scholarly journals Challenges and Solutions for Keeping Maternity and Gynecology Services Functioning Comprehensively in Secondary Level Health Care Facility in COVID-19 Pandemic Situation Using a Clinical Spproach

Author(s):  
Jayanta Kumar Biswas ◽  
Pratistha Lall ◽  
Soumen Das Poddar ◽  
Vikas Srivastava ◽  
Ajith Nilakantan

OBJECTIVE: With the nationwide lockdown in India, and with a near-exclusive focus on the novel coronavirus disease (COVID-19) there has been a great deal of neglect in the management of other illnesses leading to significant mortality and morbidity. We aimed to assess the feasibility of keeping obstetrics & gynecology services in a secondary care hospital functioning (in terms of regional experiences and comprehensive patient care measures) in the COVID-19 pandemic situation using a clinical approach. STUDY DESIGN: All policies of the World Health Organization and other international obstetrics- gynecological recommendations or guidelines were followed in keeping the services functional. Hospital data of obstetrics and gynecology services were maintained and compared with the previous year’s data of the corresponding period (January to December) through a retrospective observational study. RESULTS: Compared to figures for 2019, in-patient admissions, surgeries, and daycare procedures performed, and deliveries conducted were reduced in total but almost approached previous levels. The number of out-patient attendance and gynecologic laparoscopic surgeries were significantly reduced mostly in the initial month of lockdown (April 2020) and thereafter. Only limited COVID-19 testing was done and there was no mortality in patients or health care workers (HCW) in the obstetrics and gynecological department. CONCLUSION: COVID-19 pandemic had caused an unprecedented global healthcare crisis. The experience and data collected from our hospital in the study period validate the ‘clinical’ working protocol that enables comprehensive maternity and gynecology care at secondary level care centers even in a pandemic situation without adverse outcomes on patients or the hospital staff.

Author(s):  
Souvik Banerjee ◽  
Rakesh Kumar ◽  
Debasis Basu

Background: With about 425 million patients globally and 72.9 million patients in India, diabetes mellitus (DM) is one of the global health emergency of 21st century. Perioperative hyperglycaemia is reported in 20-40% of patients undergoing general surgery. A substantial body of literature demonstrates a clear association between perioperative hyperglycaemia and adverse clinical outcomes. This study aims to find out the frequency of preoperative hyperglycaemia and factors influencing it among patients undergoing surgery at a tertiary health care hospital of Eastern India.Methods: This Institution based, cross-sectional, observational study was conducted among study subjects who were operated at IQ City Medical College and Multispecialty Hospital, Durgapur, India during January-February 2019. Relevant medical records were reviewed to collect data regarding clinic-social data. Estimation of fasting plasma glucose (FPG) has been done as per World Health Organization (WHO) guidelines. Hyperglycaemia was defined and classified as per American Diabetes Association (ADA). Anthropometric measurements were taken as per standard WHO protocols.Results: A total 158 study subjects participated in study. The mean age and mean FPG of the study subjects was 42.63±12.95 years and 103.3±17.37 mg/dl respectively. As per the ADA criteria, 58.9% had normal FPG, 24.0% had impaired fasting glucose (IFG) and 17.1% had diabetes. Out of total 27 T2DM patients, 22 (13.9%) were known cases of T2DM and 5 (3.2%) were undiagnosed. The frequency of preoperative hyperglycaemia i.e. sums of IFG and diabetes was found to be 41.1%. Increasing age, male gender and overweight and obesity significantly influenced the occurrence of preoperative hyperglycaemia.Conclusions: The prevalence of preoperative hyperglycaemia among patients undergoing surgery is higher than the prevalence of hyperglycaemia among non surgical patients. Routine HbA1C should be done in all surgical patients to differentiate between chronic undiagnosed hyperglycaemia and stress hyperglycaemia.


2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 32s-32s
Author(s):  
P. Rajkarnikar Sthapit

Background: Retinoblastoma is the most common intraocular malignancy of childhood occurring in children below five years of age. Its worldwide incidence is one in 10,000 live births. Mortality rate in developed world is 5%, in developing countries is 50% while it can reach 99% if not treated. The etiology of high mortality in developing world is multifactorial like late presentation due to lack of knowledge or poor health care facility, limited knowledge about the severity of the disease among health care workers, fewer centers for its treatment and lack of modern day treatment facilities in the hospitals. Aim: To describe the profile of retinoblastoma presentation and management in a tertiary care hospital in a developing country. Methods: A retrospective data analysis of all diagnosed retinoblastoma patients who received treatment at a tertiary care hospital since last 12 years. Results: Mortality and morbidity due to retinoblastoma has improved in last 12 years due to earlier presentation when we can still save life as well as globe in many patients. Destructive procedures like exenteration and enucleation can be avoided by going for conservative treatment like chemotherapy if they present early. Conclusion: Early presentation and proper diagnosis of retinoblastoma significantly improves the outcome of its management. Awareness campaigns among parents as well as primary health care personnel is crucial for early detection of disease so that life and globe saving measures can be done to improve mortality and morbidity.


2020 ◽  
Vol 11 (SPL1) ◽  
pp. 380-384
Author(s):  
Priyanka Paul Madhu ◽  
Yojana Patil ◽  
Aishwarya Rajesh Shinde ◽  
Sangeeta Kumar ◽  
Pratik Phansopkar

disease in 2019, also called COVID-19, which has been widely spread worldwide had given rise to a pandemic situation. The public health emergency of international concern declared the agent as the (SARS-CoV-2) the severe acute respiratory syndrome and the World Health Organization had activated significant surveillance to prevent the spread of this infection across the world. Taking into the account about the rigorousness of COVID-19, and in the spark of the enormous dedication of several dental associations, it is essential to be enlightened with the recommendations to supervise dental patients and prevent any of education to the dental graduates due to institutional closure. One of the approaching expertise that combines technology, communications and health care facilities are to refine patient care, it’s at the cutting edge of the present technological switch in medicine and applied sciences. Dentistry has been improved by cloud technology which has refined and implemented various methods to upgrade electronic health record system, educational projects, social network and patient communication. Technology has immensely saved the world. Economically and has created an institutional task force to uplift the health care service during the COVID 19 pandemic crisis. Hence, the pandemic has struck an awakening of the practice of informatics in a health care facility which should be implemented and updated at the highest priority.


2005 ◽  
Vol 134 (2) ◽  
pp. 315-322 ◽  
Author(s):  
M. D. TANRIOVER ◽  
G. S. GUVEN ◽  
D. SEN ◽  
S. UNAL ◽  
O. UZUN

Sepsis continues to have a substantial mortality and morbidity despite advances in the diagnosis and management of this condition. We retrospectively analysed hospital charts of patients diagnosed to have sepsis between January 2002 and June 2003. Demographic characteristics of patients, microbiological findings and predictors of survival were evaluated. Sixty-nine sepsis episodes that occurred in 63 patients were analysed. The most common underlying diseases were hypertension, malignancies and diabetes mellitus. Renal insufficiency, respiratory distress and disseminated intravascular coagulation developed in 52·2, 30·4 and 30·4% of the episodes respectively; 47·7% of the blood cultures yielded an organism. Gram-negative bacteria were the predominant microorganisms (65·9%). Fifty-five patients (87·3%) died. Mechanical ventilation and underlying renal disease were significant determinants of mortality. In conclusion, Gram-negative bacteria remain the major pathogens in sepsis. The mortality remains very high, and a change in the clinical approach to the septic patient should be employed to improve the outcome.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Maria Belizan ◽  
Edna Maradiaga ◽  
Javier Roberti ◽  
Maricela Casco-Aguilar ◽  
Alison F. Ortez ◽  
...  

Abstract Background Zika virus (ZIKV) infection during pregnancy has severe consequences on the new-born. The World Health Organization declared the Zika outbreak to be a Public Health Emergency of International Concern (PHEIC) in 2016. Health facilities in the regions most affected by Zika lacked the capacity to respond to the increased demand for contraception. The objectives were to explore healthcare users’ perceptions regarding contraception, Zika prevention during pregnancy and post-abortion care (PAC) services in the context of a Zika outbreak in Tegucigalpa, Honduras, and to follow these services over time. Methods This study was part of a broader implementation research study. We used qualitative research consistent with grounded theory approach. Semi-structured interviews and focus groups were performed with women and their partners who used contraceptive services or received PAC services. Data were collected in two stages from December 2017 to July 2018. Themes explored included contraception, Zika and PAC services. Results Participants had positive attitude towards the use of contraceptive methods and demanded more information on safety, efficacy and on side effects. Health care services were inconsistent in the provision of information on Zika and contraception services. ZIKV vector transmission was known but fewer participants were aware of risk of sexual transmission of Zika. Barriers to access healthcare services included contraceptive and PAC services included distance to healthcare facilities, disorganized admission process, long waiting times and out-of-pocket expenditure to purchase medicines. Furthermore, poor quality, mistreatment and abuse of women seeking PAC was prevalent. Some positive changes were noted over time, such as improvements in infrastructure including improved privacy and cleanliness, removal of fees, requisite to bring clean water to hospital. Conclusions Our results highlight the challenges and areas for improvement in policy and practice related to contraceptive services and PAC in the context of ZIKV infection. Public policies to prevent epidemics should focus more on providing proper sanitation; removing barriers to access and use of effective contraception as human rights priority. Zika epidemic has highlighted weaknesses in health systems that obstruct access to and use of sexual and reproductive health services. The study results call for increased efforts to improve access, especially for women of low socio-economic status and intervene at different levels to eradicate discrimination and improve equity in the provision of health care. Qualitative methods can capture the community perspectives and can provide useful information to develop interventions to improve services.


2016 ◽  
Vol 06 (02) ◽  
pp. 040-043
Author(s):  
Priya Reshma Aranha

AbstractInformation seeking and receiving is the universally accepted right of children. When the children gets hospitalized and preparing for a surgery, it's the responsibility of the health care professionals to provide them with adequate information. Before giving the information it is essential to know what the children really wants to know. The main purpose of the study was to assess preoperative information needs of children undergoing surgery. With the non experimental research approach, a descriptive survey design was used in the study which was conducted in a selected hospital Mangaluru. Using non probability purposive sampling technique, 100 children of age 6-18 years were selected as study participants. The tool used were – the baseline proforma and the children's desire for preoperative information scale. The study results showed that majority of the children wanted to know the information regarding all the major happenings in their pre, intra and post operative events. Thus the study concludes that a structured preoperative teaching programme can be developed by the health care facility for the children undergoing surgery.


2019 ◽  
Vol 6 (2) ◽  
pp. 422
Author(s):  
Sujana Rachuri ◽  
Saritha Paul ◽  
Jaidev M. D.

Background: Advances in the NICU (neonatal intensive care unit) have significantly decreased mortality and morbidity and increased survival rate in neonates. SNAPPE II (Score for Neonatal Acute Physiology-Perinatal Extension II) score, which is a modified version of the SNAP score (Score for Neonatal Acute Physiology) helps in predicting the neonatal mortality. The aim of the study was to assess the risk of mortality using SNAPPE II score in neonates admitted to NICU.Methods: It was a prospective validation study done in a tertiary care hospital. Data was collected from 116 new borns admitted to NICU within 48 hours of birth who required respiratory support between December 2017 to June 2018.Results: A total of 116 newborns admitted to the NICU was included in present study. Out of 116 babies, 56 (48%) had mild SNAPPE-II score, 44 (38%) had moderate score and 16 (14%) had severe score. Among the 44 babies with moderate score, 12 (27%) died, which was statistically significant (P<0.001). Among 16 babies with severe score, 13 (81%) babies died, which was highly statistically significant (P<0.0001). Urine output, seizures, serum pH in the first 24 hours of life are independent predictors of mortality with significant p value (0.001).Conclusions: The SNAPPE-II score recorded in the first 48 hours of life could be a good predictor of mortality in babies admitted to NICU.


2019 ◽  
Vol 11 (2) ◽  
pp. 182-185 ◽  
Author(s):  
Biruk Wogayehu Taddele ◽  
Ayalewu Adinewu Wondimagegn ◽  
Mulugeta Asfaw Asaro ◽  
Mende Mensa Sorato ◽  
Bisrat Gissila Gedayi ◽  
...  

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