Parental compliance for speech therapy of their hearing-impaired children using cochlear implants

Background: Cochlear implant is a miraculous surgery to improve hearing in profound hearing-impaired children who derive no benefit from hearing aids and consequently present with speech and language disability. This study aims to explore the parental perspective regarding compliance to speech therapy and its potential benefit in hearing-impaired children with cochlear implantation. This will help understand parental concerns and plan recommendations for providing appropriate speech therapy sessions after cochlear implantation. Subjects and methods: This cross-sectional study using purposive sampling recruited 217 parents of hearing impaired cochlear implanted children of both genders, aged 1 to 15 years. Sample was collected from Audiology Department of Riphah International University, Combined Military Hospital, Bahria Town Hospital and Alam Audiology Clinic, Lahore, Pakistan over a period of 6 months. Basic demographic sheet and self-structured questionnaire was used for data collection. SPSS Version 22 was used for data analysis. Results: Results revealed that both parents of 120 (55.3%) male and 97 (44.7%) female cochlear implanted children entered the study. A poor compliance was noted with only 88(40.55%) parents got their children consulted with a speech therapist for post implant needs and of these only 75 (84.23%) received regular speech therapy. There was significant association of those who received hearing aid trial and consultation to speech therapist (p=0.01) and length of speech therapy with regular therapy sessions (p=0.03), speech language improvement with the thought that regular speech therapy was important (p=0.04) Conclusion: By and large parents are not very compliant to speech therapy needs of their implanted children with only 40.55% consulted speech language therapists and remaining remained indifferent. Of the 40.55% who consulted speech language therapists 84.23% followed speech therapy for their children. Study also revealed a significant relationship between regular speech therapy sessions and early speech and language development.

A Cross Sectional Study of Chronic Liver Disease with Reference to Portal Hypertension and Endoscopic Finding at Down Town Hospital, Guwahati, Assam

BACKGROUND Cirrhosis is a progressive clinical condition associated with considerable mortality and morbidity. It leads to a wide spectrum of characteristic clinical manifestations, mainly attributable to hepatic insufficiency and portal hypertension.1 In cirrhosis, primary diagnostic test for evaluation of upper-gastro-intestinal bleeding (UGIB) is endoscopy.2 The present study attempts to find out different clinical patterns of the chronic liver disease (CLD) with portal hypertension along with the endoscopic profile of the patients. METHODS It was a cross sectional study conducted in Down Town Hospital, Guwahati, Assam. RESULTS A cross sectional study was conducted at Downtown Hospital, Guwahati, Assam on patients diagnosed with chronic liver disease from 01 January 2017 to 31 January 2018. Male predominance was observed in this study with 84 % males and 16 % females. Male to female ratio was 5.25 : 1. Maximum patients (58 %) were observed in the age group of 40 to 60 years followed by 30 % in the age group of 60 to 80 years. The average age was 53.6 years. Most common aetiological factor was alcohol (66 %) followed by non-alcoholic steatohepatitis (NASH) (16 %). Other aetiologies were hepatitis-B, hepatitis-C and cryptogenic. 88 % cases were recorded in model for end stage liver disease (MELD) score range of 10 to 29. Ascites was noted in 88 % cases, of which 20 % had grade-1 and grade-2, 48 % had grade-3. Splenomegaly was noted in 70 % cases. Child-Pugh class-C consisted of 26 % cases (13) with grade-III varices followed by 18 % cases (9) with grade-II varices while Child-Pugh Class-B had 24 % cases (12) and 8 % cases (4) with grade-III and grade-II varices respectively. Child-Pugh class-A had all the cases with grade-I varices. CONCLUSIONS Alcoholism was the leading cause for cirrhosis followed by hepatitis-B, hepatitis-C, NASH and cryptogenic. Class-C had maximum number of cases with grade-III varices followed by class-B. MELD score ranged between 10 - 29 in majority. Severe anaemia was noted in 10 % cases. Thrombocytopenia a non-invasive indicator of oesophageal varices was noted in 70 % with different grades of oesophageal varices. KEYWORDS Endoscopy, Portal Hypertension, Chronic Liver Disease

Model to assess workload of village doctors in the National Essential Public Health Services Program in six provinces of China

Background No studies, particularly quantitative analyses, have been conducted regarding the workload of village doctors in the National Essential Public Health Services (NEPHS) program and differences in service delivery by village doctors, according to region and services. In this study, we developed a quantitative analysis approach to measure the workload of NEPHS provided by village doctors in six provinces of China in 2016. We aimed to identify areas and services of the NEPHS needing improvement, so as to implement targeted measures to ensure adequate delivery of NEPHSs in rural remote underserved areas. Methods Based on survey data from 300 town hospital centers (THCs) located in 60 counties in the six selected provinces, we calculated village doctors’ share of workload under the NEPHS using the equivalent value (EV) model. To define the workload and corresponding EV of each NEPHS, a series of five meetings was held with THC managers, public health workers, family physicians, nurses and village doctors. Field observations were conducted to verify the workload and EV of each service. Results Village doctors’ share of the workload under the NEPHS program was 43.71% across the 300 sampled THCs in six provinces. The village doctors’ workload shares for different NEPHS ranged from 17.14 to 57.00%. The percentage workload undertaken by village doctors under the NEPHS program varied across different provinces, with the highest proportion 63.4% and the lowest 28.5%. Conclusions The total NEPHS workload assigned to village doctors by THCs in the six sampled provinces exceeded the Chinese government’s requirement of 40%, but the workload proportion in some provinces was less than 40%. In addition, the percentage workload for some NEPHS undertaken by village doctors was lower than others. We suggest conducting district-level analysis of the workload among village doctors under the NEPHS program using the EV method, to identify areas and services needing improvement, to implement targeted measures to expand and promote health service provision in China’s rural underserved areas.

Model to assess workload of village doctors in the National Essential Public Health Services Program in six provinces of China

Background: No studies, particularly quantitative analyses, have been conducted regarding the workload of village doctors in the National Essential Public Health Services (NEPHS) program and differences in service delivery by village doctors, according to region and services. In this study, we developed a quantitative analysis approach to measure the workload of NEPHS provided by village doctors in six provinces of China in 2016. We aimed to identify areas and services of the NEPHS needing improvement, so as to implement targeted measures to ensure adequate delivery of NEPHSs in rural remote underserved areas.Methods: Based on survey data from 300 town hospital centers (THCs) located in 60 counties in the six selected provinces, we calculated village doctors’ share of workload under the NEPHS using the equivalent value (EV) model. To define the workload and corresponding EV of each NEPHS, a series of five meetings was held with THC managers, public health workers, family physicians, nurses and village doctors. Field observations were conducted to verify the workload and EV of each service.Results: Village doctors’ share of the workload under the NEPHS program was 43.71% across the 300 sampled THCs in six provinces. The village doctors’ workload shares for different NEPHS ranged from 17.14% to 57.00%. The percentage workload undertaken by village doctors under the NEPHS program varied across different provinces, with the highest proportion 63.4% and the lowest 28.5%.Conclusions: The total NEPHS workload assigned to village doctors by THCs in the six sampled provinces exceeded the Chinese government’s requirement of 40%, but the workload proportion in some provinces was less than 40%. In addition, the percentage workload for some NEPHS undertaken by village doctors was lower than others. We suggest conducting district-level analysis of the workload among village doctors under the NEPHS program using the EV method, to identify areas and services needing improvement, to implement targeted measures to expand and promote health service provision in China’s rural underserved areas.

Model to assess workload of village doctors in the National Essential Public Health Services Program in six provinces of China

Background: No studies, particularly quantitative analyses, have been conducted regarding the workload of village doctors in the National Essential Public Health Services (NEPHS) program and differences in service delivery by village doctors, according to region and services. In this study, we developed a quantitative analysis approach to measure the workload of NEPHS provided by village doctors in six provinces of China in 2016. We aimed to identify areas and services of the NEPHS needing improvement, so as to implement targeted measures to ensure adequate delivery of NEPHSs in rural remote underserved areas.Methods: Based on survey data from 300 town hospital centers (THCs) located in 60 counties in the six selected provinces, we calculated village doctors’ share of workload under the NEPHS using the equivalent value (EV) model. To define the workload and corresponding EV of each NEPHS, a series of five meetings was held with THC managers, public health workers, family physicians, nurses and village doctors. Field observations were conducted to verify the workload and EV of each service.Results: Village doctors’ share of the workload under the NEPHS program was 43.71% across the 300 sampled THCs in six provinces. The village doctors’ workload shares for different NEPHS ranged from 17.14% to 57.00%. The percentage workload undertaken by village doctors under the NEPHS program varied across different provinces, with the highest proportion 63.4% and the lowest 28.5%.Conclusions: The total NEPHS workload assigned to village doctors by THCs in the six sampled provinces exceeded the Chinese government’s requirement of 40%, but the workload proportion in some provinces was less than 40%. In addition, the percentage workload for some NEPHS undertaken by village doctors was lower than others. We suggest conducting district-level analysis of the workload among village doctors under the NEPHS program using the EV method, to identify areas and services needing improvement, to implement targeted measures to expand and promote health service provision in China’s rural underserved areas.

P152590 DAY MORTALITY DATA OF PATIENTS INITIATING MAINTENANCE HEMODIALYSIS AT A TERTIARY CARE FACILITY IN PAKISTAN

Background and Aims Mortality of end stage renal disease patients is 10 to 30 times higher than that of the general population. Timing of death related to dialysis vintage remains unclear. Mortality risk among hemodialysis patients may be highest soon after initiation of hemodialysis, the reason for which remains elusive. Additionally mortality on initiating hemodialysis is related to arteriovenous vascular access. Poor planning for dialysis initiation may contribute to hemodialysis catheter use and the associated high rate of infections. This study was carried out to determine the 90-day mortality in patients starting maintenance hemodialysis at a tertiary care facility in Pakistan. Method This is a cross sectional study which included all consecutive patients who initiated maintenance hemodialysis at Bahria Town Hospital Lahore. A total of 485 participants were included and the collected data was entered into the SPSS software and their mortality rate was calculated within 90 days after initiation of maintenance hemodialysis. Additionally 90-day mortality based on type of vascular access at initiation was also noted. Results The mean age of the participants included in the study was 44 with 50% of the patients were male. The 90-day mortality of patients initiating maintenance hemodialysis at our centre was found to be 37%. 90% of the patients initiating maintenance hemodialysis started through a double lumen temporary dialysis catheter. Amongst these patients the mortality rate was 39%. 10% of the patients initiating maintenance hemodialysis started through an arteriovenous fistula. Amongst these the mortality rate was 19%. Conclusion Our study showed that the mortality rate is high in patients undergoing hemodialysis with in first 90 days. Early planning for permanent vascular access may result in a reduction of mortality.

Model to assess workload of village doctors in the National E sential Public Health Services Program in six provinces of China

Background: Village doctors face many challenges in providing the National Essential Public Health Service (NEPHS) program, and many factors affect the provision of these services. However, there are no studies (particularly quantitative analyses) regarding the workload of public health services provided by village doctors. In this study, we aimed to develop a quantitative analysis approach to measure the workload of NEPHS provided by village doctors in six provinces of China in 2016. Methods: Based on survey data from 300 town hospital centers (THCs) located in 60 counties in the six selected provinces, we calculated village doctors’ share of workload under the NEPHS using the equivalent value (EV) model. To define the workload and corresponding EV of each NEPHS, a series of five meetings was held with THC managers, public health workers, family physicians, nurses and village doctors. Field observations were conducted to verify the workload and EV of each service. Results: Village doctors’ share of the workload under the NEPHS program was 47.0% across the 300 sampled THCs in six provinces. The village doctors’ workload shares for different NEPHS ranged from 17.1% to 57.0%. The percentage workload undertaken by village doctors under the NEPHS program varied across different provinces, with the highest proportion 63.4% and the lowest 28.5%. Conclusions: The total NEPHS workload assigned to village doctors by THCs in the six sampled provinces exceeded the Chinese government’s requirement of 40%, but the workload proportion in some provinces was less than 40%. We suggest that local governments conduct district-level analysis of the workload among village doctors under the NEPHS program using the EV method, to identify priorities and influencing factors and implement targeted measures to promote health service provision. An EV model of the NEPHS could be built to monitor village doctors’ workload and ensure that assigned workloads are manageable.

The Zemun hospital (1784-2020): A short history of the oldest hospital in Serbia

The Zemun Hospital - "Zemun" Medical Center is the oldest medical institution in Serbia that has been operating without interruption throughout its existence. Different dates have been noted in the literature related to its opening, but the one most often mentioned is February 25, 1784, and this date has been confirmed by a document found in the Zemun Magistracy. The first sanitary institution formed in Zemun was the Kontumac, which opened as early as 1730. Shortly after that, two confessional hospitals were also opened. The Serbian (Orthodox Christian) Hospital, which started working before 1769, and the German (Catholic) Hospital opened in 1758. In order to improve the work of these hospitals, a decision was made to merge them into one - the Town Hospital, when the General Command ordered the Magistracy of the Town of Zemun to pool the funds of the existing hospitals and commence work on building a new hospital building. Although financially united, the hospitals continued, for a time, to work in separate buildings. The physical merging of the hospitals was finalized in 1795. From that time to this day the Zemun Hospital has been working without interruption, even in wartime. It has today grown into a modern clinical and teaching center.

Identifikasi Aspergillus fumigatus pada Sputum Pasien Suspek TB Paru

Tuberculosis (TB) is a contagious infectious disease caused by the Mycobacterium tuberculosis, which can attack various organs especially the lungs. In some cases, there is a misdiagnosis between pulmonary tuberculosis and pulmonary mycosis (lung fungus). One of the species of fungus that often causing infection in the lungs is Aspergillus fumigatus.This study aims to identify Aspergillus fumigatus in sputum patients suspected of pulmonary tuberculosis patients at General Hospital in Baubau City. The types of research is descriptive with accidental sampling technique. Research was carried out by examining the BTA status of patients using the GeneXpert device and the patients sputum were isolated into Potato Dextrose Agar (PDA) medium then examined in macroscopic and microscopic (slide culture). Result of the study of 27 samples sputum patients suspected of pulmonary tuberculosis in Baubau Town Hospital obtained patients who infected Aspergillus fumigatus fungus amounted to 3 people with 2 including identified fungi with positive BTA status. Conclusion patients infected with Aspergillus fumigatus amounted to 3 people (7.4%) and 2 people (3.4%) identified fungi with positive pulmonary tuberculosis

Heart injuries: main clinical symptoms

Injuries to the heart are uncommon in peacetime, yet they result in life-threatening conditions, which makes timely diagnostics a crucial factor in saving patients' lives. In this connection, it is important to define the main signs of heart injuries. This study aimed to analyze the basic clinical symptoms associated with various wounds to the heart. We have retrospectively analyzed such symptoms registered in 86 patients with varying chest injuries that affect the heart. All patients were treated in the emergency surgery unit of the Engels Town Hospital from 1991 to 2017. 41 (47.6%) patient had stab wounds, and there were 45 (52.3%) cases of gunshot wounds. 23 (26.7%) patients had chest injuries affecting heart exclusively, while for 63 (73.2%) the consequences were wounds to other organs. We found that the clinical picture depends on the kind of injury to the heart: stab and slash wounds translate into more pronounced symptoms, while gunshot wounds do not produce such an effect. Accepting patients, practitioners should take this fact into account. The misdiagnosis rate for stab and slash heart wounds is 9.7%, that for gunshot wounds — 17.7%, the latter being the result of vagueness of the clinical picture. The clinical signs are most pronounced in the cases of stab and slash wounds to the heart.