Usability of hospital management system in clinical work physician's perspective

Objective: To assess effectiveness of hospital management system in clinical work in military hospitals: physicians' perspective

Study Design: Descriptive cross sectional study

Place and Duration of Study: Military hospitals of Rawalpindi, from Apr 2013 to Jun 2014

Material and Methods: Sample selected through convenient non probability sampling. Sixty-one [61] physicians in clinical work: 23 [38%] specialists and 38 [62%], Health Care Administrators [HCAs] were included in the study. Tools used were questionnaire, interviews, think aloud protocol, log book analysis and chart reviews

Results: More than 50% of respondents agreed that hospital management system in clinical setting lacks appropriate attributes. System is not customized to the needs of each specialty and doesn't support the continuity of care. It does not support evidence based decision making since it lacks clinical decision support system. Majority of physicians expect their clinical HMS to provide better support for collecting statistics for research. Most respondents agreed that HMS often diverts attention away from the patients and physicians [worked around] the system due to number of cofounders like lack of time, increased number of patients. Chart review revealed majority did not add alerts

Conclusion: This study has highlighted a significant number of usability issues which are on one hand lessening the effectiveness and efficiency of this system; while at the other hand leading to user frustration. These findings call for usability evaluations at all levels and the subsequent redesign of HMS application leading to a usercentered design which is effective in providing physicians with key functionalities which support physician's tasks and improve patient care

Comparison of real time polymerase chain reaction with microscopy and antigen detection assay for the diagnosis of malaria

To determine the sensitivity of a real time polymerase chain reaction [PCR] for malaria diagnosis and to compare its accuracy with microscopy and an antigen based rapid diagnostic test [OptiMal]. Cross-sectional analytical study. Military Hospital, Armed Forces Institute of Transfusion and Armed Forces Institute of Pathology, Rawalpindi, from July to December 2011. Venous blood samples of 300 clinically suspected patients of malaria were tested for malaria parasite by microscopy and OptiMal; and malaria parasite index was calculated for the positive samples. Plasmodium genus specific real time PCR was performed on all specimens, targeting small subunit rRNA gene. Diagnostic accuracy of three tests was compared and cost analysis was done. Out of 300 patients, malaria parasite was detected in 110, 106 and 123 patients by microscopy, OptiMAL and PCR respectively. Real time PCR was 100% sensitive while microscopy and OptiMal had sensitivity of 89.4% and 86.2% respectively. All methods were 100% specific. The cost per test was calculated to be 0.2, 2.75 and 3.30 US$ by microscopy, OptiMal and PCR respectively, excluding the once capital cost on PCR equipment. Genus specific real time PCR for the diagnosis of malaria was successfully established as a highly sensitive and affordable technology that should be incorporated in the diagnostic algorithm in this country.

Homozygous beta° thalassaemia presenting with warm antibody immune haemolytic anaemia in an adult male

Beta thalassaemia major in certain genetic mutations may present as thalassaemia intermedia or, its diagnosis may be missed. The management of such patients requires special consideration. We present such a case of beta thalassaemia major who developed warm antibody type of immune haemolytic anaemia