Effect of specialty oriented hospital management system [Hms] on quality of electronic medical records [Emrs] in 2 tertiary care hospitals

Objective: To assess effect of [specialty oriented HMS software] on [quality of EMRs]

Study Design: Comparative interventional study

Place and Duration of Study: Obstetrics Out Patient Department [OPD] of Pak Emirates Military Hospital [PEMH] Rawalpindi and Combined Military Hospital [CMH] Lahore, from Apr 2015 to Mar 2018

Material and Methods: The study began in 2015 with a baseline survey of quality of EMRs produced by generic HMS software in vogue. We used an observational checklist derived from hospital SOPs including 12 mandatory EMR fields. We then collaborated with IT experts to develop and implement a specialty oriented test-HMS in obstetrics OPD, PEMH. After 6 months, quality of EMRs generated by test-HMS was assessed using same method. We cross tabulated the quality of pre and post intervention EMRs. EMR quality among individual EMR fields was also compared for each software. In 2018, we assessed quality of EMRs at tertiary care hospital, a year after the official launch of customized new-HMS software in the hospital

Results: Both the test-HMS and new-HMS had a statistically significant effect in improving quality of EMRs. A statistically significant variation was also observed among EMR quality of individual fields irrespective of the software being used

Conclusion: Customization of HMS improves the quality of EMRs but there may be other factors effecting EMR quality besides customization of HMS. We need to Identify and address those factors to attain true benefits of HMS

Ultrasound Guided Fine Needle Aspiration Biopsy of Abdominal Masses

Ultrasound guided fine needle aspiration biopsy of abdominal masses. Material Methods: 200 patients with abdominal lump were subjected to fine needle aspiration biopsy by a 20-22 G needle and smears prepared were stained with H & E and Papanicolaou stains. Histopathological specimens were processed and stained with H & E stain and a cytohistological correlative study performed. 128 (74%) were females and 72 (36%) were males. 83 cases (41.5%) had a mass in the hepatobiliary region, out of which 53 (63.9%) had a mass in the gall bladder. Malignant lesion constituted the commonest cytologic diagnostic category 115 cases (57.5%). Adenocarcinoma gall bladder was found in 31 cases (37.3%) followed by metastatic adenocarcinoma liver in 12 cases (14.5%) and hepatocellular carcinoma in 8 cases (9.6%). Adenocarcinoma stomach 8 cases (18.6%) was the commonest GI malignancy followed by adenocarcinoma intestine 7 cases (16.3%). Serous cystadenocarcinoma comprised the commonest ovarian cancer, 5 cases (12.5%) followed by mucinous cystadenocarcinoma, 2 cases (5.1%). Overall sensitivity of 94.11%, specificity of 100% and diagnostic accuracy of 95.7% was found in the present cytohistological correlative study.

Mammography-guided stereotactic fine needle aspiration cytology of breast lesions.

The purpose of the present study was to evaluate the efficacy of mammographic guided stereotactic fine needle aspiration cytology in 136 patients with breast lesions including mammographic features, cytomorphological findings and nuclear grading in malignant cases. Majority of the cases were predictable correctly by combination of the three modalities of diagnosis viz, clinical examination, mammography and cytology.

Study of Fine Needle Aspiration Cytology in Lymphadenopathy with Special Reference to Acid-fast Staining in Cases of Tuberculosis

The present study was conducted to evaluate the usefulness of FNAC as a diagnostic tool in 1000 patients of lymphadenopathy. Fine needle aspiration was performed in all the patients following through clinical examination and slides were stained with H & E, PAP and Ziehl Neelsen stains. The results of FNAC were further correlated with paraffin embedded sections of tissue blocks. Eight hundred and sixty-four cases (86.4%) were of benign lymphadenopathy; out of which 536 (53.6%) cases were of reactive nature and 328 cases (32.8%) were tubercular. The remaining 136 (13.6%) cases were of malignant lymphadenopathy, consisting 45 (4.5%) cases of primary malignancies i.e. lymphomas and 91 (9.1%) cases of metastasis to lymph nodes. Out of 328 cases, Z-N positivity for AFB was found in 152 cases (46.4%) and Mantoux test was positive in 180 cases (54.9%). On correlation of FNAC findings with histopathology; sensitivity and specificity was found out to be 91.6% and 99%, respectively, with diagnostic accuracy of 97.3% in cases of benign lesions. The same being 97%, 97.5% and 97.4%, respectively in tubercular lesions. The sensitivity, specificity and diagnostic accuracy was 100% each in malignant lesions. FNAC of lymphnodes is an excellent first line method, for investigating the nature of the lesions, as it is economical and convenient alternative to open biopsy.

Pulmonary hydatidosis--a surgical experience.

Twenty-five cases of pulmonary hydatid cysts were studied with emphasis on age, sex and site distribution. In the present study, the youngest patient was of 4 years. Male predominance (2.125:1) with peak incidnce at 21-40 years was observed. Right lung was involved more frequently. Pain chest and haemoptysis were the commonest symptoms. No recurrence and no mortality were reported.