Total patient load, regional disparities and in-hospital mortality of intubated COVID-19 patients in Greece, from September 2020 to May 2021

Aims: While healthcare services have been expanding capacity during the COVID-19 pandemic, quality of care under increasing patient loads has received less attention. We examined in-hospital mortality of intubated COVID-19 patients in Greece, in relation to total intubated patient load, intensive care unit (ICU) availability and hospital region. Methods: Anonymized surveillance data were analyzed from all intubated COVID-19 patients in Greece between 1 September 2020 and 6 May 2021. Poisson regression was used to estimate the hazard of dying as a function of fixed and time-varying covariates. Results: Mortality was significantly increased above 400 patients, with an adjusted hazard ratio of 1.25 (95% confidence interval (CI): 1.03–1.51), rising progressively up to 1.57 (95% CI: 1.22–2.02) for 800+ patients. Hospitalization outside an ICU or away from the capital region of Attica were also independently associated with significantly increased mortality. Conclusions: Our results indicate that in-hospital mortality of severely ill COVID-19 patients is adversely affected by high patient load even without exceeding capacity, as well as by regional disparities. This highlights the need for more substantial strengthening of healthcare services, focusing on equity and quality of care besides just expanding capacity.

Assessment of MRI-Linac Economics under the RO-APM

The implementation of the radiation oncology alternative payment model (RO-APM) has raised concerns regarding the development of MRI-guided adaptive radiotherapy (MRgART). We sought to compare technical fee reimbursement under Fee-For-Service (FFS) to the proposed RO-APM for a typical MRI-Linac (MRL) patient load and distribution of 200 patients. In an exploratory aim, a modifier was added to the RO-APM (mRO-APM) to account for the resources necessary to provide this care. Traditional Medicare FFS reimbursement rates were compared to the diagnosis-based reimbursement in the RO-APM. Reimbursement for all selected diagnoses were lower in the RO-APM compared to FFS, with the largest differences in the adaptive treatments for lung cancer (−89%) and pancreatic cancer (−83%). The total annual reimbursement discrepancy amounted to −78%. Without implementation of adaptive replanning there was no difference in reimbursement in breast, colorectal and prostate cancer between RO-APM and mRO-APM. Accommodating online adaptive treatments in the mRO-APM would result in a reimbursement difference from the FFS model of −47% for lung cancer and −46% for pancreatic cancer, mitigating the overall annual reimbursement difference to −54%. Even with adjustment, the implementation of MRgART as a new treatment strategy is susceptible under the RO-APM.

Alloimmunisation in sickle cell patients of western Odisha: A tertiary care centre study

RBC carries numerous protein and carbohydrate antigens on their surface. Out of 347 red cell antigens recognized by international society of blood Transfusion, 308 antigens are clustered in 36 blood Group systems. Except naturally occurring anti-A and anti-B antibodies all others are unexpected. Out of these some like Duffy, Kell, Kidd, MNS, P and certain Rh types are considered clinically significant. Only few studies for prevalence of irregular red cell alloantibody have been done. Those studies were done either in general population or in thalassemia patients. Few studies were done on sickle cell disease patients but all are outside India and those are significant. But no studies have been done till now on prevalence of alloantibody in sickle cell disease patients in India. Again the western part of Odisha is with high patient load of sickle cell disease. This study is very useful for this part of Odisha as complication due to the alloantibody can be managed properly. Both the patients and the clinician will be benefited by this study.

'We had to take a hammer to get some roots out' - experiences, motivations and challenges among volunteer dentists: a qualitative study

Objectives To address a gap in the literature by examining the experiences, motivations and challenges among volunteer dentists engaged in short-term missions to low- and middle-income countries.Methods In-depth interviews among volunteer dentists (n = 20) who had provided voluntary dental care in low- or middle-income countries within the preceding five years. Interviews lasted on average 55 minutes and were recorded, transcribed and analysed using NVivo. Routine debriefings complemented analysis. COREQ principles guided this research.Results Motivations to volunteer included: exposure to new dental challenges (enhancing competence); discovering a new setting (tourism); and enhancing the lives of clients (humanitarianism). Volunteers enjoyed undertaking new tasks and developing new skills, but were burdened by a high patient load, challenging clinical conditions, peri- and post-operative complications, and a concern that their work was not addressing root causes of inadequate access to basic dental care. Respondents recommended that more information regarding the vision, equipment status, armamentarium and dental supplies be made available pre-departure, and that more dental schools include training on global oral health. Such measures could facilitate volunteers' abilities to provide care while also enhancing their personal and professional development. Creating an appropriate, sizable and competent capacity-building programme for local dentists was described as essential.

Prevalence of surgical site infection post caesarean with increased patient load during COVID-19 pandemic in tertiary care centre

Background: Increased referrals and workload during the pandemic lead to overcrowding in hospitals and increase in LSCS rates. Surgical site infection is one of the most common complication post LSCS causing physical and mental duress to the patients. The objective of the study was to analyse the effect of COVID-19 on SSI, the incidence, commonly associated factors and bacteriology of SSI. The design was prospective study design.Methods: 577 patients undergoing LSCS were studied from Day 1 till 30 days post LSCS from 1st August 2020 to 31st October 2020.Results: Out of 577, 28 (4.85%) patients developed SSI. 60% of SSI in our study were unbooked, 50% had haemoglobin less than 9.9 g/dl. Most common risk factor for developing of SSI included pre-eclampsia (32.14%) followed by previous LSCS (28.57%). Common organism isolate was MRSA (25%) and 75% required surgical management.Conclusions: Regular ANC visits can help in managing comorbidities at an earlier stage leading to reduction in SSI. Strict aseptic precautions should be followed to reduce SSI in cases with PROM and second stage arrest. SSI rate is not influenced by COVID-19 status but hospital facilities and overcrowding definitely have an effect.

Community awareness regarding dental implant: An exit response study

A community evaluative cross-sectional study was undertaken from patients attending two selected dental clinics of Gurugram to record public awareness regarding Dental implants. The patients agreeing to participate in the interview, through predesigned and pre tested proformas were included. Patients were requested for using a closed ended dichotomized questionnaire by 140 patients during their exit from the clinics from 9 AM to 12 noon period. Since the average patient load in dental clinics were not too crowding; the total coverage of the sample was time consuming. While 63% did not have much information regarding dental implants which can be used to replace missing teeth; only 14% wanted more information regarding implants and 39% were attending the clinic to know about dental implants through dentist. The major difference between Dental Implant and Root Canal Treatment (RCT) was not clear to people.

Dosimetric comparison of radiotherapy treatment plans done by IMRT and VMAT technique in head and neck cancer patients

Background: The increasing patient load in radiotherapy centres demands selection of thetechnique that provides plans with optimal dosimetry in terms of target volume coverage, organs atrisk (OAR) sparing and a lesser treatment time. This study was designed to compare the two widelypractised conformal techniques, IMRT and VMAT in head and neck cancer patients in terms ofplanning target volume (PTV) coverage, OAR sparing and treatment delivery parameters. Materialsand methods: For ten postoperative head and neck cancer patients who had been treated by IMRTtechnique virtual VMAT plans were generated for study purposes. The dose prescribed to PTV was 60Gy in 30 fractions. The dose-volume parameters of PTV and OARs and the treatment deliveryparameters were compared amongst both the techniques. Statistical significance was calculatedusing paired ‘t’ test. Results: Both the plans were comparable in terms of dosimetry. The onlysignificant difference being better conformity in the IMRT plans. The dose to OARs was alsocomparable in both the techniques except for a significant reduction in the point dose to brainstemwith the IMRT technique. Given the treatment delivery parameters, there was a significant reductionin the treatment delivery time and monitor units with the VMAT technique compared to the IMRTtechnique. Conclusion: VMAT technique gave comparable plans to that of the IMRT technique interms of dosimetry but reduced the treatment time. It seems feasible in radiotherapy centres withincreased patient load.

The Accuracy of Documented Nursing Care Plan among Registered Nurses

Background: Nursing documentation is a record of care planned and provided by qualified nurses under the guidance of a competent nurse for each patient as well as the clients. Objective: to provide published studies about accuracy of nursing documentation. Methods: Searches were conducted using the following electronic databases: PUBMED, MEDLIN, CINAHAL, SAUDI DIGETAL LIBRALY and GOOGLE SCOLAR as gray data base. Search was limited to English-Language publication. And include study over 10year period. Result: nursing documentations is inaccurate, lacking precision, and low in quality. Factors that influence nursing documentation differ but are also interrelated with each other. Shortage of employees, insufficient knowledge about the significance of documentation, patient load, lack of hospital education, and lack of support from nurse leaders are the reported challenges to documentation. Conclusion: Most of the lecture revel the necessary need of nursing documentation practice. Affected factor and with several recommendations for improvement noted. Keywords: ''nursing care plan," "nursing documentation,'' "accuracy of documentation" and ''nursing report.''

Strategies for neonatal care during the COVID-19 pandemic: a lower middle-income country perspective

COVID-19 has transformed into an all-encompassing pandemic affecting all levels of healthcare throughout the globe. The strains on healthcare systems have been evident even in the most developed countries. Low and middle income countries (LMICs), especially India, find themselves in a precarious situation due to limited resources, poor healthcare worker population ratios and a bigger population. Multiple factors can exponentially increase the actual effect of a pandemic on the vulnerable neonates and infants even though the disease itself may be less lethal for them. The situation was complicated by the implementation of lockdowns. We discuss the implications for neonatal care that such a pandemic has in LMICs and elucidate the strategies we have implemented to provide continuity of care during the pandemic. We also share our experience of providing neonatal care and summarise the patient load witnessed in a specific context of a level-3 NICU in a government multi-speciality hospital of an LMIC. Keywords: Covid-19 pandemic; Low- and middle-income countries; Neonatal care

Correction to: Validation of the modified Skåne emergency department assessment of patient load (mSEAL) model for emergency department crowding and comparison with international models; an observational study

An amendment to this paper has been published and can be accessed via the original article.