Reducing Waiting Time in the General Pediatric Clinic at Al Wakra Hospital, Qatar

Background: Waiting times for clinic appointments constitute a key indicator of an outpatient department performance for access to care and patient satisfaction. This is particularly relevant for pediatric population. The Ministry of Public Health in Qatar set a waiting time of 28 days for patients to get new appointment in General Outpatient Department (GOPD). The current average waiting time to get a new appointment in the general pediatric clinic (GPC) at AWH is 57 days. Aim: Decrease the average waiting time to get a new clinic appointment from 57 days to 28 days by the end of December 2018, and to meet the national targets set by the Ministry of Public Health. Methodology: This is a Quality Improvement (QI) project using the Model for Improvement (MFI). The MFI framework is designed to support organizations answering fundamental questions before agreeing on drivers for change. The implementation of change was be facilitated by the Plan-Do-Study-Act (PDSA) cycles methodology. The QI project team performed a root cause analysis using the Ishikawa diagram and identified the key contributing factors to the long waiting times to get a new appointment. Twenty-seven PDSA cycle ramps were designed with support of predictive tool to test innovative changes in current operational processes in an attempt to improve waiting time in the general pediatric clinic at Al Wakra Hospital. Results: The monthly average number of referrals for GPC increased by 200% between the pre and post implementation periods. The average triage waiting time improved from 6 to 2.6 days in 2018 and the average become 1 day in 2019. Post-implementation the average waiting time for patients to get new appointment improved from 57 days to 28 days in 2018 and the average waiting time improved to 16 days in 2019. Conclusion: The quality improvement project for the AWH general pediatric clinic demonstrates significant improvement in waiting times for new appointments, the recommendation for the hospital leadership would be to rollout the improvement methodology to other clinics that suffer from similar challenges.

Prevalence of Kidney Stones Among Patients Presenting to Orotta Medical Surgical National Referral Hospital

Background Nephrolithiasis is a condition of having stones in the kidneys, which progressively lead to loss of renal function if untreated properly.1 The prevalence and incidence of kidney stones is increasing across the world.2 Methods A retrospectively collected data of kidney stone disease was reviewed on patients who visited the outpatient department of Orotta Medical Surgical National Referral Hospital from January 2012 to December 2012. Results Out of 30,335 patients 173 were confirmed to have stones making them 0.5%. Generally results show male predominance with male to female ratio of 2.46:1. Results also show prevalence decreases as age increases with the highest among the age group 15-25 making a prevalence rate of 27.7% with observed significance of 0.002. Out of those patients who visited the outpatient department patients from Zoba Maekel were the highest in number (59.9%) followed by Debub (19.1%) while the southern Red Sea Zone had the lowest prevalence (2.3%). Majority of the stones were found on the kidney comprising about 80.3%, followed by ureter 16.8% of patients and 2.9% stones were located on the bladder. When data was reviewed for associated co morbidity only one patient had associated Diabetes mellitus and Hypertension, three had ectopic kidney(1.7%), one had renal cyst (0.6%) and 12 (6.9%) patients were complicated with hydronephrosis. (P=0.548) Conclusions The prevalence of kidney stone in Orotta Medical Surgical National Referral hospital from January to December 2012 is 0.5%, with higher predominance in men than in women with a ratio of 2.46:1.

Clinical pattern of cutaneous infestations in pediatric age group attending a tertiary care centre

<p class="abstract"><strong>Background:</strong> Skin diseases are a serious health concern for children of all ages, and they are linked to a high rate of morbidity. In comparison to adults, children's dermatological problems are more impacted by socioeconomic position, dietary habits, climatic exposure, and the external environment. The purpose of this study was to determine the prevalence of infestations among pediatric patients who visited the dermatology outpatient department in a tertiary care hospital.</p><p class="abstract"><strong>Methods:</strong> From December 2019 to September 2020, all newly diagnosed, untreated male and female pediatric patients (from neonates to adolescents of 14 years of age) attending dermatology outpatient department (OPD) were assessed to determine the prevalence of Infestations within the pediatric population. A thorough history was gathered, followed by a meticulous dermatological examination and if indicated, regular investigations were done and were recorded in predesigned performa.<strong></strong></p><p class="abstract"><strong>Results:</strong> The analysis included 50 patients who had been infested. There were 43 cases (86%) of scabies and 7 cases (14%) of pediculosis capitis.</p><p class="abstract"><strong>Conclusions:</strong> The infestations in the pediatric age group are associated with a high communicable rate so it’s important to diagnose these conditions early to contain the spread and limit the morbidity.</p>

The Prescribing of MEBO Ointment in a Public Hospital in Alkharj

Aim: The present study aimed to describe the prescribing of moist exposed burn ointment (MEBO) in Alkharj. Methodology: This is a retrospective study that includes reviewing the electronic prescriptions that included MEBO among the patients who received medications from the outpatient department in a public hospital in Alkharj. Results: More than 61% of the patients who received MEBO ointment were female patients and about 61.98% of them received MEBO ointment for 1 week. Most of the prescribers were residents (76.86%). More than 46% of the prescriptions were prescribed by emergency department, about 24% were prescribed by plastic surgery department. Conclusion: The use of MEBO ointment in the outpatient setting in Alkharj was uncommon. Further studies are needed to explore the pattern of using burn treating ointments such as MEBO ointment in the outpatient setting and in other settings.

Budesonide Use in the Outpatient Department in a Public Hospital in Al-Kharj

Aim: This study aimed to describe the prescribing pattern of budesonide nebulizer and budesonide nasal spray in a public hospital in Alkharj. Methodology: This retrospective study was conducted in a public hospital in Alkharj city. The outpatient prescriptions were reviewed to describe the use of budesonide in the period between 01-01- 2018 and 31-06-2018. The study included budesonide forms that are delivered directly to the respiratory system, so budesonide nebulizer and budesonide nasal spray were included in the study and other dosage forms were excluded. Results: About 53.12% of the prescribed budesonide was in the form of nebulizer and 46.88% was in the form of nasal spray. Most of them were males (62.50%) and about 43.75% of them were less than 10 years. More than 53% of the prescriptions were written by residents and 40.62% were written by consultants. The most commonly prescribed department was pediatrics department (43.75%) followed by Ear-Nose-Throat (E.N.T) department (18.75%) and emergency (18.75%). Conclusion: The present study showed that the use of budesonide was uncommon in the outpatient setting. More studies are needed to explore the frequency of prescribing other dosage forms of budesonide and to explore the frequency of prescribing other alternative agents.

Prevalence of depression, anxiety and associated factors among patients with dental disease attending outpatient department in Addis Ababa public hospitals, Addis Ababa, Ethiopia: a multicenter cross-sectional study

Background Anxiety and depression are widespread mental health problems in many populations. These problems can be major barriers to dental care and may be led to poor oral health. Objectives To assess prevalence of depression, anxiety and associated factors among patients with dental disease in Addis Ababa public hospitals outpatient department, Addis Ababa, Ethiopia, 2019. Methods An institution based cross sectional study was conducted from May 06 to June 06, 2019 among patients with dental disease attending outpatient department in Addis Ababa city administration public hospitals. Multistage sampling method was used to select study participants. Hospital Anxiety and Depression scale was used to assess anxiety and depression. Face to face interview was used to collect data and the collected data was entered into EPI data version 3.1 and analysis was done using SPSS (Statistical Package Software for Social Sciences) version 20. Bi-variable and multivariable binary logistic regression was carried out. Strength of association was determined using odds ratio with 95% CI (Confidence Interval) and p value less than 0.05 was considered as statistically significant association in the final model. Results From the total of 845 participants, 833 were studied with response rate of 98.6%. The median age of the respondent was 32 years with interquartile range (26–41 years). The prevalence of anxiety and depression were found to be 33.9% and 29.2% respectively. Being female [AOR (Adjusted Odds Ratio) 2.70 (95% CI 1.86, 3.89)], tooth extraction [AOR 3.24 (95% CI 2.11, 4.97)], history of repeat visit to dental clinic [AOR 3.21 (95% CI 2.25, 4.58)], chronic disease [AOR 2.95 (95% CI 1.98, 4.38)] and current alcohol use [AOR 3.40 (95% CI 2.28, 5.09)] were significantly associated with anxiety among patients with dental disease. Being female [AOR 2.22 (95% CI 1.53, 3.23)], Elementary educational status [AOR 2.15 (95% CI 1.28, 3.58)], periodontitis [AOR 1.74 (95% CI 1.18, 2.72)],history of repeated visit to dental clinic [AOR 4.07 (95% CI 2.84, 5.84)], current use of alcohol [AOR 4.01 (95% CI 2.68, 6.00)], current cigarette use [AOR 3.15 (95% CI 1.42, 7.00] and irregular tooth brushing [AOR 2.22 (95% CI 1.53, 3.23]were significantly associated with depression among patients with dental disease. Conclusion Anxiety and depression were high among people with dental disease. Tooth extraction and having chronic disease were significantly associated with anxiety. Elementary educational status, periodontitis, current cigarette smoking and irregular tooth brushing pattern were significant association with depression. History of repeat visit to dental clinic, current alcohol use and female sex were significantly associated with both depression and anxiety. Based on the finding of this study early screening and treating of anxiety and depression, also identifying those associated factors are important at dental clinic.

Clinical features and outcomes of bowel perforation in primary pediatric gastrointestinal lymphoma

Background Whether surgery can improve the prognosis of patients with primary pediatric gastrointestinal lymphoma (PPGL) who experienced bowel perforation remains controversial. This study aimed to evaluate the prognosis of such patients. Methods Nine patients pathologically diagnosed with PPGL who experienced perforation at our center between January 2010 and December 2020 were enrolled and divided into two groups: those with perforation during (n = 4) and before (n = 5) chemotherapy. Their medical records were reviewed, and long-term follow-up was conducted by telephone in February 2021. Results All patients with perforation during chemotherapy were diagnosed with PPGL in the outpatient department. The mean time from outpatient visit to chemotherapy was 17.3 ± 6.1 days. Two patients experienced perforation during the first chemotherapy regimen and received conservative treatment, while the others developed perforation after multiple chemotherapy regimens and underwent surgery. All of the patients received regular chemotherapy and survived for a mean follow-up time of 3.8 ± 1.9 years. No patient with perforation before chemotherapy had a definite diagnosis in the outpatient department. Among these patients, 4 experienced perforation and underwent surgery, of whom 3 developed perforation-related complications and died; the other recurred after chemotherapy. Only the patient who received conservative treatment was diagnosed with PPGL before chemotherapy, received regular chemotherapy, and survived without a recurrence for 1.0 year. Conclusion Prompt diagnosis and chemotherapy improve the prognosis of PPGL. Surgery does not affect the prognosis of patients with perforation during chemotherapy but may accelerate disease progression in patients with perforation before chemotherapy.