scholarly journals The association of chest radiographic findings and severity scoring with clinical outcomes in patients with COVID-19 presenting to the emergency department of a tertiary care hospital in Pakistan

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244886
Author(s):  
Raima Kaleemi ◽  
Kiran Hilal ◽  
Ainan Arshad ◽  
Russell Seth Martins ◽  
Avinash Nankani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Outcomes ◽  
Tertiary Care Hospital ◽  
Imaging Modality ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Care Hospital ◽  
X Rays ◽  
Radiographic Findings ◽  
Icu Admission

Introduction While chest x-rays (CXRs) represent a cost-effective imaging modality for developing countries like Pakistan, their utility for the prognostication of COVID-19 has been minimally explored. Thus, we describe the frequency and distribution of CXR findings, and their association with clinical outcomes of patients with COVID-19. Methods All adult (≥ 18 years) patients presenting between 28th February-31st May to the emergency department of a tertiary care hospital in Pakistan, who were COVID-19 positive on RT-PCR with CXR done on presentation, were included. A CXR Severity Score (CXR-SS) of 0–8 was used to quantify the extent of pulmonary infection on CXR, with a score of 0 being negative and 1–8 being positive. The patients’ initial CXR-SS and their highest CXR-SS over the hospital course were used for analysis, with cut-offs of 0–4 and 5–8 being used to assess association with clinical outcomes. Results A total of 150 patients, with 76.7% males and mean age 56.1 years, were included in this study. Initial CXR was positive in 80% of patients, and 30.7% of patients had an initial CXR-SS between 5–8. The mortality rate was 16.7% and 30.6% patients underwent ICU admission with intubation (ICU-Int). On multivariable analysis, initial CXR-SS (1.355 [1.136–1.616]) and highest CXR-SS (1.390 [1.143–1.690]) were predictors of ICU-Int, and ICU-Int was independently associated with both initial CXR-SS 5–8 (2.532 [1.109–5.782]) and highest CXR-SS 5–8 (3.386 [1.405–8.159]). Lastly, age (1.060 [1.009–1.113]), initial CXR-SS (1.278 [1.010–1.617]) and ICU-Int (5.047 [1.731–14.710]), were found to be independent predictors of mortality in our patients. Conclusion In a resource-constrained country like Pakistan, CXRs may have valuable prognostic utility in predicting ICU admission and mortality. Additional research with larger patient samples is needed to further explore the association of CXR findings with clinical outcomes.

VALIDATION OF QUICK COVID SEVERITY INDEX IN COVID PATIENTS ADMITTED THROUGH EMERGENCY DEPARTMENT OF A PRIVATE TERTIARY CARE HOSPITAL IN WEST BENGAL, INDIA

2021 ◽  
pp. 53-55
Author(s):  
Harsimran Singh Das
Keyword(s):  
Emergency Department ◽  
Respiratory Failure ◽  
Tertiary Care Hospital ◽  
Clinical Status ◽  
Tertiary Care ◽  
Severity Index ◽  
Adult Patients ◽  
Care Hospital ◽  
Oxygen Requirement ◽  
Clinical Tool

Introduction:qCSI (Quick COVID severity index) is a clinical tool established recently post pandemic to predict respiratory failure within 24 hours of admission in COVID-19 patients; respiratory failure being explain as increased oxygen requirement greater than 6L/min by low ow device, high ow device, noninvasive or invasive ventilation to maintain spO2 of greater than or equal to 94%, or death. Aim:To verify and validate the application of the qCSI in Emergency Department in Indian demographic for evidence-based guidance to aid physician decision making in safely dispositioning adult patients with COVID-19 with oxygen requirement less than or equal to 6L/min via low ow devices including nasal cannula and oxygen mask Materials and methods:This is an observational, retrospective study from Emergency Department in a private tertiary care hospital of admitted adult patients with COVID-19 disease. Clinical parameters in qCSI and disposition of 210 patients admitted through Emergency Department included in this study selected randomly was sought on admission and clinical status with level of care 24 hours following admission was recorded and compared with prediction based on qCSI from a period of 1 May 2020 to 31 October 2020. Result:We found that19(9.0%) patients Initial qCSI Score was Low, 80(38.1%) patients Initial qCSI Score was Low-intermediate, 84(40.0%) patients Initial qCSI Score was High-intermediate and 27(12.9%)patients Initial qCSI Score was High.qCSI Score after 24 hours 16(11.4%) patients were Low, 43(30.7%) patients were Low-intermediate, 63(45.0%) patients was High-intermediate and 18(12.9%) patients was High.Out of 210(100.0%) patients, 70 (33.3%) patients were critically ill. Conclusion:In conclusion these data show that the quick COVID-19 Severity Index provides easily accessed risk stratication relevant to Emergency Department provider.

THE IMPACT OF ANTIMICROBIAL STEWARDSHIP ON THE PATTERNS OF ANTIBIOTICS’ PRESCRIPTION AND CLINICAL OUTCOMES IN THE MEDICAL WARD OF A MALAYSIAN TERTIARY CARE HOSPITAL

2021 ◽  
pp. 20-25
Author(s):  
OVAIS ULLAH SHIRAZI ◽  
NORNY SYAFINAZ AB RAHMAN ◽  
CHE SURAYA ZIN ◽  
HANNAH MD MAHIR ◽  
SYAMHANIN ADNAN
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Medical Ward ◽  
Prescribing Patterns ◽  
Care Hospital ◽  
Slope Change ◽  
The Impact

Objective: To evaluate the impact of antimicrobial stewardship (AMS) on antibiotic prescribing patterns and certain clinical outcomes, the length of stay (LOS) and the re-admission rate (RR) of the patients treated within the medical ward of a tertiary care hospital in Malaysia. Methods: This quasi-experimental study was conducted retrospectively. The prescriptions of the AMS included alert antibiotics (AA) such as cefepime, ceftazidime, colistin (polymyxin E), imipenem-cilastatin, meropenem, piperacillin-tazobactam and vancomycin were reviewed for the period of 24 mo before (May, 2012–April, 2014) and after (May, 2014–April, 2016) the AMS implementation for the patients who were treated within the medical ward of a Malaysian tertiary care hospital. Patterns of antibiotics prescribed were determined descriptively. The impact of the AMS on the length of stay (LOS) and readmission rate (RR) was determined by the interrupted time series (ITS) comparative analysis of the pre-and post-AMS segments segregated by the point of onset (May, 2014) of the AMS program. Data analysis was performed through autoregressive integrated moving average (ARIMA) Winter Additive model and the Games-Howell non-parametric post hoc test by using IBM Statistical Package for Social Sciences version 25.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: A total of 1716 prescriptions of the AA included for the AMS program showed that cefepime (623, 36.3%) and piperacillin-tazobactam (424, 24.7%) were the most prescribed antibiotics from May 2012 to April 2016. A 23.6% drop in the number of the AA prescriptions was observed during the 24-month post-AMS period. The LOS of the patients using any of the AA showed a post-AMS decline by 3.5 d. The patients’ LOS showed an average reduction of 0.12 (95% CI, 0.05–0.19, P=0.001) with the level and slope change of 0.18 (95% CI, 0.04–0.32, P=0.02) and 0.074 (95% CI, 0.02–0.12, P=0.002), respectively. Similarly, the percent RR reduced from 20.0 to 9.85 during the 24-month post-AMS period. The observed post-AMS mean monthly reduction of the RR for the patients using any AA was 0.38 (95% CI, 0.23–0.53, P<0.001) with the level and slope change of 0.33 (95% CI, 0.14–0.51, P=0.02) and 0.37 (95% CI, 0.16–0.58, P=0.001), respectively. Conclusion: The AMS program of a Malaysian tertiary care hospital was a coordinated set of interventions implemented by the AMS team of the hospital that comprised of the infectious diseases (ID) physician, clinical pharmacists and microbiologist. The successful implementation of the AMS program from May, 2014 to April, 2016 within the medical ward resulted in the drop of the number of AA prescriptions that sequentially resulted in the significant (P<0.05) post-AMS reduction of the LOS and the RR.

scholarly journals ROLE OF ULTRASOUND AS AN IMAGING MODALITY IN NEOPLASTIC OVARIAN MASSES IN A TERTIARY CARE HOSPITAL

2017 ◽  
Vol 6 (94) ◽  
pp. 6858-6862
Author(s):  
Singhal R P ◽  
Pardaman Singh Setia ◽  
Kawal Preet Kaur ◽  
Virinder Mohan ◽  
Payal Bansal
Keyword(s):  
Tertiary Care Hospital ◽  
Imaging Modality ◽  
Tertiary Care ◽  
Care Hospital ◽  
Ovarian Masses

Patient perception regarding privacy and confidentiality: A study from the emergency department of a tertiary care hospital in Karachi, Pakistan

2021 ◽  
Vol 38 (ICON-2022) ◽  
Author(s):  
Syed Ghazanfar Saleem ◽  
Saima Ali ◽  
Nida Ghouri ◽  
Quratulain Maroof ◽  
Muhammad Imran Jamal ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Patient Perception ◽  
Care Hospital ◽  
Structured Interviews ◽  
Privacy Concerns ◽  
Creative Commons ◽  
Privacy And Confidentiality ◽  
And Behavior

Background and Objective: Maintaining privacy and ensuring confidentiality with patients is paramount to developing an effective patient-provider relationship. This is often challenging in over-crowded Emergency Departments (EDs). This survey was designed to explore patients’ perceptions on maintenance of privacy and confidentiality and their subsequent interactions with providers in a busy tertiary care hospital in Karachi. Methods: Trained nursing staff conducted structured interviews with 571 patients who presented to The Indus Hospital (TIH) ED from January to December 2020. All patients were 14 years of age or older, could speak and understand Urdu, and provide informed consent. Patients were asked about their perceptions of privacy and confidentiality in the ED and whether this affected their interactions with providers. Results: Respondents were primarily men (64%) under the age of 45 (62%) presenting for the first time (49%). The majority of patients felt that privacy and confidentiality were maintained, however 10% of patients reported that they had rejected examination due to privacy concerns and 15% of patients reported that they had changed or omitted information provided to a provider due to confidentiality concerns. There was correlation between privacy and confidentiality concerns and patient-provider interactions (p<0.0001). Conclusions: Despite the often over-crowded and busy environment of the ED, patients generally felt that privacy and confidentiality were maintained. Given the correlation between perception and behavior and the importance of an effective patient-provider relationship, particularly in the acute setting when morbidity and mortality is high, initiatives that focus on maintaining privacy and confidentiality should be pursued. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5785 How to cite this:Saleem SG, Ali S, Ghouri N, Maroof Q, Jamal MI, Aziz T, et al. Patient perception regarding privacy and confidentiality: A study from the emergency department of a tertiary care hospital in Karachi, Pakistan. Pak J Med Sci. 2022;38(2):351-355.  doi: https://doi.org/10.12669/pjms.38.ICON-2022.5785 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Opioid prescription practices for patients discharged from the emergency department with acute musculoskeletal fractures

CJEM ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 486-493
Author(s):  
Garrick Mok ◽  
Hailey Newton ◽  
Lisa Thurgur ◽  
Marie-Joe Nemnom ◽  
Ian G. Stiell
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Prescription Data ◽  
Care Hospital ◽  
Total Dosage ◽  
Opioid Prescription ◽  
Prescription Practices ◽  
Ed Visits

ABSTRACTBackgroundOpioid related mortality rate has increased 200% over the past decade. Studies show variable emergency department (ED) opioid prescription practices and a correlation with increased long-term use. ED physicians may be contributing to this problem. Our objective was to analyze ED opioid prescription practices for patients with acute fractures.MethodsWe conducted a review of ED patients seen at two campuses of a tertiary care hospital. We evaluated a consecutive sample of patients with acute fractures (January 2016–April 2016) seen by ED physicians. Patients admitted or discharged by consultant services were excluded. The primary outcome was the proportion of patients discharged with an opioid prescription. Data were collected using screening lists, electronic records, and interobserver agreement. We calculated simple descriptive statistics and a multivariable analysis.ResultsWe enrolled 816 patients, including 441 females (54.0%). Most common fracture was wrist/hand (35.2%). 260 patients (31.8%) were discharged with an opioid; hydromorphone (N = 115, range 1–120 mg) was most common. 35 patients (4.3%) had pain related ED visits <1 month after discharge. Fractures of the lumbar spine (OR 10.78 [95% CI: 3.15–36.90]) and rib(s)/sternum/thoracic spine (OR 5.46 [95% CI: 2.88–10.35)] had a significantly higher likelihood of opioid prescriptions.ConclusionsThe majority of patients presenting to the ED with acute fractures were not discharged with an opioid. Hydromorphone was the most common opioid prescribed, with large variations in total dosage. Overall, there were few return to ED visits. We recommend standardization of ED opioid prescribing, with attention to limiting total dosage.

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