scholarly journals A COMPARATIVE EVALUATION OF PRESCRIBING PRACTICE OF ANTIBIOTIC PROPHYLAXIS IN HOSPITALS OF POKHARA VALLEY

1970 ◽  
Vol 43 (156) ◽  
Author(s):  
Nami Palikhe ◽  
A Pokhrel
Keyword(s):  
Length Of Stay ◽  
Antibiotic Prophylaxis ◽  
Length Of Hospital Stay ◽  
Study Data ◽  
Significant Difference ◽  
Prescribing Practice ◽  
The Common ◽  
The Mean ◽  
Western Regional ◽  
Pokhara Valley

The main objective of the study was to assess the prescribing practice of antibiotic prophylaxis for differentsurgeries in hospitals of Pokhara valley. A descriptive, quantitative, retrospective study was used to evaluatethe patients who have undergone surgery between 15th April 2002 – 14th April 2003. A total of 950 patientswere taken from the medical record for the study. Data about patient (age, sex), surgery (type and indication),antibiotic/s prophylaxis (dose, duration) and length of hospital stay were collected. Caesarean Section (CS)was the common surgery in Western Regional Hospital (WRH) followed by cholecystectomy, 31.1% and24.4% respectively. In Manipal Teaching Hospital (MTH), dilatation and currettage (D and C, 21.6%) wasthe most common surgery followed by hysterectomy (21%). The mean length of stay in MTH for CS surgerywas 7.97 days whereas 7.01 days for WRH. Significant difference was found in length of stay of two hospitals(p<0.05). Antibiotic prophylaxis was given preoperatively in MTH (87%) and WRH (79.5%) respectively.Antibiotic prophylaxis was given intraoperatively in 1.2% cases of MTH. In MTH, the total antibioticduration in all surgeries is higher than WRH, significant difference was found only in cholecystectomy(p<0.05). In both hospitals Ampicillin+Cloxacillin was the most commonly used regimen, 12.4% in WRHand 34% in MTH. In WRH, Ciprofloxacin/Cefotaxim was also used by 12.4%. More than 79.1% of thepatients were exposed to, at least, two antibiotics as a prophylaxis in WRH where as more than 63.0% inMTH. Penicillin was found to be mostly used in both hospitals.Key Words: Antibiotic prophylaxis, Surgery.

To screen or not to screen? Vitamin D deficiency in chronic mental illness

2017 ◽  
Vol 26 (1) ◽  
pp. 56-59
Author(s):  
Ivana Goluza ◽  
Jay Borchard ◽  
Nalin Wijesinghe ◽  
Kishan Wijesinghe ◽  
Nagesh Pai
Keyword(s):  
Vitamin D ◽  
Length Of Stay ◽  
P Value ◽  
Hydroxyvitamin D ◽  
Psychiatric Setting ◽  
Retrospective Audit ◽  
Vitamin D Levels ◽  
Significant Difference ◽  
25 Hydroxyvitamin D ◽  
The Mean

Objectives: The objective of the current study was to examine the pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) within an Australian inpatient psychiatric setting. Method: A retrospective audit of 300 random hospital files of those admitted as inpatients between Nov 2014 and Nov 2015 was undertaken. Data was quantitatively analysed and described. Results: The number of inpatients who had a vitamin D determination during their admission was 37/300 (12.33%). The mean vitamin D level of those tested was 51.63 nmol/l. Of those that were tested, 18/37 (48.6%) were mildly to moderately deficient. There was a statistically significant difference in age and length of stay between those that were and were not tested for vitamin D levels, p-value <0.001 and 0.017, respectively. In addition, a simple linear regression indicated a weak association between length of stay and vitamin D levels. Conclusion: This audit highlights vitamin D screening inadequacy. More research is recommended to establish tangible benefits of supplementation, while local practice provides valuable data for education and policy purposes.

Abstract WMP118: In Safe Hands: Implementation on the Stroke Unit. Does it Improve Patient Care and Ward Efficiency?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sheila M Jala ◽  
Sarah Giaccari ◽  
Melissa Passer ◽  
Carin Bertmar ◽  
Susan Day ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Stroke Unit ◽  
Oral Intake ◽  
Improve Patient Care ◽  
Tertiary Hospital ◽  
Study Data ◽  
Acute Hospital ◽  
Staff Satisfaction ◽  
Number Of Patients ◽  
Significant Difference

The ‘In Safe Hands” (ISH) is a structured interdisciplinary bedside round developed to increase patients participation in their care in acute hospital wards. This has shown to improve quality of care by reducing communication errors and complications, enhancing a culture of safety in an acute hospital. The purpose of this study was to assess the effect of ISH on length of stay (LOS), in-hospital complications and assess whether the ISH enhances patient and staff satisfaction in a stroke unit of a tertiary hospital in Sydney, Australia. This was a longitudinal study pre and post implementation. A total of 200 patients participated in the study. Data on the length of stay, incidence rate relating to patient safety and patient and staff satisfaction surveys using Patient Experience Tracker (PET) devices were collected pre and post implementation. ISH increased the number of patients with at least 72hours in stroke unit care by 80 percent (P < 0.001). Fever and hyperglycaemia were treated in all patients following ISH implementation vs only 50% and 64% respectively of patients pre ISH implementation. Swallow screen was completed in all patients prior oral intake compared to 92% of patients of the pre ISH group (P = 0.03). There was no significant difference in the LOS and complications. All stroke patients received stroke education and there were no readmissions post implementation. There was no significant difference in the patient and staff satisfaction. In conclusion, although ISH did not improve the primary endpoints of LOS, complications and satisfaction it did improve protocol adherence.

scholarly journals Analysis of smile esthetics in American Board of Orthodontic patients

2013 ◽  
Vol 84 (3) ◽  
pp. 486-491 ◽  
Author(s):  
Sercan Akyalcin ◽  
Leslie K. Frels ◽  
Jeryl D. English ◽  
Stephen Laman
Keyword(s):  
Stepwise Regression ◽  
Positive Association ◽  
Inclusion Criteria ◽  
Significant Difference ◽  
Standard Deviation Range ◽  
Orthodontic Patients ◽  
The Common ◽  
The Mean ◽  
General Dentists ◽  
Smile Esthetics

ABSTRACT Objective: To investigate the common denominators of an esthetically pleasing smile in patients who were considered to be successfully treated upon the submission to American Board Orthodontics (ABO) clinical examination. Material and Methods: A total of 462 patients were examined. Ninety subjects that fulfilled the inclusion criteria were included. Standardized digital smile photographs of the subjects were rated by 30 panel members, including orthodontists, general dentists, and parents of orthodontic patients, using a numeric version of the visual analog scale. Three groups were formed using the mean esthetic score ± standard deviation range: unattractive (n  =  21), average (n  =  47), and attractive (n  =  22) smiles. Eleven smile characteristics were digitally measured on the photographs and compared between the groups using one-way analysis of variance and χ2 tests. Additionally, regression analyses were used to investigate the association of the smile characteristics with the esthetic score. Results: A significant difference was found between the three groups for the comparison of smile arc relationship (P &lt; .001). When all the variables used in this study were entered in the regression analysis, a positive association was found (r  =  0.658; r2  =  0.434; P &lt; .001). Additionally, two models were defined using stepwise regression. The first model included the smile arc (r  =  0.478; r2  =  0.228; P &lt; .001), and the second model had both the smile arc and right gingival display/visible dentition display ratio (r  =  0.567; r2  =  0.321; P &lt; .001). Conclusions: A harmonious smile arc relationship and less gingival display during a smile are significantly associated with smile attractiveness in patients considered successfully treated according to ABO standards.

Sphincter of oddi dysfunction: sonographic examination in opiate addicts

2011 ◽  
Vol 26 (S2) ◽  
pp. 107-107
Author(s):  
M. Soltan ◽  
M. Abd Ghaffar
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Age Groups ◽  
Sphincter Of Oddi Dysfunction ◽  
Sonographic Examination ◽  
Significant Difference ◽  
The Common ◽  
The Mean ◽  
Opiate Addicts ◽  
Group 1

ObjectiveTo benefit from the usefulness of ultrasonography in measurement of common bile duct in opiate addicts and to correlate between the common bile duct (CBD) diameter and the duration of addiction.Materials and methodFifteen addicts, diagnosed according to DSM IV diagnostic criteria, were examined by abdominal ultrasound. The common bile duct is measured and the results were analyzed with other factors like age, the period of addiction, laboratory findings.ResultsAccording to the findings, there is a significant increase in the range of the CBD diameter in comparison with normal bile ducts. Also, the mean diameter of the CBD in the different age groups showed a significant difference (p < 0.01) and there was a positive significant correlation between the CBD diameter and the period of addiction (p < 0.05, r = 0.875); the multiple comparisons shows that the significant difference between the 3 age groups were due to a significance between group (1) & (2), and group (1) & (3) but no significance between group (2) & (3). So, with the increased length of the addiction period, the mean CBD diameter increases.ConclusionIn opiate addicts, the common bile duct is found to be dilated; however with normal serum bilirubin and alkaline phosphatase level and no obstructive causes by ultrasound examination, no need for any further assessment.

Nonendoscopic, minimally invasive calvarial vault remodeling without postoperative helmeting for sagittal synostosis

2012 ◽  
Vol 9 (3) ◽  
pp. 222-227 ◽  
Author(s):  
Ian S. Mutchnick ◽  
Todd A. Maugans
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Intraoperative Complications ◽  
Cohort Analysis ◽  
Sagittal Synostosis ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Significant Correction ◽  
The Mean

Object Multiple surgical procedures have been described for the management of isolated nonsyndromic sagittal synostosis. Minimally invasive techniques have been recently emphasized, but these techniques necessitate the use of an endoscope and postoperative helmeting. The authors assert that a safe and effective, more “minimalistic” approach is possible, avoiding the use of endoscopic visualization and routine postoperative application of a cranial orthosis. Methods A single-institution cohort analysis was performed on 18 cases involving infants treated for isolated nonsyndromic sagittal synostosis between 2008 and 2010 using a nonendoscopic, minimally invasive calvarial vault remodeling (CVR) procedure without postoperative helmeting. The surgical technique is described. Variables analyzed were: age at time of surgery, sex, estimated blood loss (EBL), operative time, intraoperative complications, postoperative complications, length of stay, pre- and postoperative cephalic index (CI), clinical impressions, and results of a 5-question nonstandardized questionnaire administered to patient caregivers regarding outcome. Results Eleven male and 7 female infants (mean age 2.3 months) were included in the study. The mean duration of follow-up was 16.4 months (range 6–38 months). The mean procedural time was 111 minutes (range 44–161 minutes). The mean length of stay was 2.3 days (range 2–3 days). The mean EBL in all 18 patients was 101.4 ml (range 30–475 ml). One patient had significant bone bleeding resulting in an EBL of 475 ml. Excluding this patient, the mean EBL was 79.4 ml (range 30–150 ml). There were no deaths or intraoperative complications; one patient had a superficial wound infection. The mean CI was 69 preoperatively versus 79 postoperatively, a statistically significant difference (p < 0.0001). Two patients were offered helmeting for suboptimal surgical outcome; one family declined and the single helmeted patient showed improvement at 2 months. No patient has undergone further surgery for correction of primary deformity, secondary deformities, or bony irregularities. Complete questionnaire data were available for 14 (78%) of the 18 patients; 86% of the respondents were pleased with the cosmetic outcome, 92% were happy to have avoided helmeting, 72% were doubtful that helmeting would have provided more significant correction, and 86% were doubtful that further surgery would be necessary. Small, palpable, aesthetically insignificant skull irregularities were reported by family members in 6 cases (43%). Conclusions The authors present a nonendoscopic, minimally invasive CVR procedure without postoperative helmeting. Their small series demonstrates this to be a safe and efficacious procedure for isolated nonsyndromic sagittal synostosis, with improvements in CI at a mean follow-up of 16.1 months, commensurate with other techniques, and with overall high family satisfaction. Use of a CVR cranial orthosis in a delayed fashion can be effective for the infrequent patient in whom this approach results in suboptimal correction.

scholarly journals EMERGENCY LAPAROTOMIES UNDER SPINAL ANESTHESIA: A RETROSPECTIVE, FACILITY BASED OBSERVATIONAL STUDY, IN KABUL, AFGHANISTAN

2021 ◽  
Vol 9 (06) ◽  
pp. 751-756
Author(s):  
Wais Farda ◽  
◽  
Ahmad Bashir Nawazish ◽  
Keyword(s):  
Length Of Stay ◽  
Observational Study ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Average Length ◽  
Emergency Laparotomy ◽  
Complication Rates ◽  
Abdominal Incision ◽  
Significant Difference ◽  
The Mean

Background: Laparotomy is most commonly performed under general anesthesia, but spinal anesthesia (SA) is considered an alternative to in the context of limited resources. The safety and efficacy of using SA as substitute for general anesthesia(GA) has not been explored in Afghanistan. Methodology: We conductedan observational study in the general surgery department of Isteqlal hospital in Kabul, Afghanistan on 196 adult patients undergoing emergency laparotomy under spinal anesthesia betweenApril 2018-April 2020. Results: The mean age of patients was 41.5 years (SD=19.4), the ratio of males to females was 1.9:1 and almost half (44.4%) had comorbidities. 21% were classified as ASA grade III and IV with a similar pattern among males and females. A total of 11 (5.6%) cases were converted to GA. Conversion pattern to GA was similar amongmales and females(P=0.71), ASA grade (P=0.432) and age group (P=0.642). The mean length of stay after operation was 6.5 days (SD=4.1). 32 (16.3%) patients suffered SA complications with no significant difference in terms of sex (P=0.134). Hypotension and headache accounted for 97% of complications. Complication rates were similar in terms of intervertebral level (P=0.349), type of abdominal incision (P>0.1) and average length of stay (P=0.156). 18 patients (9.2%) died due to MOF, sepsis, respiratory failure, thromboembolism and cardiogenic shock. Conclusion: Spinal anesthesia is considered a safe and effective anesthesia for emergency laparotomies, even for those with comorbidities. Based on our findings we would recommend spinal anesthesia as an alternative to general anesthesiain emergency laparotomy in Afghanistan.

scholarly journals 931 Deep Inferior Epigastric Perforator (DIEP) Flap: Impact of Early Drain Removal on Seroma Formation Rate and Duration of Inpatient Stay

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Grigg ◽  
R Clancy ◽  
C Lewis ◽  
P Jackson
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Formation Rate ◽  
Seroma Formation ◽  
Diep Flap ◽  
Complication Rates ◽  
Post Surgery ◽  
Drain Removal ◽  
Significant Difference ◽  
The Mean

Abstract Aim Donor site seroma can follow deep inferior epigastric flap (DIEP) harvest. Post-surgery gradient technology (GTC) garments are worn by DIEP patients postoperatively following drain removal to reduce seroma formation. Early drain removal was considered a contributing factor to increased seroma formation rate. From June 2018 drain removal regardless of output was instigated at day two post-surgery. Prior to this, drains were removed when less than 30mls over 24 hours. We aim to assess the seroma rate post DIEP harvest with early drain removal. Method Retrospective review of prospectively managed database between June 2018 to May 2020. Surgical complications and length of stay in hospital were recorded. Results 200 patients underwent DIEP flap breast reconstruction. The mean age of patients was 52 years (range 28-73). There was no significant difference in seroma complication rate between those who had drains removed on day 3 compared with day 2 ((1.02% (1/98) vs. (0.98% (1/102); p = 1). The mean length of stay in hospital for the 1st cohort was 3.86 days and for the 2nd cohort was 3.23 days. There were no complications related to drain removal. Conclusions Our data suggests that drain removal after 2 days postoperatively with DIEP reconstruction does not affect seroma complication rates. Moreover, it leads to a shorter hospital stay. These conclusions are in keeping with enhanced recovery protocols and an early drain removal surgical process could be advised.

scholarly journals COMPARISON OF ANXIETY LEVEL, BLOOD PRESSURE AND PULSE PARAMETERS OF PATIENTS WITH AND WITHOUT CORONARY ANGIOGRAPHY EXPERIENCE: A CROSS-SECTIONAL STUDY

2021 ◽  
Vol 54 (1) ◽  
pp. 107-115
Author(s):  
Yasemin Altınbaş ◽  
Emine Derya Derya Ister
Keyword(s):  
Blood Pressure ◽  
Coronary Angiography ◽  
Trait Anxiety ◽  
Blood Pressure Measurement ◽  
Cross Sectional Study ◽  
Study Data ◽  
Cross Sectional ◽  
Significant Difference ◽  
State And Trait Anxiety ◽  
The Mean

Objective: The study aimed to compare state and trait anxiety, blood pressure, and heart rate of patients with and without coronary angiography experience who undergo coronary angiography intervention. Methodology: This study is cross-sectional comparative research. A total of 160 patients, including 80 patients undergo for the first time coronary angiography and 80 patients with at least one experience of coronary angiography were included in the sample of the study. In the study, data were collected using 'Patient Information Form' and 'State-Trait Anxiety Inventory', blood pressure measurement device, and pulse oximeter. Results: The mean of state anxiety scores of the patients with and without CA experience were 39.35±5.31 and 39.98±4.04, respectively; (p=0.395). The mean of trait anxiety scores of the patients with and without CA experience were 44.73±6.84 and 44.51±6.05, respectively (p=0.826).  There was no statistically significant difference observed in state and trait anxiety between two groups. Before the CA procedure, the systolic and diastolic blood pressure average of the patients with CA experience were statistically higher than those without CA experience (p<0.05). Conclusion: The anxiety levels of the patients before the CA were observed to be similar and moderate, regardless of their CA experience. It was observed that patients with CA experience before CA procedure had higher systolic and diastolic blood pressures compared to the group without experience.

scholarly journals Determinants of Prolonged Length of Stay among Patients with Road Traffic Injury at the Philippine General Hospital: A Retrospective Cohort Study

2021 ◽  
Vol 55 (6) ◽  
Author(s):  
Jinky Leilanie Lu ◽  
Teodoro J. Herbosa ◽  
Sophia Francesca D. Lu
Keyword(s):  
Length Of Stay ◽  
General Hospital ◽  
Road Traffic ◽  
Length Of Hospital Stay ◽  
First Aid ◽  
Road Traffic Injury ◽  
The Other ◽  
Prolonged Length ◽  
Traffic Injury ◽  
The Mean

Introduction. Road traffic injuries are among the leading causes of preventable death, claiming around 7000 lives every year. Furthermore, road traffic can injure or disable thousands more every year in the Philippines. Objectives. This study determined the hospital length-of-stay patterns and risk factors for a prolonged length of stay in a tertiary hospital after road traffic injury. Methods. A retrospective cohort study was conducted to determine the determinants of the length of stay in the Philippine General Hospital (PGH) among road traffic injury victims for the year 2016. Length of stay was recorded according to the median. The other variables were cross-tabulated against the length of stay, and each of their crude odds ratios along with corresponding p-values were presented. Continuous variables were analyzed using Wilcoxon Mann-Whitney U-test. The predictor model for the determinants of prolonged length of stay in the hospital was built using forward selection. Likelihood-ratio test was used to compare the model with and without the exposure variable. Results. A total of 427 road traffic injury victims were admitted to the Philippine General Hospital in 2016. The mean age of the patients was 31.55 years (±14.97) with a median age of 29 years. The majority of patients were males (82.4%) and single (60.8%). Most patients were riding a motorcycle during the time of the accident (64.2%) while 20% were pedestrians. The majority of the victims were intoxicated (74.3%) and were not using helmets (57.1%) at the time of the accident. Most of the victims received first aid (69.2%) and the mean time of admission was 3.03 (±13.31) days while the median time to admission was 12 hours. Receiving first aid (p<0.01), availed services (p<0.01), and married civil status (p=0.04) were found to be strongly associated with length of hospital stay. Without controlling for any confounders, pay patients (OR = 3.46, 95% CI: 1.3, -9.87), elective patients (OR = 7.88, 95% CI: 2.64, 31.61), and those in non-trauma wards (OR=2.07, 95% CI: 1.29, 3.36) had higher odds for longer hospitalization stay. On the other hand, those who did not receive first aid (OR = 0.55, CI:0.35, 0.85) had lower odds for prolonged hospitalization. Those who suffered face injury and did not suffer external injuries had a higher mean rank, suggesting a longer length of hospital stay. On the other hand, upon controlling variables found to be associated with previous studies, those with low Glasgow coma scale (GCS) scores were 2.77 times (95% CI: 1.13, 6.91) more likely to stay longer in the hospital. Conclusion. The type of victim, mortality status, age, and sex were found to be important determinants of prolonged hospitalization. To lessen the number of fatalities and road trauma injuries, laws on road safety should be strictly and properly implemented. Shared responsibility of all road users is also important in improving the safe usage of roads.

scholarly journals Comparison between Vacuum and Forceps Extraction to Neonatal outcome on Prolonged Second Stage of Labor

2016 ◽  
Author(s):  
Kurdi Syamsuri
Keyword(s):  
Apgar Score ◽  
P Value ◽  
Vacuum Extraction ◽  
Second Stage Of Labor ◽  
Second Stage ◽  
Significant Difference ◽  
The Subject ◽  
The Common ◽  
The Mean ◽  
Minute Apgar Score

Objective: To assess the effectiveness of vacuum and forceps extraction in prolonged second stage in Dr. Mohammad Hoesin Hospital Palembang. Methods: A retrospective study for 5 years (2005-2009) by doing a prognostic test on prolonged second stage of labor. Results: The subject age most commonly ranges from 20 to 35 years (84.8% in the forceps extraction group and 86% in the vacuum group). The common parity was nulliparity (58.1% in the forceps extraction group and 61.58% in the vacuum extraction). In the forceps extraction group, 76.7% scores >7 in the 1 minute APGAR score with the mean score of 7.14±1.62, whilst in the vacuum extraction group, 79.1% scores >7 in the 1 minute APGAR score, with the mean score of 7.16±1.78. And in the forceps extraction group, 94.2 scores >7 in the 5 minute APGAR score with mean score of 8.62±1.11, whilst in the vacuum extraction group, 93% scores >7 in the 5 minute APGAR score with the mean score of 8.65±1.08. It is concluded that there is no significant differences on both 1 and 5 minute APGAR scores (p value is 0.713 and 0.755, respectively). Maternal complication of extended episiotomy and perineal rupture were found more often in forceps extraction, but with no statistically significant difference (p=0.324). Conclusion: There is no difference of effectiveness between forceps extraction and vacuum extraction in the case of prolonged second stage. Physicians are free whether to use the vacuum or foceps according to their own desirability and skill. [Indones J Obstet Gynecol 2012; 36-1:28-31] Keywords: forceps extraction, prolonged second stage, vacuum extraction

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