REFERRAL PATTERN AND OUTCOMES OF NEONATES FROM SECONDARY CARE SETTING OF AGA KHAN UNIVERSITY HOSPITAL TO TERTIARY CARE CENTERS IN PAKISTAN

ABSTRACT:Objective: To determine the reasons of neonatal referrals from secondary care settings of Aga Khan University Hospital (AKUH) to tertiary care centers of Karachi, Pakistan and to assess the neonatal outcomes for referred cases. Methodology: This retrospective observational study was conducted at AKUH from July 2015 tjune 2019. All neonates born after 32 weeks of gestation at AKUH secondary care(Kharadar, Garden & Karimabad)and referred to tertiary care hospitals were consecutively enrolled. The reason for referral, i.e. surgical intervention, respiratory support, care of prematurity; need of mechanical ventilation, referral place and neonatal outcomes like discharge in stable condition, left against medical advice (LAMA) and mortality, were noted. Results: Of 348 referred cases, 306 (87.9%)were reported alive. neonatal mortality was reported in 42 (12.1%) of the cases. Of these 306 alive participants, 284 (92.81%) were discharged from the hospital whereas 22 (7.18%) LAMA. Of 348 patients, the referral place of most of the patients was outside AKU,i.e.189(56.3%).The need of mechanical ventilation was reported in, 63 (18.1%) patients. A significant association of mechanical ventilation in tertiary centers was observed in neonates born with low APGAR score at 1 and 5 min (p-value <0.001), shorter duration of stay at secondary care(p-value 0.007),and aggressive resuscitation requirement at birth (p-value <0.001). Conclusion: Most common reasons for referral of newborns to tertiary care hospital was respiratory diseases requiring respiratory support and surgical intervention. Neonatal mortality noted for referrals made to AKUH were much less as compared to cases referred to other tertiary care hospitals. Continuous...

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The Association of Nil Per Os (NPO) Days with Necrotizing Enterocolitis

Gastroenterology Research and Practice ◽

10.1155/2018/2795468 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6

Author(s):

Yongming Wang ◽

Xiaoyu Li ◽

Chunbao Guo

Keyword(s):

Mechanical Ventilation ◽

Clinical Outcomes ◽

Surgical Intervention ◽

Tertiary Care ◽

Bacterial Sepsis ◽

Low Birth Weight Infants ◽

Study Objective ◽

Significant Difference ◽

Tertiary Care Hospitals ◽

The Relationship

Background. Enteral feeds are an essential part of care for infants and may be a potential risk factor in NEC development. The present study objective was to evaluate the relationship between nil per os (NPO) and clinical outcomes in infants with NEC. Methods. This was a retrospective review of 196 premature, low-birth-weight infants with NEC from January 1, 2011, to October 31, 2016, at four academic tertiary care hospitals. The patients were evaluated based on the median nil per os (NPO) days (5.6 days) in longer NPO (6.3 ± 1.1 days) versus shorter NPO groups (4.2 ± 0.9 days). Results. Patients who experienced longer than 5.6 NPO days were more likely associated with perforated NEC (odds ratio (OR), 2.01; 95% confidence interval (CI), 1.07–3.76; p=0.021), stage III NEC (OR, 1.81; 95% CI, 0.97–3.38; p=0.042), and longer duration of mechanical ventilation (OR, 0.17; 95% CI, 0.08–0.98; p=0.005) than the shorter duration group of 5.6 NPO days. For the secondary outcomes, there was a trend towards earlier birth (p=0.083), longer NICU length of stay (p=0.093), and higher mortality (p=0.10) in the longer NPO cohort (p=0.057). The incidence of bacterial sepsis and short bowel syndrome also increased as the length of NPO increased. There was no statistically significant difference in nutritional variables between the two groups within the in-hospital period. Conclusion. Longer NPO time was associated with the severity of NEC and more injurious clinical outcomes, as demonstrated by rates of surgical intervention and duration of mechanical ventilation.

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Association of medication administration errors with interruption among nurses in public sector tertiary care hospitals

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.5.287 ◽

2019 ◽

Vol 35 (5) ◽

Author(s):

Raja - ◽

Badil - ◽

Sajid Ali ◽

Shaheen Sherali

Keyword(s):

Public Sector ◽

Tertiary Care ◽

Medication Administration ◽

Cross Sectional Study ◽

University Hospital ◽

P Value ◽

Cross Sectional ◽

Phone Calls ◽

Medication Administration Errors ◽

Tertiary Care Hospitals

Objectives: To determine the association of medication administration errors with interruption among nurses working at public sector tertiary care hospitals in Karachi, Pakistan. Methods: An analytical cross-sectional study was accomplished at two public sector healthcare facilities Civil Hospital, and Dow University Hospital, Karachi. The study was carried out from October 2017 to July 2018 over a period of 10 months. The sample was calculated by using OpenEpi version 3.0. By taking 56.4% of medication administration errors, 5% margin of error and 95% confidence level. The calculated sample size was 204 of both genders. The subjects both male and female nurses having a valid license from Pakistan Nursing Council and one year of clinical experience were enrolled in the study. The subjects were approached by using non-probability purposive sampling method. Validated and adapted questionnaire utilized to gather the data. Data was entered and analyzed by using SPSS version 21.0. Results: In this study, total 204 nurses were included, almost half (52%) of them were male. Majority of (82.3%) study participants had age between 25-35 years old. There were total 716 medications given by 204 nurses. Out of these, 295 (41.2%) were antibiotics, other common medications were acid-suppressive, analgesic and antiemetic 14.5%, 15.9% and 11.2% respectively. Among all 716 medications, 644 (89.9%) were given intravenously whereas only 6.7% drugs given orally. A significant association has been found between medication administration errors and interruption like talking with other health care personnel, patients or attendant queries, phone calls (p-value=<0.001). Nearly 91% of the study nurses who were interrupted during medication committed medication errors. Conclusion: It is concluded that there is a significant association between medication administration errors with interruption among nurses. doi: https://doi.org/10.12669/pjms.35.5.287 How to cite this:Raja, Badil, Ali S, Sherali S. Association of medication administration errors with interruption among nurses in public sector tertiary care hospitals. Pak J Med Sci. 2019;35(5):---------. doi: https://doi.org/10.12669/pjms.35.5.287 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.

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Interhospital referral of colorectal cancer patients: a Dutch population-based study

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03881-2 ◽

2021 ◽

Author(s):

A. K. Warps ◽

◽

M. P. M. de Neree tot Babberich ◽

E. Dekker ◽

M. W. J. M. Wouters ◽

...

Keyword(s):

Colorectal Cancer ◽

Cancer Patients ◽

Waiting Time ◽

Secondary Care ◽

Advanced Disease ◽

Waiting Times ◽

Tertiary Care ◽

Disease Stage ◽

Colorectal Cancer Patients ◽

Tertiary Care Hospitals

Abstract Purpose Interhospital referral is a consequence of centralization of complex oncological care but might negatively impact waiting time, a quality indicator in the Netherlands. This study aims to evaluate characteristics and waiting times of patients with primary colorectal cancer who are referred between hospitals. Methods Data were extracted from the Dutch ColoRectal Audit (2015-2019). Waiting time between first tumor-positive biopsy until first treatment was compared between subgroups stratified for referral status, disease stage, and type of hospital. Results In total, 46,561 patients were included. Patients treated for colon or rectal cancer in secondary care hospitals were referred in 12.2% and 14.7%, respectively. In tertiary care hospitals, corresponding referral rates were 43.8% and 66.4%. Referred patients in tertiary care hospitals were younger, but had a more advanced disease stage, and underwent more often multivisceral resection and simultaneous metastasectomy than non-referred patients in secondary care hospitals (p<0.001). Referred patients were more often treated within national quality standards for waiting time compared to non-referred patients (p<0.001). For referred patients, longer waiting times prior to MDT were observed compared to non-referred patients within each hospital type, although most time was spent post-MDT. Conclusion A large proportion of colorectal cancer patients that are treated in tertiary care hospitals are referred from another hospital but mostly treated within standards for waiting time. These patients are younger but often have a more advanced disease. This suggests that these patients are willing to travel more but also reflects successful centralization of complex oncological patients in the Netherlands.

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Role of BAP 65 (Blood Urea Nitrogen, Altered Mental Status, Pulse, Age 65 Years) Scoring System in Risk Stratification of Patients with Acute Exacerbation of Chronic Obstructive Lung Disease in Tertiary Care Hospital

Nepal Medical Journal ◽

10.37080/nmj.62 ◽

2019 ◽

Vol 2 (2) ◽

pp. 5-10

Author(s):

Ashish Thapa

Keyword(s):

Mechanical Ventilation ◽

Acute Exacerbation ◽

Severe Disease ◽

Tertiary Care ◽

Chronic Obstructive Lung Disease ◽

Institutional Review Boards ◽

Mortality Data ◽

Chronic Obstructive ◽

P Value ◽

Care Hospital

Introduction: Exacerbations are important events in the management of COPD because they negatively impact health status, rates of hospitalization and readmission, and disease progression. COPD AE is one of the commonest case presenting to the TUTH Emergency, average being 5 patients a day. The aim of the study was to co-relate the BAP 65 score, mortality and mechanical ventilation in patients with acute exacerbation of COPD. Methods: It was an observational study, 648 patients from emergency of TUTH were screened for the study from Magh 2073 to Asar 2074 after getting approval from the institutional review boards, among them 114 were included after applying inclusion and exclusion criteria and BAP 65 score was calculated. The patients were followed till discharge, mechanical ventilation or mortality. Data entry was done in MS EXCEL and statistical analysis was done using SPSS version 24. Results: Total of 114 patients enrolled for the study from the emergency of TUTH. There were total 16 mortality and 12 patients were mechanically ventilated. Most of the mortality and mechanical ventilation were from severe group ie BAP class IV and V. We used Pearson Chi-squared test to compare between BAP 65 class and Mortality, and found that mortality rate increased with increasing BAP 65 class with a p value of < 0.0001. The need of Mechanical Ventilation increased as well, as the BAP 65 Class increased, less than 1% of the patients with BAP class I needed MV, the cause being Type II Respiratory Failure, while around 50% of the patients with BAP class V needed MV. Conclusions: BAP 65 score is an effective and simple tool to classify the patients presenting with AECOPD, it correlated well with both the need of mechanical ventilation and mortality. Higher the score higher the chances of severe disease.

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Risk Factors Associated with Ischemic Heart Diseases in Different Age Groups Patients of Tertiary Care Hospitals of Peshawar

Journal of Gandhara Medical and Dental Science ◽

10.37762/jgmds.1-2.64 ◽

2015 ◽

Vol 1 (2) ◽

pp. 3-9

Author(s):

Riaz Gul ◽

Sumaira Naz

Keyword(s):

Risk Factors ◽

Heart Diseases ◽

Tertiary Care ◽

Age Groups ◽

Ischemic Heart ◽

P Value ◽

Age Group ◽

Ischemic Heart Diseases ◽

Sedentary Life ◽

Tertiary Care Hospitals

Objectives:To determine different risk factors associated with ischemic heart diseases in different age group patients of tertiary care hospitals of Peshawar.Methodology:A cross sectional study conducted on 350 patients of different age groups presented with ischemic heart diseases in tertiary care hospitals of Peshawar. Study was conducted for duration of 3 months from December 2013 to February 2014. Non probability convenient sampling technique was used. Sample size was calculated using standard sample size calculator. Semi structured questionnaire was used as data collection tool. Patient’s record and investigations were used as adding tools. Standard definition was made for ischemic heart disease. Different modifiable and non-modifiable factors were assessed and were analyzed using SPSS version 16.Results:This study contains 350 patients in which female patients were 133(38%) and male were 217(62%).The mean age was 57.23±11.36 years. The age of the patients ranges from 22 to 80 years. The frequencies of risk factors were stress (73.1%) followed by hypertension (65.7%), sedentary life style (59.4%), family history (57.1%), smoking (50.6%), over weight and obese (39.1%), below normal HDL (30.3%), high LDL (29.1%), hypertriglyceridemia (28%), hypercholesterolemia (23.7%). 64.3% patients were presenting with acute IHD and 35.7% were with chronic IHD. Stress, HTN, DM and sedentary life style were found to be significantly associated with male gender (p- value <0.05). Age was divided into two groups, <45 years and >45 years. Stress, HTN, DM and hypercholesterolemia had a significant association with >45 years of age group. (P-value <0.05).Conclusion:Stress, HTN, DM, sedentary life styles were the major risk factors. And they were found to be more in male gender and in equal to more than 45 years of age group.

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Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.1.237 ◽

2018 ◽

Vol 35 (1) ◽

Author(s):

Iqra Arshad ◽

Sara Mohsin ◽

Sana Iftikhar ◽

Tahseen Kazmi ◽

Luqman F. Nagi

Keyword(s):

Insulin Therapy ◽

Tertiary Care ◽

Cross Sectional Study ◽

Early Initiation ◽

P Value ◽

Diabetic Patients ◽

Cross Sectional ◽

Creative Commons ◽

Oral Medications ◽

Tertiary Care Hospitals

Background and Objective: Initiation of Insulin therapy during earlier stages has proved to significantly improve health outcomes among diabetics in comparison to oral medications. Not only patients but physicians are also often resistant to early initiation of insulin therapy. The objective was to assess misconceptions and barriers to early initiation of insulin therapy among diabetic patients coming to a diabetic clinic. Methods: This cross sectional study was conducted on 300 patients selected by convenience sampling arriving in Diabetes Outdoor Clinics of Mayo and Services Hospitals, Lahore during August 2017 to May 2018. The data was entered and analyzed by using SPSS version 17. Results: Out of 300 patients included in study, 39% (n= 117) were males and 61% (n=183) were females. The mean age of the participants at presentation was 48.46±13.15 years with a range of 13 to 80 years. Study participants considered it embarrassing to inject insulin in public place (p-value 0.01). The fear associated with lifelong commitment to insulin therapy once it is started, was also found statistically significant (p-value 0.001)particularly in subjects who have long duration of DM (>5 years). Conclusion: Perceptions of diabetic patients about insulin therapy are still barriers to early initiation of therapy and tend to prevail in Pakistan and around the globe. How to cite this:Arshad I, Mohsin S, Iftikhar S, Kazmi T, Nagi LF. Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.237 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.

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MATERNAL SEPSIS;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.05.3239 ◽

2019 ◽

Vol 26 (05) ◽

Author(s):

Fehmida Parveen Memon ◽

Majida Khan ◽

Samya Aijaz

Keyword(s):

Maternal Morbidity ◽

Tertiary Care ◽

Morbidity And Mortality ◽

University Hospital ◽

P Value ◽

Care Hospital ◽

Maternal Complications ◽

Cross Sectional ◽

Maternal Morbidity And Mortality ◽

Maternal Sepsis

Objectives: To determine the thrombocytopenia as marker of maternal sepsis and its related maternal morbidity and mortality at tertiary care Hospital. Study Design: Cross-sectional study. Setting: Gynaecological and Obstetrical department of Liaquat University Hospital, Hyderabad. Period: 6 months from March 2017 to August 2017. Material and Methods: All the pregnant females with diagnosis of sepsis were enrolled in the study. All the females with chronic hepatitis were excluded. After complete clinical examination every women underwent 5cc blood sample for complete blood picture. Thrombocytopenia was characterized as a platelet count below 150.000/mm3. Data regarding maternal mortality and maternal complications was filled in the proforma. Results: Total 120 septic mothers were included in the study, 70 patients had thrombocytopenia and 50 were with normal platelets. Most of the women 71.7% were with age groups of 20-30 years. Out of total women 65.0% were un-booked. According to the maternal morbidity, septic shock was most common 36.7%, multi-organ failure was in 08.3%, prolonged Hospital stay was in 16.7%, ICU admission occurred in 18.3% patients, while renal failure, respiratory failure, hepatic failure, coagulopathy and metabolic acidosis were found with percentage of 09.2%, 02.5%, 10.8%, 10.8% and 03.3% respectively. Mortality rate was found among 8.3% out of total cases. Almost all complications were higher among women with thrombocytopenia as compare to women with normal platelets level, while statistically p-value was quite insignificant. Mortality was significantly high among patients with thrombocytopenia p-value 0.032. Conclusion: It was concluded that thrombocytopenia is a good marker for adverse outcome among septic mothers. Maternal morbidity and mortality was higher among septic women with thrombocytopenia.

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Platelet Count in Patients with Mild Disease at Admission is Associated with Progression to Severe Hantavirus Cardiopulmonary Syndrome

Viruses ◽

10.3390/v11080693 ◽

2019 ◽

Vol 11 (8) ◽

pp. 693 ◽

Cited By ~ 1

Author(s):

René López ◽

Cecilia Vial ◽

Jerónimo Graf ◽

Mario Calvo ◽

Marcela Ferrés ◽

...

Keyword(s):

Mechanical Ventilation ◽

Platelet Count ◽

Severe Disease ◽

Tertiary Care ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Mild Disease ◽

Laboratory Variables ◽

Advanced Support ◽

Tertiary Care Centers

Background: Hantavirus cardiopulmonary syndrome (HCPS) has a mortality up to 35–40% and its treatment is mainly supportive. A variable to predict progression from mild to severe disease is unavailable. This study was performed in patients with documented infection by Andes orthohantavirus, and the aim was to find a simple variable to predict progression to moderate/severe HCPS in patients with mild disease at admission. Methods: We performed a retrospective analysis of 175 patients between 2001 and 2018. Patients were categorized into mild, moderate, and severe disease according to organ failure and advanced support need at hospital admission (e.g., mechanical ventilation, vasopressors). Progression to moderate/severe disease was defined accordingly. Clinical and laboratory variables associated with progression were explored. Results: Forty patients with mild disease were identified; 14 of them progressed to moderate/severe disease. Only platelet count was different between those who progressed versus those that did not (37 (34–58) vs. 83 (64–177) K/mm3, p < 0.001). A ROC curve analysis showed an AUC = 0.889 (0.78–1.0) p < 0.001, with a platelet count greater than 115K /mm3 ruling out progression to moderate/severe disease. Conclusions: In patients with mild disease at presentation, platelet count could help to define priority of evacuation to tertiary care centers.

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Surgical-site infections in emergency abdominal paediatric surgeries at a tertiary-care hospital in Pakistan

Journal of the Pakistan Medical Association ◽

10.47391/jpma.1107 ◽

2020 ◽

pp. 1-9

Author(s):

Ali Faisal Saleem ◽

Huma Faiz Halepota ◽

Hasaan Omar ◽

Areeba Zain ◽

Muhammad Arif Mateen Khan

Keyword(s):

Abdominal Surgery ◽

Surgical Site Infection ◽

Tertiary Care ◽

Stable Condition ◽

University Hospital ◽

P Value ◽

Care Hospital ◽

Site Infection ◽

Significant Difference ◽

Pathogen Occurrence

Abstract A retrospective chart review was carried out in children (neonates to 18 years) who underwent acute surgical abdominal exploration during 2012-2016 at the Aga Khan University Hospital, Karachi, to evaluate the post-operative surgical site infection rates in emergency paediatric abdominal surgery. Incidence of surgical site infection (SSI) was estimated. P-value was calculated, chi-square and non-parametric tests were performed by comparing pre-surgical and post-surgical procedure pathogen occurrence and pre-procedure wound status. Pathogen occurrence related to time-trend of 98 paediatric patients who underwent emergency abdominal surgery was plotted. Of the 94 who were discharged in stable condition, it was found that there was no significant difference between pre- and post-surgical pathogens. Escherichia coli (n=10) was found to be the most common pathogen. Contaminated wounds were associated with higher SSI (p=0.036, OR 1.95 95% CI 0.7-5.4). Continuous...

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Prevalence of Nontuberculous Mycobacteria among Extrapulmonary Tuberculosis Cases in Tertiary Care Centers in Northern India

BioMed Research International ◽

10.1155/2015/465403 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 15

Author(s):

A. K. Maurya ◽

V. L. Nag ◽

S. Kant ◽

R. A. S. Kushwaha ◽

M. Kumar ◽

...

Keyword(s):

Targeted Therapy ◽

Nontuberculous Mycobacteria ◽

Extrapulmonary Tuberculosis ◽

Tertiary Care ◽

Rapid Identification ◽

Northern India ◽

Tertiary Care Centers ◽

Tertiary Care Hospitals ◽

Culture Positive ◽

Final Confirmation

The reports of nontuberculous mycobacteria (NTM) associated with extrapulmonary diseases are increasing in tertiary care hospitals. Despite a significant increase in knowledge about NTM infections, they still represent a diagnostic and therapeutic challenge. The aim of this study is to know the prevalence of NTN among extrapulmonary tuberculosis cases in tertiary care centers in Northern India. A total of 227 culture positive isolates from 756 cases were tested for niacin production and catalase assay. BIO-LINE SD Ag MPT64 TB test and final identification and differentiation between MTBC and different species of NTM were further confirmed by GenoType Mycobacterium CM/AS assay. 71 cases (9.3%) were positive for AFB by ZN staining and 227 cases (30.1%) were positive for mycobacteria by culture. Niacin production and catalase activity were negative in 62/227 (27.4%) strains and after using a panel of different biochemicals and final confirmation by GenoType Mycobacterium CM assay. Out of 227 cultures tested, 165 (72.6%) strains were confirmed asM. tuberculosiscomplex, and 62 (27.4%) were confirmed as NTM. The most common NTM species identified wereM. fortuitum17 (27.5%) andM. intracellulare13 (20.9%). The rapid identification of NTM species may help in targeted therapy and management of the diseases.

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