Micro-Elimination of Hepatitis C among Patients with Kidney Disease by Using Electronic Reminder System—A Hospital-Based Experience

Background: Little is known about the use of an electronic reminder system for HCV screening among patients with kidney disease. In this study, we tried to determine whether reminder systems could improve the HCV screening rate in patients with kidney disease. Methods: Patients with kidney disease were enrolled from August 2019 to December 2020 to automatically screen and order HCV antibody and RNA testing in outpatient departments. Results: A total of 19,316 outpatients with kidney disease were included, and the mean age was 66.5 years. The assessment rate of HCV antibody increased from 53.1% prior to the reminder system to 79.8% after the reminder system (p < 0.001), and the assessment rate of HCV RNA increased from 71% to 82.9%. The anti-HCV seropositivity rate decreased from 7.3% at baseline to 2.5% after the implementation of the reminder system (p < 0.001), and the percentage of patients with detectable HCV RNA among those with anti-HCV seropositivity decreased from 69.1% at baseline to 46.8% (p < 0.001). Conclusions: The feasibility of an electronic reminder system for HCV screening among patients with kidney disease in a hospital-based setting was demonstrated.

Integration of Systematic Screening for Tuberculosis in Outpatient Departments of Urban Primary Health-Care Facilities in Zambia: A Case Study of Kitwe District

Background Tuberculosis (TB) is the leading cause of death from a single infectious agent globally, yet 3 million cases are missed every year. The World Health Organization recommends systematic screening of suspected active TB patients among those visiting the healthcare facilities. While many countries have scaled-up systematic screening of TB, there has been limited assessment of the extent of its integration into the health system. This study sought to explore factors that shaped the integration of systematic screening of TB in outpatient departments of primary healthcare facilities in Kitwe district, Zambia. Methods This was a qualitative case study with health providers including district managers, TB focal point persons and laboratory personnel working in six purposively selected primary healthcare facilities. Data was collected through key informant (n=8) and in-depth (n=15) interviews. Data analysis was conducted using QDA Miner software and guided by Atun’s Integration framework. Results Integration was facilitated by perceptions of the magnitude of the TB burden, alignment of the intervention with national TB aspirations, knowledge of stakeholder interests, power and values, regular performance management and intra-facility collaboration. Constraining factors included external partners’ influence in the TB screening program, unbalanced incentivization mechanisms, donor-driven financing and social determinants of health such as gender and stigma including the COVID-19 pandemic. Conclusion Systematic screening of TB is not well integrated into the primary healthcare facilities to capture all those suspected with active TB that make contact with the health system. Finding the missing TB cases will, therefore, require contextual adaptation of the systematic screening for TB and strengthening the health system.

A study on referral of patients in Department of Psychiatry at Lumbini Medical College and Teaching Hospital

Introduction: In a developing country like Nepal, where there is inadequate awareness but more social stigma towards psychiatric illnesses among people, there is an important role of referral psychiatry. Referral psychiatry has been considered to be an interface between psychiatric and non-psychiatric medicines as practiced in general hospital settings. This study analyses the psychiatric problems among patient referred to psychiatry department from other outpatient departments and emergency department in a tertiary care centre. Methods: This was a descriptive hospital-based study conducted among patients who were referred to psychiatry department from different outpatient departments of Lumbini Medical College and Teaching Hospital from November 1, 2019 to April 30, 2020. Ethical issues were considered strictly. Data were entered into Statistical Package for the Social Sciences version 21.0 and descriptive analysis was done. Results: A total of 781 patients were referred out of which more than half (n=487, 62.35%) were females and the most common age group was 41 to 50 years (n=175, 22.4%). Majority of patients (n=284, 36.4%) were referred from medicine department. The most common psychiatric illness diagnosed were those included under International Classification of Diseases 10th Revision F40-48 (Anxiety, Dissociative, Stress-related, Somatoform and other Non-Psychotic Mental Disorders). Conclusions: Referral psychiatry plays an important role to diagnose the undiagnosed psychiatric illnesses earlier and better and manage accordingly so it should be prioritized and practiced in health centers.

Impact of The COVID-19 Pandemic on the Malaria Burden in Northern Ghana: Analysis of Routine Surveillance Data

Introduction: The COVID-19 pandemic and its collateral damage severely impact health systems globally and risk to worsen the malaria situation in endemic countries. Malaria is a leading cause of morbidity and mortality in Ghana. This study aims to analyze routine surveillance data to assess possible effects on the malaria burden in the first year of the COVID-19 pandemic in the Northern Region of Ghana. Methods: Monthly routine data from the District Health Information Management System II (DHIMS2) of the Northern Region of Ghana were analyzed. Overall outpatient department visits and malaria incidence rates from the years 2015 to 2019 were compared to the corresponding data of the year 2020. Results: Compared to the corresponding periods of the years 2015 to 2019, overall visits and malaria incidence in pediatric and adult outpatient departments in northern Ghana decreased in March and April 2020, when major movement and social restrictions were implemented in response to the pandemic. Incidence slightly rebounded afterwards in 2020 but stayed below the average of the previous years. Data from inpatient departments showed a similar but more pronounced trend when compared to outpatient departments. In pregnant women, however, malaria incidence in outpatient departments increased after the first COVID-19 wave. Discussion: The findings from this study show that the COVID-19 pandemic affects the malaria burden in health facilities of Ghana, with declines in in- and outpatient rates. Pregnant women may experience reduced access to intermittent preventive malaria treatment and insecticide treated nets, resulting in subsequent higher malaria morbidity. Further data from other African countries, particularly on community-based studies, are needed to fully determine the impact of the pandemic on the malaria situation.

Prevalence of unrecognized depression and associated factors among medical outpatient department attendees; a cross sectional study

Objectives To determine the prevalence and associated factors of unrecognized depression among patients who visit non-psychiatric outpatient departments in the University of Gondar specialized teaching hospital. North West Ethiopia. Methods An institution-based cross-sectional study was conducted among Medical outpatient departments in the University of Gondar specialized referral hospital from March to April 2019. We collected data through face-to-face interviews. We recruited 314 participants for face-to-face interviews using the systematic random sampling technique. The patient health questionnaire (PHQ-9) was used to measure depression. Coded variables were entered into Epi Info version 7 and exported to SPSS version 20 for analysis. Descriptive statistics and multivariable logistic regression analysis were used. Adjusted odds ratios (AOR) with a 95% confidence interval were used to calculate significance. Results A total of 314 participants were interviewed with a response rate of 100%. The prevalence of depression was 15.9% with (95% CI (12.1–20.1)). In the multivariate logistic regression revealed that, able to read and write (AOR = 0.24, 95% CI (0.67–0.84)), secondary education (AOR = 0.34, 95% CI (0.12–0.91)), education in college and university level (AOR = 0.32, 95% CI (0.13–0.78)), poor social support (AOR = 7.78, 95% CI (2.74–22.09)), current cigarette smokers(AOR = 12.65, 95% CI (1.79–89.14)) were associated with depression. Conclusion The prevalence of depression among outpatient attendees was high. We recommend an early depression screening be carried out by health professionals.

An Observational Study of Physicians' Workflow Interruptions in Outpatient Departments in China

Background: Workflow interruptions are frequent in hospital outpatient clinics. Eventually, not only reducing the work efficiency and quality, but also further threatening patient safety. Over the last 10–15 years, research on workflow interruptions in inpatient care has increased, but there is a lack of research on the interruptions in outpatient clinics. The present study aimed to study the differences in physicians' workflow interruptions among outpatient departments in the tertiary hospital in China.Methods: In a tertiary hospital, a standardized observational study of 32 doctors' workflow in outpatient department of four typical clinical specialties was conducted. The record of workflow interruptions was based on a self-made observation instrument after verifying its reliability and validity. Linear regression methods were used to assess outpatient characteristics as predictors of the number of interruptions. The Kruskal-Wallis test was used to analyze the difference about the duration of interruptions among specialties, and the Chi-Square Test was used to examine the sources of interruptions among different specialties, to determine whether interruption source is associated with specialty.Results: The number of patients was the significant independent predictor of the number of interruptions(p<0.001). In terms of work tasks being interrupted, the highest interruption rate occurred when physicians were asking health history: 19.95 interruptions per hour. The distribution of interruption sources among the four clinical specialties were statistically different (Χ2 =16.988, p = 0.049). Conclusion: The findings indicate that physicians' workflow interruptions are connected with many contents in the work system. Further emphasis should be placed on the effective application of hospital management measures in an interrupted environment to promote a safe and efficiency outpatient care.

Impact of the COVID-19 pandemic on the malaria burden in northern Ghana: Analysis of routine surveillance data

Introduction: The COVID-19 pandemic and its collateral damage severely impact health systems globally and risk to worsen the malaria situation in endemic countries. Malaria is a leading cause of morbidity and mortality in Ghana. This study aims to analyze routine surveillance data to assess possible effects on the malaria burden in the first year of the COVID-19 pandemic in the Northern Region of Ghana. Methods: Monthly routine data from the District Health Information Management System II (DHIMS2) of the Northern Region of Ghana were analyzed. Overall outpatient department visits and malaria incidence rates from the years 2015 to 2019 were compared to the corresponding data of the year 2020. Results: Compared to the corresponding periods of the years 2015 to 2019, overall visits and malaria incidence in pediatric and adult outpatient departments in northern Ghana decreased in March and April 2020, when major movement and social restrictions were implemented in response to the pandemic. Incidence slightly rebounded afterwards in 2020 but stayed below the average of the previous years. Data from inpatient departments showed a similar but more pronounced trend when compared to outpatient departments. In pregnant women, however, malaria incidence in outpatient departments increased after the first COVID-19 wave. Discussion: The findings from this study show that the COVID-19 pandemic affects the malaria burden in health facilities of Ghana, with declines in in- and outpatient rates. Pregnant women may experience reduced access to intermittent preventive malaria treatment and insecticide treated nets, resulting in subsequent higher malaria morbidity. Further data from other African countries, particularly on community-based studies, are needed to fully determine the impact of the pandemic on the malaria situation.

COMPARISON OF SPIROMETRY DATA AND SYMPTOMS BETWEEN MALE AND FEMALE SMOKERS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

BACKGROUND & OBJECTIVE: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous disease, showing the exaggerated response of airways to any injurious stimulus. It is no longer considered as the disease of men as it is becoming increasingly prevalent in females. Evidence suggests that gender affects the clinical presentation of the disease. The objectives of the study is to compare spirometry data between male and female smokers with COPD and to study the association of cough, sputum, and dyspnea with gender in smokers with COPD. METHODOLOGY: This descriptive study was conducted at the University of Health Sciences Lahore. The study sample included 41 COPD patients with a history of smoking. After taking written informed consent, patients were recruited from the outpatient departments of tertiary care hospitals of Lahore by convenience sampling technique. A complete history was taken, and spirometry was done on each subject. The subjects were divided into male and female groups, followed by the comparison of Spirometry data between the groups and association of symptoms with gender using appropriate statistical techniques. RESULTS: The results of this study demonstrated females were significantly younger and exhibited a greater decline of lung functions with similar pack-years history compared to male smokers with COPD. The most common presentation of females was breathlessness compared to male patients, who had sputum production as the most common presentation. CONCLUSION: Significant differences were seen in spirometry and clinical presentation of the disease in male and female COPD groups, showing the onset and symptomology of the disease.

Evaluation of Staff Satisfaction After Implementation of a Routine Work Checklist in An Oral Outpatient Department and Its Effect On Work Efficiency

Background: To evaluate the feasibility, effectiveness and sustainability of using a checklist in the routine work of a stomatological outpatient department and investigate the satisfaction of the nursing staff with the checklist.Methods: The study was divided into two stages: design and manufacture the checklist and apply the checklist. After the expert group performed stage one, an analysis of work efficiency and work omissions and a survey of staff satisfaction were carried out. The results of the groups either using the checklist (n = 30) or not (n = 30) were analysed and compared.Results: The average time of the checklist group was 15.20±1.70 min, and the average time of the nonchecklist group was 25.30±2.70 min, P < 0.001. The working efficiency of the checklist group was significantly higher than that of the nonchecklist group. The omission rate was 0% in the checklist group and 16.67% in the nonchecklist group. Staff satisfaction with the use of the checklist was high.Conclusion: The checklist can make routine work more efficient and convenient in a stomatological outpatient department. It is recommended for use in stomatological outpatient departments or hospitals.

The Impact of the COVID-19 Pandemic on Medical Imaging Case Volumes in Aseer Region: A Retrospective Study

COVID-19 has had a significant impact on global health systems. The aim of this study was to evaluate how imaging volumes and imaging types in radiology departments have been affected by the COVID-19 pandemic across different locations. Methods: Imaging volumes in the Aseer region (in the south of Saudi Arabia) across main hospitals were reviewed retrospectively including all cases referred from different locations (outpatient, inpatient and emergency departments). Data for years 2019 and 2020 were compared. The mean monthly cases were compared using a t-test. Results: The total imaging volumes in 2019 were 205,805 compared to 159,107 in 2020 with a 22.7% overall reduction. A substantial decline was observed in both the April to June and the July to September periods of approximately 42.9% and 44.4%, respectively. With respect to location, between April and June, the greatest decline was observed in outpatient departments (76% decline), followed by emergency departments (25% decline), and the least impact was observed in inpatient departments, with only 6.8% decline over the same period. According to modality type, the greatest decreases were reported in nuclear medicine, ultrasound, MRI, and mammography, by 100%, 76%, 74%, and 66%, respectively. Our results show a statistically significant (p-value ≤ 0.05) decrease of cases in 2020 compared to 2019, except for mammography procedures. Conclusion: There has been a significant decline in radiology volumes due to COVID-19. The overall reduction in radiology volumes was dependent on the stage/period of lockdown, location, and imaging modality.