise manner during the 3 years of the study. Items related to overall quality of the discharge summary showed statistically significant improvement, as did the portion of the summaries “carbon copied” to the responsible outpatient physician. Conclusions The quality of hospital discharge summaries improved following the implementation of a novel, structured program to teach chart documentation skills. Ongoing improvement was seen 1 and 2 years into the program, suggesting that continuing instruction in those skills was beneficial.

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