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Objectives@#To determine the outcomes for patients with acute stroke improve with early intervention in a series of the first 50 patients with acute ischemic stroke who were thrombolysed at our center. @*Methods@#National Institutes of Health Stroke Scale (NIHSS) scores were recorded by NIHSS-certified nurses-on-duty in their appropriate monitoring sheets in the chart, which was double-checked by the neurology consultant co-author on duty. Source chart entries were cross-checked with logs from the CT scan, pharmacy, and other department records before being collated by the primary author. Means and averages were used to describe the patients’ data.@*Results@#We included the first 50 patients with acute ischemic stroke, eligible for and who consented for thrombolysis. The patients had an average age of 61 years (range: 29 to 87); 32 (64%) were ≥ 60 years; 16 (32%) were male. Male gender (24/50), age ≥ 60 years old (32/50), hypertension (30/50), heart disease (6/30), smoking (7/30), and ethanol intake (9/30) were the most common risk factors. Thirty-five (70%) suffered a moderate stroke. The mean NIHSS of the 50 patients was 12.6 (range: 2 to 28). All but one received intravenous recombinant tissue plasminogen activator (IV rTPA) within 4.5 hours of onset, at a dose of 0.6 to 0.9 mg/kg. Symptomatic hemorrhagic transformation occurred in one (2%); asymptomatic hemorrhagic transformation was seen in three (6%). Fifteen of the 50 (30%) were NIHSS = 0 on discharge; another 18 (36%) showed clinical improvement compared to their status upon admission. Three patients (6%) were mRS = 0; and 30 (60%) were at least ambulatory (mRS ≤ 3) on discharge. Four patients (8%) died, one (2%) from fatal hemorrhagic transformation. Ten patients (20%) developed nosocomial pneumonia; two (4%) had catheter-related urinary tract infections More than half (52%) did not develop any in-hospital complications. The patients were admitted for a mean of 6.6 days (range < 24 hours to 20 days). The average gross bill was ₱56,041.34 (range: ₱8,729.83 to ₱182,054.08); P32,194 was the average amount our Center shouldered per patient (range: zero to ₱154,272.88); almost all were Charity Service patients who used the ₱19,600 Philippine Health Insurance Corporation case rate and the 20% senior citizen discount to help defray the costs of their hospitalization.@*Conclusion@#Stroke thrombolysis can be done in a rural tertiary hospital safely and effectively if with strong government, administration, health care workers, and community support.
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@#Introduction: Hospital-acquired malnutrition (HAM) is prevalent among hospitalised children in developing countries. This condition relates to worse clinical outcomes, prolongs length of stay in hospitals, and increases mortality. A multidisciplinary approach should be performed to prevent and manage this problem. However, HAM is often underdiagnosed, especially in rural hospitals with limited human resources. This study aims to delineate the risk factors of HAM among hospitalised children in a rural hospital. Methods: This nested case-control study derived from the implementation of a nutritional screening programme in Parindu Hospital, Sanggau, West Borneo, was conducted from December 2018 to February 2019. HAM was defined as a loss of body weight of >2% after hospitalisation. Independent variables such as the age of patients, fever, gastrointestinal loss, pre-existing malnutrition, length of stay, and grade of disease were analysed in univariate and multivariate analyses using logistic regression. Risk factors were expressed as odds ratio and adjusted odds ratio (aOR) with 95% confidence interval (CI). Results: Thirty-three patients were analysed as cases with 59 controls. Median age was younger in the case group (49 months, IQR 14-72.5) than control group (88 months, IQR 43-116). After adjustment for other covariates, age <5 years old (aOR 5.50, 95% CI 1.95- 15.59) and moderate-to-severe grade of disease (aOR 3.50, 95% CI 1.09-11.09) were significant risk factors of HAM in our study. Conclusion: Risk factors of HAM in children hospitalised in a rural hospital were age <5 years old and moderate-tosevere grade of disease.
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Background: Inspite of the rapid adoption of laparoscopy as a technology for surgeries of the abdomen, its use is very limited in rural settings with limited resources in India. This study was carried out to find out whether performing laparoscopic appendicectomies (which is the commonest general surgery performed the world over) in a low volume rural hospital is feasible, safe and should it be the recommended procedure of choice. Also, the pattern of demographics, symptoms, signs, investigation reports of the patients who presented with acute appendicitis at the centre was studied.Methods: Retrospective analysis of the data from electronic medical records in Bodeli General Hospital from March 2015 to February 2020 was done. Data of all laparoscopic appendicectomies performed (108 in numbers) in this rural centre with low volume work and a single surgeon, was analysed.Results: Various cost-cutting local innovations were used, the age and sex distribution, presenting complaints, examination findings, investigation reports, operative time and complications were analysed and presented.Conclusions: It is quite evident that performing laparoscopic appendicectomies in low volume, single surgeon setting is a safe procedure and should be the procedure of choice, whenever an appendicectomy is indicated.
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Background: Purpose of time motion study is to know the time taken in different service delivery points in outpatient department (OPD), for specific activity, work function or mechanical process and to assess the perception of beneficiaries regarding the total time spent in the OPD. Therefore, the present study was conducted to study the operational efficiency and also to find the time required for various activities at different service points at rural health training centre attached to medical college.Methods: It was a cross-sectional study carried out in rural health training centre attached to BKL Walawalkar rural medical college, Sawarde), district Ratnagiri, Maharashtra, India over period of 6 month from July 2018 to December 2018. About 300 patients were included in the study.Results: According to 26.67% study participants, total time was too long. 26% study participants were not satisfied about the total time taken in the OPD while 50.34% study participants were satisfied regarding the total time.Conclusions: Patients satisfaction is the most important criterion to be met if more people are to be drawn into the hospital. Thus, improving the satisfaction of patients towards health care services by reducing their waiting time, by attending the patient in time will help to create a positive image of hospital in the mind of people and community.
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Background: Asthma is rather a clinical syndrome than a disease with availability wide range of medications. Drug utilization studies are necessary to improve prescribing pattern among physicians.Methods: The 250 study subjects were interviewed, and prescription data was recorded in a pre-designed case record form. The data was compiled using Microsoft excel and presented in a tabulated and graphical presentation.Results: Out of 250 study subjects most of the study subjects are between 61-70 years of age. Majority of subjects are males (58%). Out of 250, (49%) are found out to be smokers. Dust, smoke and pollen are found out to be most common allergen. Most common type of asthma was mild intermittent (134) study subjects. Socio-economic status of was found out to be lower middle class in majority (158 out of 250). Large number of study population is suffering from co-morbid conditions such as URTI and COPD. Salbutamol was most common single drug used for nebulization therapy and most common combination is salbutamol + ipatropium bromide + budesonide. Most common oral drug used are methylxanthines and most frequently used intravenous drugs are deriphylline and hydrocortisone. Various antibiotics are prescribed to majority of subjects, most common was amoxicillin + clavulanic acid combination. Most commonly suffered adverse drug reaction between study subjects were gastrointestinal disturbances.Conclusions: It is concluded that prescribing pattern for asthma at A.V.B.R.H. is not according to standard guidelines, hence it is need of the hour to encourage physicians to follow guidelines.
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OBJECTIVE： To investigate the current situation of medication safety in 24 public medical institutions（referred to as “hospital”） from Linyi city and the differences in medication safety between urban and rural areas. METHODS： ISMP self-assessment scale [including 10 key elements （Ⅰ-Ⅹ，such as “Ⅰ patient’s information” “Ⅱ drug information”）， 20 key characteristics and 270 evaluation projects] developed by Institute of Safe Medication Practices was used to investigate 24 hospitals in Linyi city. The implementation rates of 10 key elements in urban and rural hospitals were analyzed statistically， and the top 10 evaluation projects were listed for the key elements with the lowest implementation rate. The key elements and top 10 evaluation projects with the largest difference in the implementation rate were compared between urban and rural hospitals. Radar maps were used for comparison and analysis intuitively. RESULTS： A total of 24 hospitals were surveyed， including 12 in urban and 12 in rural areas； there were significant differences in the implementation rate of 10 key factors among 24 hospitals； the elements with the highest implementation rate were “Ⅶ environmental factors， workflow and staffing pattern”（56.55％）；the elements with the lowest implementation rate was “Ⅱ drug information” （26.77％）. Among 33 evaluation projects of “Ⅱ drug information”， the implementation rate of No. 36 project （12.50％， related to opioids） was the lowest. Among the implementation rates of 10 key elements in 12 urban hospitals and 12 rural hospitals， the key elements with the greatest difference was “Ⅳ drug label， packaging and naming” （differing by 44.44％，59.72％ vs. 15.28％）； Among“Ⅸ patient education”evaluation project with the greatest gap， there was the greatest difference in No. 199 project （related to patients’ active participation in medication， 58.33％ in urban， 4.17％ in rural）. CONCLUSIONS： The results of medication safety investigation in 24 hospitals from Linyi city show that all the item in each hospital needs to be improved expecially in the implementation of “Ⅱ drug information”. Rural hospitals should strengthen medication education for patients.
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Introduction: Immunization is a cost-effective public health intervention to decrease childhood morbidity and mortality. According to the 3rd National Family Health Survey (NFHS-3), 43.5% children aged 12 to 23 months were fully vaccinated. The 3rd District Level Household & Facility Survey (DLHS-3) showed 69% full-immunization coverage in Maharashtra with major regional variations. Rural Hospital, Panvel (Raigad), is in a peri-urban area providing health services to a mix of urban, rural, and migrant population. The study was conducted in this hospital with the aim to understand why people seeking health services for secondary prevention refrain from complying with routine immunization services. Objectives: To assess the reasons for partial and nonimmunization of the children and the knowledge regarding routine immunization. Materials and methods: All children who completed 1 year but below 5 years of age, attending the Rural Hospital, Panvel, during a period of 1 month from October 16 to November 15, 2014, were screened and those who were not fully immunized for the age were included in the study. Sociodemographic background, immunization status, reasons for partial and nonimmunization, and knowledge about routine immunization data were collected by personal interview using a prestructured, pretested questionnaire after obtaining informed consent. Results: Out of 303 children, 57 (18.8%) were found to be either partially immunized (47; 15.5%) or nonimmunized (10; 3.3%). The lack of knowledge (36%), lack of priority for immunization (33%), and poor communication by the health worker (21%) were the major reasons. 42% of the mothers were aware about the severity of the vaccine preventable diseases. However, 80% did not have the correct knowledge regarding the immunization schedule. Conclusion: The opportunities to vaccinate are still being missed and consolidated efforts to improve the active involvement of mother in the immunization activity are required.
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Background: Neonatal Septicaemia (NNS) remains a major cause of morbidity and mortality in neonates despite advances in antimicrobial therapy, life support measures and the early detection of risk factors. This study aimed at determining the risk factors, aetiologic agents and antibiotic sensitivity pattern of NNS in Wesley Guild Hospital, Ilesa. Methods: This was a prospective study involving 360 neonates admitted into Wesley Guild hospital, Ilesa over a period of seven months. Socio-demographic data and clinical characteristics of the neonates were collected using a standard proforma. Blood culture was done on admission and bacterial isolates were identified using standard procedures. Antibiotic susceptibility testing was done using disc diffusion method. Results: The prevalence of neonatal septicaemia (NNS) was 16.0% in this study. Multivariate regression model of significant risk factors revealed prolonged labour (AOR 2.2(1.036 - 4.912) p=0.041) as the only independent risk factor for NNS. Staphylococcus aureus was the predominant isolate (70%). The case fatality rate from the study was 25%. Ciprofloxacin (86.7%), Cefuroxime (82.7%) and Ceftriaxone (81.3%) were the antibiotics with the highest sensitivity, while the infective organisms were most resistant to Cloxacillin (80%) and Ampicillin (77.3%). Conclusion: Neonatal septicaemia remains a significant cause of neonatal mortality. S. aureus was the predominant bacterial isolate in this study. Cephalosporins should be considered as first-line antibiotics in its management. Prevention of preterm deliveries and encouraging good antenatal care and supervised deliveries will help in reducing the high incidence.
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Aim: To assess the association between socio-demographic factors and type of tobacco consumption among subjects attending a rural hospital in south India. Methods: A pre-tested questionnaire was designed for recording the relevant data pertaining to selected socio-demographic variables and the details of tobacco consumption. Patients as well as persons accompanying them formed the study sample and they were chosen by systematic random sampling method. Chi-square test was used to assess the association between the variables. Results: A total of 350 subjects were included in the study. There was statistically significant association between age groups, gender, education, occupation, economic status and the type of tobacco consumption. Conclusion: The present study revealed a significant association between selected sociodemographic factors and the type of tobacco consumption.
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Background: Evidence has demonstrated the metabolic relationship between dyslipidaemia and hypertension which are independent cardio-metabolic risk factors. As socio-economic and environmental dynamics in rural Nigeria changes, geriatric Nigerians tend to adopt lifestyles that predispose to atherosclerotic cardiovascular diseases. Aim: This study was designed to determine the risk factors of dyslipidaemia in a cohort of geriatric Nigerians with essential hypertension in a rural hospital in Eastern Nigeria. Study Design: This was a cross sectional study conducted on a cohort of 122 geriatric Nigerians with essential hypertension. Place and Duration of Study: The study was conducted in a rural hospital in Eastern Nigeria between June 2008 and June 2011. Methodology: Risk factor variables were examined using a pretested, structured and intervieweradministered questionnaire. Hypertension and dyslipidaemia were defined using JNC VII and The Third Report of National Cholesterol Education Panel in adult (ATP III) criteria respectively. Results: The risk factors significantly associated with dyslipidaemia were advanced old age (p=.039), abdominal obesity (p=.022) and physical inactivity (p=.042). The abdominally obese patients were three times more likely to have dyslipidaemia compared to the non-abdominally obese patients. Conclusion: Risk factors of dyslipidaemia exist in geriatric Nigerians with essential hypertension. Dyslipidaemia was significantly associated with advanced old age, abdominal obesity and physical inactivity. These risk factors should be considered alongside the complex of other cardio-metabolic risk factors during clinical encounter with geriatric hypertensives.
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In order to get information on the use of antibiotics in rural areas, 300 hospitalized patients were randomly selected from a rural hospital of Guangdong province and investigated for antibiotic use. The rate of antibiotic use in the hospitalized patients was 86.7 %; the four antibiotics at the top of the list were penicilins, cephalosporins, quinolones and macrolide. The rate of combined use of antibiotics was 68.46%. The culture of bacteria was carried out in only 4.62% of the patients and no antimicrobial susceptibility test was conducted. It is concluded that the antibiotics were not used in rational fashion in the rural hospital.