Job-related factors associated with depression, anxiety, and stress among healthcare workers in a Tertiary Government Hospital in Metro Manila during the COVID-19 pandemic

Background and Objectives@#Ensuring the total well-being of healthcare workers (HCWs), including their mental health and psychological well-being, is an essential aspect in the delivery of patient care and the preservation of the health workforce. This study aimed to determine the level of mental well-being and emotional state of HCWs in terms of depression, anxiety, and stress using the DASS-21 scale in a tertiary government hospital during the COVID-19 pandemic in the Philippines and to identify the job-related factors that may be associated with these outcomes.@*Methods@#This is an analytical, cross-sectional study among HCWs involved in direct patient care in a tertiary government hospital in the Philippines during the COVID-19 pandemic. Data collection was conducted from February to March 2022 through an online self-administered questionnaire, which included the Demand-Control-Support Questionnaire (DCSQ), and the 21-item Depression Anxiety Stress Scale (DASS-21). This was sent to doctors, nurses, and allied medical workers actively working in the clinical areas. All responses were collected and analyzed.@*Results@#Three hundred sixty-four healthcare workers were included in the study. Majority were single (62.62%), living with immediate family (50.82%), and working in a COVID-designated area (62.09%). High prevalence of depression (49.18%), anxiety (61.54%), and stress (30.22%) was found among the HCWs. Work in high infection/COVID-designated areas was significantly associated with anxiety and stress, and high-job demand was significantly associated with all three mental health states compared to low job-demand.@*Conclusion@#Focus should be placed on modifying the condition of high job demand among healthcare workers working in hospitals. This includes ensuring optimum staffing levels and patient to HCW ratio which avoids HCWs from being subjected to high workloads and time pressures that subsequently increase risk for stress, anxiety, and depression.

Comparative study of length of stay of COVID-19 recovered patients in government and private tertiary care setup

Background: COVID-19 pandemic placed an unprecedented strain on health-care systems. The demand for healthcare in hospitals and intensive care units increased everywhere in the world in the form of beds, staff, equipment, medicines, etc. In this process, length of stay in hospital of COVID-infected patients is a crucial point for hospital authorities to plan to provide effective healthcare to patients arriving at the hospital and also to treat non-COVID patients and other medical emergencies. Aims and Objectives: The aims of this study were to find the difference in length of stay in government and private tertiary care setup, to find the length of stay of COVID recovered patient with and without morbidities. Materials and Methods: After taking due permission from the ethical committee and respective authorities concerned in private and government tertiary care hospitals, case sheets of patient recovered from COVID were taken and analyzed in terms of patients condition while presentation to hospital, SpO2, morbidities, number of days symptoms developed, and length of stay in hospital. Results: In my study, the length of stay of COVID-infected people in private and government setup was almost the same, around 11–12 days. Patients with comorbidities had a higher length of stay in hospital in both private and government setup, but the duration of stay was higher in government setup 14 days in government setup, 11–12 days in private setup. Good SpO2 at time of admission had decreased the length of stay of hospital in both setups. There is no correlation between length of stay in hospital and period of symptoms before admission in both private and government setup. Conclusions: In my study, the length of stay of patient with COVID infection was higher in government setup by 1 day without morbidities and 2–3 days with morbidities.

Resilience levels among Filipino non-medical personnel at a Tertiary Government Hospital in Metro Manial during the COVID-19 Pandemic - July 2021

Objectives@#This study aimed to measure the resilience level of non-medical personnel of the University of the Philippines Manila – Philippine General Hospital (UP-PGH) and determine whether this was associated with sociodemographic factors such as gender, length of service and job position.@*Methodology@#A cross-sectional study that included non-medical personnel using convenience sampling via email was done. Data was obtained through the 14-item Resilience Scale (RS-14) as well as a sociodemographic factors questionnaire. Descriptive and non-parametric correlational analysis of data was used.@*Results@#One hundred twenty five of the 153 respondents (81.70%) garnered a resilience score of 74-98 or moderate to high resilience level, while 28 or 18.30% had a resilience score corresponding to very low and on the low end. The mean resilience score was 81.8, corresponding to a moderate resilience level. More women than men had a resilience level of moderate to high. Respondents with greater than 5 years of work experience within the hospital had higher resilience levels than those who were less experienced. Moderate to high resilience levels were found in more administrative than non-administrative personnel. No significant association was found between resilience level and the factors analyzed. In terms of Resilience Core Characteristics, all comparisons between demographic factors of interest and Self-reliance, Purpose, Equanimity, Perseverance and Authenticity yielded insignificant results except for Self-reliance versus length of service, which showed a weak but significant relationship. Exploratory factor analysis found that the unidimensionality of the RS-14 Scale (US Version) still applied when administered to Filipinos in this particular population.@*Conclusion@#Majority of the non- medical personnel of the UP -PGH had moderate level of resilience. There was a lack of significant association between resilience level and demographic characteristics like age, length of service, and position in the study sample. In terms of Resilience Core Characteristics, comparison between length of service and self -reliance showed a weak but significant relationship.

Comparison of prices of commonly used drugs in AMRIT pharmacy, Jan Aushadhi Centre and Private chemist shop: An analytical study from a tertiary care centre in Haryana

Background: The price of medicine in India has always been a point of discussion in public domain. The price range of the same drug is very large with more than 100% difference between various brands available in different settings. Aims and Objectives: To assess the price of different drugs at Jan Aushasdhi (JA), AMRIT and Private Chemist and to compare the prices of these three outlets so that the issues. Material and Methods: This institution-based cross-sectional study was carried out from May 2019 to June 2019. A pretested proforma was prepared to compare the prices of 284 different medicines in Jan Aushadhi, AMRIT and private chemist shops. The collected data were entered in an Excel spreadsheet and presented in Proportions, percentages, and mean. Results: The price of 284 medicines were compared from JA (Median(IQR)- 15.18(18.75) INR) and Private chemist shop (Median(IQR)-88(111.5) INR) while 249 medicine from AMRIT (Median(IQR)-61.05(78.33) INR). Although the majority of the AMRIT drugs are cheaper than the chemist shop except for 31% of Antipsychotic drugs, 26.6% of antihypertensives, 25% of respiratory drugs, 25% of steroids, 21.9% of antibiotics. Conclusion: We concluded that JA is providing drugs cheaper than AMRIT and Private chemist . The prices of medicines offered at AMRIT are lower than market pricing but they are costlier when compared to JA prices.

Estimated range of cost of treatment of adult Schizophrenia patients at a tertiary government hospital as of October 2015

OBJECTIVES@#Using the patient’s perspective, the study’s objective was to estimate the economic cost of treatment for adult schizophrenia patients in a tertiary hospital using key informant interviews.@*METHODS@#A guided structured key informant interview was done to determine key practices in the treatment of adult schizophrenic patients in the charity and pay in-patient and out-patient settings of the tertiary hospital. Cost of treatment included direct (medication, room and board, professional fees, ancillaries) and indirect costs (productivity losses of both patient and caregiver) and was computed based on 1 to 4 week length of stay for inpatients and varying intervals of follow-up for outpatients. Total costs were computed depending on the treatment setting.@*RESULTS@#Twenty nine members of the Department of Psychiatry, involving 5 psychiatric nursing staff, 13 residents-in-training, 4 fellows-in-training and 7 consultants were interviewed. The cost, for charity inpatient care, may range from PhP 2332.00 to PhP 44,861.00 (USD 50.88 to 978.86). For charity outpatient care, this may range from PhP 2892.00 to PhP 21,3612.00 (USD 63.10 to 4660.96) annually. For pay patients, costs were estimated to range from PhP15347.00 to PhP 24,6831.00 (USD 334.87 to 5385.80) for inpatient care and PhP 17,292.00 to PhP 1,125,600.00 (USD 377.31 to 25681.04) for outpatient care. The factor that influenced costs the most was the choice of medication. As of October 15, 2015, 1 USD = 45.83 PhP.@*CONCLUSION@#Schizophrenia is a chronic psychiatric illness that places a significant financial burden on patients and their caregivers. Based on the data gathered, patients’ and their families could spend from as low as 2332 to as high as 1,125,600 pesos depending on the treatment setting.

Undang-Undang Jagaan Kesihatan Ibu Di Malaysia: Hak Pesakit Wanita di Hospital Kerajaan

@#Introduction Women as patients is a normal situation. However, women patients of the obstetric and gynaecology category are of a different category. This is because obstetric and gynaecology patients will be warded in the maternity ward and labour room according to the needs of their care and treatment. The care and treatments in the maternity ward and labour room involving the care and treatments by a special team of trained medical doctors, midwives and nurses in obstetrics and gynaecology areas of expertise. Hence, the importance of scutinising the relevant laws and legislations pertaining to the protection of female patients’ rights when they are utilising the maternity ward and labour room are fundamental in determining whether such rights existing in our healthcare services pertaining to pregnant women. Healthcare laws relating to women’s healthcare and government health policy on pregnant women are scrutinised to ascertained whether the laws and policy give impact or effect to the healthcare services rendered, including scrutinising the qualification, capability and the quantity of obstetric and gynaecology doctors on whether it fulfils the requirement of the government hospitals’ maternity ward and labour room. Methods Doctrinal research method is adopted with applying the empirical approach whereby interviews and a focus group discussion were held with the O&G specialist doctors and selected medical officer and staff nurses of Maternity Hospital Kuala Lumpur. Results The finding shows that there are already in placed a policy of the Ministry of Health Malaysia outlining the women patients’ rights in maternity ward and labour room. However, there are deficiencies from the aspect of law and government policy wherein there is no specific laws in relation to pregnant patient rights nor is there a clear policy on women health. Conclusions The writing concludes that there is a need for a new policy to re-establish governance in maternity ward and to further enhance health care quality for women patients hence, to appropriately define the position of women patients’ rights in the government hospital’s maternity ward.

Qualitative analysis of direction of public hospital reforms in China / 医学前沿

Reforms in public hospitals are among the most important improvements in China's health care system over the last two decades. However, the reforms that should be implemented in public hospitals are unclear. Thus, a feasible direction of reforms in Chinese public hospitals is suggested and reliable policy suggestions are provided for the government to reform public hospitals. The data used in this study were mainly derived from a qualitative study. Focus group discussions and in-depth interviews were conducted in Shanghai, Guangdong, and Gansu between May and December 2014. Government funding accounted for approximately eight percent of the total annual revenue of public hospitals in China, and the insufficient government subsidy considerably affects the operation mechanism of public hospitals. However, solely increasing this subsidy cannot address the inappropriate incentives of public hospitals in China. The most crucial step in setting the direction of reforms in public hospitals in China is transforming inappropriate incentives by implementing a new evaluation index system for directors and physicians in public hospitals.

Lethal midline granuloma in a 15-year-old girl: A diagnostic dilemma

Objective@#To report a case of lethal midline granuloma and discuss the diagnostic and treatment dilemma, and management. @*Methods@#Design: Case Report. Setting: Tertiary Government Hospital. Patient: One.@*Results@#A 15-year-old girl under treatment for pulmonary tuberculosis presented to the Emergency Room for epistaxis and a nasopalatine lesion. She was managed as a case of nasopalatine osteomyelitis for one month and discharged on antibiotics. She returned due to bleeding after being lost to follow up for 3 more months. Hemostasis, debridement and biopsy yielded atypical cells, possibly lymphoma. Immunohistochemistry confirmed the diagnosis of NK-cell lymphoma. Unfortunately, she expired prior to initiation of chemotherapy. @*Conclusion@#Clinicians must have a high index of suspicion for lethal midline granuloma in chronic, non-healing midline lesions. Multiple biopsies confirm the diagnosis, and earlier initiation of treatment may improve prognosis.

Factors Associated with the Preference for Delivery at the Government Hospitals in Rural Areas of Lucknow District in Uttar Pradesh.

For assuring safe maternal and newborn health, institutional delivery was given paramount importance. In India, in spite of several efforts, lesser than 40% deliveries are conducted at health facilities, mostly at private sector. The present cross-sectional study aimed to fi nd out the determinants of preference for delivery at government hospitals in rural areas of Lucknow, a district in Uttar Pradesh. Multistage random sampling was used for selecting villages. From them, 352 recently delivered women were selected, following systematic random sampling. Overall, 84.9% of deliveries were conducted at health institutions. Out of them, 79.3% were at government hospitals. Applying multivariate logistic regression, Hindu women (odd’s ratio [OR] = 3.205), women belonging to lower socio-economic class (OR = 4.630) and late registered women (OR = 2.320) were found to be more likely to deliver at government hospitals. Attention should be given to religion, social status and timing of registration for ensuring higher fraction of deliveries at government set-up.

Practice and Experience of Government Hospital Transforming the Mode of Economic Growth / 中国卫生经济

Transforming economic growth mode is one of the most important guiding ideologies of the National twelfth Five-year development program. Since governmental hospitals are non-profit institutional organizations, it is a new topic for hospital managers to transform economic growth. Current situation of governmental hospitals is analyzed and the three main misunderstandings are pointed out. Take the Taian central hospital as the main object and analyzed the practice process of “putting hospital development scale control and revenue growth as the base and premise, shortening the average hospital stay, reducing the medicine proportion and consumable items proportion as the main means, and usd charging level, patients personal commitment to the cost proportion as important evaluation indicators of transformation economic growth mode” . By analyzing the practice process, the experience of transformation of economic growth mode is concluded, which provides some references for transforming economic growth mode in governmental hospitals.

Community pharmacy/hospital based assessment of clinical pharmacist intervention for safe and effective drug use.

The purpose of the work was to evaluate the extent of interception of prescriptions requiring review for drug order that could have led to adverse drug events or irrational drug use in the community and public hospital pharmacy unit. Three government hospitals and community pharmacy outlets in Ikot Ekpene senatorial district in Akwa Ibom state, Nigeria were selected for the study which lasted 4 months. The pharmacists in the various units were inducted into the purpose of the work and the associated documentation processes. The data collected were patient’s details, reasons for the intervention, doctor’s contact details. The years of experience of the pharmacists in the community was significantly higher than those in the hospital setting in the study (P<0.05). Within the study period, 698 and 1280 interventions were noted in the community and hospital units respectively. The prevalence of pharmacists intervention in terms of ratio of prescriptions generated and interventions made in the hospital was not significantly higher than in the community setting (P<0.05). There was no significant difference in the ratio of therapy/information to safety intervention for the two units of practice but there was significant difference in the frequency of safety to therapy/information intervention within the individual units (P<0.05).The percentage frequency of the safety interventions recorded in the hospital and community pharmacy units were thirty two percent (32) and thirty eight percent (38%) respectively. Active screening of prescriptions that leads to effective pharmaceutical interventions during dispensing process can provide useful contribution to healthcare delivery.